美国成年人动脉粥样硬化性心血管疾病（ASCVD）患者低密度脂蛋白胆固醇（LDL-C）水平普遍降至<70mg/dL对复发事件数量的预计影响

The Projected Impact of Population-Wide Achievement of LDL Cholesterol <70 mg/dL on the Number of Recurrent Events Among US Adults with ASCVD.

作者信息

McKinley Emily C, Bittner Vera A, Brown Todd M, Chen Ligong, Exter Jason, Farkouh Michael E, Huang Lei, Jackson Elizabeth A, Levitan Emily B, Orroth Kate K, Reading Stephanie R, Rosenson Robert S, Safford Monika M, Woodward Mark, Muntner Paul, Colantonio Lisandro D

机构信息

Department of Epidemiology, University of Alabama at Birmingham, 1665 University Blvd, RPHB 523B, Birmingham, AL, 35233-0013, USA.

Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.

出版信息

Cardiovasc Drugs Ther. 2023 Feb;37(1):107-116. doi: 10.1007/s10557-021-07268-x. Epub 2021 Oct 2.

DOI:10.1007/s10557-021-07268-x

PMID:34599698

Abstract

PURPOSE

Adults with atherosclerotic cardiovascular disease (ASCVD) are recommended high-intensity statins, with those at very high risk for recurrent events recommended adding ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor if their low-density lipoprotein cholesterol (LDL-C) is ≥70 mg/dL. We estimated the number of recurrent ASCVD events potentially averted if all adults in the United States (US) ≥45 years of age with ASCVD achieved an LDL-C <70 mg/dL.

METHODS

The number of US adults with ASCVD and LDL-C ≥70 mg/dL was estimated from the National Health and Nutrition Examination Survey 2009-2016 (n = 596). The 10-year cumulative incidence of recurrent ASCVD events was estimated from the REasons for Geographic And Racial Differences in Stroke study (n = 5390), weighted to the US population by age, race, and sex. The ASCVD risk reduction by achieving an LDL-C <70 mg/dL was estimated from meta-analyses of lipid-lowering treatment trials.

RESULTS

Overall, 14.7 (95% CI, 13.7-15.8) million US adults had ASCVD, of whom 11.6 (95% CI, 10.6-12.5) million had LDL-C ≥70 mg/dL. The 10-year cumulative incidence of ASCVD events was 24.3% (95% CI, 23.2-25.6%). We projected that 2.823 (95% CI, 2.543-3.091) million ASCVD events would occur over 10 years among US adults with ASCVD and LDL-C ≥70 mg/dL. Overall, 0.634 (95% CI, 0.542-0.737) million ASCVD events could potentially be averted if all US adults with ASCVD achieved and maintained LDL-C <70 mg/dL.

CONCLUSION

A substantial number of recurrent ASCVD events could be averted over 10 years if all US adults with ASCVD achieved, and maintained, an LDL-C <70 mg/dL.

摘要

目的

对于患有动脉粥样硬化性心血管疾病（ASCVD）的成年人，推荐使用高强度他汀类药物；对于复发事件风险极高的患者，如果其低密度脂蛋白胆固醇（LDL-C）≥70mg/dL，则建议加用依折麦布和/或一种前蛋白转化酶枯草溶菌素/kexin 9型抑制剂。我们估计了如果美国所有年龄≥45岁的ASCVD成年人的LDL-C<70mg/dL，可能避免的ASCVD复发事件数量。

方法

根据2009 - 2016年美国国家健康与营养检查调查（n = 596）估计美国患有ASCVD且LDL-C≥70mg/dL的成年人数量。根据卒中地理和种族差异原因研究（n = 5390）估计ASCVD复发事件的10年累积发病率，并按年龄、种族和性别对美国人群进行加权。通过降脂治疗试验的荟萃分析估计将LDL-C降至<70mg/dL对ASCVD风险的降低作用。

结果

总体而言，1470（95%CI为1370 - 1580）万美国成年人患有ASCVD，其中1160（95%CI为1060 - 1250）万成年人的LDL-C≥70mg/dL。ASCVD事件的10年累积发病率为24.3%（95%CI为23.2% - 25.6%）。我们预计，在患有ASCVD且LDL-C≥70mg/dL的美国成年人中，10年内将发生282.3（95%CI为254.3 - 309.1）万例ASCVD事件。总体而言，如果所有患有ASCVD的美国成年人实现并维持LDL-C<70mg/dL，则可能避免63.4（95%CI为54.2 - 73.7）万例ASCVD事件。