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他汀类药物不耐受的心血管高危和极高危患者的 LDL 胆固醇目标达标情况:一项模拟研究。

LDL cholesterol target attainment in cardiovascular high- and very-high-risk patients with statin intolerance: a simulation study.

机构信息

Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.

IQVIA Germany, Frankfurt am Main, Germany.

出版信息

Sci Rep. 2024 Jan 4;14(1):474. doi: 10.1038/s41598-023-50847-1.


DOI:10.1038/s41598-023-50847-1
PMID:38172531
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10764910/
Abstract

The inability to tolerate sufficient doses of statins, statin intolerance (SI), contributes to the non-achievement of guideline-recommended low-density lipoprotein cholesterol (LDL-C) treatment targets. Patients with SI require alternative lipid-lowering therapies (LLT). We conducted a simulation study on LDL-C target achievement with oral LLT (ezetimibe, bempedoic acid) in patients with SI, using representative data of 2.06 million German outpatients. SI was defined using literature-informed definitions based on electronic medical records (EMR). Among n = 130,778 patients with hypercholesterolaemia, available LDL-C measurement, and high or very-high cardiovascular risk, 8.6% met the definition of SI. Among patients with SI, 7.7% achieved the LDL-C target at baseline. After simulation of the stepwise addition of treatment with ezetimibe and bempedoic acid, 22.6 and 52.0% achieved the LDL-C target, respectively. The median achieved LDL-C was 80 and 62 mg/dL, the corresponding reductions from baseline were 20.0 and 38.0%, respectively. A higher proportion of patients classified as high risk achieved the target compared to those at very-high risk (58.1 vs. 49.9%). In conclusion, in patients with increased cardiovascular risk meeting the definition of SI based on EMR, combination LLT with ezetimibe and bempedoic acid has the potential to substantially increase the proportion of patients achieving clinically relevant LDL-C reductions.

摘要

无法耐受足够剂量的他汀类药物,即他汀类药物不耐受(SI),是导致无法达到指南推荐的低密度脂蛋白胆固醇(LDL-C)治疗目标的原因之一。对于存在 SI 的患者,需要采用替代的降脂治疗(LLT)。我们使用 206 万德国门诊患者的代表性数据,对 SI 患者使用口服 LLT(依折麦布、贝匹酸)实现 LDL-C 目标的情况进行了模拟研究。SI 是使用基于电子病历(EMR)的文献资料定义的。在 n = 130778 名患有高胆固醇血症、可测量 LDL-C 且存在高或极高心血管风险的患者中,8.6% 符合 SI 的定义。在存在 SI 的患者中,7.7%的患者在基线时达到了 LDL-C 目标。在模拟逐步添加依折麦布和贝匹酸治疗后,分别有 22.6%和 52.0%的患者达到了 LDL-C 目标。中位达到的 LDL-C 水平分别为 80 和 62mg/dL,相应的基线降幅分别为 20.0%和 38.0%。与极高风险的患者相比,被归类为高风险的患者达到目标的比例更高(58.1%比 49.9%)。总之,在基于 EMR 的 SI 定义的情况下,具有更高心血管风险的患者采用依折麦布和贝匹酸联合 LLT 治疗,有可能显著提高达到临床相关 LDL-C 降低的患者比例。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9505/10764910/4ce5fb40d550/41598_2023_50847_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9505/10764910/bd15349070f9/41598_2023_50847_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9505/10764910/d55c957015f4/41598_2023_50847_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9505/10764910/4ce5fb40d550/41598_2023_50847_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9505/10764910/bd15349070f9/41598_2023_50847_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9505/10764910/d55c957015f4/41598_2023_50847_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9505/10764910/4ce5fb40d550/41598_2023_50847_Fig3_HTML.jpg

相似文献

[1]
LDL cholesterol target attainment in cardiovascular high- and very-high-risk patients with statin intolerance: a simulation study.

Sci Rep. 2024-1-4

[2]
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Atherosclerosis. 2018-6-12

[3]
Simulation study on LDL cholesterol target attainment, treatment costs, and ASCVD events with bempedoic acid in patients at high and very-high cardiovascular risk.

PLoS One. 2022

[4]
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[5]
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Clin Res Cardiol. 2022-3

[6]
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Am J Cardiol. 2019-1-25

[7]
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Atherosclerosis. 2021-3

[8]
Ezetimibe Use and LDL-C Goal Achievement: A Retrospective Database Analysis of Patients with Clinical Atherosclerotic Cardiovascular Disease or Probable Heterozygous Familial Hypercholesterolemia.

J Manag Care Spec Pharm. 2017-9-25

[9]
Changes in LDL-C levels and goal attainment associated with addition of ezetimibe to simvastatin, atorvastatin, or rosuvastatin compared with titrating statin monotherapy.

Vasc Health Risk Manag. 2013

[10]
Simulation of bempedoic acid and ezetimibe in the lipid-lowering treatment pathway in Austria using the contemporary SANTORINI cohort of high and very high risk patients.

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引用本文的文献

[1]
Cardiovascular Risk Assessment and Lipid-Lowering Therapy Recommendations in Primary Prevention.

J Clin Med. 2025-3-25

[2]
Treatment strategies and LDL cholesterol target attainment in patients with statin intolerance: Insights from the multicentre statin intolerance registry.

Am J Prev Cardiol. 2025-3-1

[3]
Natural Bioactive Compounds in the Management of Type 2 Diabetes and Metabolic (Dysfunction)-Associated Steatotic Liver Disease.

Pharmaceuticals (Basel). 2025-2-19

[4]
Quantifying the 'distance to LDC-goal' in patients at very high cardiovascular risk with hyperlipidaemia in Germany: a retrospective claims database analysis.

Ther Adv Cardiovasc Dis. 2024

本文引用的文献

[1]
Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021: the multinational observational SANTORINI study.

Lancet Reg Health Eur. 2023-4-5

[2]
Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients.

N Engl J Med. 2023-4-13

[3]
Estimating Prevalence and Characteristics of Statin Intolerance among High and Very High Cardiovascular Risk Patients in Germany (2017 to 2020).

J Clin Med. 2023-1-16

[4]
The effect of the 2019 ESC/EAS dyslipidaemia guidelines on low-density lipoprotein cholesterol goal achievement in patients with acute coronary syndromes: The ACS EuroPath IV project.

Vascul Pharmacol. 2023-2

[5]
Simulation study on LDL cholesterol target attainment, treatment costs, and ASCVD events with bempedoic acid in patients at high and very-high cardiovascular risk.

PLoS One. 2022

[6]
Hypercholesterolemia diagnosis, treatment patterns and target achievement in patients with acute coronary syndromes in Germany.

Clin Res Cardiol. 2023-2

[7]
Hypercholesterolemia Diagnosis, Treatment Patterns, and 12-Month Target Achievement in Clinical Practice in Germany in Patients with Familial Hypercholesterolemia.

J Clin Med. 2022-6-30

[8]
NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient.

J Clin Lipidol. 2022

[9]
Prevalence of statin intolerance: a meta-analysis.

Eur Heart J. 2022-9-7

[10]
Target Populations and Treatment Cost for Bempedoic Acid and PCSK9 Inhibitors: A Simulation Study in a Contemporary CAD Cohort.

Clin Ther. 2021-9

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