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Article(id=1320442571231441409, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, articleNumber=null, orderNo=null, doi=10.11847/zgggws1148182, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1749484800000, receivedDateStr=2025-06-10, revisedDate=1757347200000, revisedDateStr=2025-09-09, acceptedDate=1761667200000, acceptedDateStr=2025-10-29, onlineDate=1792747641617, onlineDateStr=2026-10-23, pubDate=1770652800000, pubDateStr=2026-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792747641617, onlineIssueDateStr=2026-10-23, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792747641617, creator=13701087609, updateTime=1792747641617, updator=13701087609, issue=Issue{id=1320442558581424898, tenantId=1146029695717560320, journalId=1319373219989389464, year='2026', volume='42', issue='2', pageStart='129', pageEnd='256', issueExtLink='null', onlineDate='null', pubDate='1770652800000', pubDateStr='2026-02-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792747638602, creator='13701087609', updateTime=1792748118043, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1320444569574031427, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1320444569578225732, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1320442558581424898, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=194, endPage=198, ext={EN=ArticleExt(id=1320442571432768002, articleId=1320442571231441409, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Use and its influencing factors of secondary prevention drugs among patients with cardiovascular and cerebrovascular diseases in East China from 2014 to 2019: based on data analysis of China PEACE MPP, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the use and its influencing factors of secondary prevention drugs among patients with cardiovascular and cerebrovascular diseases (CVDs) in East China from 2014 to 2019, thus providing a basis for the improving medication adherence of secondary prevention drugs among these patients.

Methods

Data were collected from 19 992 patients with CVDs who aged 35–75 years and used secondary prevention drugs in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (China PEACE MPP) from September 2014 to November 2019 across 57 counties/districts in seven provincial-level administrative regions (Shanghai, Jiangsu, Zhejiang, Anhui, Fujian, Jiangxi, and Shandong) in East China. Multivariate mixed models were employed with community-specific random intercepts to analyze the associations of individual characteristics with the reported use of secondary prevention drugs.

Results

Among the 19 992 patients with CVDs reported in East China from 2014 to 2019, 4 435 (22.18%) patients used antiplatelets or statins. Among them, 3 671 (18.36%) and 2 181 (10.91%) patients used antiplatelets and statins, respectively, and 1 417 cases (7.09%) used both types of drugs. The results of the multivariate mixed model analysis showed that the patients with CVDs who had educational background of junior high school or above, hypertension history, dyslipidemia history, overweight or obesity were more likely to report taking secondary prevention drugs. Female patients, current smokers, and those diagnosed with CVDs for more than 7 years were less likely to report taking secondary prevention drugs.

Conclusions

The use of secondary prevention drugs among the patients with CVDs was suboptimal in East China from 2014 to 2019. Gender, educational background, history of hypertension and dyslipidemia, current smoking status, body mass index, and time from diagnosis of CVDs are the main influencing factors for the use of secondary prevention drugs among the patients in East China.

, authors=Hao YANG, Bowang CHEN, Jiapeng LU, Yang YANG, authorsList=Hao YANG, Bowang CHEN, Jiapeng LU, Yang YANG, authorCompany=null, correspAuthors=Yang YANG, authorNote=null, correspAuthorsNote=
YANG Yang, E-mail:
, copyrightStatement=Copyright © 2026 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1320442571806061059, articleId=1320442571231441409, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=2014—2019年中国华东地区心脑血管疾病患者二级预防用药情况及影响因素：基于一项高危筛查项目资料分析, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

了解2014—2019年中国华东地区心脑血管疾病患者二级预防用药情况及其影响因素，为提升心脑血管疾病患者服用二级预防用药的依从性提供参考依据。

方法

收集2014年9月—2019年11月心脑血管疾病高危人群早期筛查与综合干预项目中上海市、江苏省、浙江省、安徽省、福建省、江西省、山东省等华东地区7个省（直辖市）57个县/区19 992例35～75岁心脑血管疾病患者二级预防用药使用情况，并应用多变量混合效应模型以社区水平为随机截距分析患者个体水平的特征与二级预防药物使用的关联。

