Clarke Shoa L, Thomson Blake
Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, United States.
Stanford University School of Medicine, Stanford, CA, United States.
Am J Prev Cardiol. 2024 Nov 7;20:100890. doi: 10.1016/j.ajpc.2024.100890. eCollection 2024 Dec.
Guidelines for statin therapy emphasize treatment of adults ages 40-75 years, with less guidance for the treatment of younger adults, ages 20-39 years. Only two class 1 recommendations for statin apply to younger adults: 1) secondary prevention and 2) severe hypercholesterolemia (LDL-C ≥ 190 mg/dL). The implementation of guidelines within this age group has not been well studied.
METHODS & RESULTS: Here, we use data from the National Health and Nutrition Examination Survey (2013-2020) to estimate statin eligibility and use among US younger adults. Based on this nationally representative sample, we extrapolate that approximately 923,000 younger adults had a history of atherosclerotic cardiovascular disease, but only ∼24 % were on statin. Among younger adults in the primary prevention group, we extrapolate that at least 1.09 million had severe hypercholesterolemia. To expand on this analysis, we calculated untreated LDL-C values for individuals on statin using two methods, and we estimate that only ∼11-20 % of younger adults with severe hypercholesterolemia were on statin. Lastly, among untreated younger adults with a class 1 indication for statin, fewer than 25 % reported that a doctor or healthcare provider had recommended cholesterol medication.
The implementation of class 1 recommendations for statin treatment in younger adults is poor. While efforts to improve risk prediction in the young have recently received significant attention, our results indicate that identifying high risk younger adults is insufficient. We must also improve guideline-recommended treatment in this age group.
他汀类药物治疗指南着重针对40 - 75岁的成年人进行治疗，而对于20 - 39岁的年轻成年人的治疗指导较少。他汀类药物仅两项1类推荐适用于年轻成年人：1）二级预防和2）严重高胆固醇血症（低密度脂蛋白胆固醇≥190 mg/dL）。该年龄组内指南的实施情况尚未得到充分研究。
在此，我们使用美国国家健康与营养检查调查（2013 - 2020年）的数据来估计美国年轻成年人中他汀类药物的适用情况和使用情况。基于这个具有全国代表性的样本，我们推断约92.3万年轻成年人有动脉粥样硬化性心血管疾病史，但只有约24%正在服用他汀类药物。在一级预防组的年轻成年人中，我们推断至少有109万人患有严重高胆固醇血症。为了进一步分析，我们使用两种方法计算了服用他汀类药物个体的未治疗低密度脂蛋白胆固醇值，并且我们估计患有严重高胆固醇血症的年轻成年人中只有约11% - 20%正在服用他汀类药物。最后，在未接受治疗但有他汀类药物1类适应证的年轻成年人中，不到25%的人报告医生或医疗服务提供者曾推荐过胆固醇药物。
年轻成年人中他汀类药物治疗1类推荐的实施情况较差。虽然近期改善年轻人风险预测的努力受到了广泛关注，但我们的结果表明，识别高风险年轻成年人是不够的。我们还必须改善该年龄组中指南推荐的治疗。
