Global Outcomes Research, Merck & Co., Inc., One Merck Drive, P.O. Box 100, WS 2E-65, Whitehouse Station, NJ 08889, USA.
Adv Ther. 2012 May;29(5):427-41. doi: 10.1007/s12325-012-0017-9. Epub 2012 May 3.
Although low-density lipoprotein cholesterol (LDL-C) is the primary lipid target for coronary heart disease (CHD) risk reduction, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) have also emerged as CHD risk factors. The objective of this study was to evaluate attainment of lipid goals and normal levels following lipid-modifying therapy (LMT) and its predictors in a representative sample of Chinese patients from Hong Kong.
Using longitudinal data collected from patient medical records, the study identified 706 patients who initiated LMT from January 2004 to December 2006 and had full lipid panels 12 months before and after therapy. LDL-C goals and normal levels of HDL-C and TG were defined according to the National Cholesterol Education Program Adult Treatment Panel 3 guidelines. Patients with previous CHD, diabetes, and 10-year CHD risk > 20% were classified as high risk. Multiple logistic regressions evaluated predictors of normal lipid-level attainment.
Among 706 patients (mean age 64.6 years, 58.6% male), 71.7% had elevated LDL-C, 32.4% had low HDL-C, and 24.9% had elevated TG before LMT. Despite therapy (91.2% statins only), 22.7% had elevated LDL-C, 31.9% had low HDL-C, 12.3% had elevated TG, and 13.9% had multiple abnormal lipid levels. The strongest predictors of attaining ≥ 2 normal lipid levels included male gender (odds ratio [OR]: 2.11 [1.12 to 4.01]), diabetes (OR: 0.43 [0.23 to 0.78]), obesity (OR: 0.91 [0.86 to 0.97]), and CHD risk > 20% (OR: 0.33 [0.15 to 0.71]).
Current approaches to lipid management in Hong Kong, primarily using statins, considerably improve attainment of LDL-C goal. However, a large proportion of patients do not achieve normal HDL-C levels and control of multiple lipid parameters remains poor. Patients could benefit from a more comprehensive approach to lipid management that treats all three lipid risk factors, as suggested in clinical guidelines.
虽然低密度脂蛋白胆固醇（LDL-C）是降低冠心病（CHD）风险的主要脂质目标，但高密度脂蛋白胆固醇（HDL-C）和甘油三酯（TG）也已成为 CHD 风险因素。本研究的目的是评估香港代表性的中国患者人群在接受降脂治疗（LMT）前后实现脂质目标和正常水平的情况及其预测因素。
使用从患者病历中收集的纵向数据，本研究确定了 706 名于 2004 年 1 月至 2006 年 12 月期间开始接受 LMT 且在治疗前 12 个月有完整脂质谱的患者。根据国家胆固醇教育计划成人治疗专家组 3 指南，定义 LDL-C 目标和 HDL-C 和 TG 的正常水平。患有既往 CHD、糖尿病和 10 年 CHD 风险> 20%的患者被归类为高危。多因素逻辑回归评估了正常血脂水平达标情况的预测因素。
在 706 名患者（平均年龄 64.6 岁，58.6%为男性）中，71.7%的患者 LDL-C 升高，32.4%的患者 HDL-C 降低，24.9%的患者 TG 升高。尽管接受了治疗（91.2%为他汀类药物），但仍有 22.7%的患者 LDL-C 升高，31.9%的患者 HDL-C 降低，12.3%的患者 TG 升高，13.9%的患者存在多种异常血脂水平。达到≥2 个正常脂质水平的最强预测因素包括男性（比值比[OR]：2.11[1.12 至 4.01]）、糖尿病（OR：0.43[0.23 至 0.78]）、肥胖（OR：0.91[0.86 至 0.97]）和 CHD 风险>20%（OR：0.33[0.15 至 0.71]）。
香港目前主要采用他汀类药物治疗血脂管理的方法，极大地改善了 LDL-C 目标的达标情况。然而，很大一部分患者未能达到正常的 HDL-C 水平，对多种脂质参数的控制仍然较差。患者可能会受益于更全面的血脂管理方法，根据临床指南，该方法可治疗所有三种脂质危险因素。
