根据 2016 年和 2019 年欧洲心脏病学会/欧洲动脉粥样硬化学会急性心肌梗死二级预防血脂异常指南评估低密度脂蛋白胆固醇达标率。

Evaluation of Low-density Lipoprotein Cholesterol Target Attainment Rates According to the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society Dyslipidemia Guidelines for Secondary Prevention in Patients with Acute Myocardial Infarction.

机构信息

Department of Cardiology, Health Sciences University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey.

Department of Cardiology, Başakşehir Çam and Sakura Training and Research Hospital, Istanbul, Turkey.

出版信息

Rev Invest Clin. 2021 Nov 5;73(3):371-378. doi: 10.24875/RIC.21000152.

DOI:10.24875/RIC.21000152

PMID:34098569

Abstract

BACKGROUND

High-intensity statin (HIS) therapy is widely recommended for secondary prevention after an acute myocardial infarction (AMI). The 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidemia guidelines have lowered the target low-density lipoprotein cholesterol (LDL-C) level, which necessitates a more frequent use of nonstatin therapies.

OBJECTIVES

The objectives of the study were to investigate the rate of LDL-C target attainment for secondary prevention in AMI patients.

METHODS

This retrospective investigation included 1360 patients diagnosed with AMI in a tertiary heart center. Lipid parameters were collected within 24 h of admission and within 1 year after discharge. The medications used were retrieved from medical records, and the lowest LDL-C levels after statin treatment were used to assess the effectiveness of the therapy. LDL-C target attainment was defined according to the 2016 ESC/EAS dyslipidemia guidelines as an LDL-C level of < 70 mg/dL and a ≥ 50% reduction from baseline. In addition, the rate of LDL-C target attainment according to the 2019 fromESC/EAS guidelines was defined as an LDL-C level of < 55 mg/dL and a ≥ 50% reduction baseline.

RESULTS

In total, 502 (36.9%) and 247 (18.2%) patients reached the LDL-C targets according to the 2016 and 2019 ESC/EAS guidelines, respectively. The admission LDL-C levels were significantly lower and HIS treatment was used more frequently in patients who subsequently attained the LDL-C goal. Remarkably, 461 (34%) patients failed to reach the LDL-C goals despite HIS treatment. Only 27 (1.9%) patients were prescribed ezetimibe.

CONCLUSION

The rate of LDL-C goal attainment in AMI patients was low, which indicates the need for combination statin and non-statin lipid-lowering therapies.

摘要

背景

高强度他汀类药物（HIS）治疗被广泛推荐用于急性心肌梗死（AMI）后的二级预防。2019 年欧洲心脏病学会（ESC）/欧洲动脉粥样硬化学会（EAS）血脂异常指南降低了低密度脂蛋白胆固醇（LDL-C）的目标水平，这需要更频繁地使用非他汀类药物治疗。

目的

本研究旨在调查 AMI 患者二级预防中 LDL-C 目标达标率。

方法

本回顾性研究纳入了一家三级心脏中心诊断为 AMI 的 1360 例患者。在入院 24 小时内和出院后 1 年内收集血脂参数。从病历中检索使用的药物，并使用他汀类药物治疗后的最低 LDL-C 水平来评估治疗效果。根据 2016 年 ESC/EAS 血脂异常指南，LDL-C 目标达标定义为 LDL-C 水平<70mg/dL，且较基线降低≥50%。此外，根据 2019 年 ESC/EAS 指南，LDL-C 目标达标率定义为 LDL-C 水平<55mg/dL，且较基线降低≥50%。

结果

根据 2016 年和 2019 年 ESC/EAS 指南，分别有 502 例（36.9%）和 247 例（18.2%）患者达到 LDL-C 目标。在随后达到 LDL-C 目标的患者中，入院时 LDL-C 水平显著降低，且更频繁地使用 HIS 治疗。值得注意的是，尽管使用了 HIS 治疗，但仍有 461 例（34%）患者未能达到 LDL-C 目标。仅有 27 例（1.9%）患者处方了依折麦布。