Risk Stratification of Atherosclerotic Cardiovascular Disease and Lipid Goal Attainment in Hypertensive Patients Registered in Community

doi:10.12114/j.issn.1007-9572.2023.0123

Abstract

Abstract: Background Hypertension and dyslipidemia are major risk factors of cardiovascular and cerebrovascular diseases in Chinese residents. Mastering the risk stratification of atherosclerotic cardiovascular disease (ASCVD) in community residents with hypertension and formulating individualized lipid intervention targets will significantly contribute to the improvement of management of hypertension in primary care and the enhancement of lipid goal attainment rate in residents.Objective To investigate the risk stratification of ASCVD and lipid goal attainment status in hypertensive patients in Beijing's community, providing data support for comprehensive management of hypertension in the community.Methods A total of 2 943 hypertensive patients registered in Yuetan Community Health Center and Qinan Community Health Station from 2019 to 2021 were included. Non-high-density lipoprotein cholesterol (non-HDL-C) was calculated and estimated glomerular filtration rate (eGFR) was calculated from baseline data collected by reviewing health records and electronic medical records. The risk of ASCVD was stratified and blood lipid goal attainment was observed in the patients.Results The participants consisted of 1 201 males and 1 742 females, with a median age of 70 (63, 80) years. High, moderate and low risks of ASCVD were identified in 2 165, 485 and 293 cases, respectively. The LDL-C goal attainment rate was 10.5% (227/2 165) in high-risk patients, 22.9% (111/485) in moderate-risk patients, and 98.0% (287/293) in low-risk patients. Patients with concomitant coronary heart disease had statistically significant higher lipid goal attainment rate than those without 〔14.1% (116/823) vs 9.1% (192/2 120) 〕 (χ²=16.060, P<0.001) . The rate of lipid goal attainment in patients with concomitant stroke was statistically significant higher than that in those without 〔15.5% (41/264) vs 10.0% (267/2 679) 〕 (χ²=7.940, P=0.005) .

Conclusion

Hypertensive patients with moderate or high risk of ASCVD had low lipid goal attainment rate. And those with high risk of ASCVD and concomitant other high risk factors had unsatisfactory lipid control status. Attention should be paid to the management of blood lipid in hypertension patients to improve their blood lipid control rate and reduce their risk of ASCVD.

Key words: Hypertension, Atherosclerosis, Dyslipidemias, Community health services, Cross-sectional survey, Beijing

摘要： 背景高血压、血脂异常是我国居民心脑血管疾病的主要危险因素，掌握社区高血压居民动脉粥样硬化性心血管疾病（ASCVD）危险分层，制订个体化的血脂干预目标，对优化高血压患者基层管理，提高居民血脂达标率有着重要作用。目的调查北京市社区高血压患者的ASCVD危险分层及血脂达标情况，为社区开展高血压患者综合管理提供数据支持。方法纳入2019—2021年月坛社区卫生服务中心和汽南社区卫生服务站建档的2 943例高血压患者为研究对象。通过查阅健康档案及电子病历收集患者的基线资料，计算非高密度脂蛋白胆固醇（非HDL-C）和估算肾小球滤过率（eGFR）。将患者按ASCVD危险分层，观察患者血脂达标情况。结果共纳入高血压患者2 943例，其中男1 201例、女1 742例，中位年龄70（63，80）岁。高危ASCVD患者2 165例，中危ASCVD患者485例，低危ASCVD患者293例。高危ASCVD患者LDL-C达标率为10.5%（227/2 165），中危ASCVD患者LDL-C达标率为22.9%（111/485），低危ASCVD患者LDL-C达标率为98.0%（287/293）。合并冠心病患者血脂达标率〔14.1%（116/823）〕高于未合并冠心病患者〔9.1%（192/2 120）〕，差异有统计学意义（χ²=16.060，P<0.001）；合并脑卒中患者血脂达标率〔15.5%（41/264）〕高于未合并脑卒中患者〔10.0%（267/2 679）〕，差异有统计学意义（χ²=7.940，P=0.005）。结论高血压患者高危和中危ASCVD血脂达标率低，高血压合并多种其他高危因素高危ASCVD患者血脂控制情况不理想，在高血压患者血脂管理中应该引起重视，提高血脂达标率，降低ASCVD风险。

关键词: 高血压, 动脉粥样硬化, 血脂异常, 社区卫生服务, 现况调查, 北京

BIAN Lili,LI Xiaoxiao,DU Xueping, et al. Risk Stratification of Atherosclerotic Cardiovascular Disease and Lipid Goal Attainment in Hypertensive Patients Registered in Community[J]. Chinese General Practice, 2023, 26(27): 3388-3391. DOI: 10.12114/j.issn.1007-9572.2023.0123.
边立立,李肖肖,杜雪平等. 社区建档高血压患者动脉粥样硬化性心血管疾病危险分层及血脂达标调查研究[J]. 中国全科医学, 2023, 26(27): 3388-3391. DOI: 10.12114/j.issn.1007-9572.2023.0123.

Figures/Tables 1

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性别	Scr（μmol/L）	eGFR〔mL·min^-1·（1.73 m²）^-1〕
女性	≤62	144×（Scr/62）^-0.329×（0.993）^年龄
	>62	144×（Scr/62）^-1.209×（0.993）^年龄
男性	≤80	144×（Scr/62）^-0.411×（0.993）^年龄
	>80	144×（Scr/62）^-1.209×（0.993）^年龄

性别	Scr（μmol/L）	eGFR〔mL·min^-1·（1.73 m²）^-1〕
女性	≤62	144×（Scr/62）^-0.329×（0.993）^年龄
	>62	144×（Scr/62）^-1.209×（0.993）^年龄
男性	≤80	144×（Scr/62）^-0.411×（0.993）^年龄
	>80	144×（Scr/62）^-1.209×（0.993）^年龄