社区中老年心血管疾病高危人群危险因素暴露特征

Exposure characteristics of risk factors in a community-based middle-aged and elderly population at high risk of cardiovascular diseases

    摘要
  • 摘要:
    目的 评估社区中老年动脉粥样硬化性心血管疾病（ASCVD）高危人群危险因素暴露及控制现状，为优化防控策略提供依据。
    方法 横断面调查郑州市金水区40岁及以上中老年，入选已确诊ASCVD或中国动脉粥样硬化性心血管疾病风险预测研究（China-PAR）评分为高危的居民，分析其心血管疾病危险因素的暴露及控制情况。
    结果 共纳入4 357名心血管疾病高危居民，心血管危险因素患病率占前3位的分别为高血压（75.44%，3 287例），糖尿病（49.00%，2 135例），高脂血症（47.05%，2 050例）。其中女性“三高”患病率更高。高血压、糖尿病和高脂血症患者的治疗率分别为59.96%（1 971/3 287）、51.48%（1 099/2 135）和40.39%（828/2 050），治疗达标率分别为59.23%（1 947/3 287）、42.81%（914/2 135）和24.15%（533/2 050）。危险因素聚集现象显著（≥2种危险因素者占60.45%）。在糖尿病患者中，同患“三高”者血糖达标率最低。在高脂血症患者中，随共病种类增加，降脂治疗率增加，但血脂控制达标率下降。与ASCVD居民比较，China-PAR评分为高危的居民中，高血压患者降压治疗率更低（55.02%比73.18%，χ2=88.789，P＜0.001），糖尿病患者降糖治疗率更低（48.12%比62.78%，χ2=31.873，P＜0.001），高脂血症患者降脂治疗率更低（36.35%比50.97%，χ2=35.833，P＜0.001），但血脂达标率更高（28.79%比11.99%，χ2=21.218，P＜0.001）。
    结论 社区心血管高危人群呈现“两高两低”特征（心血管危险因素高发、多重危险因素聚集；治疗率低、控制率低），危险因素暴露及控制情况存在性别及人群间差异，亟待进一步优化社区心血管疾病危险因素综合管理，针对不同人群实施精准防控。

     

    Abstract:
    Objective To assess the current situation of risk factor exposure and control among middle-aged and elderly people at high risk of atherosclerotic cardiovascular disease (ASCVD) in the community and provide a basis for optimizing prevention and control strategies.
    Methods A cross-sectional survey was conducted. The middle-aged and elderly people (aged 40 years and above) with a confirmed diagnosis of ASCVD or a Prediction for ASCVD Risk in China (China-PAR) score of high-risk in Jinshui District, Zhengzhou City were enrolled. The exposure and control of risk factors for cardiovascular diseases were analyzed.
    Results A total of 4 357 residents at high risk of cardiovascular disease were enrolled, and the top three cardiovascular risk factors were hypertension (75.44%, 3 287 cases), diabetes mellitus (49.00%, 2 135 cases), and hyperlipidemia (47.05%, 2 050 cases). The prevalence of the “three highs” was higher in women. The treatment rates of patients with hypertension, diabetes mellitus and hyperlipidemia were 59.96% (1 971/3 287), 51.48% (1 099/2 135), and 40.39% (828/2 050), respectively, and the control rates were 59.23% (1 947/3 287), 42.81% (914/2 135) and 24.15% (533/2 050), respectively. Risk factor aggregation was significant (60.45% with ≥2 risk factors). Among diabetic patients, those with "three highs" had the lowest control rate. Among patients with hyperlipidemia, with the increase of co-morbidities, the lipid-lowering treatment rate increased, while the control rate decreased. Compared with ASCVD residents, among those with a high-risk China-PAR score, the antihypertensive treatment rate of hypertensive patients was lower (55.02% vs. 73.18%, χ2=88.789, P＜0.001), the anti-diabetic treatment rate of diabetic patients was lower (48.12% vs. 62.78%, χ2=31.873, P＜0.001), and the lipid-lowering treatment rate of patients with hyperlipidemia was lower (36.35% vs. 50.97%, χ2=35.833, P＜0.001), while the lipid control rate of patients with hyperlipidemia was higher (28.79% vs. 11.99%, χ2=21.218, P＜0.001).
    Conclusions The high-risk population of cardiovascular diseases in the community shows the characteristics of "two highs and two lows" (high prevalence of cardiovascular risk factors and aggregation of multiple risk factors; low treatment rate and low control rate), and there are gender and population differences in risk factor exposure and control, so it is urgent to optimize the comprehensive management of cardiovascular risk factors in the community, and implement precise prevention and control for different populations. There is an urgent need to further optimize the comprehensive management of cardiovascular risk factors in the community and to implement precise prevention and control for different populations.

     

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