Global patterns of comprehensive cardiovascular risk factor control in patients with type 2 diabetes mellitus: Insights from the DISCOVER study.
Global patterns of comprehensive cardiovascular risk factor control in patients with type 2 diabetes mellitus: Insights from the DISCOVER study.
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DOI：
10.1111/dom.14180
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Arnold SV
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文献类型：
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作者：
Patel KK;Gomes MB;Charbonnel B;Chen H;Cid-Ruzafa J;Fenici P;Hammar N;Ji L;Kennedy KF;Khunti K;Kosiborod M;Pocock S;Shestakova MV;Shimomura I;Surmont F;Watada H;Arnold SV
研究2型糖尿病（T2 D）患者心血管危险因素控制的总体模式。DISCOVER是一项在开始二线降糖治疗的T2 D患者中开展的国际观察性队列研究。在研究基线时，在合格患者（即，具有风险因素的患者）中检查风险因素管理。使用中位比值比（MORs）估计国家间变异性。在来自34个国家的14343例T2 D患者中，平均年龄为57.4 ± 12.0岁，T2 D的中位（四分位距）持续时间为4.2（2.0-8.0）年; 11.8%记录有动脉粥样硬化性心血管疾病（ASCVD）。在合格的患者中，67.5%的患者血压得到控制（9284/13756），他汀类药物处方占43.7%（5775/13208），血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂的处方率为55.6%（5292/9512），53.3%的确诊ASCVD患者（876/1645）处方阿司匹林，84.4%（12 102/14343）为非吸烟者。仅21.5%的患者（3088/14343）获得了最佳风险因素管理（定义为控制所有合格指标），即使在调整患者和研究中心差异后（莫尔1.47，95%置信区间1.24-1.66），国家间变异性也很大（10%-44%）。在全球范围内，大多数患者未实现ASCVD风险因素的全面控制，患者和研究中心差异无法解释国家之间的广泛差异。需要更好的国家特异性策略，在T2 D患者中持续实施全面的心血管风险因素控制，以改善长期结局。
To investigate global patterns of cardiovascular risk factor control in patients with type 2 diabetes mellitus (T2D). DISCOVER is an international, observational cohort study of patients with T2D beginning second‐line glucose‐lowering therapy. Risk factor management was examined among eligible patients (ie, those with the risk factor) at study baseline. Inter‐country variability was estimated using median odds ratios (MORs). Among 14 343 patients with T2D from 34 countries, the mean age was 57.4 ± 12.0 years and the median (interquartile range) duration of T2D was 4.2 (2.0–8.0) years; 11.8% had documented atherosclerotic cardiovascular disease (ASCVD). Among eligible patients, blood pressure was controlled in 67.5% (9284/13756), statins were prescribed in 43.7% (5775/13208), angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers were prescribed in 55.6% (5292/9512), aspirin was prescribed in 53.3% of those with established ASCVD (876/1645), and 84.4% (12 102/14343) were non‐smoking. Only 21.5% of patients (3088/14343) had optimal risk factor management (defined as control of all eligible measures), with wide inter‐country variability (10%–44%), even after adjusting for patient and site differences (MOR 1.47, 95% confidence interval 1.24–1.66). Globally, comprehensive control of ASCVD risk factors is not being achieved in most patients, with wide variability among countries unaccounted for by patient and site differences. Better country‐specific strategies are needed to implement comprehensive cardiovascular risk factor control consistently in patients with T2D to improve long‐term outcomes.
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