Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong.
J Gastroenterol Hepatol. 2020 Feb;35(2):320-325. doi: 10.1111/jgh.14794. Epub 2019 Sep 12.
Nonalcoholic fatty liver disease (NAFLD) patients often have dyslipidemia, and optimal treatment of dyslipidemia lowers the risk of cardiovascular disease and mortality. Our aim was to study the prescription of statin and low-density lipoprotein cholesterol treatment targets in NAFLD patients.
Consecutive NAFLD patients attending five clinics in Asia were included in this study. The 10-year cardiovascular disease risk was calculated based on the Framingham Heart Study, and patients were categorized as moderate, high, or very high risk for cardiovascular disease on the basis of the American Association of Clinical Endocrinologist 2017 Guidelines. The low-density lipoprotein cholesterol treatment goal for each of the risk groups was 2.6, 2.6, and 1.8 mmol/L, respectively.
The data for 428 patients were analyzed (mean age 54.4 ± 11.1 years, 52.1% male). Dyslipidemia was seen in 60.5% (259/428), but only 43.2% (185/428) were on a statin. The percentage of patients who were at moderate, high, and very high risk for cardiovascular disease was 36.7% (157/428), 27.3% (117/428), and 36.0% (154/428), respectively. Among patients who were on a statin, 58.9% (109/185) did not achieve the treatment target. Among patients who were not on a statin, 74.1% (180/243) should be receiving statin therapy. The percentage of patients who were not treated to target or who should be on statin was highest among patients at very high risk for cardiovascular disease at 79.6% (78/98) or 94.6% (53/56), respectively.
This study highlights the suboptimal treatment of dyslipidemia and calls for action to improve the treatment of dyslipidemia in NAFLD patients.
非酒精性脂肪性肝病（NAFLD）患者常伴有血脂异常，血脂异常的最佳治疗可降低心血管疾病和死亡率的风险。我们的目的是研究 NAFLD 患者他汀类药物的处方和低密度脂蛋白胆固醇（LDL-C）治疗目标。
本研究纳入了亚洲五个诊所连续就诊的 NAFLD 患者。根据弗雷明汉心脏研究计算了 10 年心血管疾病风险，根据美国临床内分泌医师协会 2017 年指南，患者被分为心血管疾病中危、高危和极高危。对于每个风险组，LDL-C 的治疗目标分别为 2.6、2.6 和 1.8mmol/L。
共分析了 428 例患者的数据（平均年龄 54.4±11.1 岁，52.1%为男性）。60.5%（259/428）的患者存在血脂异常，但仅有 43.2%（185/428）接受了他汀类药物治疗。心血管疾病中危、高危和极高危的患者比例分别为 36.7%（157/428）、27.3%（117/428）和 36.0%（154/428）。在接受他汀类药物治疗的患者中，58.9%（109/185）未达到治疗目标。在未接受他汀类药物治疗的患者中，74.1%（180/243）应接受他汀类药物治疗。在心血管疾病极高危的患者中，未治疗或应接受他汀类药物治疗的患者比例最高，分别为 79.6%（78/98）和 94.6%（53/56）。
本研究强调了血脂异常治疗的不足，并呼吁采取行动改善 NAFLD 患者的血脂异常治疗。
