Intensive Multifactorial Intervention for Stable Coronary Artery Disease Optimal Medical Therapy in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) Trial
Intensive Multifactorial Intervention for Stable Coronary Artery Disease Optimal Medical Therapy in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) Trial
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DOI：
10.1016/j.jacc.2009.10.062
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发表时间：
2010-03-30
影响因子：
24
通讯作者：
Teo, Koon K.
中科院分区：
文献类型：
--
作者：
Maron, David J.;Boden, William E.;Teo, Koon K.
Objectives本文介绍了在COUperion（临床结果利用血运重建和积极的药物评价）trial. Background的风险因素和它的效果，大多数心血管临床试验测试一个单一的干预措施中使用的药物治疗。COUbirth试验测试多种生活方式和药物干预（最佳药物治疗）或不经皮冠状动脉介入治疗的患者与stable coronary disease.Methods所有患者，无论治疗分配，接受同等的生活方式和药物干预的二级预防。大多数药物是免费提供的。治疗管理的护士个案经理根据协议，旨在实现预定义的生活方式和危险因素的goals.Results患者（n = 2,287）进行了为期4.6年的随访。治疗组之间达到治疗目标的患者比例无显著差异。吸烟者的比例从23%下降到19%（p = 0.025），那些报告≥ 150分钟/周的人从58%上升到66%（p < 0.001）。体重指数从28.8 +/- 0.13 kg/m2增加到29.3 +/- 0.23 kg/m2（p < 0.001）。从随机化前到5年，适当的药物使用增加如下：抗血小板药87%至96%; β受体阻滞剂69%至85%;肾素-血管紧张素-醛固酮系统抑制剂46%至72%;他汀类药物64%至93%。收缩压中位数从131 +/- 0.49 mm Hg降至123 +/- 0.88 mm Hg。低密度脂蛋白胆固醇从中位数的101 +/- 0.83 mg/dl下降到72 +/- 0.88 mg/dl。结论二级预防同样适用于两个治疗组的COUbirth试验的护士病例管理与治疗方案，并导致显着改善的危险因素。COUperson试验中的最佳药物治疗为慢性冠状动脉疾病患者的二级预防提供了一个有效的模型。（利用血运重建和积极药物评价的临床结局; NCT 00007657）（J Am科尔心脏病学杂志2010; 55：1348-58）（C）美国心脏病学会基金会2010年
Objectives This paper describes the medical therapy used in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial and its effect on risk factors.Background Most cardiovascular clinical trials test a single intervention. The COURAGE trial tested multiple lifestyle and pharmacologic interventions (optimal medical therapy) with or without percutaneous coronary intervention in patients with stable coronary disease.Methods All patients, regardless of treatment assignment, received equivalent lifestyle and pharmacologic interventions for secondary prevention. Most medications were provided at no cost. Therapy was administered by nurse case managers according to protocols designed to achieve predefined lifestyle and risk factor goals.Results The patients (n = 2,287) were followed for 4.6 years. There were no significant differences between treatment groups in proportion of patients achieving therapeutic goals. The proportion of smokers decreased from 23% to 19% (p = 0.025), those who reported = 150 min/week increased from 58% to 66% (p < 0.001). Body mass index increased from 28.8 +/- 0.13 kg/m(2) to 29.3 +/- 0.23 kg/m(2) (p < 0.001). Appropriate medication use increased from pre-randomization to 5 years as follows: antiplatelets 87% to 96%; beta-blockers 69% to 85%; renin-angiotensin-aldosterone system inhibitors 46% to 72%; and statins 64% to 93%. Systolic blood pressure decreased from a median of 131 +/- 0.49 mm Hg to 123 +/- 0.88 mm Hg. Low-density lipoprotein cholesterol decreased from a median of 101 +/- 0.83 mg/dl to 72 +/- 0.88 mg/dl.Conclusions Secondary prevention was applied equally and intensively to both treatment groups in the COURAGE trial by nurse case managers with treatment protocols and resulted in significant improvement in risk factors. Optimal medical therapy in the COURAGE trial provides an effective model for secondary prevention among patients with chronic coronary disease. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation; NCT00007657) (J Am Coll Cardiol 2010; 55: 1348-58) (C) 2010 by the American College of Cardiology Foundation