Miedema Michael D, Garberich Ross F, Schnaidt Lucas J, Peterson Erin, Strauss Craig, Sharkey Scott, Knickelbine Thomas, Newell Marc C, Henry Timothy D
Minneapolis Heart Institute Foundation, Minneapolis, MN
Minneapolis Heart Institute, Minneapolis, MN.
J Am Heart Assoc. 2017 Apr 12;6(4):e005333. doi: 10.1161/JAHA.116.005333.
The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear.
We analyzed a prospective cohort of consecutive ST-segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low-density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre-STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138] mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI.
In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre-STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI.
2013年美国心脏病学会/美国心脏协会胆固醇指南对原本注定会发生心血管疾病（CVD）事件的个体使用他汀类药物的适用性影响尚不清楚。
我们分析了一个来自区域ST段抬高型心肌梗死（STEMI）系统的连续STEMI患者前瞻性队列，该队列包含患者人口统计学数据、低密度脂蛋白胆固醇水平、CVD危险因素、用药情况以及STEMI前2年的门诊就诊情况。我们根据美国心脏病学会/美国心脏协会指南以及先前的成人治疗小组第三次报告指南确定STEMI前的适用性。我们的样本包括1062例患者，平均年龄63.7（13.0）岁（72.5%为男性），761例（71.7%）在STEMI前无已知CVD。在STEMI前，有和无先前CVD的个体分别只有62.5%和19.3%正在服用他汀类药物。在未服用他汀类药物的个体中，有和无已知CVD者的低密度脂蛋白胆固醇水平中位数（四分位间距）较低（分别为108[83,138]mg/dL和110[87,133]mg/dL）。对于未服用他汀类药物的个体，根据成人治疗小组第三次报告指南，只有38.7%符合使用他汀类药物的条件。相反，根据美国心脏病学会/美国心脏协会指南，79.0%符合条件。在STEMI前2年，有（49.2%）和无（41.1%）先前CVD的个体中，不到一半曾看过初级保健医生。
在一大群STEMI患者中，与成人治疗小组第三次报告指南相比，应用美国心脏病学会/美国心脏协会指南使STEMI前他汀类药物的适用性增加了一倍多。然而，在STEMI前，作为指南实施必要条件的医疗保健的可及性和利用率并不理想。
