School of Public Health, Imperial College London, London, UK.
Department of Medicine, Faculty of Medicine, University of Seville, Seville, Spain.
Cardiovasc Drugs Ther. 2023 Oct;37(5):941-953. doi: 10.1007/s10557-022-07343-x. Epub 2022 May 14.
Low-density lipoprotein cholesterol (LDL-C) recommendations differ between the 2018 American College of Cardiology/American Heart Association (ACC/AHA) and 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for patients with atherosclerotic cardiovascular disease (ASCVD) (< 70 vs. < 55 mg/dl, respectively). In the DA VINCI study, residual cardiovascular risk was predicted in ASCVD patients. The extent to which relative and absolute risk might be lowered by achieving ACC/AHA versus ESC/EAS LDL-C recommended approaches was simulated.
DA VINCI was a cross-sectional observational study of patients prescribed lipid-lowering therapy (LLT) across 18 European countries. Ten-year cardiovascular risk (CVR) was predicted among ASCVD patients receiving stabilized LLT. For patients with LDL-C ≥ 70 mg/dl, the absolute LDL-C reduction required to achieve an LDL-C of < 70 or < 55 mg/dl (LDL-C of 69 or 54 mg/dl, respectively) was calculated. Relative and absolute risk reductions (RRRs and ARRs) were simulated.
Of the 2039 patients, 61% did not achieve LDL-C < 70 mg/dl. For patients with LDL-C ≥ 70 mg/dl, median (interquartile range) baseline LDL-C and 10-year CVR were 93 (81-115) mg/dl and 32% (25-43%), respectively. Median LDL-C reductions of 24 (12-46) and 39 (27-91) mg/dl were needed to achieve an LDL-C of 69 and 54 mg/dl, respectively. Attaining ACC/AHA or ESC/EAS goals resulted in simulated RRRs of 14% (7-25%) and 22% (15-32%), respectively, and ARRs of 4% (2-7%) and 6% (4-9%), respectively.
In ASCVD patients, achieving ESC/EAS LDL-C goals could result in a 2% additional ARR over 10 years versus the ACC/AHA approach.
2018 年美国心脏病学会/美国心脏协会（ACC/AHA）和 2019 年欧洲心脏病学会/欧洲动脉粥样硬化学会（ESC/EAS）指南对动脉粥样硬化性心血管疾病（ASCVD）患者的低密度脂蛋白胆固醇（LDL-C）推荐值不同（分别为<70 与<55mg/dl）。在 DA VINCI 研究中，对 ASCVD 患者进行了残余心血管风险预测。通过实现 ACC/AHA 与 ESC/EAS 推荐的 LDL-C 目标，模拟相对和绝对风险降低的程度。
DA VINCI 是一项在 18 个欧洲国家进行的接受降脂治疗（LLT）的患者的横断面观察性研究。对接受稳定 LLT 的 ASCVD 患者进行了 10 年心血管风险（CVR）预测。对于 LDL-C≥70mg/dl 的患者，计算了实现 LDL-C<70 或<55mg/dl（分别为 LDL-C 为 69 或 54mg/dl）所需的 LDL-C 绝对降低量。模拟了相对和绝对风险降低（RRR 和 ARR）。
在 2039 例患者中，61%的患者 LDL-C 未达到<70mg/dl。对于 LDL-C≥70mg/dl 的患者，中位（四分位距）基线 LDL-C 和 10 年 CVR 分别为 93（81-115）mg/dl 和 32%（25-43%）。分别需要降低 LDL-C 24（12-46）和 39（27-91）mg/dl，以达到 LDL-C 为 69 和 54mg/dl。实现 ACC/AHA 或 ESC/EAS 目标分别可导致模拟 RRR 为 14%（7-25%）和 22%（15-32%），ARR 为 4%（2-7%）和 6%（4-9%）。
在 ASCVD 患者中，与 ACC/AHA 方法相比，实现 ESC/EAS LDL-C 目标可能会导致 10 年内额外的 ARR 增加 2%。
