Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA.
Cardiovasc Drugs Ther. 2024 Oct;38(5):937-945. doi: 10.1007/s10557-023-07452-1. Epub 2023 Apr 13.
Many adults with atherosclerotic cardiovascular disease (ASCVD) who are recommended to take a statin, ezetimibe and/or a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) by the 2018 American Heart Association/American College of Cardiology cholesterol guideline do not receive these medications. We estimated the percentage of recurrent ASCVD events potentially prevented with guideline-recommended cholesterol-lowering therapy following a myocardial infarction (MI) hospitalization.
We conducted simulations using data from US adults with government health insurance through Medicare or commercial health insurance in the MarketScan database. We used data from patients with an MI hospitalization in 2018-2019 to estimate the percentage receiving guideline-recommended therapy. We used data from patients with an MI hospitalization in 2013-2016 to estimate the 3-year cumulative incidence of recurrent ASCVD events (i.e., MI, coronary revascularization or ischemic stroke). The low-density lipoprotein cholesterol (LDL-C) reduction with guideline-recommended therapy was derived from trials of statins, ezetimibe and PCSK9i, and the associated ASCVD risk reduction was estimated from a meta-analysis by the Cholesterol-Lowering Treatment Trialists Collaboration.
Among 279,395 patients with an MI hospitalization in 2018-2019 (mean age 75 years, mean LDL-C 92 mg/dL), 27.3% were receiving guideline-recommended cholesterol-lowering therapy. With current cholesterol-lowering therapy use, 25.3% (95%CI: 25.2%-25.4%) of patients had an ASCVD event over 3 years. If all patients were to receive guideline-recommended therapy, 19.8% (95%CI: 19.5%-19.9%) were estimated to have an ASCVD event over 3 years, representing a 21.6% (95%CI: 20.5%-23.6%) relative risk reduction.
Implementation of guideline-recommended cholesterol-lowering therapy could prevent a substantial percentage of recurrent ASCVD events.
2018 年美国心脏协会/美国心脏病学会胆固醇指南建议，许多患有动脉粥样硬化性心血管疾病（ASCVD）的成年人服用他汀类药物、依折麦布和/或前蛋白转化酶枯草溶菌素 9 抑制剂（PCSK9i），但这些药物并未被广泛使用。本研究旨在评估心肌梗死（MI）住院后，采用指南推荐的降脂治疗，潜在预防 ASCVD 事件复发的比例。
我们使用美国市场扫描数据库中拥有政府医疗保险（Medicare 或商业健康保险）的成年人的数据进行模拟。我们使用 2018-2019 年 MI 住院患者的数据来评估接受指南推荐治疗的比例。我们使用 2013-2016 年 MI 住院患者的数据来估计 3 年内 ASCVD 事件（即 MI、冠状动脉血运重建或缺血性卒中）的累积复发率。指南推荐治疗的低密度脂蛋白胆固醇（LDL-C）降低幅度来源于他汀类药物、依折麦布和 PCSK9i 的临床试验，而 ASCVD 风险降低幅度则是通过胆固醇治疗试验协作组的荟萃分析估计得出。
在 2018-2019 年接受 MI 住院治疗的 279395 例患者中（平均年龄 75 岁，平均 LDL-C 92mg/dL），有 27.3%接受了指南推荐的降脂治疗。目前降脂治疗的应用情况下，3 年内有 25.3%（95%CI：25.2%-25.4%）的患者发生 ASCVD 事件。如果所有患者都接受指南推荐的治疗，预计 3 年内有 19.8%（95%CI：19.5%-19.9%）的患者发生 ASCVD 事件，相对风险降低 21.6%（95%CI：20.5%-23.6%）。
实施指南推荐的降脂治疗可预防相当一部分 ASCVD 事件的复发。
