Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
IRCCS Neuromed, Pozzilli, IS, Italy.
Atherosclerosis. 2019 Jun;285:40-48. doi: 10.1016/j.atherosclerosis.2019.03.017. Epub 2019 Apr 8.
Target and intensity of low-density lipoprotein cholesterol (LDL-C) lowering therapy should be tailored according to the individual global cardiovascular (CV) risk. We aimed at retrospectively evaluating real-life LDL-C goal attainment and predictive factors for predefined LDL-C therapeutic goals both in primary and secondary prevention.
We collected data from a large cohort of outpatients aged 40-65 years, followed by general practitioners, cardiologists and diabetologists in Italy. All data were centrally analysed for global CV risk assessment and rates of control of major CV risk factors, including LDL-C. Study population was stratified according to the presence or absence of previous CV events, including coronary artery disease (CAD), peripheral artery disease (PAD) or stroke/TIA. CV risk profile characterization was based on the European SCORE. Predefined therapeutic goals were set according to the European guidelines on dyslipidaemia: LDL-C levels <70 mg/dl for very high CV risk patients in primary prevention and for those in secondary prevention; <100 mg/dl LDL-C levels for high CV risk patients in primary prevention. Logistic regression analysis with clinical covariates was used to identify predictive factors for achieving these goals; lipid lowering therapy entered in the analysis as continuous (model 1) or categorical variable (model 2).
We included 4,142 outpatients (43,7% female, age 58.0 ± 5.2 years, BMI 28.5 ± 5.0 kg/m) among whom 2,964 (71.6%) in primary and 1,178 (28.4%) in secondary prevention. In primary prevention, none of the patients at very high CV risk had LDL-C <70 mg/dl and 8.9% of patients at high CV risk showed LDL-C <100 mg/dl. Only 5.8% of patients in secondary prevention had LDL-C levels <70 mg/dl, specifically 6.5% of patients with CAD, 2.6% of patients with PAD and 4.7% of patients with CVD (p < 0.001). Beyond diabetes and lipid lowering therapy, high risk SCORE estimation resulted a strong and independent predictor for the lack of achieving all predefined therapeutic targets, including LDL-C <100 mg/dl [OR: 0.806 (0.751-0.865)); p < 0.001], and LDL-C <70 mg/dl [OR: 0.712 (0-576-0.880); p = 0.002], in primary prevention.
Despite high or very high SCORE risk and use of lipid lowering therapies, we observed poor achievement of LDL-C targets in this large cohort of outpatients followed in a setting of real practice in Italy.
根据个体的总体心血管（CV）风险，应调整低密度脂蛋白胆固醇（LDL-C）降低治疗的目标和强度。我们旨在回顾性评估初级和二级预防中真实世界的 LDL-C 目标达标情况以及预设 LDL-C 治疗目标的预测因素。
我们从意大利的一个由全科医生、心脏病专家和糖尿病专家随访的大型门诊患者队列中收集数据。所有数据均经过中心分析，以评估全球 CV 风险并评估主要 CV 危险因素（包括 LDL-C）的控制率。根据是否存在先前的 CV 事件（包括冠状动脉疾病（CAD）、外周动脉疾病（PAD）或中风/TIA）对研究人群进行分层。CV 风险特征基于欧洲 SCORE。根据欧洲血脂异常指南设定了预设的治疗目标：初级预防中极高 CV 风险患者的 LDL-C 水平<70mg/dl，以及二级预防中极高 CV 风险患者的 LDL-C 水平<100mg/dl；初级预防中高 CV 风险患者的 LDL-C 水平<100mg/dl。使用具有临床协变量的逻辑回归分析来确定实现这些目标的预测因素；将降脂治疗作为连续（模型 1）或分类变量（模型 2）纳入分析。
我们纳入了 4142 名门诊患者（43.7%为女性，年龄 58.0±5.2 岁，BMI 28.5±5.0kg/m），其中 2964 名（71.6%）为初级预防患者，1178 名（28.4%）为二级预防患者。在初级预防中，没有任何极高 CV 风险患者的 LDL-C<70mg/dl，只有 8.9%的高 CV 风险患者 LDL-C<100mg/dl。只有 5.8%的二级预防患者的 LDL-C 水平<70mg/dl，具体来说，CAD 患者的 6.5%，PAD 患者的 2.6%，CVD 患者的 4.7%（p<0.001）。除糖尿病和降脂治疗外，高风险 SCORE 估计也是未能实现所有预设治疗目标（包括 LDL-C<100mg/dl 和 LDL-C<70mg/dl）的一个强有力且独立的预测因素，包括 LDL-C<100mg/dl [OR：0.806（0.751-0.865））；p<0.001]和 LDL-C<70mg/dl [OR：0.712（0-576-0.880））；p=0.002]，在初级预防中。
尽管存在高或极高的 SCORE 风险和使用降脂治疗，但我们在意大利真实实践环境中观察到，该大型门诊患者队列中 LDL-C 目标的达标情况不佳。
