Cardiovascular Center Cardiology, Rämistrasse 100, 8091 Zürich, Switzerland.
Swiss Med Wkly. 2011 May 13;141:w13200. doi: 10.4414/smw.2011.13200. eCollection 2011.
Statin therapy reduces cardiovascular morbidity and mortality. However, a substantial residual cardiovascular risk can be observed in patients receiving this therapy due to persisting lipid abnormalities as well as to the lack of a systematic global risk-reduction strategy. The objective of the study was to assess the prevalence of dyslipidemia in a cohort of patients living in Switzerland and receiving statin therapy.
This cross-sectional study was conducted by 61 primary care physicians, cardiologists, endocrinologists and internists in Switzerland. Patients were consecutive outpatients≥45 years-old, on statin therapy for at least 3 months with available lipid values. A clinical examination and a recording of the latest lipid values on statin therapy were performed in all patients.
A total of 473 patients (age 66.3±9.41 years; 61.9% male) were included in the final analysis. Under statin therapy, 40% of the analysed patients had a normal lipid profile, 32.6% presented increased low-density lipoprotein cholesterol (LDL-C) (3.35±0.88 mmol/L), 28.8% low high-density lipoprotein-cholesterol (HDL-C) (0.95±0.18 mmol/L) and 31.1% elevated triglycerides (2.69±1.04 mmol/L). It is of note that the included population was characterised by a high prevalence of cardiovascular risk factors (86.5% patients had 10-year cardiovascular risk>20%). Nevertheless, the lipid lowering therapy was modified in only 15.4% of the patients.
Persistent dyslipidemia is a reality in statin-treated patients and may contribute to their residual cardiovascular risk. Therefore, comprehensive lipid management should be preferred to aggressive LDL-C lowering alone. Moreover, strategies to assess and modify the global cardiovascular risk of patients should be taken into account as an important component of primary and secondary prevention.
他汀类药物治疗可降低心血管发病率和死亡率。然而，由于持续存在脂质异常以及缺乏系统性的整体降低风险策略，接受这种治疗的患者仍存在相当大的心血管残余风险。本研究的目的是评估在瑞士接受他汀类药物治疗的患者队列中血脂异常的流行情况。
本横断面研究由瑞士的 61 名初级保健医生、心脏病专家、内分泌学家和内科医生进行。患者为连续门诊≥45 岁，接受他汀类药物治疗至少 3 个月且有可用脂质值的患者。所有患者均进行临床检查和记录最近他汀类药物治疗时的血脂值。
共有 473 名患者（年龄 66.3±9.41 岁；61.9%为男性）纳入最终分析。在他汀类药物治疗下，40%的分析患者血脂谱正常，32.6%的患者存在低密度脂蛋白胆固醇（LDL-C）升高（3.35±0.88mmol/L），28.8%的患者高密度脂蛋白胆固醇（HDL-C）降低（0.95±0.18mmol/L），31.1%的患者甘油三酯升高（2.69±1.04mmol/L）。值得注意的是，纳入的人群具有高心血管风险因素的患病率（86.5%的患者 10 年心血管风险>20%）。然而，仅有 15.4%的患者改变了降脂治疗。
他汀类药物治疗患者中持续存在血脂异常是一个现实，可能导致其残余心血管风险。因此，应优先考虑全面的血脂管理，而不仅仅是强化 LDL-C 降低。此外，评估和改变患者整体心血管风险的策略应作为一级和二级预防的重要组成部分。
