Læknablaðið - 15.02.1999, Page 11

LÆKNABLAÐIÐ 1999; 85
109
Hvernig er kólesteróllækkandi
lyfjameöferð háttað meðal íslenskra
kransæðasjúklinga?
Emil L. Sigurösson121, Jón Steinar Jónsson3’, Guömundur Þorgeirsson41
Sigurðsson EL, Jónsson JS, Þorgeirsson G
How is cholesterol lowering therapy impleniented
ainong patients with coronary heart disease in
Iceland?
Læknablaðið 1999; 85: 109-19
Objective: High serum cholesterol is one of the
major risk factors for coronary heart disease (CHD).
Results from large clinical trials have convincingly
shown the importance of cholesterol lowering thera-
py among patients with established CHD. Revised
guidelines for cholesterol lowering therapy were
published in Iceland in 1996 recommending reduc-
tion of total cholesterol below 5.0 mmol/L in the face
of established coronary heart disease. We have today
very limited knowledge about whether we are imple-
menting these recomnrendations or not and the aim
of this study was to evaluate this question. This study
is a part of a larger enquiry into the actual practice of
secondary prevention of CHD in Iceland.
Material and methods: All patients with residence
in Hafnarfjörður, Garðabær and Bessastaðahreppur
who have been diagnosed as having CHD were sent
a letter with an invitation to participate in the study
and a request for an informed consent. Those who
chose to participate responded to a questionnaire and
gave a permission for a review of their records with
respect to a specific diagnosis and Iipid values. The
patients were divided into four groups on the basis of
their history: I. myocardial infarction (MI), II. coro-
nary artery bypass surgery (CABG), III. percuta-
neous transiluminal coronary angioplasty (PTCA),
IV. angina pectoris (AP). If a patient fulfilled a cri-
terion for ntore than one diagnostic group the CABG
Frá "Heilsugæslustöðinni Sólvangi, Hafnarfiröi, 2|heimilis-
læknisfræöi Háskóla íslands, 3,Heilsugæslunni i Garðabæ,
■"lyflækningadeild Landspítalans. Fyrirspurnir, bréfaskipti:
Emil L. Sigurösson, Heilsugæslustöðinni Sólvangi, 220
Hafnarfirði.
Lykilorð: kransæðasjúkdómur, meöferö, forvarnir, kótest-
eról.
group had the highest priority followed by PTCA,
MI and finally AP.
Results: Of 533 patients with CHD 402 (75%) chose
to participate. Average cholesterol in the total group
was 6.2 mmol/L (95% C.I. 6.07-6.34). In the four
subgroups the respective cholesterol values were: I
6.3, II 5.9, III 5.9, IV 6.5 mmol/L. Only 25% of the
patients knew their cholesterol values, 20% in group
1,43% in group II, 30% and 15% in groups III and IV
respectively. A total of 113 patients (28%) were
receiving cholesterol lowering drug therapy at the
time of the study. Respective treatment ratios in the
four subgroups were 25% in group I, 47% in II, 42%
in III and 13% in group IV.
Conclusions: In spite of overwhelming evidence of
the benefit associated with lipid lowering therapy for
CHD patients this study has shown marked underuse
of this therapeutic modality. Quality control study as
this one is a valuable method to evaluate how prac-
tising physicians are implementing recommenda-
tions, based on scientific evidence, given by health
authorities.
Keywords: coronary heart disease, treatment, prevention,
cholesterol.
Ágrip
Tilgangur: Hátt kólesteról í blóði er einn
helsti áhættuþáttur kransæðasjúkdóms. Á síð-
ustu árum hafa niðurstöður úr stórum klínískum
rannsóknum staðfest mikilvægi þess að lækka
kólesteról meðal kransæðasjúklinga. Endur-
skoðaðar leiðbeiningar um hvenær beita skuli
kólesteróllækkandi lyfjameðferð voru gefnar út
árið 1996 og var þar mælt með að lækka kólest-
eról hjá kransæðasjúklingum niður fyrir 5,0
mmól/L. Vitneskja um það hvernig þessi þekk-
ing er nýtt er afar takmörkuð. Tilgangur þessar-
ar rannsóknar var því að kanna kólesteróllækk-
andi lyfjameðferð meðal sjúklinga með þekktan
kransæðasjúkdóm. Rannsókn þessi er hluti af
stærri rannsókn á meðferð og eftirliti sjúklinga
nteð kransæðasjúkdóm á Islandi.