Balder J W, Scholtens S, de Vries J K, van Schie L M, Boekholdt S M, Hovingh G K, Kamphuisen P W, Kuivenhoven J A
Department of Pediatrics, Section Molecular Genetics, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
Neth J Med. 2015 Aug;73(7):316-23.
Cardiovascular disease (CVD) is the leading cause of death worldwide. While there is indisputable evidence that statin treatment reduces the burden of CVD, undertreatment remains a concern for primary and secondary prevention. The aim of this study was to assess the use of lipid-lowering drugs (LLD) among 70,292 individuals in the Netherlands as a proxy of adherence to the national guideline for prevention and treatment of CVD.
LifeLines is a population-based prospective cohort study in the three Northern provinces of the Netherlands. At baseline, all participants completed questionnaires, and underwent a physical examination and lab testing. The national guidelines were used to assess how many participants were eligible for LLD prescription and we analysed how many indeed reported LLD use.
For primary prevention, 77% (2515 of 3268) of those eligible for LLD treatment did not report using these drugs, while for secondary prevention this was 31% (403 of 1302). Patients with diabetes mellitus were treated best (67%) for primary prevention. Notably, of the patients with stroke, only 47% (182 of 386) reported LLD treatment.
Despite clear guidelines and multiple national initiatives to improve CVD risk management, adherence to guidelines for the treatment of CVD in the Netherlands remains a major challenge. This study calls out for improving public awareness of CVD and to improve primary and secondary prevention to prevent unnecessary CVD-related morbidity and mortality.
心血管疾病（CVD）是全球首要死因。尽管有确凿证据表明他汀类药物治疗可减轻心血管疾病负担，但治疗不足仍是一级和二级预防的一个问题。本研究的目的是评估荷兰70292名个体中降脂药物（LLD）的使用情况，以此作为遵守国家心血管疾病防治指南情况的一个指标。
生命线研究是一项针对荷兰北部三个省份人群的前瞻性队列研究。在基线时，所有参与者都完成了问卷调查，并接受了体格检查和实验室检测。采用国家指南来评估有多少参与者符合LLD处方条件，并且我们分析了实际报告使用LLD的人数。
对于一级预防，符合LLD治疗条件的人群中有77%（3268人中的2515人）未报告使用这些药物，而对于二级预防，这一比例为31%（1302人中的403人）。糖尿病患者在一级预防中的治疗情况最佳（67%）。值得注意的是，中风患者中只有47%（386人中的182人）报告接受了LLD治疗。
尽管有明确的指南以及多项旨在改善心血管疾病风险管理的国家倡议，但在荷兰，遵守心血管疾病治疗指南仍然是一项重大挑战。本研究呼吁提高公众对心血管疾病的认识，并改善一级和二级预防，以预防不必要的心血管疾病相关发病和死亡。
