Levine Adam P, Mikhailidis Dimitri P, Moross Tessa, Benson Karen, Gor Mayur
The Crouch Hall Road Surgery, Hornsey, United Kingdom.
Angiology. 2008 Feb-Mar;59(1):36-46. doi: 10.1177/0003319707309538.
We assessed lipid goal achievement in patients at high risk for vascular events from a general practice (London, United Kingdom). Patients were identified as those with a prescription for hypolipidaemic medication, a significant (>20%) Framingham risk, and from the myocardial infarction register. Two hundred forty-five patients were currently taking a statin (average dose, 23.1 mg/day). Cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, and triglycerides changed significantly following statin treatment. Of 285 patients who had taken statins at some time point, 11 (3.9%) were intolerant, 5 of which subsequently tolerated another statin. Approximately 10.1% of patients discontinued statin treatment for unclear reasons. Only 64 patients (29.1% of 220) reached the Joint British Societies' Guidelines on Prevention of Cardiovascular Disease target of a total cholesterol of <4.0 mmol/L; 50 patients (38.8% of 129) reached the low-density lipoprotein-cholesterol target of <2.0 mmol/L. This value of low-density lipoprotein-cholesterol is similar to that recommended by the American Heart Association/American College of Cardiology. With regard to the General Medical Services guidelines target for total cholesterol, 162 (73.6% of 220) patients reached <or=5.0 mmol/L. The group that best achieved target cholesterol (Joint British Societies' Guidelines and General Medical Services) were those with comorbidities. In conclusion, while reaching General Medical Services targets was satisfactory, the percentage of patients reaching Joint British Societies' Guidelines targets was not. This discrepancy may reflect the presence of multiple guidelines. The current stricter lipid targets are difficult to achieve; possible methods that may be used to improve lipids further could involve using combination therapy, statin dose titration, and better education.
我们评估了来自英国伦敦一家普通诊所的血管事件高危患者的血脂目标达成情况。患者被确定为那些有降血脂药物处方、具有显著（>20%）的弗明汉风险且来自心肌梗死登记册的人。245名患者目前正在服用他汀类药物（平均剂量，23.1毫克/天）。他汀类药物治疗后，胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和甘油三酯有显著变化。在285名曾在某个时间点服用过他汀类药物的患者中，11名（3.9%）不耐受，其中5名随后耐受了另一种他汀类药物。约10.1%的患者因不明原因停用他汀类药物治疗。只有64名患者（220名中的29.1%）达到了英国联合学会心血管疾病预防指南中总胆固醇<4. mmol/L的目标；50名患者（129名中的38.8%）达到了低密度脂蛋白胆固醇<2.0 mmol/L的目标。这个低密度脂蛋白胆固醇值与美国心脏协会/美国心脏病学会推荐的值相似。关于全科医疗服务指南中总胆固醇的目标，162名（220名中的73.6%）患者达到了≤5.0 mmol/L。最能达到胆固醇目标（英国联合学会指南和全科医疗服务）的是那些患有合并症的患者。总之，虽然达到全科医疗服务目标令人满意，但达到英国联合学会指南目标的患者百分比并不令人满意。这种差异可能反映了多种指南的存在。目前更严格的血脂目标难以实现；可用于进一步改善血脂的可能方法可能包括联合治疗、他汀类药物剂量滴定和更好的教育。
