中国糖尿病合并动脉粥样硬化性心血管疾病患者他汀类药物的应用现状调查

目的了解中国糖尿病合并动脉粥样硬化性心血管疾病(CVD)患者他汀类药物的应用现状。方法借助1项国际多中心大规模临床试验在中国实施之际,于2007年6～12月在10个城市的39家三级医院对符合标准的高危动脉粥样硬化性CVD患者进行调查,利用电子问卷采集临床资料,对他汀类药物的使用情况进行统计描述和分析。结果调查4429例糖尿病合并动脉粥样硬化性CVD患者,年龄50～80岁,平均(64±8)岁,66.2%为男性,3345例(75.5%)合并冠心病,2053例(46.4%)合并心肌梗死,1976例(44.6%)合并缺血性脑卒中,3181例(71.8%)合并高血压。仅1952例(44.1%)患者在服用他汀类药物,其中1411例(72.3%)患者末在确诊糖尿病后立即开始服用他汀,而451例(23.1%)患者未在确诊CVD后即开始服用他汀。辛伐他汀(20mg≤且40mg)和阿托伐他汀(10mg≤且20mg)为最常用剂量,分别占63.5%(489/770)和61.0%(428/702)。结论目前中国糖尿病合并动脉粥样硬化性CVD患者他汀类药物的使用明显不足,应加强对医师的培训和对患者的健康宣教,努力缩小临床实践与循证医学证据和指南推荐之间的差距。

Survey of statin usage in 4429 diabetic patients with atherosclerostic cardiovascular disease in China

Objective To investigate statin usage in diabetic patients with atherosclerostic cardiovascular disease in China. Methods This survey was carried out in 2007 in 39 first class hospitals from 10 cities in China. Potential participants of an international multi-center clinical trial were identified and interviewed. The clinical data including the usage of statin were collected by electronic questionnaire, and were described and analyzed. Results The 4429 diabetic patients with atherosclerosfic cardiovascular disease were interviewed. Their average age was 64 years, 66. 2% were male, 75.5% had coronary heart disease, 46.4% had myocardial infarction, 44.6% had ischeamie stroke, 71.8% had hypertention. Among them, only 1952 （44. 1%） were taking statins. The 1411 （72.3%） patients didn＇t start statin therapy following the diagnosis of diabetes. And 451 （23. 1% ） patients didn＇t start statin therapy following the diagnosis of atherosclerostic cardiovascular disease. Simvastatin （20 mg ≤ and 〈 40 rag） and atorvastatin （ 10 mg ≤ and 〈 20 mg） were most commonly used, which accounted for 25% and 22% of all patients taking statin respectively. Conclusions Statin therapy is underused for secondary prevention in diabetic patients with atherosclerostic cardiovascular disease in China. Training for doctors and education for patients should be strengthened, to narrow the gap between clinical practice and the guidelines.