Hess Gregory, Chang Chun-Lan, Chung Karen
University of Pennsylvania , Philadelphia, PA , USA.
Curr Med Res Opin. 2014 Sep;30(9):1743-56. doi: 10.1185/03007995.2014.925436. Epub 2014 Jun 10.
Guidelines for preventing and treating patients with coronary artery disease have traditionally focused on reducing low-density lipoprotein cholesterol (LDL-C). Current treatments are effective; however, previous studies have identified a significant proportion of patients that are not achieving the recommended lipid levels. New guidelines were introduced November 2013. The objective of this study was to examine recent practice patterns and factors related to initiating treatment for hypercholesterolemia, which provides a comparative baseline to the introduction of new guidelines.
We conducted a retrospective cohort analysis utilizing laboratory results of lipid profiles and medical claims from January 2007 to September 2011 to identify patients with elevated LDL-C and diagnoses of hypercholesterolemia without prior pharmacotherapy. Pharmacotherapy dispensed, treatment modifications, LDL-C-goal attainment, and potential drug intolerance were evaluated.
Overall, among newly treated patients, 70.9% achieved the recommended LDL-C level within the first year of treatment; however, only 19.4% of those with coronary heart disease (CHD) or CHD risk equivalents achieved the more aggressive LDL-C goal of <70 mg/dL (1.8 mmol/L). LDL-C goals were generally achieved with the use of statins; however, a majority of patients underwent treatment modification(s) (e.g., discontinuation or restart). More than half of the patients diagnosed with elevated LDL-C did not initiate pharmacotherapy.
Data was unavailable for inpatient hospitalizations, family history of cardiovascular diseases, body weight, and height, and likely under-reporting of smoking within claims data.
Newly treated patients with elevated LDL-C results generally achieved the recommended and risk-specific LDL-C goal with the use of lipid-altering drugs; however, there still exists a notable population of patients with CHD or CHD risk equivalents who were not treated to goal and a significant number of patients who do not receive lipid-lowering pharmacotherapy. New therapies and prescribing practices are warranted to adequately address these two patient populations.
传统上，冠状动脉疾病患者的防治指南一直侧重于降低低密度脂蛋白胆固醇（LDL-C）。目前的治疗方法是有效的；然而，先前的研究发现，有相当一部分患者未达到推荐的血脂水平。2013年11月出台了新的指南。本研究的目的是检查近期的实践模式以及与启动高胆固醇血症治疗相关的因素，为新指南的引入提供一个比较基线。
我们利用2007年1月至2011年9月的血脂谱实验室结果和医疗理赔数据进行了一项回顾性队列分析，以识别LDL-C升高且诊断为高胆固醇血症但未接受过药物治疗的患者。评估了药物治疗的配药情况、治疗调整、LDL-C目标达成情况以及潜在的药物不耐受情况。
总体而言，在新接受治疗的患者中，70.9%在治疗的第一年内达到了推荐的LDL-C水平；然而，冠心病（CHD）或CHD风险等同症患者中只有19.4%达到了更为严格的LDL-C目标，即<70mg/dL（1.8mmol/L）。使用他汀类药物一般能实现LDL-C目标；然而，大多数患者都进行了治疗调整（如停药或重新开始用药）。超过一半被诊断为LDL-C升高的患者未启动药物治疗。
无法获取住院治疗、心血管疾病家族史、体重和身高的数据，而且理赔数据中可能存在吸烟情况报告不足的问题。
新接受治疗的LDL-C结果升高的患者使用调脂药物一般能达到推荐的和针对风险的LDL-C目标；然而，仍有相当一部分冠心病或CHD风险等同症患者未达到治疗目标，并且有大量患者未接受降脂药物治疗。需要新的治疗方法和处方实践来充分应对这两类患者群体。
