Observational study of the medical management of patients with peripheral artery disease
Observational study of the medical management of patients with peripheral artery disease
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DOI：
10.1002/bjs.11214
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发表时间：
2019-08-01
影响因子：
9.6
通讯作者：
Richards, T.
中科院分区：
文献类型：
--
作者：
Saratzis, A.;Jaspers, N. E. M.;Richards, T.
背景：先前的研究表明，尽管外周动脉疾病（PAD）患者的心血管风险很高，但他们没有得到足够的危险因素修正。本研究的目的是评估 PAD 患者的心血管状况，并量化基于目标的危险因素修正的生存获益。 方法：血管和血管内研究网络 (VERN) 前瞻性收集了来自英国 10 个血管中心（2018 年 4 月至 6 月）的 PAD 患者的心血管状况，以根据英国和欧洲目标导向的最佳医疗指南评估实践。使用 SMART-REACH 模型（一种经过验证的 PAD 患者心血管预测工具）评估风险因素控制的风险和益处。结果：约 440 名患者（平均年龄 70(11) 岁，24.8% 为女性）纳入研究。平均（标准差）胆固醇（4.3（1.2）mmol/l）和低密度脂蛋白胆固醇（2.7（1.1）mmol/l）水平高于推荐目标； 319 名患者（72.5%）患有高血压，343 名患者（78.0%）是活跃吸烟者。只有 11.1% 的患者接受了大剂量他汀类药物治疗，39.1% 的患者接受了抗血栓药物治疗。计算得出的 10 年内发生重大心血管事件的风险中位数为 53%（i.q.r. 44-62）。根据英国和欧洲指导目标（低密度脂蛋白胆固醇低于 2 mmol/l、收缩压低于 140mmHg、戒烟、抗血小板治疗）控制所有可改变的心血管危险因素将导致中位 10 年心血管风险绝对风险降低 29 (20-38)%，并获得 6.3 (4.0-9.3) 个无心血管疾病年。 结论： PAD 患者的医疗管理在这个二级护理队列中，情况并不理想。将可改变的风险因素控制到基于指南的目标将为患者带来显着的益处。
Background: Previous research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target-based risk factor modification.Methods: The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal-directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD.Results: Some 440 patients (mean(s.d.) age 70(11) years, 24.8 per cent women) were included in the study. Mean(s.d.) cholesterol (4.3(1.2) mmol/l) and LDL-cholesterol (2.7(1.1) mmol/l) levels were above recommended targets; 319 patients (72.5 per cent) were hypertensive and 343 (78.0 per cent) were active smokers. Only 11.1 per cent of patients were prescribed high-dose statin therapy and 39.1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44-62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL-cholesterol less than 2 mmol/l, systolic BP under 140mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10-year cardiovascular risk by 29 (20-38) per cent with 6.3 (4.0-9.3) cardiovascular disease-free years gained.Conclusion: The medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline-based targets would confer significant patient benefit.