van Trier Tinka J, Snaterse Marjolein, Herings Ron M C, Overbeek Jetty A, Peters Ron J G, Jørstad Harald T
Department of Cardiology, Amsterdam University Medical Centres, location Academic Medical Centre, Amsterdam, The Netherlands.
Department of Epidemiology and Data Science, Amsterdam Public Health research institute, Amsterdam University Medical Centres, location Free University Medical Centre, Amsterdam, The Netherlands.
Neth Heart J. 2024 Jan;32(1):45-54. doi: 10.1007/s12471-023-01823-x. Epub 2023 Oct 23.
In patients with ischaemic heart disease (IHD) aged > 70 years, Dutch and European guidelines recommend different treatment targets: low-density lipoprotein cholesterol (LDL-c) < 2.6 versus < 1.4 mmol/l and systolic blood pressure (SBP) < 140 versus < 130 mm Hg, respectively. How this impacts cardiovascular event-free life expectancy has not been investigated. The study objective was to compare estimated lifelong treatment benefits of implementing Dutch and European LDL‑c and SBP targets.
Data from patients aged 71-80 years hospitalised for IHD in 2017-2019 were extracted from the PHARMO Database Network, which links primary and secondary healthcare settings, with follow-up until 31 December 2020. Potential benefit according to treatment strategy (in gain in event-free years) was estimated using the SMART-REACH model.
Of the 3003 eligible patients, 1186 (39%) had missing LDL‑c and/or SBP measurements. Of the 1817 included patients (36% women, median age at event: 74 years (interquartile range (IQR): 72-77), 84% achieved the Dutch targets for both LDL‑c and SBP; for European targets, this was 23% and 61%, respectively. If Dutch targets were met for LDL‑c and SBP (n = 1281), the additional effect of reaching European targets was a median gain of 0.6 event-free life years (IQR: 0.3-1.0). The greatest effect could be reached in patients not reaching Dutch targets (n = 501), with a median gain of 0.6 (IQR: 0.2-1.2) and 1.7 (IQR: 1.2-2.5) event-free years with Dutch versus European targets.
In patients aged > 70 years with IHD, implementation of European targets resulted in a greater gain of event-free years compared with Dutch targets, especially in patients with poorer risk factor control. The considerable number of patients with missing risk factor documentation suggested additional opportunities for risk reduction.
在年龄大于70岁的缺血性心脏病（IHD）患者中，荷兰和欧洲的指南推荐了不同的治疗目标：低密度脂蛋白胆固醇（LDL-c）分别为<2.6与<1.4 mmol/l，收缩压（SBP）分别为<140与<130 mmHg。这对无心血管事件预期寿命有何影响尚未得到研究。本研究的目的是比较实施荷兰和欧洲LDL-c及SBP目标所估计的终身治疗益处。
从PHARMO数据库网络提取2017 - 2019年因IHD住院的71 - 80岁患者的数据，该数据库连接了初级和二级医疗保健机构，随访至2020年12月31日。使用SMART-REACH模型估计根据治疗策略（无事件年数的增加）的潜在益处。
在3003名符合条件的患者中，1186名（39%）患者的LDL-c和/或SBP测量值缺失。在纳入的1817名患者中（36%为女性，事件发生时的中位年龄：74岁（四分位间距（IQR）：72 - 77）），84%的患者达到了荷兰的LDL-c和SBP目标；对于欧洲目标，这一比例分别为23%和61%。如果LDL-c和SBP达到荷兰目标（n = 1281），达到欧洲目标的额外效果是无事件生命年数中位数增加0.6年（IQR：0.3 - 1.0）。在未达到荷兰目标的患者中（n = 501）效果最为显著，达到荷兰目标与欧洲目标相比，无事件年数中位数增加分别为0.6年（IQR：0.2 - 1.2）和1.7年（IQR：1.2 - 2.5）。
在年龄大于70岁的IHD患者中，与荷兰目标相比，实施欧洲目标可使无事件年数增加更多，尤其是在危险因素控制较差的患者中。相当数量的患者缺乏危险因素记录表明存在额外的降低风险机会。
