中国四省市阿司匹林预防心血管疾病用药现状调查

Current status of aspirin use in cardiovascular prevention in some areas of China

目的 调查阿司匹林在我国部分地区心血管疾病一级预防和二级预防中的应用现状.方法 入选来自2007年6月至2008年5月糖尿病和代谢综合征患病率变迁调查研究中湖南、广东、四川、辽宁四省的9000例受试者,进行问卷调查,内容包括是否服用阿司匹林、服用频率及剂量.总体人群心血管一级预防治疗标准依据美国心脏病协会心血管及脑卒中一级预防指南（2002）10年心血管风险＞10%的推荐,计算阿司匹林实际使用率;糖尿病和高血压亚组则分别将美国糖尿病协会（2010）指南和欧洲心脏病学会/欧洲高血压协会高血压指南（2007）的相关推荐作为治疗标准.结果 共收回7186份有效问卷,其中233例有明确的心血管疾病.总人群中符合一级预防人群实际阿司匹林使用率为14.09%,二级预防人群使用率为26.61%;糖尿病亚组无心血管疾病患者实际阿司匹林使用率为32.47%,糖尿病心血管疾病二级预防阿司匹林使用率为51.16%.高血压亚组心血管疾病一级预防阿司匹林使用率为19.93%,二级预防人群使用率为29.52%.所有服用阿司匹林的人群中,87.67%为每日1次,10.35%为不规律服用,1.98%为隔日1次,半数受试者（50.25%）服用剂量低于指南推荐的最小剂量.结论 我国心血管疾病一级预防和二级预防人群阿司匹林使用率过低,在使用阿司匹林预防的人群中,使用剂量也不规范,半数每日应用少于75 mg.应进一步提高心血管疾病中高危患者及已有心血管疾病患者阿司匹林的使用率并规范其应用.

Objective To investigate the current use of aspirin for primary and secondary prevention of cardiovascular diseases （CVD） in some areas of China.Methods Nine thousands of patients from a research of the change of prevalence of diabetes mellitus （DM） and metabolism syndrome （MS） from June 2007 to May 2008 were investigated in some areas of China （ Hunan province,Guangdong province,Sichuan province and Liaoning province ）. The questions mainly focused on the use rate,dosage and frequency of aspirin.The treatment standard of primary prevention in overall population was based on the recommendation of the use of aspirin in people at high coronary and stroke risk 〉 10% risk per 10 years in American Heart Association （ AHA ） Guidelines for Primary Prevention of Cardiovascular Disease and Stroke： 2002 Update. For the treatment standard in DM and hypertension subgroup,the relevant recommendations of the American Diabetes Association （ADA） 2010 Standards of Medical Care in Diabetes and 2007 Guidelines for the Management of Arterial Hypertension of the European Society of Hypertension （ESH） and the European Society of Cardiology （ESC） was followed respectively.Results A total of 7186questionnaires were available for statistical analysis.Of them,233 cases were established CVD patients.Among all patients,14.09% of them used aspirin for primary prevention and 26.61% used for secondary prevention.In DM subgroup,32.47% of the patients used aspirin for primary prevention of CVD and 51.16% used for secondary prevention; in hypertension subgroup,19.93% patients used aspirin for primary prevention of CVD and 29.52% for secondary prevention. On frequency,87.67% of the patients took aspirin once daily,10.35% took irregularly,and 1.98% took every other day.Over half of the responders （50.25% ） had not taken the optimal dose,the doses were often much lower than minimum optimal recommended in the guidelines.Conclusions Aspirin is underused in primary and secondary prevention of CVD in cases at risk in China.In the cases using aspirin,the drug is not used according to the guidelines,and 50.25% of the patients used a dosage 〈75 mg.Therefore,the use of aspirin for primary and secondary prevention of CVD should be further improved and standardized.