Medaffcon Oy, Espoo, Finland.
Amgen AB, Espoo, Finland.
Eur J Prev Cardiol. 2021 Jul 23;28(8):884-892. doi: 10.1177/2047487320904334.
The study evaluated the quality of cardiovascular prevention in real-world clinical practice. The recurrence of up to five cardiovascular events was assessed, as data on recurrence beyond the first event and interindividual variations in event rates past the second event have been sparse. Low-density lipoprotein cholesterol concentrations and lipid-lowering therapy use were investigated.
This retrospective register-based study included adult patients with an incident cardiovascular event between 2004 and 2016 treated in the hospital district of southwest Finland. Patients were followed for consecutive cardiovascular events or cardiovascular death, low-density lipoprotein cholesterol and statin purchases. The timing of event recurrence was evaluated, and predictive factors were assessed.
A wide interindividual variation in cardiovascular event recurrence was observed, each additional event caused an increased risk, the median time of recurrence decreased from 7 to one year for the second and fifth event. Event rates increased correspondingly from 12 to 43/100 patient-years and were most pronounced in the first years following the previous event. The low-density lipoprotein cholesterol goal (<1.8 mmol/l) was reached by 18% in the year after the event and statin underuse was associated with an increased risk of recurrence. Six months after the index event high intensity statins were used by only 22% of the cohort.
The study provides new perspectives on individual risk assessment showing that event rates are not stable for all patients but increase 1.2-1.9-fold per consecutive event. The underuse of statins and poor adherence support the identification of these patients for intensified multifactorial preventive measures.
本研究评估了真实临床实践中心血管预防的质量。评估了多达 5 次心血管事件的复发情况，因为关于首次事件后复发的数据以及第二次事件后个体间事件发生率的差异较为稀少。研究调查了低密度脂蛋白胆固醇浓度和降脂治疗的使用情况。
本回顾性基于登记的研究纳入了 2004 年至 2016 年期间在芬兰西南部医院区发生心血管事件的成年患者。对患者进行连续心血管事件或心血管死亡、低密度脂蛋白胆固醇和他汀类药物购买的随访。评估了事件复发的时间，并评估了预测因素。
观察到心血管事件复发存在广泛的个体间差异，每次额外的事件都会增加风险，复发的中位时间从第二次和第五次事件的 7 年缩短至 1 年。相应地，事件发生率从 12/100 患者年增加到 43/100 患者年，且在前次事件后最初几年最为显著。在事件发生后的一年内，18%的患者达到了低密度脂蛋白胆固醇目标(<1.8mmol/l)，而他汀类药物的使用不足与复发风险增加相关。在索引事件发生后的 6 个月，只有 22%的队列患者使用高强度他汀类药物。
本研究提供了个体风险评估的新视角，表明并非所有患者的事件发生率都稳定不变，而是每增加一次事件，风险增加 1.2-1.9 倍。他汀类药物的使用不足和较差的依从性支持对这些患者进行强化多因素预防措施的识别。
