Mantel-Teeuwisse A K, Verschuren W M M, Klungel O H, Kromhout D, Lindemans A D, Avorn J, Porsius A J, de Boer A
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands.
Br J Clin Pharmacol. 2003 Apr;55(4):389-97. doi: 10.1046/j.1365-2125.2003.01769.x.
To assess the level of undertreatment of hypercholesterolaemia in the general population, taking intra-person variability in serum cholesterol concentrations into account, and to identify determinants of undertreatment of hypercholesterolaemia.
In this cross-sectional study, data from two population-based surveys on cardiovascular disease risk factors conducted between 1987 and 1997 in the Netherlands were used. For all 64 757 respondents aged 20-59 years, treatment eligibility for lipid-lowering drug use was established according to the Dutch Cholesterol Consensus. Multivariate logistic models were used to identify determinants of undertreatment.
During the study period, 56.8% of the study population had undesirable cholesterol concentrations (serum total cholesterol> 5 mmol l(-1)) and 5.5% of those were eligible for pharmacological treatment based on their absolute risk of coronary heart disease. Of those eligible for pharmacological treatment, 16.3% were treated, and 19.6% of those treated had their serum total cholesterol concentration controlled. Only 3.2% of those eligible for pharmacological treatment were both treated and controlled. We identified several determinants for undertreatment, e.g. male gender and younger age for primary prevention and female gender and older age for secondary prevention. Treatment has improved slightly in more recent years.
Over 95% of the population eligible for the pharmacological treatment of hypercholesterolaemia was either untreated or was uncontrolled. To decrease undertreatment, identification of high-risk patients should be increased. Those who are treated with lipid-lowering medication could further benefit from more aggressive treatment, especially with statins.
评估普通人群中高胆固醇血症治疗不足的水平，同时考虑血清胆固醇浓度的个体内变异性，并确定高胆固醇血症治疗不足的决定因素。
在这项横断面研究中，使用了1987年至1997年在荷兰进行的两项基于人群的心血管疾病危险因素调查的数据。对于所有64757名年龄在20至59岁之间的受访者，根据荷兰胆固醇共识确定使用降脂药物的治疗资格。采用多变量逻辑模型确定治疗不足的决定因素。
在研究期间，56.8%的研究人群胆固醇浓度不理想（血清总胆固醇>5 mmol l⁻¹），其中5.5%的人基于其冠心病绝对风险有资格接受药物治疗。在有资格接受药物治疗的人群中，16.3%接受了治疗，其中19.6%的人血清总胆固醇浓度得到控制。在有资格接受药物治疗的人群中，只有3.2%的人既接受了治疗又得到了控制。我们确定了几个治疗不足的决定因素，例如，一级预防中的男性和较年轻年龄以及二级预防中的女性和较年长年龄。近年来治疗情况略有改善。
超过95%有资格接受高胆固醇血症药物治疗的人群要么未接受治疗，要么未得到控制。为了减少治疗不足，应加强对高危患者的识别。接受降脂药物治疗的患者可以从更积极的治疗中进一步获益，尤其是使用他汀类药物。
