Munkhaugen John, Sverre Elise, Otterstad Jan E, Peersen Kari, Gjertsen Erik, Perk Joep, Gullestad Lars, Moum Torbjørn, Dammen Toril, Husebye Einar
1 Department of Medicine, Drammen Hospital, Norway.
2 Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Norway.
Eur J Prev Cardiol. 2017 Jun;24(9):981-989. doi: 10.1177/2047487317693134. Epub 2017 Feb 14.
Objective Understanding the determinants of low-density lipoprotein cholesterol (LDL-C) control constitutes the basis of modelling interventions for optimal lipid control and prognosis. We aim to identify medical and psychosocial (study) factors associated with unfavourable LDL-C control in coronary patients. Methods A cross-sectional explorative study used logistic and linear regression analysis to investigate the association between study factors and LDL-C in 1095 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records, a comprehensive self-report questionnaire, clinical examination and blood samples after 2-36 months follow-up. Results Fifty-seven per cent did not reach the LDL-C target of 1.8 mmol/l at follow-up. Low socioeconomic status and psychosocial factors were not associated with failure to reach the LDL-C target. Statin specific side-effects (odds ratio 3.23), low statin adherence (odds ratio 3.07), coronary artery by-pass graft operation as index treatment (odds ratio 1.95), ≥ 1 coronary event prior to the index event (odds ratio 1.81), female gender (odds ratio 1.80), moderate- or low-intensity statin therapy (odds ratio 1.62) and eating fish < 3 times/week (odds ratio 1.56) were statistically significantly associated with failure to reach the LDL-C target, in adjusted analyses. Only side-effects (standardized β 0.180), low statin adherence ( β 0.209) and moderate- or low-intensity statin therapy ( β 0.228) were associated with LDL-C in continuous analyses. Conclusions Statin specific side-effects, low statin adherence and moderate- or low-intensity statin therapy were the major factors associated with unfavourable LDL-C control. Interventions to improve LDL-C should ensure adherence and prescription of sufficiently potent statins, and address side-effects appropriately.
目的 了解低密度脂蛋白胆固醇（LDL-C）控制的决定因素是为实现最佳血脂控制和预后制定干预模型的基础。我们旨在确定冠心病患者中与LDL-C控制不佳相关的医学和社会心理（研究）因素。方法 一项横断面探索性研究采用逻辑回归和线性回归分析，调查了1095例因心肌梗死和/或冠状动脉血运重建术住院患者的研究因素与LDL-C之间的关联。数据收集自医院记录、一份全面的自我报告问卷、临床检查以及随访2至36个月后的血样。结果 57%的患者在随访时未达到LDL-C目标值1.8 mmol/l。社会经济地位低下和社会心理因素与未达到LDL-C目标无关。在调整分析中，他汀类药物的特定副作用（比值比3.23）、他汀类药物依从性低（比值比3.07）、冠状动脉搭桥手术作为索引治疗（比值比1.95）、索引事件之前发生≥1次冠状动脉事件（比值比1.81）、女性（比值比1.80）、中低强度他汀类药物治疗（比值比1.62）以及每周吃鱼<3次（比值比1.56）与未达到LDL-C目标在统计学上显著相关。在连续分析中，只有副作用（标准化β 0.180）、他汀类药物依从性低（β 0.209）和中低强度他汀类药物治疗（β 0.228）与LDL-C相关。结论 他汀类药物的特定副作用、他汀类药物依从性低和中低强度他汀类药物治疗是与LDL-C控制不佳相关的主要因素。改善LDL-C的干预措施应确保依从性和使用足够强效的他汀类药物，并妥善处理副作用。
