Ho Li-Ting, Yin Wei-Hsian, Chuang Shao-Yuan, Tseng Wei-Kung, Wu Yen-Wen, Hsieh I-Chang, Lin Tsung-Hsien, Li Yi-Heng, Huang Lien-Chi, Wang Kuo-Yang, Ueng Kwo-Chang, Fang Ching-Chang, Pan Wen-Harn, Yeh Hung-I, Wu Chau-Chung, Chen Jaw-Wen
Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
PLoS One. 2015 Mar 10;10(3):e0116513. doi: 10.1371/journal.pone.0116513. eCollection 2015.
Epidemiological and clinical studies have clearly established the link between low-density lipoprotein cholesterol (LDL-C) and atherosclerosis-related cardiovascular consequences. Although it has been a common practice for physicians to prescribe lipid-lowering therapy for patients with dyslipidemia, the achievement rate is still not satisfied in Taiwan. Therefore, the determinants for achieving the LDL-C target needed to be clarified for better healthcare of the patients with dyslipidemia.
This registry-type prospective observational study enrolled the patients with cardiovascular diseases (coronary artery disease (CAD) and cerebrovascular disease (CVD)) from 18 medical centers across Taiwan, and clinically followed them for five years. At every clinical visit, vital signs, clinical endpoints, adverse events, concurrent medications and laboratory specimens were obtained as thoroughly as possible. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, LDL-C, triglyceride), liver enzymes, and creatinine phosphokinase were evaluated at baseline, and every year thereafter. The cross sectional observational data was analyzed for this report.
Among the 3,486 registered patients, 54% had their LDL-C < 100 mg/dL. By univariate analysis, the patients achieving the LDL-C target were associated with older age, more male sex, taller height, lower blood pressure, more under lipid-lowering therapy, more smoking cessation, more history of CAD, DM, physical activity, but less history of CVD. The multivariate analysis showed statin therapy was the most significant independent determinant for achieving the treatment target, followed by age, history of CAD, diabetes, blood pressure, and sex. However, most patients were on regimens of very-low to low equipotent doses of statins.
Although the lipid treatment guideline adherence is improving in recent years, only 54% of the patients with cardiovascular diseases have achieved their LDL-C target in Taiwan, and the most significant determinant for this was statin therapy.
流行病学和临床研究已明确证实低密度脂蛋白胆固醇（LDL-C）与动脉粥样硬化相关心血管后果之间的联系。尽管医生为血脂异常患者开具降脂治疗药物已是常见做法，但在台湾，达标率仍不尽人意。因此，为了更好地治疗血脂异常患者，需要明确实现LDL-C目标的决定因素。
这项登记型前瞻性观察性研究纳入了来自台湾18家医疗中心的心血管疾病（冠状动脉疾病（CAD）和脑血管疾病（CVD））患者，并对他们进行了为期五年的临床随访。每次临床就诊时，尽可能全面地获取生命体征、临床终点、不良事件、同时服用的药物和实验室标本。在基线时以及此后每年评估血脂谱（总胆固醇、高密度脂蛋白胆固醇、LDL-C、甘油三酯）、肝酶和肌酸磷酸激酶。本报告分析了横断面观察数据。
在3486名登记患者中，54%的患者LDL-C<100mg/dL。单因素分析显示，达到LDL-C目标的患者与年龄较大、男性较多、身高较高、血压较低、接受降脂治疗较多、戒烟较多、有CAD、DM病史、进行体育活动有关，但CVD病史较少。多因素分析显示，他汀类药物治疗是实现治疗目标的最显著独立决定因素，其次是年龄、CAD病史、糖尿病、血压和性别。然而，大多数患者使用的是极低至低等效剂量的他汀类药物治疗方案。
尽管近年来对血脂治疗指南的依从性有所提高，但在台湾，只有54%的心血管疾病患者达到了他们的LDL-C目标，而最重要的决定因素是他汀类药物治疗。
