在欧洲的一项登记研究中，哪种他汀类药物在实现血脂水平目标方面效果最佳？对冠心病患者的EUROASPIRE III进行的事后分析。
Which statin worked best to achieve lipid level targets in a European registry? A post-hoc analysis of the EUROASPIRE III for coronary heart disease patients.
作者信息
Alnouri Fahad, Wood David, Kotseva Kornelia, Ibrahim Mohamed E A
机构信息
Cardiovascular Prevention Unit, Prince Sultan Cardiac Centre Riyadh, Saudi Arabia.
Garfield Weston Chair, National Heart and Lung Institute, Imperial College London, United Kingdom.
出版信息
J Saudi Heart Assoc. 2014 Oct;26(4):183-91. doi: 10.1016/j.jsha.2014.04.005. Epub 2014 May 4.
OBJECTIVE
The objective of the study is to determine the proportion of patients within the subsample reaching the target lipid levels defined in the European guidelines, stratified according to type and dose of statin used.
BACKGROUND
Many factors affect the attainment of lipid level targets including gender, age, compliance, statin type, and dosage. This study aimed to determine the percentage of post-interventional coronary heart disease (CHD) patients who met the lipid level targets recommended by the Joint European Societies Guidelines, the medications used, and their doses.
METHODS
A post-hoc analysis of a subsample of 2,000 patients from EUROASPIRE III database was selected randomly from patients who attended the interviews (between six months to three years after event). Further stratification according to type and dose of statin was performed.
RESULTS
The sample comprised 74.5% males, and two thirds (63.8%) of the entire sample were over 60 years of age. More women than men showed elevated total cholesterol (>4.5 mmol/l and >4.0 mmol/l), LDL-cholesterol (>2.5 mmol/l and >2.0 mmol/l), and triglycerides (>1.7 mmol/l). Atorvastatin was the most widely used at both discharge and interview (47.1% and 45.4%) than simvastatin (37.7% and 39.4%). A dose of 20 mg atorvastatin was used by 44.10% of patients, while those on fluvastatin used a higher dose: ⩾40 mg in 88.31%. Patients who achieved targeted total cholesterol levels for atorvastatin, fluvastatin, lovastatin and simvastatin showed a trend in dose increase. Pravastatin users who achieved the target were taking a dose of 10 mg (75%) and less were in the 20 mg group (33.33%). Rosuvastatin users who consumed 10 mg and ⩾40 mg dose achieved the lipid level targets by 61.82% and 66.67%, respectively.
CONCLUSION
Compliance with medications was high after a CHD incident in this European sample and the increase of the atorvastatin and simvastatin doses enabled the attainment of the target levels recommended.
目的
本研究的目的是确定亚样本中达到欧洲指南所定义的血脂目标水平的患者比例，并根据所使用他汀类药物的类型和剂量进行分层。
背景
许多因素会影响血脂水平目标的达成，包括性别、年龄、依从性、他汀类药物类型和剂量。本研究旨在确定接受干预后的冠心病（CHD）患者中达到欧洲联合学会指南推荐的血脂水平目标的患者百分比、所使用的药物及其剂量。
方法
从EUROASPIRE III数据库的2000例患者亚样本中进行事后分析，这些患者是从参加访谈的患者（事件发生后6个月至3年）中随机选取的。根据他汀类药物的类型和剂量进行进一步分层。
结果
样本中男性占74.5%，整个样本的三分之二（63.8%）年龄超过60岁。总胆固醇（>4.5 mmol/l和>4.0 mmol/l）、低密度脂蛋白胆固醇（>2.5 mmol/l和>2.0 mmol/l）以及甘油三酯（>1.7 mmol/l）升高的女性多于男性。出院时和访谈时阿托伐他汀的使用最为广泛（分别为47.1%和45.4%），高于辛伐他汀（分别为37.7%和39.4%）。44.10%的患者使用20 mg阿托伐他汀剂量，而氟伐他汀使用者使用更高剂量：88.31%的患者使用⩾40 mg剂量。阿托伐他汀、氟伐他汀、洛伐他汀和辛伐他汀达到目标总胆固醇水平的患者显示出剂量增加的趋势。达到目标的普伐他汀使用者服用10 mg剂量（75%），服用20 mg剂量的较少（33.33%）。服用10 mg和⩾40 mg剂量的瑞舒伐他汀使用者分别有61.82%和66.67%达到血脂水平目标。
结论
在这个欧洲样本中，冠心病事件后药物依从性较高，阿托伐他汀和辛伐他汀剂量的增加使得能够达到推荐的目标水平。
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