Nguyen Tan Van, Tran Dieu Thi Thanh, Ngo Trinh Thi Kim, Nguyen Tu Ngoc
Department of Geriatrics & Gerontology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam.
Department of Interventional Cardiology, Thong Nhat Hospital, Ho Chi Minh City 700000, Vietnam.
Geriatrics (Basel). 2022 Jun 24;7(4):71. doi: 10.3390/geriatrics7040071.
Objective. The main aim of this study is to examine the achievement of low-density lipoprotein cholesterol (LDL-C) targets in older patients after acute coronary syndrome (ACS), and the secondary aim is to examine sex difference in LDL-C target achievement. Methods. Patients aged ≥60 years with ACS admitted to a tertiary hospital in Vietnam were recruited from December 2019 to August 2020. LDL-C target achievement was defined as having an LDL-C goal of <1.8 mmol/L. Multivariate logistic regression was applied to investigate the predictive factors for LDL-C target achievement. Results. A total of 232 participants were included in this study (mean age 75.5 years, 40.1% were women). Participants had an average of three chronic conditions other than coronary heart disease. All participants were prescribed statin monotherapy at discharge (59.5% on high-intensity statins). After 3 months, 218 (94.0%) of the participants were on statin monotherapy, 14 (6.0%) were on statin combined with ezetimibe. The proportion of participants that achieved LDL-C target after 3 months was 56.5% (40.9% in women and 66.9% in men, p < 0.001). On univariate logistic regression, women were less likely to achieve their LDL-C target compared to men (unadjusted OR 0.34, 95% CI 0.20−0.59). This association was still significant in the adjusted model (adjusted OR 0.43, 95% CI 0.24−0.78). Other factors that were significantly associated with LDL-C target achievement included age, smoking, sedentary lifestyle, LDL-C level on admission, history of using statin before admission, and high-intensity statin prescribed at discharge. Conclusions. Our study found that nearly a half of older patients with ACS did not achieve their LDL-C target after 3 months, and suboptimal control of LDL-C was more common in women.
目的。本研究的主要目的是检查急性冠状动脉综合征（ACS）后老年患者低密度脂蛋白胆固醇（LDL-C）目标的达成情况，次要目的是检查LDL-C目标达成情况中的性别差异。方法。2019年12月至2020年8月，招募了越南一家三级医院收治的年龄≥60岁的ACS患者。LDL-C目标达成定义为LDL-C目标<1.8 mmol/L。应用多因素逻辑回归研究LDL-C目标达成的预测因素。结果。本研究共纳入232名参与者（平均年龄75.5岁，40.1%为女性）。参与者除冠心病外平均有三种慢性病。所有参与者出院时均接受他汀类单药治疗（59.5%接受高强度他汀类药物治疗）。3个月后，218名（94.0%）参与者接受他汀类单药治疗，14名（6.0%）接受他汀类与依折麦布联合治疗。3个月后达成LDL-C目标的参与者比例为56.5%（女性为40.9%，男性为66.9%，p<0.001）。单因素逻辑回归分析显示，与男性相比，女性达成LDL-C目标的可能性较小（未调整的OR为0.34，95%CI为0.20 - 0.59）。在调整模型中，这种关联仍然显著（调整后的OR为0.43，95%CI为0.24 - 0.78）。与LDL-C目标达成显著相关的其他因素包括年龄、吸烟、久坐的生活方式、入院时的LDL-C水平、入院前使用他汀类药物的病史以及出院时开具的高强度他汀类药物。结论。我们的研究发现，近一半的老年ACS患者在3个月后未达成其LDL-C目标，LDL-C控制不佳在女性中更为常见。
