Zheng Wen, Zhang Yu-Jiao, Bu Xiang-Ting, Guo Xin-Zhu, Hu Da-Yi, Li Zhan-Quan, Sun Jian
aEmergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University bInternal Medicine Department, China-Japan Friendship Hospital cDepartment of Cardiology, Peking University People's Hospital, Beijing dDepartment of Cardiology, the People's Hospital of Liaoning Province, Shenyang eDepartment of Cardiology, the First Hospital of Jilin University, Changchun, China.
Medicine (Baltimore). 2017 Nov;96(46):e8555. doi: 10.1097/MD.0000000000008555.
Lipid-lowering therapy with statins reduces the risk of cardiovascular events, but the efficacy of persistent treatment in a real-world setting may vary from regions. Routine lipid-lowering therapy in the region with a high prevalence of cardiovascular disease may lead to more failures of goal attainment. We therefore performed a study to observe different lipid-lowering strategies in northeast (NE) China with respect to low-density lipoprotein-cholesterol (LDL-C) reduction and goal attainments.A cross-sectional study (DYSIS-China) was conducted in 2012, involving 25,317 patients from 122 centers across China who were diagnosed with hyperlipidemia and treated with lipid-lowering therapy for at least 3 months. Of these patients, 4559 (18.0%) were assigned to the NE group according to their residential zones.Patients in the NE group tended to be younger, female, overweight, and had more comorbidities and higher blood lipid levels than those in the non-NE group (P < .001). The goal attainment for LDL-C in NE was lower than non-NE (45.3% vs 65.1%, P < .001), and especially lower in high (NE vs non-NE, 38.5% vs 58.6%) and very high (NE vs non-NE, 22.6% vs 43.7%) risk patients. The proportion of high intensity statin was lower in NE than non-NE, and the proportion of combination therapy was similar (∼2%). However, the goal attainment did not increase after administering higher dosages of statins in 2 groups. Logistic regression analysis identified diabetes mellitus (DM), coronary heart disease (CHD), cerebrovascular disease (CBD), being female, body mass index (BMI) >24 kg/m, drinking alcohol, smoking, and being residence in NE China as independent predictors of LDL-C attainment.Despite having received persistent lipid-lowering treatments, the current situation of dyslipidemia patients in NE China is unsatisfactory. The main treatment gap might be related to the choice of statin and effective combination therapy and the control of comorbidities and obesity, especially for high-risk patients.
他汀类药物降脂治疗可降低心血管事件风险，但在现实环境中持续治疗的疗效可能因地区而异。在心血管疾病高发地区进行常规降脂治疗可能导致更多未达治疗目标的情况。因此，我们开展了一项研究，以观察中国东北地区在降低低密度脂蛋白胆固醇（LDL-C）及实现治疗目标方面的不同降脂策略。
2012年进行了一项横断面研究（中国血脂异常干预研究，DYSIS-China），纳入了来自中国各地122个中心的25317例诊断为高脂血症且接受降脂治疗至少3个月的患者。其中，4559例（18.0%）根据居住地区被分配到东北组。
东北组患者相较于非东北组患者往往更年轻、女性居多、超重，且合并症更多、血脂水平更高（P＜0.001）。东北地区LDL-C的治疗目标达成率低于非东北地区（45.3%对65.1%，P＜0.001），在高危（东北组对非东北组，38.5%对58.6%）和极高危（东北组对非东北组，22.6%对43.7%）患者中尤其低。东北地区高强度他汀类药物的使用比例低于非东北地区，联合治疗的比例相似（约2%）。然而，两组在增加他汀类药物剂量后治疗目标达成率并未提高。逻辑回归分析确定糖尿病（DM）、冠心病（CHD）、脑血管疾病（CBD）、女性、体重指数（BMI）＞24kg/m²、饮酒、吸烟以及居住在中国东北地区是LDL-C达标情况的独立预测因素。
尽管接受了持续的降脂治疗，但中国东北地区血脂异常患者的现状仍不尽人意。主要的治疗差距可能与他汀类药物的选择、有效的联合治疗以及合并症和肥胖的控制有关，尤其是对于高危患者。
