School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Curr Probl Cardiol. 2022 Jul;47(7):101068. doi: 10.1016/j.cpcardiol.2021.101068. Epub 2021 Nov 21.
Little is known about the attainment of low-density lipoprotein cholesterol (LDL-C) targets in patients treated with statins in Australian primary healthcare setting that are at increased risk of cardiovascular disease. A retrospective cohort study was conducted using data from electronic medical records of patients treated by general practitioners across Australia. LDL-C target attainment was defined as LDL-C levels ≤ 2 mmol/L for all risk groups, in line with Australian guidelines. Multivariable logistic regression was used to identify the factors associated with LDL-C target attainment. Overall, 61,407 patients were included in the analysis. The mean age was 65 years (± standard deviation [SD] 12.1); 52.0% were males.. Overall, the median LDL-C level was 2.3 mmol/L (IQR = 1.8 - 2.8) and 36.0% of the study population met therapeutic targets. Increased likelihood to achieve LDL-C targets was observed in patients diagnosed with type 2 diabetes (OR 2.07, 95% CI 1.92 - 2.24), stroke (OR = 1.58, 95% CI 1.39 - 1.79, P < 0.001) or chronic heart disease (OR = 1.67, 95% CI 1.55 - 1.81, P < 0.001). Patients diagnosed with dyslipidemia (OR = 0.59, 95% CI 0.55 - 0.64, P < 0.001), hypertension (OR = 0.91, 95% CI 0.83 - 1.00, P < 0.05) and current smokers (OR = 0.71, 95% CI 0.71 - 1.00, P < 0.05), were less likely to attain LDL-C targets, regardless of the type, intensity and length of use of the prescribed statin. Longer duration and higher intensity statin were associated with more patients achieving targeted LDL-C goal, however nearly two thirds of Australians still failed to achieve targeted outcome even after 24 months of statin therapy.
在澳大利亚初级医疗保健环境中，接受他汀类药物治疗的心血管疾病高危患者的低密度脂蛋白胆固醇 (LDL-C) 目标达标情况知之甚少。本研究使用来自澳大利亚全科医生治疗的患者电子病历中的数据进行了回顾性队列研究。LDL-C 目标达标定义为所有风险组的 LDL-C 水平≤2mmol/L，符合澳大利亚指南。多变量逻辑回归用于确定与 LDL-C 目标达标相关的因素。总体而言，有 61407 名患者纳入分析。平均年龄为 65 岁（±标准差 [SD] 12.1）；52.0%为男性。总体而言，中位数 LDL-C 水平为 2.3mmol/L（IQR=1.8-2.8），研究人群中有 36.0%达到治疗目标。患有 2 型糖尿病（OR 2.07，95%CI 1.92-2.24）、中风（OR=1.58，95%CI 1.39-1.79，P<0.001）或慢性心脏病（OR=1.67，95%CI 1.55-1.81，P<0.001）的患者更有可能达到 LDL-C 目标。诊断为血脂异常（OR=0.59，95%CI 0.55-0.64，P<0.001）、高血压（OR=0.91，95%CI 0.83-1.00，P<0.05）和当前吸烟者（OR=0.71，95%CI 0.71-1.00，P<0.05）的患者不太可能达到 LDL-C 目标，无论所开他汀类药物的类型、强度和使用时间如何。他汀类药物的使用时间更长、强度更高与更多患者达到目标 LDL-C 相关，但即使在开始他汀类药物治疗 24 个月后，仍有近三分之二的澳大利亚人未能达到目标结果。
