Gaspardone A, Proietti I, Altamura L, Tomai F, Versaci F, Crea F, Chiariello L, Gioffrè P A
Division of Cardiac Surgery, Tor Vergata University of Rome, Italy.
Ital Heart J. 2001 Nov;2(11):848-53.
In the last decade, large-scale clinical trials have consistently shown that therapy with statins is of great benefit to patients with and at risk of developing coronary artery disease. We assessed, in a sample of patients with coronary artery disease in whom coronary angiography was indicated and hospitalized in the last 10 years, the use of statins at admission.
One hundred patients with stable coronary artery disease were randomly selected per year from 1991 to 2000. The final study population consisted of 1000 patients. The prescription of statins for > or = 6 months before hospital admission was determined from a hospital-wide clinical database.
From 1995, the prevalence of patients treated with statins at hospital admission progressively increased. In 1991, only 2% of patients were treated with statins before hospital admission while in the year 2000, 38% of patients were receiving this treatment. The mean prevalence of patients treated with statins before and after 1995 was 3 vs 22% (p < 0.0001) respectively. The distribution of the demographic and clinical parameters and the prevalence of conventional cardiovascular risk factors were similar in patients treated or not treated with statins.
After 1994, in coincidence with the publication of the results of clinical trials showing the benefit of statins in patients with coronary artery disease, the use of these drugs increased significantly. This finding suggests that the widespread diffusion of the results of the major clinical trials and of guidelines drawn up by medical associations have had a significant impact on statin prescription in patients with coronary artery disease. Nevertheless our data also indicate that, despite overwhelming evidence on the benefits of statin therapy, in current clinical practice cardiologists are not optimally utilizing lipid management and that statins are frequently prescribed without an appropriate analysis of risk factors.
在过去十年中，大规模临床试验一直表明，他汀类药物治疗对患有冠状动脉疾病及有患冠状动脉疾病风险的患者大有裨益。我们在过去10年中因需进行冠状动脉造影而住院的冠状动脉疾病患者样本中，评估了入院时他汀类药物的使用情况。
从1991年至2000年，每年随机选取100例稳定型冠状动脉疾病患者。最终研究人群包括1000例患者。通过全院临床数据库确定入院前服用他汀类药物≥6个月的处方情况。
从1995年起，入院时接受他汀类药物治疗的患者比例逐渐增加。1991年，入院前仅有2%的患者接受他汀类药物治疗，而在2000年，这一比例为38%。1995年前后接受他汀类药物治疗患者的平均比例分别为3%和22%（p<0.0001）。接受或未接受他汀类药物治疗的患者在人口统计学和临床参数分布以及传统心血管危险因素患病率方面相似。
1994年后，与显示他汀类药物对冠状动脉疾病患者有益的临床试验结果发表的时间一致，这些药物的使用显著增加。这一发现表明，主要临床试验结果和医学协会制定的指南的广泛传播对冠状动脉疾病患者的他汀类药物处方产生了重大影响。然而，我们的数据也表明，尽管有压倒性的证据证明他汀类药物治疗有益，但在当前临床实践中，心脏病专家并未最佳地利用血脂管理，而且他汀类药物的处方往往没有对危险因素进行适当分析。
