Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, USA.
Am J Cardiol. 2013 Aug 1;112(3):373-9. doi: 10.1016/j.amjcard.2013.03.041. Epub 2013 Apr 30.
Despite available medications for dyslipidemia, many treated patients still have suboptimal lipid levels. The aim of this study was to examine the extent of residual dyslipidemia in United States adults. Of 2509 United States adults aged ≥18 years from the National Health and Nutrition Examination Survey (NHANES) 2009-2010, 1,129 (41.8% weighted) had hyperlipidemia on the basis of modified treatment guidelines for low-density lipoprotein (LDL) cholesterol according to risk category or pharmacologic treatment. Of these, 484 (42.4%) were treated with lipid-modifying therapy, and the proportions of subjects who still had LDL cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, or non-HDL cholesterol not at recommended levels were examined. In this cohort treated for hyperlipidemia, the mean age was 60.1 ± 14.9 years, and 52% were men. Only 36.5% of subjects receiving treatment for hyperlipidemia were at goal or normal levels for all 3 lipids (LDL cholesterol, HDL cholesterol, and triglycerides). LDL cholesterol remained higher than goal for 37.5% of subjects, 28.9% had low HDL cholesterol, and 36.3% had elevated triglycerides. One, 2, and 3 lipid parameters were at abnormal levels in 32.4%, 23.0%, and 8.2% of subjects, respectively; 36.5% had no lipid disorder. In addition, 38.6% of treated subjects were above non-HDL cholesterol goal, and even in those at LDL cholesterol goal, 12.9% were not at non-HDL cholesterol goal. Those with cardiovascular disease conditions had poorer goal attainment of LDL cholesterol, HDL cholesterol, and composite all lipids than those without cardiovascular disease. In conclusion, despite widely available treatments for dyslipidemia, many patients remain at suboptimal lipid levels, indicating need for greater adherence to lifestyle and medical therapies to address these gaps in the management of dyslipidemia.
尽管有治疗血脂异常的药物,但许多接受治疗的患者的血脂水平仍不理想。本研究旨在评估美国成年人血脂异常的严重程度。在 2009-2010 年全国健康和营养调查(NHANES)中,有 2509 名年龄≥18 岁的美国成年人(根据体重计算占 41.8%)患有根据危险分层或药物治疗修改后的低密度脂蛋白胆固醇(LDL-C)治疗指南定义的高脂血症。其中,1129 名患者(42.4%)接受了降脂治疗,研究人员检查了仍有 LDL-C、高密度脂蛋白胆固醇(HDL-C)、甘油三酯或非高密度脂蛋白胆固醇未达到推荐水平的患者比例。在这个接受降脂治疗的队列中,患者的平均年龄为 60.1±14.9 岁,52%为男性。仅 36.5%接受高脂血症治疗的患者达到了所有 3 种血脂(LDL-C、HDL-C 和甘油三酯)的目标或正常水平。37.5%的患者 LDL-C 仍高于目标值,28.9%的患者 HDL-C 低,36.3%的患者甘油三酯升高。在分别有 32.4%、23.0%和 8.2%的患者中,1 项、2 项和 3 项血脂参数处于异常水平;36.5%的患者没有血脂异常。此外,38.6%的治疗患者的非高密度脂蛋白胆固醇目标值升高,即使在 LDL-C 目标值的患者中,仍有 12.9%的患者未达到非高密度脂蛋白胆固醇目标值。患有心血管疾病的患者 LDL-C、HDL-C 和复合所有血脂的达标情况均不如无心血管疾病的患者。总之,尽管有广泛的治疗血脂异常的药物,但许多患者的血脂水平仍不理想,这表明需要更加坚持生活方式和医疗治疗,以解决血脂异常管理中的这些差距。