Lama Soubra, Souraya Domiati, Youssef Fattouh
Department of Pharmacy Practice, Beirut Arab University, Beirut, Lebanon.
Department of Pharmacology and Therapeutics, Beirut Arab University, Beirut, Lebanon.
Int J Clin Pharm. 2017 Aug;39(4):919-926. doi: 10.1007/s11096-017-0483-x. Epub 2017 May 18.
Background Current guidelines recommend a low-density lipoprotein cholesterol goal of <1.8 mmol/L (<70 mg/dL) and a non high-density lipoprotein cholesterol (non-HDL-C) goal of <2.6 mmol/L (<00 mg/dL) for coronary artery disease (CAD) patients. Objective This study aimed to describe real-life statin prescription strategies and to assess their effectiveness in terms of LDL-C and non-HDL-C goals attainment in a cohort of CAD patients. Setting Outpatient cardiology specialty clinics located in main Lebanese cities. Methods This is a retrospective crosssectional study. Eligible patients were those who had established CAD, treated with statins and having complete follow-up lipid panel at least 3 months from statin prescription. The following statin prescription strategies were considered in data analysis: prescription of different intensity statin as monotherapy, prescription of a statin in combination with: a low fat diet, another lipid-altering agent and another lipidaltering agent plus a low fat diet. Main outcome measure LDL-C goal attainment for each of the statin prescription strategy. Results Of the 423 CAD statin-treated patients, only 38.5 and 36.6% attained their recommended LDL-C and non-HDL-C goals, respectively. Using a statin in combination with ezetimibe or with another lipid-altering agent plus a low fat diet were significantly associated with LDL-C and non-HDL-C goals attainment. Conclusion Improvement of statin prescription strategies, such as using regular and scheduled dosage of high-intensity statins and combining statin therapy with ezetimibe, is therefore required when managing patients with CAD.
背景 当前指南建议,对于冠状动脉疾病(CAD)患者,低密度脂蛋白胆固醇目标为<1.8 mmol/L(<70 mg/dL),非高密度脂蛋白胆固醇(non-HDL-C)目标为<2.6 mmol/L(<100 mg/dL)。目的 本研究旨在描述现实生活中的他汀类药物处方策略,并评估其在一组CAD患者中实现低密度脂蛋白胆固醇(LDL-C)和非高密度脂蛋白胆固醇目标方面的有效性。地点 位于黎巴嫩主要城市的门诊心脏病专科诊所。方法 这是一项回顾性横断面研究。符合条件的患者为已确诊CAD、接受他汀类药物治疗且自他汀类药物处方起至少3个月有完整随访血脂检测结果的患者。数据分析中考虑了以下他汀类药物处方策略:不同强度他汀类药物作为单一疗法的处方、他汀类药物与以下药物联合使用的处方:低脂饮食、另一种调脂药物、另一种调脂药物加低脂饮食。主要结局指标 每种他汀类药物处方策略的LDL-C目标达成情况。结果 在423例接受他汀类药物治疗的CAD患者中,分别只有38.5%和36.6%达到了推荐的LDL-C和非HDL-C目标。使用他汀类药物联合依泽替米贝或与另一种调脂药物加低脂饮食显著与LDL-C和非HDL-C目标达成相关。结论 因此,在管理CAD患者时,需要改进他汀类药物处方策略,例如使用常规和预定剂量的高强度他汀类药物,并将他汀类药物治疗与依泽替米贝联合使用。