Xing Y Y, Liu J, Liu J, Hao Y C, Yang N, Zhou M G, Zhao D
Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2019 May 24;47(5):351-359. doi: 10.3760/cma.j.issn.0253-3758.2019.05.005.
To assess the use of statins and low-density lipoprotein cholesterol (LDL-C) levels at admission in hospitalized patients aged 75 years and older with acute coronary syndrome (ACS) in China. Data used in this study derived from the Improving Care for Cardiovascular Disease in China (CCC)-ACS project, a nationwide registry with 150 tertiary hospitals reporting details of clinical information of ACS patients. This study enrolled patients 75 years and older with ACS in CCC-ACS project from November 2014 to June 2017. Patients were divided into two groups according to the history of atherosclerotic cardiovascular disease (ASCVD). Pre-hospital statin use, LDL-C levels at admission and prescription of statins at discharge were reported. A total of 10 899 patients 75 years and older with ACS were enrolled. The median age was 79 years and 58.7% (6 397 cases) were male. Among patients with history of ASCVD, 33.9% (1 028 cases) of them received statins before hospitalization. Among patients without history of ASCVD, 12.7% (996/7 871) received statins before hospitalization. The mean level of LDL-C was (2.4±0.9) mmol/L and LDL-C was <1.8 mmol/L in 24.7% (747 cases) of patients with history of ASCVD. The mean level of LDL-C was (2.6±0.9) mmol/L and LDL-C was <2.6 mmol/L in 51.7% (4 072 cases) of patients without history of ASCVD. At discharge, 91.2% (9 524/10 488) of patients were prescribed with statins in patients without contraindications for statin. In elderly patients with recurrent ASCVD, there was an inadequate statin use before hospitalization and most patients did not reach the LDL-C target level when they had the recurrent events. In the elderly ACS patients without history of ASCVD, more than half of the patients had an ideal LDL-C level. It seems that ideal LDL-C level for primary prevention of ACS in elderly people needs to be reevaluated with further studies.
评估中国75岁及以上急性冠状动脉综合征(ACS)住院患者入院时他汀类药物的使用情况及低密度脂蛋白胆固醇(LDL-C)水平。本研究使用的数据来自中国心血管疾病医疗质量改善项目(CCC-ACS),这是一项全国性登记研究,有150家三级医院报告ACS患者的临床信息细节。本研究纳入了2014年11月至2017年6月期间CCC-ACS项目中75岁及以上的ACS患者。根据动脉粥样硬化性心血管疾病(ASCVD)病史将患者分为两组。报告了院前他汀类药物的使用情况、入院时的LDL-C水平以及出院时他汀类药物的处方情况。共纳入10899例75岁及以上的ACS患者。中位年龄为79岁,男性占58.7%(6397例)。在有ASCVD病史的患者中,33.9%(1028例)在住院前接受了他汀类药物治疗。在无ASCVD病史的患者中,12.7%(996/7871)在住院前接受了他汀类药物治疗。有ASCVD病史的患者中,LDL-C平均水平为(2.4±0.9)mmol/L,24.7%(747例)的患者LDL-C<1.8 mmol/L。无ASCVD病史的患者中,LDL-C平均水平为(2.6±0.9)mmol/L,51.7%(4072例)的患者LDL-C<2.6 mmol/L。在无他汀类药物禁忌证的患者中,出院时91.2%(9524/10488)的患者被处方了他汀类药物。在老年复发性ASCVD患者中,住院前他汀类药物使用不足,且大多数患者在复发时未达到LDL-C目标水平。在无ASCVD病史的老年ACS患者中,超过一半的患者LDL-C水平理想。似乎老年人ACS一级预防的理想LDL-C水平需要通过进一步研究重新评估。