Medical Department, Novartis Pharma, Vilvoorde, Belgium.
Cegedim Health Data Belgium, Brussels, Belgium.
Clin Cardiol. 2024 Sep;47(9):e24330. doi: 10.1002/clc.24330.
Dyslipidemia remains the major cause of atherosclerotic cardiovascular disease (ASCVD). Lipid management in patients with increased cardiovascular (CV) risk needs improvement across Europe, and data gaps are noticeable at the country level.
We described the current treatment landscape in Belgium, hypothesizing that lipid management in patients with ASCVD remains inadequate and aiming to understand the reasons.
Using data from an anonymized primary care database in Belgium derived from 494 750 individuals, we identified those with any CV risk factor between November 2019 and October 2022 and described the clinical features of patients with ASCVD. The main outcomes were the proportion of patients (i) receiving lipid-lowering therapies (LLTs), (ii) per low-density lipoprotein cholesterol (LDL-C) threshold, stratified per LLT, (iii) reaching the 2021 ESC recommended LDL-C goals, and (iv) LDL-C reduction per type of LLT was also determined.
Among 40 888 patients with very high CV risk, 24 859 had established ASCVD. Most patients with ASCVD were either receiving monotherapy (59.6%) or had no documented LLT (25.1%). Further, 64.2% of those with no documented LLT exhibited LDL-C levels ≥ 100 mg/dL. Among common treatment options, one of the greatest improvements in LDL-C levels was achieved with combination therapy of statin and ezetimibe, reducing LDL-C levels by 41.5% (p < 0.0001). Yet, in this group, 24.8% of patients had still LDL-C levels ≥ 100 mg/dL and only 20.7% were at goal.
Our study emphasizes the importance of developing strategies to help patients achieve their LDL-C goals, with a focus on supporting the implementation of combination LLT in routine clinical practice.
血脂异常仍是动脉粥样硬化性心血管疾病（ASCVD）的主要病因。在整个欧洲，心血管（CV）风险增加的患者的血脂管理需要改善，并且在国家层面上存在明显的数据差距。
我们描述了比利时当前的治疗现状，假设 ASCVD 患者的血脂管理仍然不足，并旨在了解原因。
我们使用来自比利时的一个匿名初级保健数据库的数据，该数据库源自 494750 个人，确定了 2019 年 11 月至 2022 年 10 月期间任何 CV 危险因素的患者，并描述了 ASCVD 患者的临床特征。主要结局包括（i）接受降脂治疗（LLT）的患者比例，（ii）按 LDL-C 阈值分层的每一种 LLT 的患者比例，（iii）达到 2021 年 ESC 推荐的 LDL-C 目标的患者比例，以及（iv）按 LLT 类型确定的 LDL-C 降低比例。
在 40888 名极高 CV 风险的患者中，24859 名患者患有已确诊的 ASCVD。大多数 ASCVD 患者要么接受单药治疗（59.6%），要么没有记录的 LLT（25.1%）。此外，64.2%没有记录的 LLT 的患者的 LDL-C 水平≥100mg/dL。在常见的治疗选择中，他汀类药物和依折麦布联合治疗使 LDL-C 水平降低幅度最大，降低了 41.5%（p<0.0001）。然而，在这一组中，24.8%的患者 LDL-C 水平仍≥100mg/dL，仅有 20.7%的患者达到目标。
我们的研究强调了制定策略以帮助患者达到 LDL-C 目标的重要性，重点是支持联合 LLT 在常规临床实践中的实施。
