Department of Angiology, University Hospital Zurich, Switzerland.
Institute of Pharmacology, University of Bern, Switzerland.
Vasa. 2022 Nov;51(6):357-364. doi: 10.1024/0301-1526/a001025. Epub 2022 Sep 2.
The global burden of peripheral arterial disease (PAD) is substantial. Reducing the major modifiable risk factors for noncommunicable disease, including dyslipidaemia, represents a public health priority. Aim is to evaluate the prevalent adequate use of lipid-lowering therapy (LLT) and low-density lipoprotein cholesterol (LDL-C) attainment among patients with PAD of the lower extremities undergoing percutaneous transluminal angioplasty. We screened PAD patients treated at the University Hospital Zurich (January 2012-December 2018). We excluded patients <18 years, without classifiable severity of PAD, or with missing LDL-C or medication data. In this cross-sectional study, we studied the prevalent LLT use and LDL-C values in target according to the most recent European guidelines. Available clinical data included demographic information, lipid profile, type and dose of LLT, characteristics of the artery obstruction and angioplasty. A total of 2,148 angioplasties were performed in 956 patients: 614 (64%) were men; the mean age was 70.6 (SD 11.4) years. A total of 608 (64%) had a non-critical PAD (Fontaine stage I-IIb), whereas the remaining had a critical limb ischemia or a diabetic foot syndrome. Their median LDL-C value was 2.00 (Q1-Q3: 1.50-2.60) mmol/L. In accordance to the 2016 and 2019 European Society of Cardiology guidelines, the LDL-C target of 1.8 and 1.4 mmol/L was not reached in 63% (n=599) and in 79% (n=760) of patients, respectively. Only 41% (n=390) of patients were on high-intensity statin therapy. The attainment of LDL-C targets, as recommended by current European guidelines, and the use of high-intensity LLT were unsatisfactory in the majority of PAD patients.
外周动脉疾病（PAD）的全球负担很大。降低包括血脂异常在内的非传染性疾病的主要可改变风险因素是公共卫生的重点。目的是评估正在接受经皮腔内血管成形术的下肢 PAD 患者中降脂治疗（LLT）的普遍充分使用情况和低密度脂蛋白胆固醇（LDL-C）达标情况。
我们筛选了苏黎世大学医院（2012 年 1 月至 2018 年 12 月）治疗的 PAD 患者。我们排除了年龄<18 岁、PAD 严重程度不可分类或 LDL-C 或药物数据缺失的患者。在这项横断面研究中，我们根据最新的欧洲指南研究了普遍存在的 LLT 使用情况和 LDL-C 值。可用的临床数据包括人口统计学信息、血脂谱、LLT 的类型和剂量、动脉阻塞和血管成形术的特征。
共对 956 名患者的 2148 次血管成形术进行了研究：614 名（64%）为男性；平均年龄为 70.6（SD 11.4）岁。共有 608 名（64%）患有非临界 PAD（Fontaine 分期 I-IIb），而其余患者患有严重肢体缺血或糖尿病足综合征。他们的中位 LDL-C 值为 2.00（Q1-Q3：1.50-2.60）mmol/L。根据 2016 年和 2019 年欧洲心脏病学会指南，分别有 63%（n=599）和 79%（n=760）的患者未达到 LDL-C 目标 1.8 和 1.4 mmol/L。只有 41%（n=390）的患者接受高强度他汀类药物治疗。
目前欧洲指南推荐的 LDL-C 目标达标率和高强度 LLT 的使用率在大多数 PAD 患者中均不理想。
