波兰三级医疗中心急性冠脉综合征患者家族性高胆固醇血症的流行情况和管理：来自 TERCET 登记研究的结果，共纳入 19781 例个体。
The prevalence and management of familial hypercholesterolemia in patients with acute coronary syndrome in the Polish tertiary centre: Results from the TERCET registry with 19,781 individuals.
机构信息
3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland.
3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland.
出版信息
Atherosclerosis. 2019 Sep;288:33-41. doi: 10.1016/j.atherosclerosis.2019.06.899. Epub 2019 Jun 15.
BACKGROUND AND AIMS
The prevalence of familial hypercholesterolemia (FH) is high among patients with stable coronary artery disease (CAD). However, data on FH on admission among patients with acute coronary syndrome (ACS) are still relatively scarce. Therefore, we aimed to assess the prevalence, lipid-lowering therapy and short- and long-term outcomes in patients with FH among ACS patients.
METHODS AND RESULTS
The investigation was performed in a cohort of 19,781 consecutive patients from the TERCET Registry. There were 7319 patients admitted with ACS: 3085 due to STEMI, 2256 due to NSTEMI, and 1978 due to UA. The stable CAD group (n = 12,462) was considered the reference group. Based on the personal and familial history of premature cardiovascular disease and LDL cholesterol concentration, the Dutch Lipid Clinic Network (DLCN) algorithm was used for FH diagnosis. The overall occurrence of probable/definite FH and possible FH was 1.2% and 13.5% respectively. Among patients with ACS, 1.6% had probable/definite FH and 17.0% possible FH. The highest occurrence of FH was observed in the STEMI subgroup (20.6%). Patients with definite and probable FH had higher 30-day mortality than patients without FH (8.2% and 3.8% vs. 2.0%, respectively; p = 0.0052). No significant differences were observed between the FH groups in the 12-, 36- and 60-month follow-up. Propensity-score matching analysis showed that definite/probable FH patients had significantly higher all-cause mortality at 36- and 60-month follow-up in comparison to non-FH subjects (11.4% vs. 4.8% and 19.2% vs. 7.2%, respectively; p ≤ 0.021 for both).
CONCLUSIONS
The prevalence of FH according to the DLCN criteria in the Polish very high-risk population is significantly higher in patients with ACS than in patients with sCAD. FH is a cause of increased all-cause mortality in the long-term follow-up.
背景和目的
在稳定型冠心病（CAD）患者中，家族性高胆固醇血症（FH）的患病率较高。然而，关于急性冠状动脉综合征（ACS）患者入院时 FH 的数据仍然相对较少。因此，我们旨在评估 ACS 患者中 FH 的患病率、降脂治疗以及短期和长期结局。
方法和结果
本研究在 TERCET 注册研究的 19781 例连续患者队列中进行。有 7319 例患者因 ACS 入院：3085 例因 STEMI，2256 例因 NSTEMI，1978 例因 UA。稳定型 CAD 组（n=12462）被视为参考组。根据早发性心血管疾病的个人和家族史以及 LDL 胆固醇浓度，使用荷兰血脂诊所网络（DLCN）算法诊断 FH。可能/确定 FH 和可能 FH 的总体发生率分别为 1.2%和 13.5%。在 ACS 患者中，1.6%有可能/确定 FH，17.0%可能有 FH。FH 发生率最高的是 STEMI 亚组（20.6%）。与无 FH 的患者相比，有确定和可能 FH 的患者 30 天死亡率更高（8.2%和 3.8% vs. 2.0%；p=0.0052）。在 12、36 和 60 个月的随访中，FH 组之间没有观察到显著差异。倾向评分匹配分析显示，与非 FH 患者相比，确定/可能 FH 患者在 36 和 60 个月的随访中全因死亡率显著更高（11.4% vs. 4.8%和 19.2% vs. 7.2%；p≤0.021）。
结论
根据 DLCN 标准，在波兰极高危人群中，ACS 患者 FH 的患病率明显高于 sCAD 患者。FH 是长期随访中全因死亡率增加的一个原因。
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