我国东北地区缺血性心血管病患者人群二级预防用药情况

Secondary Preventive Drugs for Patients with Ischaemic Cardiovascular Disease in Northeast China

目的 了解我国东北地区社区人群中既往罹患冠心病或缺血性脑卒中患者的二级预防用药情况,并分析药物使用情况与患者个体特征之间的关联关系,为东北地区制定缺血性心血管病二级预防用药指导提供借鉴。方法 利用2014-2019年心血管病高危人群早期筛查与综合干预项目(简称“高危筛查项目”)中我国东北地区(辽宁省、吉林省、黑龙江省)采集的数据,选取东北地区26个县/区年龄在35~75岁的常住居民,通过问卷调查的方式,收集人群中冠心病或缺血性脑卒中的患病情况以及二级预防药物使用情况。使用多变量混合效应模型以社区水平为随机截距评估个体特征与二级预防用药的相关性。结果在463188名调查对象中,4.5%(20927)报告患有冠心病或缺血性脑卒中史(年龄标化后比例为3.4%),在这些患者中,报告使用抗血小板药物或他汀类药物的比例为8.0%(6.0%使用抗血小板药物,3.5%使用他汀类药物,1.5%两种药物均使用)。多因素分析结果显示,女性、农村地区、既往诊断心血管病> 2年的患者服用抗血小板药物或他汀类药物的可能性更低,受教育程度越高、患有糖尿病、超重、肥胖的患者服用抗血小板药物或他汀类药物的可能性更高。结论 我国东北地区冠心病或缺血性脑卒中患者中,抗血小板药物及他汀类药物的应用严重不足,不同亚组人群中药物应用差异较大。本研究结果提示东北地区应尽快制定针对性心血管病二级预防干预措施并采取行动,提高相关药物的使用率,改善患者预后。

Objective To estimate the current use of secondary preventive drugs and identify its association of individual characteristics among those with established cardiovascular diseases(CVD) in the communities of northeast China from 2014to 2019.Methods We screened participants aged 35-75 years from 31 communities in northeast China in the China PatientCentered Evaluative Assessment of Cardiac Events Million Persons Project,a government-funded public health project conducted from 2014 to 2019.Participants self-reported their history of ischaemic heart disease(IHD) or ischaemic stroke(IS) and medication use in an interview.Multivariable mixed models were fitted to assess the associations of individual characteristics with the reported use of secondary preventive therapies.Results Among 463188 participants,4.5%(20927)reported a history of IHD and/or IS,among whom the reported use rate either antiplatelet drugs or statins was 8.0%(6.0%antiplatelet drugs,3.5% statins and 1.5% both).In the multivariable analysis,rural,women and those with established CVD for more than 2 years were less likely report taking antiplatelet drugs or statins.Higher education,people with hypertension,overweight and obesity were more likely report taking antiplatelet drugs or statins.Conclusion The current use of secondary preventive drugs in northeast China is low and varies substantially across population subgroups.Our study identifies target populations for scalable,tailored interventions to improve secondary prevention of CVD.