结果

2014—2019年中国华东地区报告的19 992例心脑血管疾病患者中，使用抗血小板药物或他汀类药物者4 435例（22.18%），使用抗血小板药物者3 671例（18.36%），使用他汀类药物者2 181例（10.91%），2种药物均使用者1 417例（7.09%）；多变量混合效应模型分析结果显示，文化程度初中及以上、高血压、血脂异常、超重和肥胖的心脑血管疾病患者服用二级预防药物的可能性更高，女性、目前吸烟、诊断年限>7年的心脑血管疾病患者服用二级预防药物的可能性更低。

结论

中国华东地区2014—2019年心脑血管疾病患者的二级预防用药服药比例较低，性别、文化程度、有无高血压史、有无血脂异常史、是否目前吸烟、体质量指数和诊断年限是该地区心脑血管疾病患者二级预防用药的主要影响因素。

, authors=杨皓, 陈伯望, 路甲鹏, 杨阳*, *, authorsList=杨皓, 陈伯望, 路甲鹏, 杨阳, authorCompany=null, correspAuthors=杨阳, authorNote=

杨皓（1991—），实习研究员，硕士，研究方向：心血管疾病人群管理

, correspAuthorsNote=
杨阳，E-mail：
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Comparison of use of secondary prevention drugs among patients with CVDs and different characteristics

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特征分组心脑血管疾
病患者例数		服用抗血小板药物和/或他汀类药物服用抗血小板药物
服用他汀类药物同时服用2种药物
例数构成比/%例数构成比/%例数构成比/%例数构成比/%
性别男性10 0972 57725.522 17421.531 30212.898998.90
女性98951 85818.78 d1 49715.13 d8798.88 d5185.23 d
年龄/岁35～443074715.313912.70299.45216.84
45～542 14147722.2840118.7325111.721758.17
55～6469471 59022.891 33619.2374410.714907.05
65～7510 5972 32121.90 b1 89517.88 c1 15710.927316.90
文化程度小学及以下11 7652 28019.381 93416.441 0278.736815.79
初中及以上82272 15526.19 d1 73721.11 d1 15414.03 d7368.95 d
婚姻状况 a非在婚1 62930718.8526015.961368.35895.46
在婚18 262411022.51 d3 39618.60 c2 03411.14 d1 3207.23 c
职业 a非农民95452 34824.601 85119.391 33313.978368.76
农民10 250206120.11 d1 80017.56 d8368.16 d5755.61 d
家庭年收入/万元 a<1359676221.1968018.912908.062085.78
1～510 1652 21321.771 86418.341 05410.377056.94
>547941 20225.07 d92819.3669614.52 d4228.80 d
居住地城市95722 50426.162 02721.181 28713.458108.46
农村10 4201 93118.53 d1 64415.78 d8948.58 d6075.83 d
高血压史无80441 51918.881 28916.027359.145056.28
有11 9482 91624.41 d2 38219.94 d1 44612.10 d9127.63 d
糖尿病史无16 090345321.461 90818.071 64710.241 1026.85
有390298225.17 d76319.55 b53413.69 d3158.07 c
血脂异常史无18 171377420.773 25017.891 6739.211 1496.32
有1 82166136.30 d42123.12 d50827.90 d26814.72 d
目前吸烟否16 297360422.112 94718.081 80211.061 1457.03
是369583122.4972419.59 b37910.262727.36
目前饮酒否16 584363221.902 98417.991 80810.901 1606.99
是340880323.56 b68720.16 c37310.942577.54
体质量指数低体重2764215.222910.51238.33103.62
正常体重70361 34219.071 11815.896399.084155.90
超重8726205223.521 70019.481 02811.786767.75
肥胖395499925.27 d82420.84 d49112.42 d3167.99 d
诊断年限/年 a<23 36279723.7166719.8442212.552928.69
2～710 2712 36122.99195319.011 16311.327557.35
>7373672619.43 d59215.85 d3138.38 d1794.79 d
), ArticleFig(id=1320442574683353637, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1320442571231441409, language=CN, label=表1, caption=

