Facharzt für Innere Medizin und Kardiologie, MVZ am Küchwald GmbH, Chemnitz, Germany.
Curr Med Res Opin. 2013 Jan;29(1):33-40. doi: 10.1185/03007995.2012.750602. Epub 2012 Nov 30.
To establish determinants of lipid goal attainment in primary care patients, with particular focus on participation in a disease management programme (DMP) on diabetes mellitus (DM) and/or coronary heart disease (CHD), with real-world practical relevance.
The present analysis was based on an observational study in 2359 patients with dyslipidaemia or hypercholesterolaemia that were treated with nicotinic acid 1000 mg/laropiprant 20 mg (Tredaptive) one or two tablets daily. Subgroups were formed by DMP participation (DMP vs. no DMP). A stepwise logistic regression model with backward selection of variables was applied to investigate factors influencing the probability of reaching lipid goals. Follow-up was 23 ± 7 weeks.
Low density lipoprotein cholesterol (LDL-C) <100 mg/dl was achieved by 30.8% in DMP versus 26.8% (no DMP), high density lipoprotein (HDL-C) >40/50 mg/dl in 61.3% versus 66.1%, and triglycerides (TG) <150 mg/dl in 28.9% versus 31.7%. On multivariate analysis, age, sex, concomitant high-risk cardiovascular disease, or participation in a DMP appeared to have inconsistent effects on reaching LDL-C, HDL-C and TG goals. Likelihood to reach the LDL-C goal tended to be higher in males, in patients outside DMP, and in patients with DM or CHD, and those treated with 1 tablet (versus 2 tablets) extended release nicotinic acid 1000 mg/laropiprant 20 mg. The likelihood of reaching the HDL-C goal was higher in males and in patients without DM or DM+CHD (no effect of DMP). The likelihood of reaching the TG goals was higher in females, in patients outside DMP, and in patients with DM and/or CHD. Limitations include potential bias due to study design, physician and patient selection, and missing values at follow-up.
DMP participation was not associated with overall improved lipid goal attainment. Physicians cannot predict the magnitude of effects of newly initiated lipid modifying therapy based on baseline characteristics of their patients.
确定初级保健患者实现血脂目标的决定因素，特别关注参与糖尿病（DM）和/或冠心病（CHD）疾病管理计划（DMP）的情况，具有实际意义。
本分析基于一项对 2359 例血脂异常或高胆固醇血症患者的观察性研究，这些患者每天服用烟酸 1000mg/laropiprant 20mg（Tredaptive）一片或两片。根据是否参与 DMP 形成亚组（DMP 与非 DMP）。应用逐步逻辑回归模型进行变量的向后选择，以研究影响达到血脂目标的概率的因素。随访时间为 23±7 周。
在 DMP 组中，低密度脂蛋白胆固醇（LDL-C）<100mg/dl 的比例为 30.8%，而非 DMP 组为 26.8%；高密度脂蛋白（HDL-C）>40/50mg/dl 的比例分别为 61.3%和 66.1%；甘油三酯（TG）<150mg/dl 的比例分别为 28.9%和 31.7%。多变量分析显示，年龄、性别、合并高心血管风险疾病或参与 DMP 似乎对达到 LDL-C、HDL-C 和 TG 目标的影响不一致。男性、未参与 DMP 的患者、患有 DM 或 CHD 的患者以及服用 1 片（而非 2 片）烟酸 1000mg/laropiprant 20mg 延长释放制剂的患者，达到 LDL-C 目标的可能性较高。达到 HDL-C 目标的可能性在男性和无 DM 或 DM+CHD 的患者中更高（DMP 无影响）。达到 TG 目标的可能性在女性、未参与 DMP 的患者以及患有 DM 和/或 CHD 的患者中较高。局限性包括由于研究设计、医生和患者选择以及随访时缺失值的潜在偏倚。
参与 DMP 与整体改善血脂目标达标率无关。医生不能根据患者的基线特征预测新启动的血脂调节治疗的效果大小。
