Duke Clinical Research Institute, Durham, North Carolina, USA.
Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Clin Cardiol. 2021 Jun;44(6):863-870. doi: 10.1002/clc.23625. Epub 2021 May 18.
Non-statin lipid lowering therapies (LLTs) provide additional treatment options for patients. Use patterns and patient perceptions of non-statin LLT remain incompletely described.
The guideline-recommended statin intensity remains underutilized in patients treated with and without non-statin LLT.
The PALM Registry collected LLT information on patients with or at risk of ASCVD treated at 125 US clinics in 2015. We compared patient perceptions, lipid levels and statin use among patients treated with and without non-statin LLT.
Among 7720 patients, 1930 (25.0%) were treated with a non-statin LLT (1249 fish oil, 417 fibrates, 329 ezetimibe, 196 niacin). Concurrent statin treatment occurred in 73.7%, of which 45.4% were dosed under the guideline-recommended intensity. Compared with patients on statin alone, patients receiving both a statin and non-statin LLT (n = 1423) were more likely to be male, white race and to perceive themselves as higher risk of ASCVD compared with their peers (38.5% vs. 34.9%, p = .047). Only 27.4% of patients treated with non-statin LLT alone perceived themselves at higher risk. Most (75.7%) patients treated with a non-statin LLT alone reported never being treated with a statin, despite ASCVD in 30.8% of these patients. Among those previously treated with a statin, 59.3% reported being willing to try a statin again.
Non-statin LLT is used in one in four patients with or at risk for ASCVD; its use is frequently in place of statin therapy or in the absence of guideline-recommended statin intensity. More work is needed to establish statins as first line therapy.
非他汀类降脂治疗（LLT）为患者提供了额外的治疗选择。然而，非他汀类 LLT 的使用模式和患者认知仍不完全清楚。
接受和未接受非他汀类 LLT 治疗的患者中，指南推荐的他汀类药物强度仍未得到充分利用。
PALM 登记处收集了 2015 年在美国 125 家诊所接受 ASCVD 治疗或有 ASCVD 风险的患者的 LLT 信息。我们比较了接受和未接受非他汀类 LLT 治疗的患者的患者认知、血脂水平和他汀类药物使用情况。
在 7720 名患者中，有 1930 名（25.0%）接受了非他汀类 LLT 治疗（1249 名鱼油、417 名贝特类、329 名依折麦布、196 名烟酸）。同时使用他汀类药物的患者占 73.7%，其中 45.4%的患者使用剂量低于指南推荐的强度。与单独使用他汀类药物的患者相比，同时使用他汀类药物和非他汀类 LLT 的患者（n=1423 名）更可能是男性、白种人，并且认为自己患 ASCVD 的风险高于同龄人（38.5%比 34.9%，p=0.047）。只有 27.4%单独使用非他汀类 LLT 的患者认为自己的风险更高。大多数（75.7%）单独使用非他汀类 LLT 的患者报告从未接受过他汀类药物治疗，尽管其中 30.8%的患者患有 ASCVD。在那些之前接受过他汀类药物治疗的患者中，有 59.3%的患者报告愿意再次尝试使用他汀类药物。
在有或有 ASCVD 风险的患者中，每四名患者中就有一名接受非他汀类 LLT 治疗；其使用频率通常是替代他汀类药物治疗或在没有指南推荐的他汀类药物强度的情况下使用。需要进一步努力将他汀类药物确立为一线治疗药物。