华东地区不同特征心脑血管疾病患者二级预防用药情况比较

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特征分组心脑血管疾
病患者例数		服用抗血小板药物和/或他汀类药物服用抗血小板药物
服用他汀类药物同时服用2种药物
例数构成比/%例数构成比/%例数构成比/%例数构成比/%
性别男性10 0972 57725.522 17421.531 30212.898998.90
女性98951 85818.78 d1 49715.13 d8798.88 d5185.23 d
年龄/岁35～443074715.313912.70299.45216.84
45～542 14147722.2840118.7325111.721758.17
55～6469471 59022.891 33619.2374410.714907.05
65～7510 5972 32121.90 b1 89517.88 c1 15710.927316.90
文化程度小学及以下11 7652 28019.381 93416.441 0278.736815.79
初中及以上82272 15526.19 d1 73721.11 d1 15414.03 d7368.95 d
婚姻状况 a非在婚1 62930718.8526015.961368.35895.46
在婚18 262411022.51 d3 39618.60 c2 03411.14 d1 3207.23 c
职业 a非农民95452 34824.601 85119.391 33313.978368.76
农民10 250206120.11 d1 80017.56 d8368.16 d5755.61 d
家庭年收入/万元 a<1359676221.1968018.912908.062085.78
1～510 1652 21321.771 86418.341 05410.377056.94
>547941 20225.07 d92819.3669614.52 d4228.80 d
居住地城市95722 50426.162 02721.181 28713.458108.46
农村10 4201 93118.53 d1 64415.78 d8948.58 d6075.83 d
高血压史无80441 51918.881 28916.027359.145056.28
有11 9482 91624.41 d2 38219.94 d1 44612.10 d9127.63 d
糖尿病史无16 090345321.461 90818.071 64710.241 1026.85
有390298225.17 d76319.55 b53413.69 d3158.07 c
血脂异常史无18 171377420.773 25017.891 6739.211 1496.32
有1 82166136.30 d42123.12 d50827.90 d26814.72 d
目前吸烟否16 297360422.112 94718.081 80211.061 1457.03
是369583122.4972419.59 b37910.262727.36
目前饮酒否16 584363221.902 98417.991 80810.901 1606.99
是340880323.56 b68720.16 c37310.942577.54
体质量指数低体重2764215.222910.51238.33103.62
正常体重70361 34219.071 11815.896399.084155.90
超重8726205223.521 70019.481 02811.786767.75
肥胖395499925.27 d82420.84 d49112.42 d3167.99 d
诊断年限/年 a<23 36279723.7166719.8442212.552928.69
2～710 2712 36122.99195319.011 16311.327557.35
>7373672619.43 d59215.85 d3138.38 d1794.79 d
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2014—2019年中国华东地区心脑血管疾病患者二级预防用药情况及影响因素：基于一项高危筛查项目资料分析
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杨皓 , 陈伯望 , 路甲鹏 , 杨阳 *, *
中国公共卫生 | 调查报告与分析 2026,42(2): 194-198
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中国公共卫生 |调查报告与分析 2026 , 42 (2) : 194 -198
2014—2019年中国华东地区心脑血管疾病患者二级预防用药情况及影响因素：基于一项高危筛查项目资料分析
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杨皓, 陈伯望, 路甲鹏, 杨阳*, *
作者信息
  • 国家心血管病中心 中国医学科学院阜外医院，北京 102308
通讯作者:
杨阳，E-mail：
作者简介:

