RA病患在MI之后的治疗不够


  【24drs.com】根据发表于欧洲抗风湿病联盟(EULAR)2011研讨会针对Danish National Registry资料库中,在2002-2009年间初次发生心肌梗塞(MI)之病患的大型研究,初次发生心肌梗塞之后,相较于健康对照组,类风湿性关节炎(RA)病患比较不会被处方标准的MI后治疗,如阿斯匹灵、statin类药物和乙型阻断剂。
  
  丹麦哥本哈根Gentofte大学医院的Jesper Lindharsen医师表示,我们知道RA病患的心血管风险增加约50%,我们的研究认为,这类患者的心血管疾病可能治疗不足,治疗不足的原因可能包括,医师不愿意对进行积极疗法的RA病患开立额外的药物,也可能是因为病患的遵医嘱性。
  
  虽然这篇研究并未探讨实际的处方,只探讨一开始的治疗,有开立处方的患者比较会购药并开始治疗,估计有95%的人会买一种处方药,研究认为,这些病患在发生MI之后并没有获得对心脏有保护力的药物处方。
  
  该研究是根据初次发生MI后的66,389名存活者的资料,875人(1.3%)同时有RA诊断;开始时,平均年纪约为70岁,63%是男性、37%是女性;开始时,在RA病患中,约25%服用阿斯匹灵、20%服用某种statin类药物、23%服用某种乙型阻断剂、3%服用clopidogrel;健康对照组服用这些药物的百分比和开始时类似。
  
  Lindharsen医师表示,第30天时,相较于健康对照组,RA病患服用statin类药物的少32%、开始使用乙型阻断剂治疗者少24%、开始使用阿斯匹灵治疗者少25%,这些比率到了第180天时并未改变;RA病患和对照组在第30天和第180天时服用clopidogrel的比率相似,clopidogrel一般是由进行侵入性治疗的心脏科医师开立。
  
  需要后续研究确认RA病患治疗不足的原因,Lindharsen医师表示,其它研究认为,RA病患的心血管疾病风险增加,但是没有发生过MI,也是治疗不足。
  
  根据EULAR的科学计划委员会主席Georg Schett医师表示,这篇研究可能反映出取样偏差,因为在开始时,应该要接受阿斯匹灵、降血压药物和降血脂药物等具心脏保护力药物的RA病患较多,但是只有少部分病患服用这些药物,这或许是遵医嘱性不佳。
  
  Schett医师表示,一线照护医师应多注意RA病患的心血管风险因素,由于此类患者的心血管风险增加,应处方适当药物并确保病患有确实服用。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=6539&x_classno=0&x_chkdelpoint=Y
  

Patients With RA Are Undertreated After MI

By Alice Goodman
Medscape Medical News

June 6, 2011 (London, United Kingdom) — After experiencing a first myocardial infarction (MI), patients with rheumatoid arthritis (RA) were much less likely to have been prescribed standard post-MI treatments, including aspirin, statins, and beta blockers, than were healthy control patients, according to a very large study based on a Danish National Registry of patients with a first MI between 2002 and 2009, presented here at the European League Against Rheumatism (EULAR) Congress 2011.

"We know that RA patients are at about a 50% increased risk of cardiovascular disease. Our study suggests that cardiovascular disease may be undertreated in these patients," said Jesper Lindharsen, MD, from the Gentofte University Hospital in Copenhagen, Denmark. He suggested that reasons for undertreatment might include physicians' reluctance to prescribe additional medications to patients with RA on active treatment and/or patient adherence.

Although the study did not look at actual prescriptions, only initiation of treatment, "people given prescriptions are more likely to buy the drug and initiate treatment. It is estimated that 95% of people do buy a prescribed drug. The study suggests that these patients did not get the prescriptions for the cardioprotective drugs post-MI."

The study was based on 66,389 survivors of a first MI; 875 (1.3%) also had a diagnosis of RA. At baseline, average age was about 70 years, 63% were men, and 37% were women; among patients with RA, at baseline, about 25% were taking aspirin, 20% a statin, 23% a beta blocker, and 3% clopidogrel. The percentages of healthy control patients taking these drugs were similar at baseline.

At 30 days, patients with RA were 32% less likely to get a statin, 24% less likely to initiate therapy with a beta blocker, and 25% less likely to initiate aspirin therapy compared with healthy control patients. These findings were unchanged at 180 days. A similar percentage of patients with RA and control patients were taking clopidogrel at 30 and 180 days, which is usually prescribed by an invasive cardiologist, Dr. Lindharsen said.

Further research is needed to identify the reasons for the undertreatment of patients with RA. Dr. Lindharsen said that other studies have suggested that patients with RA who are at increased risk for cardiovascular disease, but have not suffered an MI, are undertreated as well.

According to EULAR's Chair of the Scientific Program Committee Georg Schett, MD, this study could reflect a selection bias, because at baseline, more patients with RA should have been receiving cardioprotective drugs that include aspirin, antihypertension agents, and lipid-lowering agents, but only a small percentage were taking these drugs. "This might have selected for poor compliance," he noted.

Primary care physicians should be paying more attention to cardiovascular risk factors in patients with RA, who are at increased cardiovascular risk, and prescribing appropriate drugs and making sure patients are taking them, Dr. Schett said.

Dr. Lindharsen and Dr. Schett have disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2011: Abstract OP0283. Presented May 27, 2011.

    
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