ABSTRACT
<p><b>OBJECTIVE</b>This study investigated current use of ACEI/ARB among high risk patients with coronary heart disease (CHD) in China and factors affecting ACEI/ARB use in these patients.</p><p><b>METHODS</b>This cross-sectional survey was performed between June to December 2007 and May to November 2009 in 51 hospitals from 14 cities. The characteristics of patients with established CHD were collected by electronic questionnaire.</p><p><b>RESULTS</b>Only 45.8% high risk CHD patients were taking ACEI/ARB and the ACEI/ARB medication decreased significantly with time after initial CHD diagnosis. ACEI/ARB was taken in 46.1% CHD patients complicated with diabetes mellitus and in 56.3% CHD patients complicated with hypertension. Logistic regression analysis showed that comorbid hypertension was the strongest factor associated with ACEI/ARB use. In addition, male gender, history of myocardial infarction (MI), PCI and the time after initial CHD diagnosis were independent factors affecting the use of ACEI/ARB. Captopril was the most commonly prescribed ACEI in this cohort.</p><p><b>CONCLUSION</b>ACEI/ARB is underused in secondary prevention among high risk CHD patients in China. It remains a major challenge for healthcare professionals and policy makers to make efforts on narrowing the gap between evidence and practice.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Angiotensin-Converting Enzyme Inhibitors , Therapeutic Uses , China , Epidemiology , Coronary Disease , Drug Therapy , Epidemiology , Cross-Sectional Studies , Risk Factors , Treatment OutcomeABSTRACT
<p><b>BACKGROUND</b>Well designed randomized trials and meta-analyses have clearly shown that statins reduce the risk of major vascular events, including ischemic stroke, in a wide range of patients and their routine use is recommended for patients at an increased cardiovascular risk. Survivors of a first ischemic stroke are at a risk of recurrence and of other vascular events and statins are generally recommended to reduce this risk. This study investigated how widely statins were being used for such patients in China.</p><p><b>METHODS</b>Totally 6422 patients with a history of ischemic stroke were identified by reviewing medical records at 51 highest-ranking hospitals in 14 cities in China, and invited to attend a screening clinic to assess eligibility for a randomized trial. Their current statin and other drug uses were recorded alongside clinical and demographic characteristics. Univariate chi-square test and multivariate Logistic regression were used to determine the factors associated with treatment.</p><p><b>RESULTS</b>Only 24% of these patients reported currently taking a statin. The most important predictor of statin use among these patients was prior history of coronary heart disease. History of diabetes or hypertension, as well as treated in university affiliated hospitals is related to increased use. The status had improved significantly during a 2-year period. Atorvastatin (40%) and simvastatin (39%) were the most commonly used.</p><p><b>CONCLUSIONS</b>In China, statins are still underused for secondary prevention among survivors of ischemic stroke. Reasons for this poor use need to be understood in order to increase use of these evidence based therapies.</p>
Subject(s)
Aged , Female , Humans , Male , Middle Aged , China , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Therapeutic Uses , Stroke , Drug TherapyABSTRACT
<p><b>BACKGROUND</b>Despite considerable improvements in the care of patients with cardiovascular disease in various populations over the last few decades, there are still limited data about long-term treatment patterns among patients with various atherosclerotic vascular conditions in China, especially the use of statin therapy.</p><p><b>METHODS</b>Between June 2007 and October 2009, 16 860 patients aged 50 - 80 years with established history of atherosclerotic vascular disease (coronary heart disease (CHD), atherosclerotic cerebrovascular disease (CVD), or peripheral arterial disease (PAD)) from 51 hospitals in 14 cities of China were screened for a large randomized trial. Detailed information about current use of statins and various other treatments was recorded and analyzed by prior disease history, adjusting for various baseline characteristics.</p><p><b>RESULTS</b>Among the 16 860 patients, the mean age was 63 years and 74% were male. Overall, 78% of the patients had documented CHD, 40% had CVD, 5% had PAD and 21% reported more than one condition. The median time from initial diagnosis of vascular disease to screening was 18 months. At screening, the proportions who took various treatments were 83% for antiplatelet agents, 49% for beta-blockers, 47% for statins and 28% for angiotensin-converting enzyme inhibitors. The proportion treated with statin was much higher in CHD than in CVD or PAD patients (61% vs. 10% vs. 22% respectively) and decreased significantly with time from initial diagnosis. Simvastatin (mainly 20 mg) and atorvastatin (mainly 10 mg) each accounted for about 40% of total statin use.</p><p><b>CONCLUSIONS</b>In urban China, there is still significant underuse of various proven secondary preventive therapies, with particularly low use of statins in patients with ischaemic stroke.</p>
Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Atherosclerosis , Drug Therapy , Atorvastatin , Cerebrovascular Disorders , Drug Therapy , Coronary Artery Disease , Drug Therapy , Cross-Sectional Studies , Heptanoic Acids , Therapeutic Uses , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Therapeutic Uses , Peripheral Vascular Diseases , Drug Therapy , Pyrroles , Therapeutic Uses , Secondary Prevention , Methods , Simvastatin , Therapeutic UsesABSTRACT
Objective To investigate the degree and determinants of the use on statin among patients with atherosclerotic ischernic stroke in China. Methods In the context of an international multi-center clinical trial being undertaken in China, 5585 patients with atherosclerotic ischemic stroke were screened in 39 prestigious hospitals in 10 cities. The characteristics collected through electronic questionnaire were described and analyzed. Results All the screened patients had indications for statins. Among those, 60% of the patients had a history from 3 months to 2 years of suffering from stroke. However, up to 80% of the patients were not using statins when screened. Even in those with statins, about 1/4 of the patients took statins for much shorter period than the history of stroke. The proportion using statins among IS patients with CHD was 4 times more than in those without CHD. Simvastatin and Atorvastatin were most commonly used. Conclusion Statins were greatly nnderused for secondary prevention among patients with atherosclerotic ischemic stroke in China. There was a large gap between evidence and practice. It remains a major challenge for healthcare professionals and policy makers to tackle this problem more positively.