杨皓（1991—），实习研究员，硕士，研究方向：心血管疾病人群管理

Use and its influencing factors of secondary prevention drugs among patients with cardiovascular and cerebrovascular diseases in East China from 2014 to 2019: based on data analysis of China PEACE MPP
Hao YANG, Bowang CHEN, Jiapeng LU, Yang YANG
Affiliations
  • National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 102308, China
    • Corresponding Author:
    YANG Yang, E-mail:
出版时间: 2026-02-10 doi: 10.11847/zgggws1148182
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摘要
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目的

了解2014—2019年中国华东地区心脑血管疾病患者二级预防用药情况及其影响因素，为提升心脑血管疾病患者服用二级预防用药的依从性提供参考依据。

方法

收集2014年9月—2019年11月心脑血管疾病高危人群早期筛查与综合干预项目中上海市、江苏省、浙江省、安徽省、福建省、江西省、山东省等华东地区7个省（直辖市）57个县/区19 992例35～75岁心脑血管疾病患者二级预防用药使用情况，并应用多变量混合效应模型以社区水平为随机截距分析患者个体水平的特征与二级预防药物使用的关联。

结果

2014—2019年中国华东地区报告的19 992例心脑血管疾病患者中，使用抗血小板药物或他汀类药物者4 435例（22.18%），使用抗血小板药物者3 671例（18.36%），使用他汀类药物者2 181例（10.91%），2种药物均使用者1 417例（7.09%）；多变量混合效应模型分析结果显示，文化程度初中及以上、高血压、血脂异常、超重和肥胖的心脑血管疾病患者服用二级预防药物的可能性更高，女性、目前吸烟、诊断年限>7年的心脑血管疾病患者服用二级预防药物的可能性更低。

结论

中国华东地区2014—2019年心脑血管疾病患者的二级预防用药服药比例较低，性别、文化程度、有无高血压史、有无血脂异常史、是否目前吸烟、体质量指数和诊断年限是该地区心脑血管疾病患者二级预防用药的主要影响因素。

心脑血管疾病  /  二级预防用药  /  影响因素  /  华东地区
Objective

To understand the use and its influencing factors of secondary prevention drugs among patients with cardiovascular and cerebrovascular diseases (CVDs) in East China from 2014 to 2019, thus providing a basis for the improving medication adherence of secondary prevention drugs among these patients.

Methods

Data were collected from 19 992 patients with CVDs who aged 35–75 years and used secondary prevention drugs in the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project (China PEACE MPP) from September 2014 to November 2019 across 57 counties/districts in seven provincial-level administrative regions (Shanghai, Jiangsu, Zhejiang, Anhui, Fujian, Jiangxi, and Shandong) in East China. Multivariate mixed models were employed with community-specific random intercepts to analyze the associations of individual characteristics with the reported use of secondary prevention drugs.

Results

Among the 19 992 patients with CVDs reported in East China from 2014 to 2019, 4 435 (22.18%) patients used antiplatelets or statins. Among them, 3 671 (18.36%) and 2 181 (10.91%) patients used antiplatelets and statins, respectively, and 1 417 cases (7.09%) used both types of drugs. The results of the multivariate mixed model analysis showed that the patients with CVDs who had educational background of junior high school or above, hypertension history, dyslipidemia history, overweight or obesity were more likely to report taking secondary prevention drugs. Female patients, current smokers, and those diagnosed with CVDs for more than 7 years were less likely to report taking secondary prevention drugs.

