尽管他汀类药物控制了低密度脂蛋白胆固醇水平，但根据甘油三酯水平分层的极高动脉粥样硬化性心血管疾病风险患者中非高密度脂蛋白胆固醇目标的实现情况。
The Achievement of Non-high-density Lipoprotein Cholesterol Target in Patients with Very High Atherosclerotic Cardiovascular Disease Risk Stratified by Triglyceride Levels Despite Statin-controlled Low-density Lipoprotein Cholesterol.
作者信息
Al-Sabti Hilal, Al-Hinai Ali T, Al-Zakwani Ibrahim, Al-Hashmi Khamis, Al Mahmeed Wael, Arafah Mohamed, Shehab Abdullah, Al Tamimi Omer, Al Awadhi Mahmoud, Al Herz Shorook, Al Anazi Faisal, Al Nemer Khalid, Metwally Othman, Alkhadra Akram, Fakhry Mohammed, Elghetany Hossam, Medani Abdel Razak, Yusufali Afzal Hussein, Al Jassim Obaid, Al Hallaq Omar, Baslaib Fahad Omar Ahmed S, Amin Haitham, Al-Waili Khalid, Al-Rasadi Khalid
机构信息
Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.
Ministry of Health, Muscat, Oman.
出版信息
Oman Med J. 2022 Mar 22;37(2):e367. doi: 10.5001/omj.2022.79. eCollection 2022 Mar.
OBJECTIVES
We sought to estimate the percentage achievements of non-high-density lipoprotein cholesterol (non-HDL-C) target in patients with very high atheroscleroticcardiovascular diseases (ASCVD) risk stratified by triglyceride (TG) levels despite statin-controlled low-density lipoprotein cholesterol (LDL-C) in the Centralized Pan-Middle East Survey on the under treatment of hypercholesterolemia.
METHODS
The non-HDL-C target achievement in patients with diabetes mellites (DM) and patients with established ASCVD was defined according to European Society of Cardiology and European Atherosclerosis Society 2019 guidelines for managing dyslipidemia. Patients were stratified to controlled LDL-C defined as < 70 mg/dL (< 1.8 mmol/L) with normal TG < 150 mg/dL (< 1.7 mmol/L) and high TG between 150-400 mg/dL (1.7-4.5 mmol/L).
RESULTS
The mean age of our cohort was 58.0±11.0 years, 6.8% (n = 717) were male, 9.7% (104) were smokers, and 48.4% (n = 518) had body mass index of ≥ 30 kg/m. Those with high TG levels male (76.5% vs. 63.8%; < 0.001), smokers (16.1% vs. 7.7%; < 0.001), have metabolic syndrome (77.6% vs. 17.1%; < 0.001), and low HDL-C levels (79.2% vs. 49.4%; < 0.001). The majority (93.9%, n = 1008) were on statins (atorvastatin and rosuvastatin) with only 2.2% (n = 24) on the combined statins plus fenofibrate/gemfibrozil. Only 27.4% (n = 294) of patients had non-HDL-C goal attainment. Goal attainment rates in patients with diabetes (3.1% vs. 34,4%; < 0.001), coronary artery disease (CAD) (2.4% vs. 37.9%; < 0.001), diabetes plus CAD (0% vs. 40.0%; < 0.001), and CVD (0% vs. 30.0%; = 0.048) were significantly lower in those with higher TG levels.
CONCLUSIONS
A large proportion of statin-controlled LDL-C diabetic patients and patients with established ASCVD with high TGs did not achieve the non-HDL-C target. Our study did not demonstrate an association between ASCVD and high TG levels; and therefore, a follow-up study is highly required to assess long-term ASCVD outcomes in this cohort.
目的
在中东地区血脂异常治疗不足的集中调查中，我们试图评估极高动脉粥样硬化性心血管疾病（ASCVD）风险且甘油三酯（TG）水平分层的患者，在他汀类药物控制低密度脂蛋白胆固醇（LDL-C）的情况下，非高密度脂蛋白胆固醇（non-HDL-C）目标的达成率。
方法
糖尿病（DM）患者和已确诊ASCVD患者的非HDL-C目标达成情况，根据欧洲心脏病学会和欧洲动脉粥样硬化学会2019年血脂异常管理指南进行定义。患者被分层为LDL-C控制良好，即LDL-C<70mg/dL（<1.8mmol/L）且TG正常<150mg/dL（<1.7mmol/L），以及TG升高，范围在150 - 400mg/dL（1.7 - 4.5mmol/L）。
结果
我们队列的平均年龄为58.0±11.0岁，男性占6.8%（n = 717），吸烟者占9.7%（104），48.4%（n = 518）的体重指数≥30kg/m²。TG水平升高的患者中，男性比例更高（76.5%对63.8%；P<0.001），吸烟者比例更高（16.1%对7.7%；P<0.001），患有代谢综合征的比例更高（77.6%对17.1%；P<0.001），HDL-C水平更低（79.2%对49.4%；P<0.001）。大多数患者（93.9%，n = 1008）使用他汀类药物（阿托伐他汀和瑞舒伐他汀），只有2.2%（n = 24）使用他汀类药物联合非诺贝特/吉非贝齐。只有27.4%（n = 294）的患者达到了非HDL-C目标。TG水平较高的患者中，糖尿病患者（3.1%对34.4%；P<0.001）、冠状动脉疾病（CAD）患者（2.4%对37.9%；P<0.001）、糖尿病合并CAD患者（0%对40.0%；P<0.001）以及心血管疾病（CVD）患者（0%对30.0%；P = 0.048）的目标达成率显著更低。
结论
很大一部分他汀类药物控制LDL-C的糖尿病患者以及已确诊ASCVD且TG升高的患者未达到非HDL-C目标。我们的研究未显示ASCVD与高TG水平之间存在关联；因此，迫切需要进行一项后续研究，以评估该队列的长期ASCVD结局。
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