加拿大初级保健机构中的单纯性和混合性血脂异常：来自加拿大初级保健哨点监测网络数据库的研究结果。
Single and mixed dyslipidaemia in Canadian primary care settings: findings from the Canadian primary care sentinel surveillance network database.
作者信息
Asghari Shabnam, Aref-Eshghi Erfan, Godwin Marshall, Duke Pauline, Williamson Tyler, Mahdavian Masoud
机构信息
Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
出版信息
BMJ Open. 2015 Dec 11;5(12):e007954. doi: 10.1136/bmjopen-2015-007954.
OBJECTIVES
Dyslipidaemia is a major risk factor to cardiovascular disease (CVD)--the leading cause of death worldwide. Limited data are available about the prevalence of various dyslipidaemia in Canada. The objective of this study is to describe the prevalence of various single and mixed dyslipidaemia within the Canadian population in a primary care setting.
SETTING
A cross-sectional study, using the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), was undertaken.
PARTICIPANTS
Non-pregnant adults older than 20 years were included.
OUTCOME MEASURES
Canadian guidelines were used to define dyslipidaemia. Descriptive statistics and multivariate regression analyses were conducted to compare the prevalence of single/mixed dyslipidaemia.
RESULTS
134,074 individuals with a mean age of 59.2 (55.8% women) were identified. 34.8% of this population had no lipid abnormality, whereas 35.8%, 17.3% and 3.2% had abnormalities in one, two and three lipid components, respectively. Approximately 86% of these patients did not receive any lipid-lowering medication. Among the medication users (14%), approximately 12% were on statin monotherapy. Statin users (n=16,036) had a lower rate of low-density lipoprotein dyslipidaemia compared to non-medication users (3% vs 17%), whereas the prevalence of high-density lipoprotein (HDL) (20% vs 12%) and triglycerides (TG) (12% vs 7%) dyslipidaemia were higher in statin users. Statin users had a greater prevalence of HDL, TG and combined HDL-TG dyslipidaemia compared to non-medication users (OR 1.44, 95% CI 1.36 to 153), (OR 1.18, 95% CI 1.10 to 1.27) and (OR 1.30, 95% CI 1.22 to 1.38), respectively, (all p values<0.0001).
CONCLUSIONS
One of every five patients in primary care settings in Canada is suffering from mixed dyslipidaemia. The overall prevalence of dyslipidaemia remains the same between treated and untreated groups, although the type of abnormal lipid component is considerably different. Among the CVD risk factors, obesity has the greatest effect on the prevalence of all types of dyslipidaemia.
目的
血脂异常是心血管疾病（CVD）的主要危险因素，而心血管疾病是全球首要死因。关于加拿大各种血脂异常患病率的数据有限。本研究的目的是描述在初级保健环境中加拿大人群中各种单一和混合性血脂异常的患病率。
设置
采用加拿大初级保健哨点监测网络（CPCSSN）进行了一项横断面研究。
参与者
纳入年龄超过20岁的非妊娠成年人。
观察指标
采用加拿大指南定义血脂异常。进行描述性统计和多变量回归分析以比较单一/混合性血脂异常的患病率。
结果
共识别出134,074名个体，平均年龄59.2岁（女性占55.8%）。该人群中34.8%没有血脂异常，而分别有35.8%、17.3%和3.2%的人在一种、两种和三种血脂成分上存在异常。这些患者中约86%未接受任何降脂药物治疗。在使用药物的患者（14%）中，约12%接受他汀类单药治疗。与未用药患者相比，他汀类药物使用者（n = 16,036）低密度脂蛋白血脂异常的发生率较低（3%对17%），而他汀类药物使用者高密度脂蛋白（HDL）（20%对12%）和甘油三酯（TG）（12%对7%）血脂异常的患病率较高。与未用药患者相比，他汀类药物使用者HDL、TG以及HDL - TG合并血脂异常的患病率更高，分别为（比值比1.44，95%置信区间1.36至1.53）、（比值比1.18，95%置信区间1.10至1.27）和（比值比1.30，95%置信区间1.22至1.38），（所有p值<0.0001）。
结论
在加拿大初级保健机构中，每五名患者中就有一名患有混合性血脂异常。血脂异常的总体患病率在治疗组和未治疗组之间保持不变，尽管异常血脂成分的类型有很大差异。在心血管疾病危险因素中，肥胖对所有类型血脂异常患病率的影响最大。
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