Endocrinologie, Hospital Pitie-Salpetriere, 75013, Paris, France.
Health Economics, Amgen SAS, 92100, Boulogne-Billancourt, France.
Rev Cardiovasc Med. 2020 Dec 30;21(4):643-650. doi: 10.31083/j.rcm.2020.04.189.
Despite dyslipidaemia management guidelines, many patients do not reach low-density lipoprotein cholesterol targets due to insufficiently intensive regimens or lack of adherence to their medication. This was a retrospective cohort study on the Pharmacoepidemiologic General Research eXtension (PGRx)-acute coronary syndrome (ACS) registry. Patients included were ≥ 18 years old who suffered an ACS between 2013 and 2016, and treated with lipid-lowering therapy (LLT) at hospital discharge or within 92 days. Patients were followed up to 12 months' post index ACS, a new cardiovascular event, loss to follow-up or death. Treatment intensity (high, moderate and low intensity statins ± ezetimibe) and adherence (proportion of days covered > 80%) are described. A total of 2,695 patients were included; mean age [SD] was 63.1 [12.8] years, and 77% were men. High, moderate and low intensity statins were started in 56% (1,520), 36% (971), and 3% (86) of patients, respectively. A further 2% (46) were on statin/ezetimibe combination, 2% (42) on other LLT and 1% (30) on ezetimibe alone. At follow-up, around 70% of patients were adherent to LLT, with those on moderate intensity treatments showing better adherence (76%) than those on low (63%) or high (67%) intensity treatments. Despite guideline recommendations, many patients following an ACS are not treated with high intensity statins, and adherence remains far from optimal. Effort should be made to increase the proportion of patients treated with high intensity statins following an ACS and to further improve treatment adherence.
尽管有血脂异常管理指南，但由于治疗方案不够强化或患者不遵医嘱，许多患者仍无法达到低密度脂蛋白胆固醇目标。这是一项关于 Pharmacoepidemiologic General Research eXtension（PGRx）-急性冠脉综合征（ACS）登记处的回顾性队列研究。纳入的患者年龄≥18 岁，在 2013 年至 2016 年期间患有 ACS，并在出院时或 92 天内接受降脂治疗（LLT）。患者随访至 ACS 后 12 个月、新发心血管事件、失访或死亡。描述了治疗强度（高强度他汀类药物±依折麦布、中强度他汀类药物和低强度他汀类药物）和依从性（覆盖天数比例>80%）。共纳入 2695 例患者；平均年龄[标准差]为 63.1[12.8]岁，77%为男性。高强度、中强度和低强度他汀类药物分别在 56%（1520 例）、36%（971 例）和 3%（86 例）的患者中开始使用。另有 2%（46 例）接受他汀类药物/依折麦布联合治疗，2%（42 例）接受其他 LLT 治疗，1%（30 例）接受依折麦布单独治疗。在随访时，约 70%的患者依从 LLT 治疗，中强度治疗组的依从性（76%）优于低强度（63%）或高强度（67%）治疗组。尽管有指南建议，但许多 ACS 后患者并未接受高强度他汀类药物治疗，且依从性远非最佳。应努力增加 ACS 后接受高强度他汀类药物治疗的患者比例，并进一步提高治疗依从性。
