Van Ganse Eric, Laforest Laurent, Alemao Evo, Davies Glenn, Gutkin Stephen, Yin Don
Pharmacoepidemiology EA 3091 Centre Hospitalier Lyon-Sud, Pierre Bénite, France.
Curr Med Res Opin. 2005 Sep;21(9):1389-99. doi: 10.1185/030079905X59139.
Few studies have been conducted in actual clinical practice settings to evaluate the ways in which dyslipidemia is managed using lipid-modifying therapies.
To determine lipid-modifying therapy practices and their effects on low-density lipoprotein cholesterol (LDL-C) and/or total cholesterol (TC) goal attainment in Europeans based on prevailing guidelines at the time of therapy in each country.
Retrospective cohort analysis involving 58,223 patients initiated on lipid-modifying therapies in 10 European countries, with a median patient follow-up on lipid-modifying therapy of 15.3 months. Data on prescriptions of lipid-modifying therapies, laboratory data including LDL-C and TC, achievement of cholesterol goals for LDL-C and/or TC, and hospitalizations were obtained from healthcare administrative databases and/or patient chart reviews.
Across Europe, statin monotherapy was the initial lipid-modifying treatment in 51,786 (89.3%) of 58,009 patients with available data. In addition, 38,853 (89.5%) of 43,410 patients with available follow-up statin potency data were initiated on statin regimens of medium or lower equipotency. Low-equipotency regimens include atorvastatin 5 mg, simvastatin 10 mg, and pravastatin 20 mg, whereas medium-equipotency regimens include atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg. Regimens were adjusted to higher equipotency via either up-titration or switches to combination regimens in 16.2% of patients. On average, 40.5% of patients across Europe who were not initially at guideline recommended cholesterol goals (either LDL-C or TC) and had follow-up data attained recommended cholesterol levels, including <30% of patients in Spain, Italy, or Hungary. In many countries, the likelihood of goal attainment was inversely associated with baseline cardiovascular risk and/or LDL-C levels.
Lipid management strategies in Europe during the study period were dominated by statin monotherapy. Even after prolonged follow-up on lipid-modifying therapy, approximately 60% of Europeans studied did not achieve guideline recommended cholesterol goals. Future emphasis must be placed on subsequent lipid panel monitoring, as well as the use of more efficacious, well-tolerated lipid-modifying therapies such as dual cholesterol inhibitors to enable more European patients to attain their recommended cholesterol goals.
在实际临床实践环境中，很少有研究评估使用调脂疗法管理血脂异常的方式。
根据每个国家治疗时的现行指南，确定欧洲人调脂治疗的实践及其对低密度脂蛋白胆固醇（LDL-C）和/或总胆固醇（TC）目标达成情况的影响。
对10个欧洲国家开始接受调脂治疗的58223例患者进行回顾性队列分析，患者接受调脂治疗的中位随访时间为15.3个月。调脂治疗处方数据、包括LDL-C和TC在内的实验室数据、LDL-C和/或TC胆固醇目标的达成情况以及住院数据，均从医疗管理数据库和/或患者病历回顾中获取。
在欧洲，在有可用数据的58009例患者中，51786例（89.3%）最初接受他汀类药物单药治疗。此外，在有可用随访他汀类药物效力数据的43410例患者中，38853例（89.5%）开始使用中等或低等效性的他汀类药物治疗方案。低等效性治疗方案包括阿托伐他汀5mg、辛伐他汀10mg和普伐他汀20mg，而中等等效性治疗方案包括阿托伐他汀10mg、辛伐他汀20mg和普伐他汀40mg。16.2%的患者通过滴定或改用联合治疗方案将治疗方案调整为更高等效性。在欧洲，平均而言，最初未达到指南推荐胆固醇目标（LDL-C或TC）且有随访数据的患者中，40.5%达到了推荐的胆固醇水平，包括西班牙、意大利或匈牙利不到30%的患者。在许多国家，目标达成的可能性与基线心血管风险和/或LDL-C水平呈负相关。
研究期间欧洲的血脂管理策略以他汀类药物单药治疗为主。即使在对调脂治疗进行长期随访后，约60%接受研究的欧洲人仍未达到指南推荐的胆固醇目标。未来必须更加重视后续血脂指标监测，以及使用更有效、耐受性良好的调脂疗法，如双胆固醇抑制剂，以使更多欧洲患者达到推荐的胆固醇目标。
