上海市徐汇区45~55岁居民动脉粥样硬化性心血管疾病风险的影响因素分析

背景　动脉粥样硬化性心血管疾病（ASCVD）是我国居民健康的首要威胁，也是我国居民的首要死亡原因，占城市居民的41.8%，占农村居民的44.8%。家庭医生及其团队对社区中年人群相关风险因素的调研评估、干预及综合管理，可尽早预防ASCVD的发生发展。目的　调查上海市徐汇区45~55岁居民ASCVD风险因素，为日后对相关人群开展针对性的健康干预提供参考意见和建议。方法　采集2019年1-5月在上海市徐汇区枫林街道社区卫生服务中心门诊就诊、信息平台留存准确个人资料（性别、年龄、联系电话）及在本单位体检留存生理、生化数据〔身高、体质量、BMI、血压和血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）及空腹血糖（FPG）〕的530例居民的信息。采用电话回访或现场面对面调查，参照《中国成人血脂异常防治指南（2016年修订版）》中“总体心血管危险评估”相关章节内容定义ASCVD 风险，同时基于社区实际情况，将评估低危和中危人群归为ASCVD低风险组，高危和极高危人群归为ASCVD高风险组。采用多元Logistic逐步回归分析探究居民ASCVD风险的影响因素。结果　发放问卷530份，回收有效问卷502份，有效回收率为94.7%。ASCVD低风险组38例，ASCVD高风险组464例。ASCVD高风险组年龄、TG、FPG、男性比例、心脑血管病史比例、糖尿病史比例、高血压史比例、服用降压药史比例、服用调脂药史比例高于ASCVD低风险组（P<0.05）。多元Logistic逐步回归分析结果显示，≥50岁、TG≥1.5 mmol/L、FBG≥6.1 mmol/L、男性是居民ASCVD风险的危险因素（P<0.05）；服用调脂药史是居民ASCVD风险的保护因素（P<0.05）。结论　上海市徐汇区45~55岁居民ASCVD风险的主要可控危险因素是血脂（TG）及血糖的异常；不可控危险因素是年龄、性别。对于增龄、男性、合并脂代谢异常的居民更应关注ASCVD的风险并予以生活方式干预和调脂药规范使用指导。社区开展多重风险因素评估及管理对ASCVD的早期筛查、早期干预及治疗均非常重要，对家庭医生及其团队开展相关一、二级预防工作有指导借鉴意义。

Risk Factors for Atherosclerotic Cardiovascular Disease among 45-55-year-old Residents Receiving Outpatient Care：a Survey from a Community in Shanghai's Xuhui District

Background　Atherosclerotic cardiovascular disease（ASCVD） is a leading threat to Chinese resident's health.It is also a primary cause of death，accounting for 41.8% of deaths in urban residents and 44.8% in rural residents，respectively.To early prevent the occurrence and development of ASCVD in community-dwelling middle-aged residents，it is essential for family doctors and family doctor teams to take major responsibility to carry out surveys and evaluations about risk factors associated with ASCVD，and provide targeted interventions and comprehensive management.Objective　To investigate the risk factors of ASCVD among 45-55-year-old residents with outpatient care from Xuhui District Fenglin Community Health Center，Shanghai，providing suggestions for delivering targeted interventions for this group in the community.Methods　Participants were 530 outpatient patients recruited from Xuhui District Fenglin Community Health Center during January to May 2019.From the information database and physical examination department of this health center，their correct personal information（sex，age and telephone number），and physiological and biochemical data〔height，weight，BMI，blood pressure，serum total cholesterol（TC），triacylglycerol （TG），high-density lipoprotein cholesterol（HDL-C），low density lipoprotein cholesterol（LDL-C），and fasting plasma glucose（FPG） 〕 were collected.They were invited to participate in a telephone-based questionnaire survey or a fact-to-face questionnaire survey for assessing overall cardiovascular risks.The risk of ASCVD was classified according to the chapter "Overall cardiovascular risk assessment" in 2016 Chinese Guidelines for the Management of Dyslipidemia in Adults.According to the conditions of the community that the participants came from，those were evaluated with low and medium risks were assigned to low-risk group and those with high and extremely high risk were assigned to high-risk group.Stepwise Logistic regression analysis was used to identify the factors associated with levels of ASCVD risks.Results　530 questionnaires were sent out and 502 effective questionnaires were recovered. The effective recovery rate was 64.7%. There were 38 cases in ASCVD low risk group and 464 cases in ASCVD high risk group.High-risk group showed greater mean age，higher mean levels of TG and FPG，male ratio，prevalence rates of cardiovascular disease，diabetes，hypertension，and rates of oral administration of antihypertensive agents，and lipid-lowering drugs compared with low-risk group（P<0.05）.High-risk group showed greater mean age，higher mean levels of TG and FPG，male ratio，prevalence rates of cardiovascular disease，diabetes，hypertension，and rates of oral administration of antihypertensive agents，and lipid-lowering drugs compared with low-risk group（P<0.05）.Stepwise multiple Logistic regression analysis found that≥50 years old，TG≥1.5 mmol/L and FPG≥6.1 mmol/L，male were associated with increased risk of ASCVD（P<0.05），while oral administration of lipid-lowering drugs was associated with decreased risk of ASCVD（P<0.05）.Conclusion　In this group，the controllable risk factors for ASCVD mainly are abnormal blood lipids（TG） and FPG，and the uncontrollable risk factors are age and sex.So more attention should be paid to ASCVD risks in elderly，men，and those with dyslipidemia，and give them interventions for changing unhealthy lifestyles，as well as guidance for standard use of lipid-lowering drugs.Community-based evaluation and management of multiple risk factors of ASCVD are very important for early screening，intervening and treating ASCVD，and may offer assistance for family doctors and family doctor teams in carrying out primary and secondary prevention of ASCVD.