Kim H-S, Kim H, Lee H, Park B, Park S, Lee S-H, Cho J H, Song H, Kim J H, Yoon K-H, Choi I Y
Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Clin Pharm Ther. 2016 Feb;41(1):70-7. doi: 10.1111/jcpt.12350. Epub 2016 Jan 21.
There is a disparity between the Korean treatment guidelines and actual clinical prescription habits. This study was designed to evaluate the department-specific disparities and achievement rates for low-density lipoprotein cholesterol (LDL-C) targets, based on each department's specific statin prescription patterns.
We retrospectively evaluated data from 31 718 patients who had been prescribed a statin at least once between January 2008 and June 2013 at our institution. Patients were classified into the high-risk (target LDL-C < 100 mg/dL) or moderate-risk (target LDL-C < 130 mg/dL) groups, according to the National Cholesterol Education Programme-Adult Treatment Panel III guidelines.
Statins were most commonly prescribed in the cardiology (32·0%) and endocrinology (26·6%) departments. For the high-risk group, 70% of patients in the cardiology, endocrinology and cardiac surgery departments achieved their target LDL-C levels (<100 mg/dL). However, the target achievement rates in most other departments were <70%. For the moderate-risk group, 79·2% of patients achieved their target levels. Departments that prescribed a greater number of high- or intermediate-potency statins were more likely to achieve their target LDL-C levels. The group that achieved their target LDL-C levels (<100 mg/dL) exhibited a significant positive relationship (Spearman's correlation coefficient = 0·8571, P = 0·0065), from low to high potency.
Some departments tend to undertreat when prescribing statins. However, to reach to the target LDL-C levels, physicians must overcome their tendency to undertreat with statins. We believe that the target achievement rate will increase if doctors are more actively aware of a patient's individual status and related risk factors before prescribing statins.
韩国的治疗指南与实际临床处方习惯之间存在差异。本研究旨在根据各科室特定的他汀类药物处方模式，评估科室特异性差异以及低密度脂蛋白胆固醇（LDL-C）目标的达成率。
我们回顾性评估了2008年1月至2013年6月期间在我院至少接受过一次他汀类药物处方的31718例患者的数据。根据美国国家胆固醇教育计划成人治疗小组第三次指南，将患者分为高危组（目标LDL-C<100mg/dL）或中危组（目标LDL-C<130mg/dL）。
他汀类药物最常用于心内科（32.0%）和内分泌科（26.6%）。对于高危组，心内科、内分泌科和心脏外科的70%患者达到了目标LDL-C水平（<100mg/dL）。然而，大多数其他科室的目标达成率<70%。对于中危组，79.2%的患者达到了目标水平。开具更多高剂量或中等剂量他汀类药物的科室更有可能达到目标LDL-C水平。达到目标LDL-C水平（<100mg/dL）的组从低到高剂量呈现出显著的正相关关系（斯皮尔曼相关系数=0.8571，P=0.0065）。
一些科室在开具他汀类药物时往往治疗不足。然而，为了达到目标LDL-C水平，医生必须克服他汀类药物治疗不足的倾向。我们认为，如果医生在开具他汀类药物之前更积极地了解患者的个体状况和相关危险因素，目标达成率将会提高。
