Hospital Israelita Albert Einstein, São Paulo, SP - Brasil.
Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
Arq Bras Cardiol. 2024 Nov 22;121(11):e20240116. doi: 10.36660/abc.20240116. eCollection 2024.
Individuals with severe hypercholesterolemia (SH) are considered at high atherosclerosis risk and should be intensively treated with lipid-lowering drugs aiming for an LDL-C reduction of≥50% and a goal of <70 mg/dL.
This study aimed to evaluate cholesterol control in individuals with SH (LDL-C ≥ 190 mg/dL or 160-189 mg/dL using lipid-lowering drugs) followed in a health evaluation program.
55,000 individuals were evaluated, of which 2,214 (4%) had SH, and 1,016 (45.8%) had repeated assessments. Achievement of recommended LDL-C goals was the primary study endpoint. A p-value < 0.05 was considered significant.
Mean age (± SD) was 44.9±8.8 years, 84.2% were men, and 0.5% reported previous myocardial infarction. Mean LDL-C was 203.0±22.0 mg/dL, and although 62.5% referred dyslipidemia, only 19% were using lipid-lowering drugs (5.9% in cases with LDL-C ≥ 190 mg/dL). During a 4.1±2.8-year follow-up, use of lipid-lowering drugs increased from 18.1% to 48.4% (p<0.00001), 5.9% to 45.4% in those with LDL-C ≥ 190 mg/dL (p< 0.00001) though 31% of cases with LDL-C 160-189 mg/dL stopped taking medications. Overall, there was a mean 26.7% reduction in LDL-C (p<0.0001), and LDL-C reductions ≥50% were attained in 19.2%, 19.1%, and 19.7 % of all individuals, and in those with LDL-C > 190 mg/dL and 160-189 mg/dL respectively. Only 3.1% reached LDL-C < 70 mg/dL (2.7% in those with LDL-C ≥ 190 and 5.3% in those with 160-189 mg/dL).
A serious gap was found between treatment recommendations and reality in individuals at high atherosclerosis risk due to SH.
严重高胆固醇血症（SH）患者被认为具有较高的动脉粥样硬化风险，应采用降脂药物进行强化治疗，目标是 LDL-C 降低≥50%，并达到<70mg/dL。
本研究旨在评估在健康评估计划中接受治疗的严重高胆固醇血症（LDL-C≥190mg/dL 或 160-189mg/dL 时使用降脂药物）患者的胆固醇控制情况。
共评估了 55000 名个体，其中 2214 名（4%）患有 SH，1016 名（45.8%）有重复评估。推荐 LDL-C 目标的达标情况是主要的研究终点。p 值<0.05 被认为具有统计学意义。
平均年龄（±标准差）为 44.9±8.8 岁，84.2%为男性，0.5%有心肌梗死病史。平均 LDL-C 为 203.0±22.0mg/dL，尽管 62.5%患者存在血脂异常，但仅 19%使用降脂药物（5.9% LDL-C≥190mg/dL）。在 4.1±2.8 年的随访期间，降脂药物的使用率从 18.1%增加到 48.4%（p<0.00001），LDL-C≥190mg/dL 患者从 5.9%增加到 45.4%（p<0.00001），但 31% LDL-C 为 160-189mg/dL 的患者停止了药物治疗。总体而言，LDL-C 平均降低了 26.7%（p<0.0001），所有患者中 LDL-C 降低≥50%的比例分别为 19.2%、19.1%和 19.7%，LDL-C>190mg/dL 和 160-189mg/dL 患者的比例分别为 19.2%、19.1%和 19.7%。仅有 3.1%的患者达到 LDL-C<70mg/dL（LDL-C≥190mg/dL 的患者为 2.7%，160-189mg/dL 的患者为 5.3%）。
由于 SH，严重高胆固醇血症患者的治疗建议与实际情况之间存在严重差距，导致动脉粥样硬化风险较高。