Conclusions

The use of secondary prevention drugs among the patients with CVDs was suboptimal in East China from 2014 to 2019. Gender, educational background, history of hypertension and dyslipidemia, current smoking status, body mass index, and time from diagnosis of CVDs are the main influencing factors for the use of secondary prevention drugs among the patients in East China.

cardiovascular and cerebrovascular disease  /  secondary prevention drug  /  influencing factor  /  East China
杨皓, 陈伯望, 路甲鹏, 杨阳. 2014—2019年中国华东地区心脑血管疾病患者二级预防用药情况及影响因素：基于一项高危筛查项目资料分析. 中国公共卫生, 2026 , 42 (2) : 194 -198 . DOI: 10.11847/zgggws1148182
Hao YANG, Bowang CHEN, Jiapeng LU, Yang YANG. Use and its influencing factors of secondary prevention drugs among patients with cardiovascular and cerebrovascular diseases in East China from 2014 to 2019: based on data analysis of China PEACE MPP[J]. Chinese Journal of Public Health, 2026 , 42 (2) : 194 -198 . DOI: 10.11847/zgggws1148182
正文
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目前，随着人口老龄化加剧、慢性病患者增加，中国心脑血管疾病患病率仍处于上升阶段，估计患病数已>3亿，其中冠心病和脑卒中患病数均超过千万，给人们的生活带来了沉重的负担[1–2]。一项针对中国居民的心脑血管疾病危险因素分析报告显示，我国华东地区标化后的心脑血管疾病高风险人群检出率为9.6%，在全国范围处于居中位置[3]，但上海、江苏、浙江、安徽、福建、江西和山东7个华东地区省（市）在社会经济发展、医疗资源分布等方面均存在差异[4]，且心脑血管疾病的防控水平、人群风险等不同，导致缺血性心脏病和缺血性脑卒中的疾病负担在各省（市）之间亦存在差异[5]。心脑血管疾病的二级预防是针对患有心脑血管疾病的人群采取药物治疗、生活方式干预等措施，从而降低心脑血管疾病的复发和死亡风险。国内外研究均表明，抗血小板药物和他汀类药物可显著降低冠心病和脑卒中患者的复发率和死亡率，但我国缺血性心脏病和缺血性脑卒中等心脑血管疾病患者的二级预防用药情况却不佳[6–10]。为了解2014—2019年中国华东地区心脑血管疾病患者二级预防用药情况及其影响因素，为提升心脑血管疾病患者服用二级预防药物的依从性提供参考依据，本研究收集2014年9月—2019年11月心血管病高危人群早期筛查与综合干预项目（简称“高危筛查项目”）中上海市、江苏省、浙江省、安徽省、福建省、江西省、山东省等华东地区7个省（直辖市）57个县/区19 992例35～75岁心脑血管疾病患者二级预防药物使用情况，并应用多变量混合效应模型以社区水平为随机截距分析患者个体水平的特征与二级预防药物使用的关联。结果报告如下。
1　资料与方法
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1.1　资料来源
