[Coronary risk factor management in primary practice in Shibuya, Tokyo].
OBJECTIVE
Many large-scale clinical trials have confirmed that coronary risk factors such as hypertension, hyperlipidemia and diabetes mellitus predict a higher incidence of cardiovascular events and that control of these risk factors reduces the incidence. However, the actual management of such risk factors and the resultant improvement of the cardiovascular events in primary practice remains unclear. The Heart Care Network Shibuya, a voluntary study group of regional primary physicians, surveyed the management of coronary risk factors and the clinical outcomes.


METHODS
Behavioral patterns of the coronary risk factor was investigated in the management and resultant changes of the risk factors in 209 outpatients (mean age 65.6 +/- 11.2 years) with more than one of hypertension, hyperlipidemia, diabetes mellitus or prior myocardial infarction for 1 year.


RESULTS
Prescriptions of anti-hypertensive (from 1.3 +/- 0.8 to 1.4 +/- 0.8 drugs per patient) and antihyperlipidemia drugs (from 0.70 +/- 0.4 to 0.73 +/- 0.4 drugs per patient) did not significantly increase. Patient education for diet (93% to 97%, p = 0.077), exercise (69% to 81%, p < 0.05) and nonsmoking (66% to 86%, p < 0.05) significantly increased after 1 year. Blood pressure decreased from 142 +/- 16/81 +/- 10 to 138 +/- 78/78 +/- 9 mmHg (p < 0.05), serum total cholesterol level decreased from 215 +/- 39 to 203 +/- 39 mg/dl (p < 0.05). As a result, more patients attained the treatment goals recommended in the guidelines by the Japanese Society of Hypertension (34.6% to 46.8%) and Japan Atherosclerosis Society (40.2% to 49.5%), respectively. However, none of blood hemoglobin A1c level, body mass index or smokers significantly changed.


CONCLUSIONS
Regional practitioners attempted to control all coronary risk factors. Hypertension and hyperlipidemia, which are relatively more dependent on the medical management, improved. In contrast, diabetes mellitus, obesity or smoking, which require life style changes, did not improve. The main issue in the risk factor management is how physicians act rather than specific actions.
Nakamura
Jo
J
Department of Cardiovascular Medicine, Sakura Hospital, Faculty of Medicine, Toho University, Chiba.
Amano
Wataru
W
Araki
You
Y
Ishii
Kazuchika
K
Uchida
Yoshihiro
Y
Kon
Toshio
T
Sato
Yasuo
Y
Shiozaki
Masahide
M
Takada
Kazuko
K
Naito
Hirokuni
H
Nagaiwa
Jiro
J
Nakajima
Kiyotaka
K
Yoshida
Katsuya
K
Watanabe
Yutaka
Y
Tomaru
Takanobu
T
Aoyagi
Teruhiko
T
D000368:Aged; D015992:Body Mass Index; D003327:Coronary Disease / Q000209:etiology*; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management; D010353:Patient Education as Topic; D011320:Primary Health Care; D012307:Risk Factors; D012907:Smoking