Cherubini Antonella, Palomba Andrea, Morosin Marco, Russo Giulia, Mazzone Carmine, Barbati Giulia, Tarantini Luigi, Cioffi Giovanni, Cattin Luigi, Sinagra Gianfranco, Di Lenarda Andrea
G Ital Cardiol (Rome). 2015 Apr;16(4):240-9. doi: 10.1714/1848.20190.
It is known that less than half of patients with coronary heart disease reaches the target of LDL cholesterol (LDL-C) <100 mg/dl. According to the latest international guidelines, this target has been lowered to <70 mg/dl in very high-risk patients.
From November 1, 2009 to December 31, 2012, 4953 patients with coronary heart disease were enrolled in the Cardiovascular Registry of Trieste (Italy). We assessed clinical data, LDL-C levels, statin prescription and medium-term outcome in patients with coronary heart disease.
At first clinical evaluation, LDL-C values were available for only 61.5% of patients. The target level of LDL-C <70 mg/dl was reached in 17% of cases and LDL-C <100 mg/dl in 53%. Patients with lower LDL-C levels were more frequently males, with higher cardiovascular risk profile, more comorbidity and more frequent polypharmacy. LDL-C levels influenced statin prescription: in patients with LDL-C ≥ 100 mg/dl, cardiologists started or modified the dosage of statin therapy twice more than in patients with LDL-C <100 mg/dl, even if only in less than 20% of cases. Patients with LDL-C <100 mg/dl in statin therapy had better prognosis, whereas patients with low LDL-C levels without statin therapy had the worst prognosis. Other prognostic factors in this population with LDL-C <100 mg/dl were age, presence of heart failure, comorbidities (evaluated with Charlson index) and polypharmacy.
In our population of outpatients with coronary heart disease, the target of LDL-C <100 mg/dl was reached in 53% of cases. LDL-C levels influenced statin prescription and modification of dosages. The medium-term outcome is closely influenced by the achievement of target LDL-C levels and statin prescription.
已知冠心病患者中不到一半能达到低密度脂蛋白胆固醇（LDL-C）<100mg/dl的目标值。根据最新的国际指南，在极高危患者中，该目标已降至<70mg/dl。
2009年11月1日至2012年12月31日，4953例冠心病患者被纳入的里雅斯特（意大利）心血管注册研究。我们评估了冠心病患者的临床资料、LDL-C水平、他汀类药物处方及中期结局。
在首次临床评估时，仅61.5%的患者有LDL-C值。17%的病例达到了LDL-C<70mg/dl的目标水平，53%的病例达到了LDL-C<100mg/dl的目标水平。LDL-C水平较低的患者男性更为常见，具有更高的心血管风险概况、更多的合并症和更频繁的联合用药。LDL-C水平影响他汀类药物处方：LDL-C≥100mg/dl的患者中，心脏病专家启动或调整他汀类药物治疗剂量的频率是LDL-C<100mg/dl患者的两倍，即便仅在不到20%的病例中如此。接受他汀类药物治疗且LDL-C<100mg/dl的患者预后较好，而未接受他汀类药物治疗且LDL-C水平较低的患者预后最差。在LDL-C<100mg/dl的这一人群中，其他预后因素包括年龄、心力衰竭的存在、合并症（用查尔森指数评估）和联合用药。
在我们的冠心病门诊患者人群中，53%的病例达到了LDL-C<100mg/dl的目标。LDL-C水平影响他汀类药物处方及剂量调整。中期结局受到LDL-C目标水平的实现及他汀类药物处方的密切影响。
