Division of Cardiovascular Medicine, Department of Medicine. Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Cardiovascular Medicine Division, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.
Heart Lung Circ. 2020 Mar;29(3):405-413. doi: 10.1016/j.hlc.2019.02.193. Epub 2019 Mar 28.
Patients suffering an acute coronary syndrome (ACS) are at increased risk for future cardiovascular events. Effective management of hyperlipidaemia in such patients is essential. We aimed to document the use of lipid-lowering therapy (LLT) and low-density lipoprotein cholesterol (LDL-C) target achievement in patients hospitalised with an ACS in Thailand.
The Dyslipidemia International Study (DYSIS) II was a multinational, observational study that enrolled patients over 18 years of age who were hospitalised with an ACS in 2013-2014 and survived until discharge. Patients were analysed according to whether or not they were treated with LLT prior to hospital admission. A lipid profile was carried forward from blood taken within the first 24 hours after admission, and attainment of the LDL-C target of <70 mg/dL (1.8 mmol/L) for very high-risk subjects was reported. Details of LLTs were collected. Lipid levels, LLT use and cardiovascular events since discharge were collected at a follow-up interview 4 months later.
A total of 320 ACS patients were enrolled from seven sites across Thailand, 188 (58.8%) of whom were being treated with LLT prior to the acute event. The mean LDL-C levels of the LLT and no LLT patients were 106.2 ± 39.4 mg/dL (2.75 ± 1.02 mmol/L) and 139.8 ± 46.6 mg/dL (3.62 ± 1.21), respectively, with 15.4% and 4.5% having an LDL-C level below 70 mg/dL (1.8 mmol/L). Lipid-lowering therapy consisted mainly of statins, with an atorvastatin-equivalent daily dosage of 17 ± 13 mg/day. At the 4-month follow-up, LDL-C target attainment remained low at 26.7% for the initial LLT group and 24.1% for the no LLT group. Although most patients were being treated with LLT at this point, the dosage was still low (28 ± 16 mg/day) and there was little use of combination therapy.
In this cohort of Thai ACS patients, LDL-C levels were highly elevated, placing them at extreme risk of recurrent adverse cardiovascular events. Lipid-lowering therapy was widely used after the ACS; however, treatment was rarely optimised. Huge improvements are required in the management of hyperlipidaemia in Thailand.
患有急性冠状动脉综合征（ACS）的患者未来发生心血管事件的风险增加。有效管理此类患者的血脂异常至关重要。我们旨在记录在泰国因 ACS 住院的患者中降脂治疗（LLT）的使用情况和低密度脂蛋白胆固醇（LDL-C）目标达标情况。
血脂异常国际研究（DYSIS）II 是一项多中心观察性研究，纳入了 2013-2014 年期间因 ACS 住院且存活至出院的年龄大于 18 岁的患者。根据患者入院前是否接受 LLT 治疗进行分析。在入院后 24 小时内采集的首次血液样本中进行血脂检测，并报告极高危患者 LDL-C 目标值<70mg/dL（1.8mmol/L）的达标情况。收集 LLT 的详细信息。在 4 个月后的随访中，收集出院后的血脂水平、LLT 使用情况和心血管事件。
从泰国的 7 个地点共纳入 320 例 ACS 患者，其中 188 例（58.8%）在急性事件前接受 LLT 治疗。LLT 组和无 LLT 组的 LDL-C 水平分别为 106.2±39.4mg/dL（2.75±1.02mmol/L）和 139.8±46.6mg/dL（3.62±1.21mmol/L），分别有 15.4%和 4.5%的患者 LDL-C 水平<70mg/dL（1.8mmol/L）。降脂治疗主要采用他汀类药物，阿托伐他汀等效日剂量为 17±13mg/天。在 4 个月的随访中，初始 LLT 组 LDL-C 目标达标率仍较低，为 26.7%，无 LLT 组为 24.1%。尽管大多数患者此时正在接受 LLT 治疗，但剂量仍然较低（28±16mg/天），且联合治疗的应用较少。
在本队列中，泰国 ACS 患者的 LDL-C 水平显著升高，使他们处于复发不良心血管事件的极高风险中。ACS 后降脂治疗广泛应用，但治疗很少优化。泰国在高脂血症的管理方面需要有巨大的改善。
