Samia Kazi, Desi Quintans, Simone Marschner, Haeri Min, James Chong, Clara K Chow
{"title":"有早发冠心病史者的危险因素监测、管理和预防药物的使用","authors":"Samia Kazi, Desi Quintans, Simone Marschner, Haeri Min, James Chong, Clara K Chow","doi":"10.1136/openhrt-2024-003092","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Those with premature coronary heart disease (pCHD) have a lower 5-year risk of repeat events; however, their lifetime risk is high. The aim of this study was to assess secondary prevention (SP) medical therapy and risk factor (RF) monitoring in patients with pCHD compared with those without pCHD.</p><p><strong>Methods: </strong>Analysis of a national primary care database including patients attending the same practice between January 2015 and March 2021 with at least 3 follow-up appointments, a history of CHD and a follow-up duration of at least 2 years. pCHD was defined as males under 55 and females under 65 at age of diagnosis of their CHD.</p><p><strong>Results: </strong>Among the 64 704 with CHD, 21 035 (32.5%) had pCHD (10 339 women <65 years of age and 10 696 men <55 years of age). Patients with pCHD compared with non-pCHD were more likely to be smokers (59.4% vs 52.6%, p<0.001), less likely to have hypertension (61.9% vs 73.2%, p<0.001) and similar rates of dyslipidaemia (57.8% and 57.5%, p=0.806) and diabetes (30.8% vs 30%, p=0.696). After adjusting for RF, pCHD was not associated with odds of blood pressure (BP) assessment (OR 0.63, 95% CI 0.40 to 1.00), measurement of glycated haemoglobin (OR 0.99, 95% CI 0.94 to 1.04) and any lipid monitoring (OR 1.05, 95% CI 0.96 to 1.14). Patients with PCHD had lower odds of prescription of statins (OR 0.81, 95% CI 0.76 to 0.87), any antiplatelets (OR 0.81, 95% CI 0.77 to 0.86), antihypertensive medication (OR 0.73, 95% CI 0.67 to 0.79) and beta blockers (OR 0.94, 95% CI 0.90 to 0.98) after adjustment for baseline RF. Women with pCHD were even less likely to be prescribed SP medicines of BP lowering and antiplatelets, both p value for interaction <0.000.1 CONCLUSIONS: Patients with a history of pCHD had similar rates of RF monitoring to patients without pCHD, but patients with pCHD were less likely to be prescribed SP medication of statins, antihypertensives and antiplatelets.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"12 2","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk factor monitoring, management and use of prevention medicines in those with a history of premature coronary heart disease.\",\"authors\":\"Samia Kazi, Desi Quintans, Simone Marschner, Haeri Min, James Chong, Clara K Chow\",\"doi\":\"10.1136/openhrt-2024-003092\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Those with premature coronary heart disease (pCHD) have a lower 5-year risk of repeat events; however, their lifetime risk is high. The aim of this study was to assess secondary prevention (SP) medical therapy and risk factor (RF) monitoring in patients with pCHD compared with those without pCHD.</p><p><strong>Methods: </strong>Analysis of a national primary care database including patients attending the same practice between January 2015 and March 2021 with at least 3 follow-up appointments, a history of CHD and a follow-up duration of at least 2 years. pCHD was defined as males under 55 and females under 65 at age of diagnosis of their CHD.</p><p><strong>Results: </strong>Among the 64 704 with CHD, 21 035 (32.5%) had pCHD (10 339 women <65 years of age and 10 696 men <55 years of age). Patients with pCHD compared with non-pCHD were more likely to be smokers (59.4% vs 52.6%, p<0.001), less likely to have hypertension (61.9% vs 73.2%, p<0.001) and similar rates of dyslipidaemia (57.8% and 57.5%, p=0.806) and diabetes (30.8% vs 30%, p=0.696). After adjusting for RF, pCHD was not associated with odds of blood pressure (BP) assessment (OR 0.63, 95% CI 0.40 to 1.00), measurement of glycated haemoglobin (OR 0.99, 95% CI 0.94 to 1.04) and any lipid monitoring (OR 1.05, 95% CI 0.96 to 1.14). Patients with PCHD had lower odds of prescription of statins (OR 0.81, 95% CI 0.76 to 0.87), any antiplatelets (OR 0.81, 95% CI 0.77 to 0.86), antihypertensive medication (OR 0.73, 95% CI 0.67 to 0.79) and beta blockers (OR 0.94, 95% CI 0.90 to 0.98) after adjustment for baseline RF. Women with pCHD were even less likely to be prescribed SP medicines of BP lowering and antiplatelets, both p value for interaction <0.000.1 CONCLUSIONS: Patients with a history of pCHD had similar rates of RF monitoring to patients without pCHD, but patients with pCHD were less likely to be prescribed SP medication of statins, antihypertensives and antiplatelets.</p>\",\"PeriodicalId\":19505,\"journal\":{\"name\":\"Open Heart\",\"volume\":\"12 2\",\"pages\":\"\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Heart\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1136/openhrt-2024-003092\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Heart","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1136/openhrt-2024-003092","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Risk factor monitoring, management and use of prevention medicines in those with a history of premature coronary heart disease.
Background: Those with premature coronary heart disease (pCHD) have a lower 5-year risk of repeat events; however, their lifetime risk is high. The aim of this study was to assess secondary prevention (SP) medical therapy and risk factor (RF) monitoring in patients with pCHD compared with those without pCHD.
Methods: Analysis of a national primary care database including patients attending the same practice between January 2015 and March 2021 with at least 3 follow-up appointments, a history of CHD and a follow-up duration of at least 2 years. pCHD was defined as males under 55 and females under 65 at age of diagnosis of their CHD.
Results: Among the 64 704 with CHD, 21 035 (32.5%) had pCHD (10 339 women <65 years of age and 10 696 men <55 years of age). Patients with pCHD compared with non-pCHD were more likely to be smokers (59.4% vs 52.6%, p<0.001), less likely to have hypertension (61.9% vs 73.2%, p<0.001) and similar rates of dyslipidaemia (57.8% and 57.5%, p=0.806) and diabetes (30.8% vs 30%, p=0.696). After adjusting for RF, pCHD was not associated with odds of blood pressure (BP) assessment (OR 0.63, 95% CI 0.40 to 1.00), measurement of glycated haemoglobin (OR 0.99, 95% CI 0.94 to 1.04) and any lipid monitoring (OR 1.05, 95% CI 0.96 to 1.14). Patients with PCHD had lower odds of prescription of statins (OR 0.81, 95% CI 0.76 to 0.87), any antiplatelets (OR 0.81, 95% CI 0.77 to 0.86), antihypertensive medication (OR 0.73, 95% CI 0.67 to 0.79) and beta blockers (OR 0.94, 95% CI 0.90 to 0.98) after adjustment for baseline RF. Women with pCHD were even less likely to be prescribed SP medicines of BP lowering and antiplatelets, both p value for interaction <0.000.1 CONCLUSIONS: Patients with a history of pCHD had similar rates of RF monitoring to patients without pCHD, but patients with pCHD were less likely to be prescribed SP medication of statins, antihypertensives and antiplatelets.
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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