收集2014年9月—2019年11月高危筛查项目中上海市、江苏省、浙江省、安徽省、福建省、江西省、山东省等华东地区7个省（直辖市）57个县/区19 992例35～75岁心脑血管疾病患者二级预防药物使用情况。高危筛查项目是财政部和原国家卫生和计划生育委员会于2014年立项资助的重大公共卫生服务项目[11]。该项目综合考虑地理环境、人口结构以及暴露风险和疾病模式等因素，并根据当地人口规模、人口稳定性和项目支持能力，在华东地区选取了57个项目点（上海市8个、江苏省8个、浙江省8个、安徽省8个、福建省8个、江西省8个、山东省9个，其中城市地区24个、农村地区33个）开展调查。本研究中，心脑血管疾病患者包括缺血性心脏病（心肌梗死和接受冠脉搭桥或冠脉介入治疗）和缺血性脑卒中患者，收集患者性别、年龄、文化程度、婚姻状况、职业、家庭年收入、居住地、有无高血压史、有无糖尿病史、有无血脂异常史、目前是否吸烟、目前是否饮酒、体质量指数、诊断年限和二级预防药物使用情况等因素进行分析。其中，有高血压史、糖尿病史和血脂异常史者为自报曾在正规医疗机构有明确诊断的患者；对于患者目前是否吸烟的判定，研究采用分级调查的方式，在调查中询问患者吸烟情况，如患者选择偶尔吸、大部分天数吸或每天都吸，则表示该患者目前吸烟[12]；由于目前没有研究表明任何的饮酒剂量会对心脑血管疾病存在潜在的保护作用，且无法确定对健康而言的饮酒安全剂量[13]，故研究采用分级调查的方式，通过询问过去1年里的饮酒频率来判定患者目前是否饮酒，如患者选择2～4次/月、2～3次/周或≥4次/周，则表示该患者目前饮酒；体质量指数=体重（kg）/[身高（m）]2，其中体质量指数<18.5 kg/m2为低体重，18.5～23.9 kg/m2为正常体重，24.0～27.9 kg/m2为超重，≥28.0 kg/m2为肥胖[14]；二级预防药物使用情况为患者自报过去2周内使用抗血小板药物或他汀类药物情况。本研究经中国医学科学院阜外医院中心伦理委员会审查批准（批号为：NO.2014–574）。
1.2　统计分析
应用SAS 9.4和R 3.4.1软件进行统计分析。计数资料采用n和%进行描述，不同特征患者二级预防药物使用率的比较采用χ2检验；应用多变量混合效应模型，以社区水平作为随机截距效应，分析患者个体水平的特征与二级预防药物使用的关联。多变量混合效应模型可以指定多种随机效应，在本研究中使用调查对象居住的社区为随机截距，在数据具有层次结构或重复测量的特点时，使得应用的模型能够更好地反映出数据的真实结构，因变量为心脑血管疾病患者自报服用抗血小板药物和/或他汀类药物情况，自变量为性别、年龄、文化程度、婚姻状况、职业、家庭年收入、居住地、有无高血压史、有无糖尿病史、有无血脂异常史、目前是否吸烟、目前是否饮酒、体质量指数和诊断年限。检验水准为双侧检验α=0.05。
2　结　果
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2.1　一般情况
华东地区19 992例心脑血管疾病患者中，男性10 097例（50.51%），女性9 895例（49.49%）；年龄35～44岁307例（1.53%），45～54岁2 141例（10.71%），55～64岁6 947例（34.75%），65～75岁10 597例（53.01%）；文化程度小学及以下11 765例（58.85%），初中及以上8 227例（41.15%）；婚姻状况非在婚1 629例（8.15%），在婚18 262例（91.35%），不详101例（0.50%）；职业为非农民9 545例（47.74%），农民10 250例（51.27%），不详197例（0.99%）；家庭年收入<1万元3 596例（17.99%），1～5万元10 165例（50.84%），>5万元4 794例（23.98%），不详1 437例（7.19%）；居住在城市9 572例（47.88%），农村10 420例（52.12%）；无高血压史8 044例（40.24%），有高血压史11 948例（59.76%）；无糖尿病史16 090例（80.48%），有糖尿病史3 902例（19.52%）；无血脂异常史18 171例（90.89%），有血脂异常史1 821例（9.11%）；目前不吸烟16 297例（81.52%），目前吸烟3 695例（18.48%）；目前不饮酒17 416例（87.11%），目前饮酒2 576例（12.89%）；低体重276例（1.38%），正常体重7 036例（35.19%），超重8 726例（43.65%），肥胖3 954例（19.78%）；诊断年限<2年3 362例（16.82%），2～7年10 271例（51.37%），>7年3 736例（18.69%），不详2 623例（13.12%）。
