Department of Vascular Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan.
Department of Clinical Laboratory Technology, Faculty of Medical Science, Juntendo University, Urayasu, Chiba, Japan.
J Cardiol. 2024 Jul;84(1):36-40. doi: 10.1016/j.jjcc.2023.10.002. Epub 2023 Oct 9.
The risk of coronary artery disease in peripheral arterial disease (PAD) is high, life prognosis is poor, and lipid-lowering treatment with statins has been reported to improve prognosis. In clinical practice, however, hypolipidemia is more common in patients with severe PAD and statin prescription rates appear to be low, but specific data are scarce in Japan. Therefore, we conducted this cross-sectional study in collaboration with other centers of vascular surgery to determine the rate of statin prescriptions for PAD patients in real-world practice, the rate of achievement of low-density lipoprotein (LDL) cholesterol control targets, and whether statin non-use is a determinant factor of critical limb ischemia (CLI).
A total of 246 PAD patients (97 with CLI) from 5 sites were included in this study. Medical history and blood test data were obtained from medical records and interviews with patients, and were compared between CLI and non-CLI patients.
Statin prescription rate was only 34 %. The overall LDL cholesterol control target rate was 46 % of CLI cases and 51 % of non-CLI cases, according to the lipid management criteria of the Japanese Society for Atherosclerosis 2022 guidelines. Patients in the CLI group had a lower mean body mass index and lower LDL cholesterol levels than those in the non-CLI group, suggesting that these factors were responsible for the lower statin prescription rate. However, multivariate analysis revealed that statin non-use was one of the determinants of CLI.
Statin prescription rates for PAD patients were low in real-world practice settings in the field of vascular surgery. Since statin non-use is a determinant of CLI, there is a need to educate physicians engaged in treatment regarding lipid-lowering treatment with statins.
外周动脉疾病（PAD）患者发生冠状动脉疾病的风险较高，预后较差，他汀类药物降脂治疗已被证实可改善预后。然而，在临床实践中，严重 PAD 患者更常出现血脂异常，他汀类药物的处方率似乎较低，但日本缺乏具体数据。因此，我们与其他血管外科中心合作开展了这项横断面研究，以确定 PAD 患者在真实世界实践中的他汀类药物处方率、低密度脂蛋白（LDL）胆固醇控制目标的达标率，以及他汀类药物未使用是否是导致严重肢体缺血（CLI）的决定因素。
本研究共纳入了来自 5 个中心的 246 名 PAD 患者（97 名患有 CLI）。从病历和患者访谈中获取病史和血液检查数据，并对 CLI 患者和非 CLI 患者进行比较。
他汀类药物的处方率仅为 34%。根据 2022 年日本动脉粥样硬化学会的血脂管理指南，所有 CLI 病例的 LDL 胆固醇控制目标总体达标率为 46%，而非 CLI 病例的 LDL 胆固醇控制目标总体达标率为 51%。CLI 组患者的平均体重指数和 LDL 胆固醇水平均低于非 CLI 组，这表明这些因素导致他汀类药物的处方率较低。然而，多变量分析显示，他汀类药物未使用是 CLI 的决定因素之一。
血管外科领域的真实世界实践中，PAD 患者的他汀类药物处方率较低。由于他汀类药物未使用是 CLI 的决定因素之一，因此需要对参与治疗的医生进行降脂治疗方面的教育。
