Hoskins Michael H, Jacobson Terry A
Emory University, Atlanta, GA, USA.
J Natl Med Assoc. 2006 Jan;98(1):58-62.
Multiple clinical trials have established the benefits of controlling hyperlipidemia in patients with coronary heart disease (CHD). Nonetheless, many patients still remain untreated or not at goal low-density lipoprotein (LDL). There is limited data concerning the control of this risk factor in CHD patients in the primary care outpatient setting.
We evaluated the treatment of hyperlipidemia in the main primary care clinics of an academic, urban hospital. We identified 147 patients in a one-month period with a diagnosis of CHD and assessed the frequency of lipid-lowering therapy as well as the number of patients with LDL values that were at goal according to the National Cholesterol Education Program (NCEP) guidelines.
A large proportion of patients were minorities and of low income, with 91.8% being African-American and 54.4% female. Although the frequency of statin therapy was relatively high (74.8%), only 55 patients (45.8%) were at goal LDL: < 100 mg/dl. The mean dose of statin prescribed (primarily simvastatin) was 33.3 +/- 17.1 mg. Only seven patients (6.5%) were on the maximum statin dose of 80 mg.
These data show that while the frequency of lipid-lowering therapy in CHD patients in the primary care outpatient setting is relatively high, there remains a treatment gap. Specific areas for improvement are the initiation of higher doses of statins and more aggressive statin titration. The primary care outpatient setting may represent an ideal opportunity to improve control of hyperlipidemia in CHD patients.
多项临床试验已证实控制冠心病（CHD）患者的高脂血症具有益处。尽管如此，许多患者仍未接受治疗或低密度脂蛋白（LDL）未达目标值。在基层医疗门诊环境中，关于控制CHD患者这一危险因素的数据有限。
我们评估了一家学术性城市医院主要基层医疗诊所中高脂血症的治疗情况。我们在一个月内确定了147例诊断为CHD的患者，并根据美国国家胆固醇教育计划（NCEP）指南评估了降脂治疗的频率以及LDL值达标的患者数量。
大部分患者为少数族裔且收入较低，其中91.8%为非裔美国人，54.4%为女性。尽管他汀类药物治疗的频率相对较高（74.8%），但只有55例患者（45.8%）的LDL达标：<100mg/dl。所开具他汀类药物的平均剂量（主要是辛伐他汀）为33.3±17.1mg。只有7例患者（6.5%）使用了80mg的最大他汀类药物剂量。
这些数据表明，虽然基层医疗门诊环境中CHD患者的降脂治疗频率相对较高，但仍存在治疗差距。需要改进的具体方面是开始使用更高剂量的他汀类药物以及更积极地调整他汀类药物剂量。基层医疗门诊环境可能是改善CHD患者高脂血症控制的理想契机。
