Lis Anna, Lis Paulina, Łowicka Weronika, Grabarczyk Małgorzata, Wita Michał, Żarczyński Piotr, Żarczyńska Małgorzata, Haberka Maciej
Cardiology Students' Scientific Association, Department of Cardiology, SHS, Medical University of Silesia, 40-635 Katowice, Poland.
Health Promotion and Obesity Management Unit, Department of Pathophysiology, Faculty of Medicine in Katowice, Medical University of Silesia, 40-752 Katowice, Poland.
J Cardiovasc Dev Dis. 2023 Aug 2;10(8):329. doi: 10.3390/jcdd10080329.
Hypercholesterolemia is the main cardiovascular (CV) risk factor with a large body of evidence. Our aim was to assess the achievement of the main therapeutic goal of Low-Density Lipoprotein Cholesterol (LDL-C) in patients with a very high CV risk and a high-dose statin therapy. The study group consisted of 1413 consecutive patients hospitalised at the Upper-Silesian Medical Centre in Katowice due to acute myocardial infarction (AMI) treated with atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg. The lipid profile was performed on admission and within 12 months after AMI. The main therapeutic goal was defined as LDL-C < 55 mg%. The study group ( = 1413) included 979 males (69.3%) with arterial hypertension (83.3%), diabetes (33.5%), peripheral artery disease (13.6%) and nicotinism (46.2%). In the study group, only 61 patients (4.3%) were additionally taking ezetimibe. During hospitalisation, the primary LDL-C goal was found in only 186 patients (13.2%). Subsequently, a follow-up lipidogram within 12 months was performed in 652 patients (46%), and the therapeutic goal was achieved in 255 patients (39%). There were 258 (18.26%) patients who died within 12 months after myocardial infarction. The lowest mortality rate was found in the subgroup of patients with LDL-C < 55 mg% during follow-up (11.02%). The primary lipid goal attainment among patients with a high-dose statin and a very high CV risk is low and far from the expected rate. Patients hospitalised for AMI should be given a combination of statin and ezetimibe more frequently. Low LDL-C levels measured at follow-up predict a lower risk of death at 12-month follow-up in a large group of patients.
高胆固醇血症是有大量证据支持的主要心血管（CV）危险因素。我们的目的是评估极高CV风险且接受高剂量他汀类药物治疗的患者低密度脂蛋白胆固醇（LDL-C）主要治疗目标的达成情况。研究组由1413例因急性心肌梗死（AMI）在卡托维兹上西里西亚医疗中心住院的连续患者组成，他们接受了≥40mg阿托伐他汀或≥20mg瑞舒伐他汀治疗。在入院时和AMI后12个月内进行血脂检测。主要治疗目标定义为LDL-C<55mg%。研究组（n = 1413）包括979名男性（69.3%），伴有动脉高血压（83.3%）、糖尿病（33.5%）、外周动脉疾病（13.6%）和吸烟（46.2%）。在研究组中只有61例患者（4.3%）额外服用依折麦布。住院期间，仅186例患者（13.2%）达到了LDL-C的主要目标。随后，652例患者（46%）在12个月内进行了随访血脂检测，其中255例患者（39%）达到了治疗目标。有258例（18.26%）患者在心肌梗死后12个月内死亡。随访期间LDL-C<55mg%的患者亚组死亡率最低（11.02%）。高剂量他汀类药物治疗且CV风险极高的患者主要血脂目标达成率较低，远未达到预期水平。因AMI住院的患者应更频繁地接受他汀类药物和依折麦布联合治疗。随访时测得的低LDL-C水平预示着一大组患者在随访12个月时死亡风险较低。
