Lee Vivian W Y, Ho Ivan C H, Chan Windy S Y, Tam Kai Yin, Lee Kenneth K C
School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Hospital Authority, Shatin, New Territories, Hong Kong, China.
Am J Cardiovasc Drugs. 2008;8(3):199-205. doi: 10.2165/00129784-200808030-00006.
In Hong Kong, about 10% of adults 25-74 years of age have diabetes mellitus. The management of dyslipidemia with lipid-lowering agents (LLAs), including HMG-CoA reductase inhibitors (statins) for the primary prevention of cardiovascular complications, has been found to be beneficial. This study examined statin utilization patterns for the primary prevention of cardiovascular events in patients with diabetes mellitus in two public hospitals in Kong Kong; clinical outcomes in patients who received statins for primary prevention were compared with those in patients not treated with any LLAs.
This was a retrospective study in patients who were diagnosed with diabetes mellitus. Only patients with no prior history of coronary artery disease were included in the study. Utilization patterns of LLAs and the incidences of cardiovascular complications were recorded from 1 January 2002 to 31 December 2003.
A total of 222 patient records were reviewed. Only 75/222 (33.8%) of patients with diabetes mellitus received one or more LLAs for the primary prevention of cardiovascular events. Among these patients, only 21% of patients attained target lipid goals. Nearly half of the patients who were not treated with LLAs (n=147) had dyslipidemia problems. The overall incidence of cardiovascular complications in patients treated and not treated with LLAs was 12.2%. Absence of routine screening for cardiovascular risk and sub-optimal utilization and inadequate dosage titration of LLAs were identified as contributory factors towards cardiovascular events in this patient group.
The current study failed to prove the benefits of LLAs in reducing the risk of first cardiovascular events in diabetic patients. This may have been due to the use of low doses of LLAs and a lack of laboratory monitoring of cholesterol levels. Development and implementation of guidelines may help promote the use of LLAs in primary prevention of cardiovascular complications.
在香港，25 - 74岁的成年人中约10%患有糖尿病。使用降脂药物（LLA）来管理血脂异常，包括使用HMG - CoA还原酶抑制剂（他汀类药物）进行心血管并发症的一级预防，已被证明是有益的。本研究调查了香港两家公立医院中糖尿病患者使用他汀类药物进行心血管事件一级预防的模式；将接受他汀类药物一级预防的患者的临床结局与未接受任何LLA治疗的患者进行了比较。
这是一项针对已确诊糖尿病患者的回顾性研究。研究仅纳入无冠状动脉疾病既往史的患者。记录了2002年1月1日至2003年12月31日期间LLA的使用模式和心血管并发症的发生率。
共审查了222份患者记录。仅75/222（33.8%）的糖尿病患者接受了一种或多种LLA进行心血管事件的一级预防。在这些患者中，只有21%的患者达到了血脂目标。近一半未接受LLA治疗的患者（n = 147）存在血脂异常问题。接受和未接受LLA治疗的患者心血管并发症的总体发生率为12.2%。未进行心血管风险的常规筛查、LLA使用不当及剂量滴定不足被确定为该患者群体发生心血管事件的促成因素。
当前研究未能证明LLA在降低糖尿病患者首次发生心血管事件风险方面的益处。这可能是由于LLA使用剂量低且缺乏胆固醇水平的实验室监测。制定和实施指南可能有助于促进LLA在心血管并发症一级预防中的使用。
