Outcomes Insights Inc, Agoura Hills, California, USA
Health Economics and Outcomes Research, Amgen Europe GmbH, Rotkreuz, Switzerland.
BMJ Open. 2022 Apr 29;12(4):e055015. doi: 10.1136/bmjopen-2021-055015.
To compare treatment patterns, risk factors and cardiovascular disease (CVD) event rates in the UK from 2008 to 2017.
Retrospective cohort study using the Clinical Practice Research Datalink.
UK primary care.
We selected 10 annual cohorts of patients with documented CVD receiving lipid-lowering therapy and the subsets with myocardial infarction (MI). Each cohort included patients ≥18 years old, with ≥1 year of medical history and ≥2 lipid-lowering therapy prescriptions in the prior year.
For each annual cohort, we identified cardiovascular risk factors and lipid-lowering therapy and estimated the 1-year composite rate of fatal and non-fatal MI, ischaemic stroke (IS) or revascularisation.
The documented CVD cohort mean age was 71.6 years in 2008 (N=173 424) and 72.5 (N=94 418) in 2017; in the MI subset, mean age was 70.1 years in 2008 (N=38 999) and 70.4 in 2017 (N=25 900). Both populations had larger proportions of men. In the documented CVD cohort, the proportion receiving high-intensity lipid-lowering therapy from 2008 to 2017 doubled from 16% to 32%; in the MI subset, the increase was 20% to 48%. In the documented CVD cohort, the proportion of patients with low-density lipoprotein cholesterol (LDL-C) <1.8 mmol/L increased from 28% to 38%; in the MI subset, the proportion with LDL-C <1.8 mmol/L increased from 32% to 42%. The composite event rate per 100 person-years declined over time, from 2.5 to 2.0 in the documented CVD cohort, and from 3.7 to 2.8 in the MI subset. After excluding revascularisation from the composite outcome, the decline in the event rate in both populations was substantially attenuated.
Despite an increase in high-intensity therapy use and a decline in revascularisation, more than half of patients did not receive high-intensity lipid-lowering therapy by 2017 and incidence rates of MI and IS remained virtually unchanged.
比较 2008 年至 2017 年英国的治疗模式、风险因素和心血管疾病 (CVD) 事件发生率。
使用临床实践研究数据链接的回顾性队列研究。
英国初级保健。
我们选择了 10 个每年记录 CVD 患者的队列，这些患者正在接受降脂治疗，并且是心肌梗死 (MI) 的亚组。每个队列都包括年龄≥18 岁、有≥1 年病史且在前一年至少有 2 次降脂治疗处方的患者。
对于每个年度队列，我们确定了心血管危险因素和降脂治疗，并估计了 1 年内致命和非致命性 MI、缺血性中风 (IS) 或血运重建的复合发生率。
2008 年（N=173424）和 2017 年（N=94418）记录 CVD 患者队列的平均年龄分别为 71.6 岁和 72.5 岁；在 MI 亚组中，2008 年（N=38999）和 2017 年（N=25900）的平均年龄分别为 70.1 岁和 70.4 岁。两个群体的男性比例都较大。在记录 CVD 的队列中，高强度降脂治疗的比例从 2008 年到 2017 年增加了一倍，从 16%增加到 32%；在 MI 亚组中，该比例增加了 20%至 48%。在记录 CVD 的队列中，低密度脂蛋白胆固醇 (LDL-C) <1.8mmol/L 的患者比例从 28%增加到 38%；在 MI 亚组中，LDL-C <1.8mmol/L 的患者比例从 32%增加到 42%。每 100 人年的复合事件发生率随时间下降，记录 CVD 队列从 2.5 降至 2.0，MI 亚组从 3.7 降至 2.8。从复合结果中排除血运重建后，两个群体的事件发生率下降幅度明显减弱。
尽管高强度治疗的使用有所增加，血运重建的数量有所减少，但到 2017 年，仍有一半以上的患者未接受高强度降脂治疗，MI 和 IS 的发生率几乎没有变化。
