Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Department of Clinical Biochemistry and the Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Denmark.
Atherosclerosis. 2017 Feb;257:9-15. doi: 10.1016/j.atherosclerosis.2016.11.025. Epub 2016 Nov 24.
We estimated the extent of undertreatment and overtreatment with cholesterol-lowering therapy according to European guidelines in individuals in the Danish general population without ischemic cardiovascular disease and diabetes.
We examined 92,348 such individuals aged 35-100 years recruited from 2004 through 2014 in the Copenhagen General Population Study. Each individual was assigned their 10-year risk of fatal cardiovascular disease according to the European SCORE chart based on age, sex, smoking, total cholesterol, and systolic blood pressure. European guidelines recommend cholesterol-lowering therapy definitely at ≥10% risk and LDL cholesterol ≥1.8 mmol/L, definitely at 5-9% risk and LDL cholesterol ≥2.5 mmol/L, possibly at 1-4% risk and LDL cholesterol ≥3 mmol/L, but not at <1% risk.
3858 individuals had ≥10% risk, 16,255 had 5-9% risk, 49,131 had 1-4% risk, and 23,104 had <1% 10-year risk of fatal cardiovascular disease. In these groups, 81%, 86%, 93%, and 99% did not receive cholesterol-lowering therapy. Definite undertreatment and overtreatment according to guidelines were found in 19% and 0.2% or in 187,660 and 1570 per million 35-100 year olds without ischemic cardiovascular disease and diabetes. If definite and possible undertreatment and overtreatment were combined, the corresponding numbers were 52% and 3% or 519,416 and 29,194 per million.
In the Danish general population, ∼190,000 per million 35-100 year olds without ischemic cardiovascular disease and diabetes are not treated to LDL cholesterol goals according to European guidelines. Conversely, ∼1600 per million received cholesterol-lowering therapy without endorsement in European guidelines.
我们根据欧洲指南，评估了丹麦普通人群中无缺血性心血管疾病和糖尿病个体的降脂治疗不足和过度治疗的程度。
我们研究了 2004 年至 2014 年期间从哥本哈根普通人群研究中招募的 92348 名年龄在 35-100 岁的此类个体。根据欧洲 SCORE 图表，根据年龄、性别、吸烟状况、总胆固醇和收缩压，为每位个体分配了其 10 年致命心血管疾病的风险。欧洲指南建议降脂治疗明确适用于≥10%风险和 LDL 胆固醇≥1.8mmol/L，明确适用于 5-9%风险和 LDL 胆固醇≥2.5mmol/L，可能适用于 1-4%风险和 LDL 胆固醇≥3mmol/L，但不适用于<1%风险。
3858 名个体的风险≥10%，16255 名个体的风险为 5-9%，49131 名个体的风险为 1-4%，23104 名个体的风险<1%，10 年内致命心血管疾病的风险。在这些组中，81%、86%、93%和 99%的个体未接受降脂治疗。根据指南，发现明确的治疗不足和过度治疗分别占 19%和 0.2%，即每 100 万 35-100 岁无缺血性心血管疾病和糖尿病的个体中分别有 187660 人和 1570 人；如果将明确和可能的治疗不足和过度治疗合并，则相应的数字分别为 52%和 3%，即每 100 万 35-100 岁无缺血性心血管疾病和糖尿病的个体中分别有 519416 人和 29194 人。
在丹麦普通人群中，约有 190000 人每 100 万 35-100 岁无缺血性心血管疾病和糖尿病的个体未达到欧洲指南的 LDL 胆固醇目标。相反，约有 1600 人每 100 万接受了欧洲指南不推荐的降脂治疗。
