Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Clinic for Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Principality of Liechtenstein, Triesen, Liechtenstein; Drexel University College of Medicine, Philadelphia, PA, USA.
J Clin Lipidol. 2018 May-Jun;12(3):711-717. doi: 10.1016/j.jacl.2018.02.013. Epub 2018 Mar 1.
Patients with peripheral artery disease (PAD) are at very high risk of future cardiovascular (CV) events. Strict lipid-lowering therapy is recommended. However, data on target level attainment are scarce.
The objective of the study was to investigate guideline equitable lipid lowering in a large observational study of symptomatic PAD patients.
Single-center observational study including 1109 patients with symptomatic PAD planned for revascularization at a tertiary university center. Between 2010 and 2017, guideline target level attainment trends over time and the association of statin therapy with CV mortality were analyzed.
Atorvastatin (52.3%) and rosuvastatin (23.5%) were the most frequently prescribed statins and amounted to an average simvastatin equivalent of 52 mg/d. Attainment rates of low-density lipoprotein cholesterol (LDL-C) and of non-high-density lipoprotein cholesterol goals were as low as 27% and 33%, respectively. Although there was a significant improvement of LDL-C from 2010 to 2017 (mean LDL-C 110 vs 80 mg/dL, P < .0001 for trend), attainment remained poor, that is, only 42% in 2016 and 45% in 2017 achieved the <70 mg/dL goal. CV mortality was significantly lower (4% vs 11%, P < .01) in statin-treated patients over a median follow-up period of 50 ± 26 months.
There is a remarkable undertreatment of LDL-C and non-high-density lipoprotein cholesterol in patients with symptomatic PAD, although LDL-C decreased significantly from 2010 to 2017. As statin treatment was associated with a reduced CV mortality rate, our findings call for an increased awareness in clinical lipidology regarding symptomatic PAD patients.
外周动脉疾病（PAD）患者未来发生心血管（CV）事件的风险非常高。建议进行严格的降脂治疗。但是，达标数据非常有限。
本研究旨在调查一项针对有症状 PAD 患者的大型观察性研究中，指南建议的降脂治疗达标情况。
这是一项单中心观察性研究，纳入了计划在三级大学中心进行血运重建的 1109 例有症状 PAD 患者。2010 年至 2017 年期间，分析了指南目标水平达标趋势以及他汀类药物治疗与 CV 死亡率的关系。
阿托伐他汀（52.3%）和瑞舒伐他汀（23.5%）是最常开的他汀类药物，平均等效于每天 52mg 的辛伐他汀。低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白胆固醇目标的达标率分别低至 27%和 33%。尽管 LDL-C 从 2010 年到 2017 年有显著改善（平均 LDL-C 从 110 降至 80mg/dL，P<0.0001），但达标情况仍不理想，即只有 42%的患者在 2016 年和 45%的患者在 2017 年达到<70mg/dL 的目标。在中位随访 50±26 个月期间，他汀类药物治疗患者的 CV 死亡率显著降低（4%比 11%，P<0.01）。
尽管 LDL-C 从 2010 年到 2017 年显著下降，但有症状 PAD 患者的 LDL-C 和非高密度脂蛋白胆固醇治疗不足的情况仍然明显。由于他汀类药物治疗与 CV 死亡率降低相关，我们的研究结果呼吁临床脂质学界提高对有症状 PAD 患者的认识。
