Vikulova Diana N, Lee May Kuen, Humphries Karin H, Pinheiro-Muller Danielle, Dawes Martin, Pimstone Simon N, Brunham Liam R
Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada.
Department of Medicine, University of British Columbia, Vancouver, Canada.
JACC Adv. 2024 Oct 16;4(1):101316. doi: 10.1016/j.jacadv.2024.101316. eCollection 2025 Jan.
Rates of premature coronary artery disease (CAD) are stagnant, and the prevalence of cardiovascular risk factors in young and middle-aged adults is increasing. Lipid-lowering therapy (LLT) is effective in preventing CAD but is underutilized in younger patients. The reasons for and consequences of this underutilization are not fully understood.
The purpose of the study was to assess prepresentation health care encounters, eligibility for, usage patterns, and predictors of initiation of LLT and its relationships with the severity of clinical presentation of CAD.
Using administrative databases and a clinical registry, we analyzed health care encounters, cardiovascular risk, and medication dispensations in females <55 and males <50 years old who presented with angiographically confirmed premature CAD.
Among 11,445 patients (27.6% females, age 46.14 ± 5.05 years) in the administrative database, in the 3 years before presentation, 93.3% were eligible for lipid screening and 92.2% had health care visits, but only 14.8% received LLT dispensations, and 5.9% displayed good adherence. In multivariable analysis, females (OR: 0.75; 95% CI: 0.65-0.86), rural residents (OR: 0.75; 95% CI: 0.62-0.91), and smokers (OR: 0.65; 95% CI: 0.57-0.74) were less likely to receive LLT. High-intensity LLT vs no LLT was associated with lower odds of presenting with acute coronary syndrome (OR: 0.25; 95% CI: 0.19-0.38). Among 470 clinical registry participants (27.4% females, mean age 45.72 ± 5.07 years), 70.2% had lipids assessed, 55.7% were eligible for LLT based on the estimated cardiovascular risk, 18.9% received treatment recommendations, and 12.1% received dispensations of LLT before presentation.
Prior to presenting with premature CAD, most patients had medical encounters, but few received LLT, demonstrating a substantial gap in prevention.
早发性冠状动脉疾病（CAD）的发病率停滞不前，而中青年成年人心血管危险因素的患病率却在上升。降脂治疗（LLT）在预防CAD方面有效，但在年轻患者中未得到充分利用。这种未充分利用的原因和后果尚未完全了解。
本研究的目的是评估CAD临床表现之前的医疗保健接触情况、LLT的适用资格、使用模式和启动预测因素，以及LLT与CAD临床表现严重程度的关系。
利用行政数据库和临床登记处，我们分析了年龄小于55岁的女性和年龄小于50岁的男性，这些患者经血管造影证实患有早发性CAD，分析了他们的医疗保健接触情况、心血管风险和药物配给情况。
在行政数据库中的11445名患者（27.6%为女性，年龄46.14±5.05岁）中，在出现症状前的3年里，93.3%符合血脂筛查条件，92.2%有医疗保健就诊，但只有14.8%接受了LLT配给，5.9%表现出良好的依从性。在多变量分析中，女性（比值比：0.75；95%置信区间：0.65-0.86）、农村居民（比值比：0.75；95%置信区间：0.62-0.91）和吸烟者（比值比：0.65；95%置信区间：0.57-0.74）接受LLT的可能性较小。高强度LLT与未接受LLT相比，出现急性冠状动脉综合征的几率较低（比值比：0.25；95%置信区间：0.19-0.38）。在470名临床登记参与者中（27.4%为女性，平均年龄45.72±5.07岁），70.2%进行了血脂评估，55.7%根据估计的心血管风险符合LLT条件，18.9%接受了治疗建议，12.1%在出现症状前接受了LLT配给。
在出现早发性CAD之前，大多数患者有过医疗接触，但很少有人接受LLT，这表明在预防方面存在很大差距。