2.2　华东地区心脑血管疾病患者二级预防用药使用情况（表1）
华东地区19 992例心脑血管疾病患者中，自报服用抗血小板药物和/或他汀类药物者4 435例（22.18%），仅使用抗血小板药物者3 671例（18.36%），仅使用他汀类药物者2 181例（10.91%），2种药物均使用者1 417例（7.09%）。华东地区不同特征心脑血管疾病患者比较，不同性别、年龄、文化程度、婚姻状况、职业、家庭年收入、居住地、有无高血压史、有无糖尿病史、有无血脂异常史、目前是否饮酒、体质量指数和诊断年限心脑血管疾病患者抗血小板药物和/或他汀类药物使用比例不同；不同性别、年龄、文化程度、婚姻状况、职业、居住地、有无高血压史、有无糖尿病史、有无血脂异常史、目前是否吸烟、目前是否饮酒、体质量指数和诊断年限抗血小板药物使用比例不同；不同性别、文化程度、婚姻状况、职业、家庭年收入、居住地、有无高血压史、有无糖尿病史、有无血脂异常史、体质量指数和诊断年限他汀类药物使用比例不同；不同性别、文化程度、婚姻状况、职业、家庭年收入、居住地、有无高血压史、有无糖尿病史、有无血脂异常史、体质量指数和诊断年限2种药物均使用的比例不同，差异均有统计学意义（均P<0.05）。
2.3　中国华东地区心脑血管疾病患者二级预防用药情况影响因素分析
以中国华东地区心脑血管疾病患者是否自报服用抗血小板药物和/或他汀类药物为因变量（0=否，1=是），以性别、年龄、文化程度、婚姻状况、职业、家庭年收入、居住地、有无高血压史、有无糖尿病史、有无血脂异常史、目前是否吸烟、目前是否饮酒、体质量指数和诊断年限共14个因素为自变量进行多变量混合效应模型分析。结果显示，文化程度初中及以上（OR=1.53，95%CI=1.39～1.70）、高血压（OR=1.28，95%CI=1.17～1.40）、血脂异常（OR=2.44，95%CI=2.13～2.79）、超重（OR=1.22，95%CI=1.11～1.34）和肥胖（OR=1.24，95%CI=1.11～1.40）的心脑血管疾病患者服用二级预防用药的可能性更高；女性（OR=0.68，95%CI=0.62～0.75）、目前吸烟（OR=0.83，95%CI=0.74～0.93）、诊断年限>7年（OR=0.74，95%CI=0.65～0.85）的心脑血管疾病患者服用二级预防药物的可能性更低。
3　讨　论
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本研究结果显示，2014—2019年中国华东地区心脑血管疾病患者二级预防药物服药比例为22.2%，低于全国平均比例的34.2%[6]。提示2014—2019年华东地区心脑血管疾病患者的二级预防用药比例较低。
多变量混合效应模型分析结果显示，文化程度初中及以上（OR=1.53，95%CI=1.39～1.70）、高血压（OR=1.28，95%CI=1.17～1.40）、血脂异常（OR=2.44，95%CI=2.13～2.79）、超重（OR=1.22，95%CI=1.11～1.34）和肥胖（OR=1.24，95%CI=1.11～1.40）的心脑血管疾病患者服用二级预防药物的可能性更高；女性（OR=0.68，95%CI=0.62～0.75）、目前吸烟（OR=0.83，95%CI=0.74～0.93）、诊断年限>7年（OR=0.74，95%CI=0.65～0.85）的心脑血管疾病患者服用二级预防药物的可能性更低。既往研究表明，患者接受的教育水平越高，理解自身疾病和与医生沟通的能力越强，对心脑血管疾病用药能够有更明确的认知[15]，从而佐证了该患病人群可能更容易服用二级预防药物。而合并高血压、血脂异常以及超重、肥胖的人群，通常可以更加深入地了解心脑血管疾病及其相关危险因素的危害。因此，更倾向于规律接受二级预防药物的治疗，同时使用抗血小板药物和他汀类药物还可以有效改善心脑血管疾病的相关症状，增强患者的服药信心，从而产生药物协同效应的正向反馈，提升服药的依从性[16]。但本研究未发现有糖尿病史与无糖尿病史心脑血管疾病患者的二级预防用药情况有显著差异，这可能是因为本研究中心脑血管疾病的二级预防用药分析仅包括抗血小板药物和他汀类药物，且在多因素混合模型中纳入常规需要服用他汀类药物的有血脂异常史的患者进行分析所导致的。