University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland.
Health Centre of Jyväskylä Cooperation Area, Jyväskylä, Finland.
BMC Fam Pract. 2020 Apr 14;21(1):62. doi: 10.1186/s12875-020-01138-5.
In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control.
In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting.
More than half (54% of women and 53% of men) of untreated patients did not meet the LDL-C target of < 3 mmol/l and one third (35% of women and 33% of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p < 0.001) and lower LDL-C level (p < 0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p < 0.001). In total, about half of the patients were on LLM (53% of women and 51% of men).
Our findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.
在高血压患者中，降低血浆低密度脂蛋白胆固醇（LDL-C）水平是预防慢性心血管疾病（CVD）的主要干预措施之一。然而，LDL-C 的控制总体上仍然不足，即使在高血压患者中也是如此。我们分析了 7117 例高血压患者的电子健康记录（EHR）数据，以找到在现实生活中血脂异常治疗中最需要改善的最具潜力的年龄和性别亚组。考虑到目前对终生 CVD 风险的讨论，我们重点关注 LDL-C 控制的年龄依赖性。
在这项观察性横断面研究中，我们基于常规电子健康记录（EHR）数据，调查了芬兰初级保健环境中年龄在 30 岁或以上、无肾功能障碍或 CVD 的非糖尿病高血压患者的 LDL-C 控制情况。
超过一半（女性 54%，男性 53%）未经治疗的患者未达到 LDL-C 目标<3mmol/l，三分之一（女性 35%，男性 33%）的患者即使使用降脂药物（LLM）也未达到目标。此外，无论是否使用 LLM，较高的年龄与更好的 LDL-C 控制（p<0.001）和较低的 LDL-C 水平（p<0.001）强烈相关。较高的年龄也与 LLM 处方强烈相关（p<0.001）。总的来说，大约一半的患者服用 LLM（女性 53%，男性 51%）。
我们的研究结果表明，芬兰初级保健高血压患者的血脂异常治疗总体上不足，特别是在年轻年龄组中，随着时间的推移，他们可能从 CVD 风险降低中获益最大。临床医生在治疗处于工作年龄的高血压患者时，可能应该更多地依赖 CVD 的终生风险。
