Department of Public Health, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Lipids Health Dis. 2020 Apr 7;19(1):64. doi: 10.1186/s12944-020-01235-5.
Few recent large-scale studies have examined healthcare consumption associated with dyslipidemia in countries outside Western Europe and North America.
This analysis, from a cross-sectional observational study conducted in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America, evaluated avoidable healthcare consumption (defined as ≥1 hospitalization for cardiovascular reasons or ≥1 visit to the emergency room for any reason in the previous 12 months) in patients receiving stable lipid-lowering therapy (LLT). A total of 9049 patients (aged ≥18 years) receiving LLT for ≥3 months and who had had their low-density lipoprotein cholesterol (LDL-C) value measured on stable LLT in the previous 12 months were enrolled between August 2015 and August 2016. Patients who had received a proprotein convertase subtilisin/kexin type 9 inhibitor in the previous 6 months were excluded. Patients were stratified by cardiovascular risk level using the Systematic Coronary Risk Estimation chart for high-risk countries.
The proportion of patients at their LDL-C goal was 32.1% for very-high risk patients compared with 55.7 and 51.9% for patients at moderate and high cardiovascular risk, respectively. Overall, 20.1% of patients had ≥1 reported hospitalization in the previous 12 months (7.9% for cardiovascular reasons), 35.2% had ≥1 intensive care unit stay and 13.8% visited the emergency room. Avoidable healthcare resource consumption was reported for 18.7% patients overall, and in 27.8, 7.7, 7.7 and 13.2% of patients at very-high, high, moderate and low risk, respectively. Across all risk groups 22.4% of patients not at LDL-C goal and 16.6% of patients at LDL-C goal had avoidable healthcare resource consumption. Being at very-high cardiovascular risk, having cardiovascular risk factors (including hypertension and smoking), and having factors indicating that the patient may be difficult to treat (including statin intolerance, comorbidities and chronic medication), were independent risk factors for avoidable healthcare resource consumption (all p <0.05).
Healthcare resource consumption associated with adverse clinical outcomes was observed in patients on stable LLT in countries outside Western Europe and North America, particularly those at very-high cardiovascular risk and those who were difficult to treat.
在西欧和北美以外的国家，鲜有近期的大规模研究探讨血脂异常相关的医疗保健消费。
这项分析来自于在东欧、亚洲、非洲、中东和拉丁美洲的 18 个国家进行的一项横断面观察性研究，评估了正在接受稳定降脂治疗（LLT）的患者的可避免医疗保健消费（定义为过去 12 个月内因心血管原因住院治疗≥1 次或因任何原因急诊就诊≥1 次）。共纳入 9049 名年龄≥18 岁、接受 LLT 治疗≥3 个月且在过去 12 个月内稳定 LLT 期间 LDL-C 水平已被测量的患者。在过去 6 个月内接受过前蛋白转化酶枯草溶菌素/糜蛋白酶 9 抑制剂的患者被排除在外。根据高危国家的系统冠状动脉风险评估图表，按心血管风险水平对患者进行分层。
极高危患者的 LDL-C 达标率为 32.1%，而中危和高危患者的 LDL-C 达标率分别为 55.7%和 51.9%。总体而言，过去 12 个月内有 20.1%的患者报告住院治疗（心血管原因住院治疗 7.9%），35.2%有 ICU 入住，13.8%患者去了急诊室。总体而言，18.7%的患者存在可避免的医疗资源消耗，极高危、高危、中危和低危患者分别有 27.8%、7.7%、7.7%和 13.2%的患者存在可避免的医疗资源消耗。在所有风险组中，未达到 LDL-C 目标的患者中有 22.4%，达到 LDL-C 目标的患者中有 16.6%存在可避免的医疗资源消耗。极高心血管风险、存在心血管危险因素（包括高血压和吸烟）以及存在表明患者可能难以治疗的因素（包括他汀类药物不耐受、合并症和慢性用药）是可避免医疗资源消耗的独立危险因素（均 P<0.05）。
在西欧和北美以外的国家，正在接受稳定 LLT 的患者出现了与不良临床结局相关的医疗保健资源消耗，尤其是极高心血管风险患者和难以治疗的患者。