既往研究表明，女性社会属性更偏向于家庭，对于家庭照料意识要强于男性，这可能会导致其对于自身健康管理的疏忽[17]，而吸烟则会影响患者的药物依从性[18]，与本研究中女性和目前吸烟的心脑血管疾病患者服用二级预防药物可能性更低的结果一致。此外，有研究表明，随着医保范围扩大和医疗水平的提升，虽然我国心脑血管疾病二级预防药物的处方率近年来逐渐提高[19–20]，但患者对于药物治疗的长期依从性仍较低，患者的服药依从性随时间的推移逐渐降低[21]，与本研究结果一致。这可能是由于随着患病时间的延长，患者对于用药的重视程度逐渐下降，而对于药物副作用的关注度逐渐增加，从而影响了服药的依从性。
我国华东地区经济发达的一线城市占比较其他地区高，在中国百强城市中，华东地区7个省（直辖市）包含43个[22]，占比接近一半。同时，在心脑血管疾病防控领域中的卫生政策与服务能力评分方面，上海市、浙江省、江苏省和福建省占据了前5名中的4席[23]。虽然华东地区大部分省（市）经济比较发达，但卫生资源配置的公平性相较于中西部地区而言略为逊色，医疗资源也相对紧张[24]，这可能是导致该地区心脑血管疾病患者用药依从性与其居住地（城市地区或农村地区）、职业（农民或非农民）和家庭年收入水平等无统计学相关性的原因。
综上所述，2014—2019年中国华东地区心脑血管疾病患者的二级预防用药情况服药比例较低，尤其应重点关注女性和患病时间较长的心脑血管疾病患者的二级预防用药情况。这些患者在日常生活中对自身患病情况、疾病发展进程及相关用药的关注度较低，并且随着患病时间的延长，自身心理状态也会产生变化，出现倦怠或厌服药物的情况。因此，在随访管理过程中要通过多种渠道和方式进一步加强健康宣教和用药提醒，同时劝阻患病人群吸烟，养成良好的生活方式和健康的生活习惯。对于教育程度较低的患者，则应该关注其对疾病和用药的认知，在随访管理过程中应加强临床干预和专业指导，以促进该人群从根本上认识和理解心脑血管疾病的复发风险以及对健康的影响。此外，本研究尚存在一定局限性：第一，心脑血管疾病患者的病史调查由医务人员完成，未经过基于病历资料的复核，但本研究在对于缺血性心脏病史的定义中仅纳入自报信息相对准确和诊断标准相对统一的心肌梗死、冠脉搭桥或冠脉介入治疗，从而确保了研究对象符合二级预防人群的入选条件；第二，心脑血管疾病患者的二级预防用药情况也为患者自报，这在一定程度上可能存在信息不准确的情况；第三，研究未采用随机概率抽样方法进行抽样，但项目点的抽样综合考虑了城乡人口分布、地域和经济等因素，并保证了较大样本量；第四，研究未收集心脑血管疾病患者对于疾病治疗和药物可及性等方面的主观信息，故无法直接阐明抗血小板药物和他汀类药物服用比例较低的原因。因此，关于病史和诊断等自报的情况，建议以后将队列人群与医疗机构电子病历记录或医政、医保和疾控的专项（监测）数据相关联，从而获得更加完整可靠的信息。

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2026年第42卷第2期
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doi: 10.11847/zgggws1148182
  • 接收时间：2025-06-10
  • 首发时间：2026-10-23
  • 出版时间：2026-02-10
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  • 收稿日期：2025-06-10
  • 修回日期：2025-09-09
  • 录用日期：2025-10-29
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    国家心血管病中心 中国医学科学院阜外医院，北京 102308

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species		 占总种数比例
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total species (%)		 属
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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