Alanaeme Chibuike J, Bittner Vera, Brown Todd M, Colantonio Lisandro D, Dhalwani Nafeesa, Jones Jenna, Kalich Bethany, Exter Jason, Jackson Elizabeth A, Levitan Emily B, Poudel Bharat, Wang Zhixin, Woodward Mark, Muntner Paul, Rosenson Robert S
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.
Am Heart J Plus. 2022 Sep;21. doi: 10.1016/j.ahjo.2022.100201. Epub 2022 Aug 27.
The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline recommends a maximally-tolerated statin with add-on lipid-lowering therapy, ezetimibe and/or proprotein convertase subtilisin/kexin type 9 (PCSK9) for adults with very-high atherosclerotic cardiovascular disease (ASCVD) risk to achieve a low-density lipoprotein cholesterol (LDL-C) <70 mg/dL. We estimated the percentage of US adults with ASCVD recommended, by the 2018 AHA/ACC cholesterol guideline, and receiving add-on lipid-lowering therapy.
Cross-sectional study including 805 participants from the US National Health and Nutrition Examination Survey (NHANES) 2013-2020 data. NHANES sampling weights were used to obtain estimates for the US adult population.
Very-high ASCVD risk was defined as either: ≥2 ASCVD events, or one ASCVD event with ≥2 high-risk conditions. Being recommended add-on lipid-lowering therapy was defined as having very-high ASCVD risk and LDL-C ≥ 70 mg/dL, or LDL-C < 70 mg/dL while taking ezetimibe or a PCSK9 inhibitor.
An estimated 18.7 (95%CI, 16.0-21.4) million US adults had ASCVD, of whom 81.6 % (95%CI, 76.7 %-86.4 %) had very-high ASCVD risk, and 60.1 % (95%CI, 54.5 %-65.7 %) had very-high ASCVD risk and LDL-C ≥ 70 mg/dL. Overall, 61.4 % (95%CI, 55.8 %-66.9 %) were recommended add-on lipid-lowering therapy and 3.2 % (95 % CI, 1.2 %-5.3 %) were taking it. Smokers, adults with diabetes, hypertension and chronic kidney disease were more likely, while those taking atorvastatin or rosuvastatin were less likely, to be recommended add-on lipid-lowering therapy.
The majority of US adults with ASCVD are recommended add-on lipid-lowering therapy by the 2018 AHA/ACC cholesterol guideline but few are receiving it.
2018年美国心脏协会/美国心脏病学会（AHA/ACC）胆固醇指南建议，对于动脉粥样硬化性心血管疾病（ASCVD）风险极高的成年人，使用最大耐受剂量的他汀类药物并联合降脂治疗，即依折麦布和/或前蛋白转化酶枯草溶菌素9型（PCSK9）抑制剂，以实现低密度脂蛋白胆固醇（LDL-C）<70mg/dL。我们估算了按照2018年AHA/ACC胆固醇指南建议接受联合降脂治疗的美国ASCVD成年患者的比例。
设计、背景与参与者：横断面研究，纳入来自美国国家健康与营养检查调查（NHANES）2013 - 2020年数据的805名参与者。采用NHANES抽样权重来估算美国成年人口情况。
ASCVD极高风险定义为：≥2次ASCVD事件，或1次ASCVD事件且伴有≥2种高危情况。被建议接受联合降脂治疗定义为具有ASCVD极高风险且LDL-C≥70mg/dL，或在服用依折麦布或PCSK9抑制剂时LDL-C<70mg/dL。
估计有1870万（95%CI，1600 - 2140万）美国成年人患有ASCVD，其中81.6%（95%CI，76.7% - 86.4%）有ASCVD极高风险，60.1%（95%CI，54.5% - 65.7%）有ASCVD极高风险且LDL-C≥70mg/dL。总体而言，61.4%（95%CI，55.8% - 66.9%）被建议接受联合降脂治疗，3.2%（95%CI，1.2% - 5.3%）正在接受治疗。吸烟者、患有糖尿病、高血压和慢性肾病的成年人更有可能被建议接受联合降脂治疗，而服用阿托伐他汀或瑞舒伐他汀的人被建议接受联合降脂治疗的可能性较小。
按照2018年AHA/ACC胆固醇指南，大多数美国ASCVD成年患者被建议接受联合降脂治疗，但实际接受治疗的人很少。
