Medlior Health Outcomes Research Ltd, Calgary, Alberta, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Medlior Health Outcomes Research Ltd, Calgary, Alberta, Canada.
Can J Cardiol. 2019 Jul;35(7):884-891. doi: 10.1016/j.cjca.2019.04.008.
Low-density lipoprotein cholesterol (LDL-C) is an important indicator in the development and management of atherosclerotic cardiovascular disease (ASCVD). Herein, we describe the management of LDL-C with lipid-lowering therapy, among patients diagnosed with clinical ASCVD in Alberta, Canada.
A retrospective study was conducted by linking multiple health system databases to examine clinical characteristics, treatments, and LDL-C assessments. Patients with ASCVD were identified using a specific case definition on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification/International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada codes between 2011 and 2015. LDL-C was assessed at the first measurement (index test) and second measurement (follow-up test) during the study period. LDL-C levels were evaluated on the basis of the 2016 Canadian Cardiovascular Society guideline recommendations for achieving < 2.0 mmol/L or a 50% reduction. Statin therapies were categorized as low-, moderate-, and high-intensity.
Among the 281,665 individuals identified with ASCVD during the study period, 219,488 (77.9%) had an index LDL-C test, whereas 120,906 (55.1%) and 144,607 (65.9%) were prescribed lipid-lowering therapy before and after their index test, respectively. Most patients who received any lipid-lowering therapy were receiving moderate-/high-intensity statins (n = 133,029; 60.6%). Among the study cohort who had 2 LDL-C tests (n = 91,841; 32.6%), 48.5% of patients who received any lipid-lowering therapy did not achieve LDL-C levels < 2.0 at index date, whereas 36.6% did not achieve LDL-C levels < 2.0 or a 50% reduction at the follow-up test.
The current study revealed that only two-thirds of patients with ASCVD were receiving pharmacotherapy and of those, a significant proportion did not reach recommended LDL-C levels. A remarkable treatment gap was identified for at-risk ASCVD patients. Further implementation strategies are required to address this undermanagement.
低密度脂蛋白胆固醇（LDL-C）是动脉粥样硬化性心血管疾病（ASCVD）发展和管理的重要指标。在此，我们描述了加拿大艾伯塔省临床 ASCVD 患者的降脂治疗中 LDL-C 的管理。
通过链接多个健康系统数据库进行回顾性研究，以检查临床特征、治疗和 LDL-C 评估。在 2011 年至 2015 年期间，基于国际疾病分类，第九修订版，临床修正/国际疾病分类和相关健康问题，第十版，加拿大代码，使用特定的病例定义确定 ASCVD 患者。在研究期间，在第一次测量（索引测试）和第二次测量（随访测试）时评估 LDL-C。根据 2016 年加拿大心血管学会指南建议，评估 LDL-C 水平<2.0mmol/L 或降低 50%。他汀类药物治疗分为低、中、高强度。
在研究期间确定的 281665 例 ASCVD 患者中，219488 例（77.9%）进行了 LDL-C 指数测试，而在索引测试之前和之后，分别有 120906 例（55.1%）和 144607 例（65.9%）接受了降脂治疗。大多数接受任何降脂治疗的患者均接受中/高强度他汀类药物治疗（n=133029；60.6%）。在进行了 2 次 LDL-C 测试的研究队列中（n=91841；32.6%），在接受任何降脂治疗的患者中，48.5%的患者在索引日期未达到 LDL-C 水平<2.0mmol/L，而 36.6%的患者在随访测试中未达到 LDL-C 水平<2.0mmol/L 或降低 50%。
本研究显示，只有三分之二的 ASCVD 患者接受药物治疗，其中相当一部分患者未达到推荐的 LDL-C 水平。高危 ASCVD 患者存在显著的治疗差距。需要进一步实施策略来解决这种管理不足的问题。
