摘要
目的:评价青年冠心病患者的二级预防措施及危险因素控制情况对心肌梗死事件的影响。方法:回顾性纳入2019年10月至2021年10月在首都医科大学附属北京安贞医院心内科门诊就诊的曾于18~44岁初次诊断为冠心病的患者1013例,分析冠心病危险因素控制情况及其与心肌梗死事件的关系。结果:共纳入青年冠心病患者1013例,其中男性959例(94.7%),初诊冠心病时平均年龄(38.5±3.9)岁,中位随访1.1(1.0,2.6)年,共发生心肌梗死事件96例(9.5%)。研究终点时(我院门诊纳入时),吸烟者戒烟率为51.8%,血压、血糖、低密度脂蛋白胆固醇(LDL-C)、体重指数和心率达标的比例较基线时(初诊冠心病时)显著增加(P均<0.05),然而LDL-C、体重指数、心率达标者仍仅占约1/3。与不吸烟相比,持续吸烟增加心肌梗死发生风险(OR=2.27,95%CI:1.15~4.48,P=0.019);与LDL-C<1.4 mmol/L相比,LDL-C≥2.6 mmol/L增加心肌梗死发生风险(OR=2.20,95%CI:1.07~4.55,P=0.033)。研究终点时≥4个危险因素达标可显著降低心肌梗死事件的发生风险(OR=0.40,95%CI:0.19~0.82,P=0.013)。结论:青年冠心病患者出院后危险因素控制得到明显加强,然而LDL-C、体重指数与心率达标率以及戒烟率仍较低。强化多项危险因素的控制或可降低心肌梗死事件发生风险,改善二级预防效果。
Objectives:To evaluate the effects of secondary prevention measures and control of risk factors in young patients with coronary heart disease(CHD)on the occurrence of myocardial infarction(MI)events during follow-up and analyze the relationship between the achievement of risk factor controlling targets and outcome.Methods:We included young patients(18-44 years old)diagnosed with CHD for the first time in the cardiology department at Beijing Anzhen Hospital between October 2019 and October 2021.A retrospective analysis was conducted to assess the control of CHD risk factors and their relationship with MI events during follow-up.Results:A total of 1013 young patients with CHD were included,959(94.7%)were male patients.The average age at the initial diagnosis of CHD was(38.5±3.9)years.With a median follow-up duration of 1.1 years,96(9.5%)MI events occurred.At the study endpoint,the smoking cessation rate was 51.8%,and the proportions of patients meeting control standards for blood pressure,blood glucose,low-density lipoprotein cholesterol(LDL-C),body mass index(BMI),and heart rate significantly increased compared to baseline levels(all P<0.05).However,the rates of LDL-C,BMI,and heart rate reaching the targets were still only about one-third.Compared to non-smokers,continuous smoking increased the risk of MI(OR=2.27,95%CI:1.15-4.48,P=0.019).Compared to LDL-C<1.4 mmol/L,LDL-C≥2.6 mmol/L was related to increased risk of MI(OR=2.20,95%CI:1.07-4.55,P=0.033).Achieving control targets for four or more risk factors at the endpoint significantly reduced the risk of MI events(OR=0.40,95%CI:0.19-0.82,P=0.013).Conclusions:The control of risk factors in young patients with CHD improved significantly after discharge.However,the rates of achieving control targets for LDL-C,BMI,heart rate,and smoking cessation were still low in this cohort.Strengthening the control of multiple risk factors might reduce the risk of MI events and improve the effectiveness of secondary prevention.
作者
杨雪瑶
邢浩然
杨红霞
王锦纹
左惠娟
宋现涛
张宏家
YANG Xueyao;XING Haoran;YANG Hongxia;WANG Jinwen;ZUO Huijuan;SONG Xiantao;ZHANG Hongjia(Department of Cardiology,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Community Health Research,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing 100029,China;Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart Lung and Blood Vessel Diseases,Beijing Advanced Innovation Center for Big Data-based Precision Medicine,Capital Medical University,Beijing Lab for Cardiovascular Precision Medicine,Beijing 100029,China)
出处
《中国循环杂志》
CSCD
北大核心
2023年第11期1150-1156,共7页
Chinese Circulation Journal
基金
首都卫生发展科研专项(2022-2G-1055)
心血管疾病精准医学北京实验室(PXM2020_014226_000017_00377132_FCG)。
