患者性别与家族性高胆固醇血症与急性冠状动脉综合征 5 年后长期心血管风险因素管理的关系。
Association Between Patient Sex and Familial Hypercholesterolemia and Long-Term Cardiovascular Risk Factor Management 5 Years After Acute Coronary Syndrome.
机构信息
Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland (K.K., I.L., D.N.).
Service of Cardiology, Geneva University Hospital, Switzerland (B.G., D.C., F.M.).
出版信息
Circ Cardiovasc Qual Outcomes. 2024 Aug;17(8):e010790. doi: 10.1161/CIRCOUTCOMES.123.010790. Epub 2024 Jun 20.
BACKGROUND
Long-term control of cardiovascular risk factors after acute coronary syndrome (ACS) is the cornerstone for preventing recurrence. We investigated the extent of cardiovascular risk factor management in males and females with and without familial hypercholesterolemia (FH) 5 years after ACS.
METHODS
We studied patients hospitalized for ACS between 2009 and 2017 in a Swiss multicenter prospective cohort study. FH was defined based on clinical criteria from the Dutch Lipid Clinic Network and Simon Broome definitions. Five years post-ACS, we assessed low-density lipoprotein-cholesterol (LDL-c) levels, lipid-lowering therapy (LLT), and other cardiovascular risk factors, comparing males to females with and without FH using generalized estimating equations.
RESULTS
A total of 3139 patients were included; mean age was 61.4 years (SD, 12.1), 620 (19.8%) were female, and 747 (23.5%) had possible FH. Compared with males at 5-years post-ACS, females were more likely to not use statins (odds ratio, 1.61 [95% CI, 1.28-2.03]) and less likely to have combination LLT (odds ratio, 0.72 [95% CI, 0.55-0.93]), without difference between patients with FH and without FH. Females in both FH and non-FH groups less frequently reached LDL-c values ≤1.8 mmol/L (odds ratio, 0.78 [95% CI, 0.78-0.93]). Overall, patients with FH were more frequently on high-dose statins compared with patients without FH (51.0% versus 42.9%; =0.001) and presented more frequently with a combination of 2 or more LLT compared with patients without FH (33.8% versus 17.7%; <0.001), but less frequently reached LDL-c targets of ≤1.8 mmol/L (33.5% versus 44.3%; <0.001) or ≤2.6 mmol/L (70.2% versus 78.1%; =0.001).
CONCLUSIONS
Five years after ACS, females had less intensive LLT and were less likely to reach target LDL-c levels than males, regardless of FH status. Males and females with FH had less optimal control of LDL-c despite more frequently taking high-dose statins or combination LLT compared with patients without FH. Long-term management of patients with ACS and FH, especially females, warrants optimization.
背景
急性冠状动脉综合征（ACS）后长期控制心血管风险因素是预防复发的基石。我们研究了 5 年后 ACS 男性和女性中有无家族性高胆固醇血症（FH）的心血管风险因素管理程度。
方法
我们在瑞士多中心前瞻性队列研究中研究了 2009 年至 2017 年间因 ACS 住院的患者。FH 根据荷兰脂质诊所网络的临床标准和西蒙·布鲁姆的定义来定义。ACS 后 5 年，我们使用广义估计方程比较了 FH 男性和女性与 FH 男性和女性之间的低密度脂蛋白胆固醇（LDL-c）水平、降脂治疗（LLT）和其他心血管风险因素。
结果
共纳入 3139 例患者；平均年龄为 61.4 岁（标准差，12.1），620 例（19.8%）为女性，747 例（23.5%）可能患有 FH。与 ACS 后 5 年的男性相比，女性更有可能不使用他汀类药物（比值比，1.61 [95%置信区间，1.28-2.03]）且不太可能使用联合 LLT（比值比，0.72 [95%置信区间，0.55-0.93]），FH 和非 FH 患者之间无差异。FH 和非 FH 组的女性也较少达到 LDL-c 值≤1.8mmol/L（比值比，0.78 [95%置信区间，0.78-0.93]）。总体而言，与非 FH 患者相比，FH 患者更常使用高剂量他汀类药物（51.0%比 42.9%；=0.001），且更常联合使用 2 种或更多种 LLT（33.8%比 17.7%；<0.001），但较少达到 LDL-c 目标值≤1.8mmol/L（33.5%比 44.3%；<0.001）或≤2.6mmol/L（70.2%比 78.1%；=0.001）。
结论
ACS 后 5 年，女性 LLT 强度低于男性，且达到 LDL-c 目标值的可能性低于男性，无论 FH 状态如何。与非 FH 患者相比，FH 男性和女性尽管更常使用高剂量他汀类药物或联合 LLT，但 LDL-c 的控制仍不理想。需要优化 ACS 和 FH 患者，尤其是女性患者的长期管理。
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