Dopheide Jörn F, Adam Luise, Wiedmer Sebastian, Kaspar Mathias, Silbernagel Günther, Baumgartner Iris, Drexel Heinz
Division for Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Internal Medicine, Division of Angiology, Medical University of Graz, Graz, Austria.
Curr Vasc Pharmacol. 2021;19(6):634-642. doi: 10.2174/1570161119666210111123621.
Patients with peripheral artery disease (PAD) fall under the category of a very high cardiovascular risk. Although consequent lipid-lowering therapy (LLT) is advised, only sparse data on attained target level in PAD exists.
We aimed to analyse contemporary guideline recommendations for LLT in symptomatic PAD patients.
A monocentric, prospective, observational study involving 200 symptomatic PAD patients was conducted. Guideline target level attainment and LLT were analysed between 2017 and 2019.
Overall, 78.5% of the patients were on statin therapy, mainly of high intensity, with atorvastatin in 50% and rosuvastatin in 33% of the cases. The average statin dosage adjusted for simvastatin was 55 mg/d. Low density lipoprotein-cholesterol (LDL-C) was <1.8 mmol/L in 53% and <1.4 mmol/L in 34% of the cases. Mean LDL-C levels were at 1.85 ± 0.88 mmol/L. We observed no difference in the treatment and the target level attainment of patients with a stable PAD (intermittent claudication) or chronic critical PAD. However, patients with ≥ 1 vascular region affected (i.e., coronary and/or cerebrovascular) were treated more intensively and had lower LDL-C levels than patients with PAD alone.
It appears that there are more awareness and improvement of previously documented undertreatment of LDL-C levels in symptomatic PAD patients. Although statin treatment is initiated in the majority of patients, our findings call for a continuously intensified LLT in symptomatic PAD patients.
外周动脉疾病（PAD）患者属于心血管风险非常高的类别。尽管建议进行相应的降脂治疗（LLT），但关于PAD患者达到目标水平的数据却很少。
我们旨在分析针对有症状PAD患者的LLT的当代指南建议。
进行了一项单中心、前瞻性、观察性研究，纳入200例有症状的PAD患者。分析了2017年至2019年间指南目标水平的达成情况和LLT情况。
总体而言，78.5%的患者接受他汀类药物治疗，主要是高强度治疗，50%的患者使用阿托伐他汀，33%的患者使用瑞舒伐他汀。以辛伐他汀调整后的平均他汀类药物剂量为55毫克/天。53%的病例中低密度脂蛋白胆固醇（LDL-C）<1.8毫摩尔/升，34%的病例中<1.4毫摩尔/升。平均LDL-C水平为1.85±0.88毫摩尔/升。我们观察到稳定型PAD（间歇性跛行）或慢性严重PAD患者在治疗和目标水平达成方面没有差异。然而，有≥1个血管区域受累（即冠状动脉和/或脑血管）的患者比单纯PAD患者接受了更强化的治疗，且LDL-C水平更低。
有症状的PAD患者中，之前记录的LDL-C水平治疗不足的情况似乎有了更多的认识和改善。尽管大多数患者开始了他汀类药物治疗，但我们的研究结果呼吁对有症状的PAD患者持续强化LLT。
