BACKGROUNDDespite 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.

METHODSBetween 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.

RESULTSAmong 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.

CONCLUSIONSIn urban China, there is still significant underuse of various proven secondary preventive therapies, with particularly low use of statins in patients with ischaemic stroke.

Aged ; Aged, 80 and over ; Atherosclerosis ; drug therapy ; Atorvastatin Calcium ; Cerebrovascular Disorders ; drug therapy ; Coronary Artery Disease ; drug therapy ; Cross-Sectional Studies ; Female ; Heptanoic Acids ; therapeutic use ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Male ; Middle Aged ; Peripheral Vascular Diseases ; drug therapy ; Pyrroles ; therapeutic use ; Secondary Prevention ; methods ; Simvastatin ; therapeutic use

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.

BACKGROUNDWell 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.

METHODSTotally 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.

RESULTSOnly 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.

CONCLUSIONSIn 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.

Aged ; China ; Female ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Male ; Middle Aged ; Stroke ; drug therapy ; prevention & control

Background 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.Methods 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.Results 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.Conclusions 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.

Objective To investigate the current statin use among high-risk patients with atherosclerotic cardiovascular diseases in Chinese large hospitals.Methods Clinical history and current medication were recorded in 11 783 patients with a history of atherosclerotic cardiovascular disease(CVD)from 39 highest-ranking hospitals in 10 Chinese cities.Results Indication for statin use was given for all screened patients and statin was not prescribed in up to 59.6% (7022)patients. For patients with statin use, medication time was shorter than their atherosclerotic CVD history in 1120 (23.5%) patients. The proportion of statin use among patients with ischemic stroke was 19.6%,among patients with coronary heart disease without ischemic stroke was 59.2%.Conclusion Statin is underused in secondary prevention among patients with atherosclerotic CVD in China.There is a large gap between guideline recommended statin use and in practice.Thus,it remains a major challenge for healthcare professionals and policy makers to resolve this problem rapidly.

Objective 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.Methods This cross-sectional survey was performed between June to December 2007 and May to November 2009 in 51hospitals from 14 cities.The characteristics of patients with established CHD were collected by electronic questionnaire.Results 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.Conclusion 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 tn make efforts on narrowing the gap between evidence and practice.