评估高危血脂异常患者血脂管理状况的横断面调查：依折麦布联合治疗的临床影响
Cross-sectional survey to assess the status of lipid management in high-risk patients with dyslipidemia: clinical impact of combination therapy with ezetimibe.
作者信息
Teramoto Tamio, Kashiwagi Atsunori, Ishibashi Shun, Daida Hiroyuki
机构信息
Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan.
Department of Medicine, Shiga University of Medical Science, Shiga, Japan.
出版信息
Curr Ther Res Clin Exp. 2012 Feb;73(1-2):1-15. doi: 10.1016/j.curtheres.2012.02.001.
BACKGROUND
Previous retrospective surveys have shown that lipid management goals are well achieved in patients with dyslipidemia at relatively low risk for atherosclerotic diseases. However, more than half of patients in high-risk groups have not achieved the management goals. Since these surveys, newer medications, including rosuvastatin and ezetimibe, have emerged in clinical practice that may influence lipid management.
OBJECTIVE
To assess the current status of lipid management in high-risk patients, we conducted a cross-sectional study between January and March 2010.
METHODS
Eligible patients were those with dyslipidemia who were classified into the primary prevention high-risk or secondary prevention groups according to the Japan Atherosclerosis Society guideline for diagnosis and prevention of atherosclerotic cardiovascular diseases. Patient data were collected from 300 randomly selected physicians at hospitals and clinics across Japan if patients had been receiving the same statin with or without other lipid-lowering agents for ≥3 months. The main outcome was the percentage of patients who achieved the serum LDL-C goal according to the guideline.
RESULTS
Data were collected from 1720 patients. The LDL-C goal was achieved in 56.5% of patients (447 of 791) in the primary prevention high-risk group and in 24.5% (103 of 420) in the secondary prevention group by statin monotherapy. For patients who had not reached the LDL-C goal with statin therapy alone, 53.8% (113 of 210) in the primary prevention high-risk group and 63.8% (111 of 174) in the secondary prevention group achieved their lipid management goal with the addition of ezetimibe. Ezetimibe significantly lowered mean serum LDL-C levels by 17.9% to 34.6% when added to various statins (P < 0.001).
CONCLUSIONS
Although strong statins are available, lipid management in high-risk patients remains unsatisfactory. More aggressive treatment is needed for these patients.
背景
既往回顾性调查显示，血脂异常且动脉粥样硬化疾病风险相对较低的患者，其血脂管理目标达成情况良好。然而，高危组中超过半数的患者未达成管理目标。自这些调查开展以来，包括瑞舒伐他汀和依折麦布在内的新型药物已在临床实践中出现，这可能会影响血脂管理。
目的
为评估高危患者的血脂管理现状，我们于2010年1月至3月开展了一项横断面研究。
方法
符合条件的患者为血脂异常患者，根据日本动脉粥样硬化学会诊断和预防动脉粥样硬化性心血管疾病指南，将其分为一级预防高危组或二级预防组。如果患者接受同一种他汀类药物治疗（无论是否联用其他降脂药物）≥3个月，则从日本各地医院和诊所随机选取的300名医生处收集患者数据。主要结局是根据指南达成血清低密度脂蛋白胆固醇（LDL-C）目标的患者百分比。
结果
共收集了1720例患者的数据。在一级预防高危组中，他汀类药物单药治疗使56.5%（791例中的447例）的患者达成了LDL-C目标；在二级预防组中，这一比例为24.5%（420例中的103例）。对于仅接受他汀类药物治疗未达成LDL-C目标的患者，在一级预防高危组中，53.8%（210例中的113例），在二级预防组中，63.8%（174例中的111例）在加用依折麦布后达成了血脂管理目标。依折麦布与各种他汀类药物联用时，可使平均血清LDL-C水平显著降低17.9%至34.6%（P < 0.001）。
结论
尽管有强效他汀类药物可用，但高危患者的血脂管理仍不尽人意。这些患者需要更积极的治疗。
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