Trends in myocardial infarction secondary prevention: The National Health and Nutrition Examination Surveys (NHANES), 1999-2012.
Trends in myocardial infarction secondary prevention: The National Health and Nutrition Examination Surveys (NHANES), 1999-2012.
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DOI：
10.1161/jaha.114.001709
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发表时间：
2015-04-22
影响因子：
5.4
通讯作者：
Lloyd-Jones DM
中科院分区：
文献类型：
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作者：
Shah NS;Huffman MD;Ning H;Lloyd-Jones DM
评价缺血性心脏病二级预防中血管危险因素治疗和控制率的近期趋势和未来预测的全国代表性数据很少。我们评估了1999年至2012年国家健康和营养检查调查（NHANES）中1580名自我报告心肌梗死史的个体的性别和种族分层胆固醇，血压和血红蛋白A1 c水平以及风险因素治疗和控制率。我们使用加权线性回归来估计时间趋势，并创建了到2020年的前瞻性线性预测。参与者中30%至41%为女性，73%至85%为白色，平均年龄为63至66岁。到2011-2012年，男性和女性的胆固醇治疗率增加并达到80%以上，男性的控制率（当时的定义）在2011-2012年显著增加到85%，预计到2020年将达到100%。胆固醇治疗率在非西班牙裔白人和西班牙裔中显著增加。到2011-2012年，他汀类药物的使用显著增加到73%的心肌梗死幸存者，阿司匹林的使用显著增加，但到2011-2012年仅为28%。按性别划分的血压治疗或控制率没有变化，高血压治疗仅在非西班牙裔黑人中增加。预计的高血压控制率仍不理想。虽然时间趋势表明胆固醇治疗有所改善，但不变的治疗和血压控制以及持续低阿司匹林使用代表错失了机会。需要采取紧急行动，提高到2020年的二级预防率，以减少这一高危人群的复发事件。
Nationally representative data evaluating recent trends and future projections of vascular risk factor treatment and control rates in secondary prevention of ischemic heart disease are sparse. We evaluated sex‐ and race‐stratified cholesterol, blood pressure, and hemoglobin A1c levels and risk factor treatment and control rates in 1580 individuals who self‐reported a history of myocardial infarction from The National Health and Nutrition Examination Surveys (NHANES) 1999 to 2012. We used weighted linear regression to estimate time trends and created forward linear projections to 2020. Participants were 30% to 41% women, 73% to 85% white, and had a mean age of 63 to 66 years. Cholesterol treatment rates increased and reached above 80% in men and women by 2011–2012, with significant increases in control rates (as then defined) in men to 85% in 2011–2012, with projections to reach 100% by 2020. Cholesterol treatment rates significantly increased in non‐Hispanic whites and Hispanics. Statin use increased significantly to 73% of myocardial infarction survivors by 2011–2012, and aspirin use increased significantly but only to 28% by 2011–2012. There were no changes in blood pressure treatment or control rates by sex, and hypertension treatment increased only in non‐Hispanic blacks. Projected hypertension control rates remained suboptimal. While temporal trends suggest improvements in cholesterol treatment, unchanged treatment and control of blood pressure and persistently low aspirin use represent missed opportunities. Urgent action is needed to improve secondary prevention rates projected by 2020 to reduce recurrent events in this high‐risk group.