Reiner Ž, De Backer G, Fras Z, Kotseva K, Tokgözoglu L, Wood D, De Bacquer D
Department of Internal Medicine, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Croatia.
Department of Public Health, Ghent University, Ghent, Belgium.
Atherosclerosis. 2016 Mar;246:243-50. doi: 10.1016/j.atherosclerosis.2016.01.018. Epub 2016 Jan 13.
Since dyslipidaemia is one of the most important risk factors for coronary heart disease (CHD), lowering of LDL-cholesterol (LDL-C) causes significant reduction in morbidity and mortality, particularly in patients with established CHD. The aim of this survey was to assess how statins were prescribed in CHD patients at discharge after a coronary event from hospitals throughout Europe and how the intake of these drugs was reported by the patients when they were seen more than one year later in relationship with their achieved LDL-C levels.
6648 CHD patients' data from centres in 24 European countries were gathered using standardized methods. Lipid measurements were performed in one central laboratory. Patients were divided in three groups: high-intensity statin therapy, moderate or low intensity statin therapy and no statin therapy at all.
90.4% CHD patients were on statin therapy at the time of discharge from the hospital which decreased to 86% one year later. Only 37.6% of these patients were prescribed a high-intensity statin at discharge which even decreased to 32.7% later. In only 6 countries (all of them high-income countries) the number of patients on a high-intensity statin therapy increased substantially after the hospital discharge. It is worrying that statin therapy was discontinued in 11.6% and that only 19.3% of all CHD patients achieved target values of LDL-C < 1.8 mmol/L at the time of interview.
Too many CHD patients with dyslipidaemia are still inadequately treated and most of these patients on statin therapy are not achieving the treatment targets. Therapeutic control of LDL-C is clearly related to the intensity of lipid lowering drug regimen after the CHD event indicating that a considerable potential still exists throughout Europe to reduce CHD mortality and morbidity rates through more efficient LDL-C lowering.
由于血脂异常是冠心病（CHD）最重要的危险因素之一，降低低密度脂蛋白胆固醇（LDL-C）可显著降低发病率和死亡率，尤其是在已确诊冠心病的患者中。本调查的目的是评估欧洲各地医院冠心病患者出院时他汀类药物的处方情况，以及这些患者在一年多后复诊时报告的药物摄入量与其LDL-C水平的关系。
采用标准化方法收集了来自24个欧洲国家中心的6648例冠心病患者的数据。脂质测量在一个中央实验室进行。患者分为三组：高强度他汀类药物治疗组、中度或低强度他汀类药物治疗组和完全未使用他汀类药物治疗组。
90.4%的冠心病患者在出院时接受他汀类药物治疗，一年后这一比例降至86%。这些患者中只有37.6%在出院时被处方高强度他汀类药物，后来甚至降至32.7%。只有6个国家（均为高收入国家）出院后接受高强度他汀类药物治疗的患者数量大幅增加。令人担忧的是，11.6%的患者停止了他汀类药物治疗，在访谈时所有冠心病患者中只有19.3%达到了LDL-C<1.8 mmol/L的目标值。
太多血脂异常的冠心病患者仍未得到充分治疗，大多数接受他汀类药物治疗的患者未达到治疗目标。冠心病事件后LDL-C的治疗控制显然与降脂药物治疗方案的强度有关，这表明在整个欧洲，通过更有效地降低LDL-C来降低冠心病死亡率和发病率仍有相当大的潜力。
