Reuser Annika, Look Christiane, Laufs Ulrich
Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103 Leipzig.
Sanofi-Aventis Deutschland, Lützowstr. 107, 10785 Berlin.
Dtsch Med Wochenschr. 2024 Sep;149(19):e84-e91. doi: 10.1055/a-2332-9120. Epub 2024 Aug 7.
ESC/EAS guidelines for the management of dyslipidemia after acute coronary syndrome (ACS) were updated in 2019 with lower LDL cholesterol (LDL-C) goals. Their effect on LDL-C lowering in Germany and across Europe is not known. The EuroPath IV survey was designed to compare the lipid management in patients post ACS in the year 2022 with 2018.
Online surveys were conducted between March and June 2022 in 6 European countries (Germany, the Netherlands, Spain, France, Italy, United Kingdom) in 2650 ACS patients (EuroPath IV). These data were compared with those gathered in 2018 from 2650 ACS-patients (EuroPath I).
Lipid testing was performed in > 90 % of the patients with ACS in 2022 and 2018 in Germany (GER). Total LDL-C levels were lower in 2022 than in 2018 in Germany (GER: 2022 131 mg/dl; 2018: 151 mg/dl). At discharge, more patients received lipid lowering therapy (LTT) in 2022 than in 2018 (GER 2022: 99 %; 2018: 96 %). In 2022, a higher proportion of patients received statins in combination with another LLT, mostly Ezetimibe. LDL-C decreased within the follow-up visits. In comparison to 2018, more patients achieved the LDL-C goal of < 55 mg/dl in 2022 in Germany. Similar effects were observed in other European Countries excluding Germany (EU) with lipid testing in 2022: 89 % vs. 90 % in 2018. Lipid testing was performed later after admission in the EU compared to Germany in 2022 (2022: GER 1.3 days; EU: 1.5 days). In the EU the percentage of statin + Ezetimibe rose stronger in comparison to 2018 than in Germany (GER: 2022 33 %; 2018: 22 %; EU: 2022 34 %; 2018: 11 %). The decrease of LDL-C levels was more pronounced within the EU than in Germany in 2022, and more patients achieved the LDL-C goal of < 55 mg/dl. Lp(a) was tested less often in the EU compared to Germany (2022: GER 22 %, EU 14 %).
Achievement of LDL-C goals improved after the update of the ESC/EAS lipid guidelines in 2019 but LDL-C goal achievement remains still very low. Even less patients in Germany achieved the LDL-C goals compared to other European countries.
欧洲心脏病学会（ESC）/欧洲动脉粥样硬化学会（EAS）关于急性冠状动脉综合征（ACS）后血脂异常管理的指南于2019年更新，设定了更低的低密度脂蛋白胆固醇（LDL-C）目标。其对德国及整个欧洲LDL-C降低的影响尚不清楚。EuroPath IV调查旨在比较2022年与2018年ACS患者的血脂管理情况。
2022年3月至6月期间，在6个欧洲国家（德国、荷兰、西班牙、法国、意大利、英国）对2650例ACS患者进行了在线调查（EuroPath IV）。这些数据与2018年从2650例ACS患者收集的数据（EuroPath I）进行了比较。
2022年和2018年德国（GER）超过90%的ACS患者进行了血脂检测。2022年德国的总LDL-C水平低于2018年（德国：2022年131mg/dl；2018年：151mg/dl）。出院时，2022年接受降脂治疗（LTT）的患者比2018年更多（德国2022年：99%；2018年：96%）。2022年，更高比例的患者接受了他汀类药物与另一种LTT联合治疗，主要是依折麦布。随访期间LDL-C下降。与2018年相比，2022年德国更多患者实现了LDL-C目标<55mg/dl。在德国以外的其他欧洲国家（欧盟）也观察到了类似效果，2022年进行血脂检测的比例为89%，而2018年为90%。与德国相比，2022年欧盟患者入院后进行血脂检测的时间更晚（2022年：德国1.3天；欧盟1.5天）。与2018年相比，欧盟他汀类药物+依折麦布的比例上升幅度比德国更大（德国：2022年33%；2018年：22%；欧盟：2022年34%；2018年：11%）。2022年欧盟LDL-C水平的下降比德国更明显，更多患者实现了LDL-C目标<55mg/dl。与德国相比，欧盟对脂蛋白（a）[Lp(a)]的检测频率更低（2022年：德国22%，欧盟14%）。
2019年ESC/EAS血脂指南更新后，LDL-C目标的达成情况有所改善，但LDL-C目标的达成率仍然很低。与其他欧洲国家相比，德国实现LDL-C目标的患者更少。
