Hafiz Awatif, Aljohani Sarah, Kutbi Hussam, Fatani Nayyara, Alkhathran Lama, Alyaqub Majd, Alhamed Meshal S, Alhaqbani Abdulrhaman O, Alhadlaq Abdulrahman A, Alsalman Mohammed A, Al Yami Majed S, Almohammed Omar A
Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah 22252, Saudi Arabia.
Department of Clinical Pharmacy, King Fahd Armed Forces Hospital, Jeddah 23311, Saudi Arabia.
J Clin Med. 2025 Jan 30;14(3):908. doi: 10.3390/jcm14030908.
: The objective of this study was to evaluate the effects of adherence to the ACC/AHA 2018 dyslipidemia guidelines on patient management of lipid-lowering therapy in patients with ischemic heart diseases (IHD) and its correlation with major adverse cardiovascular events (MACEs), including non-fatal MI, stroke, death, hospitalization for revascularization, and peripheral arterial disease. : A multi-center retrospective observational study was conducted in patients with IHD between January 2019 and December 2020, who were followed for two years. The primary objective was to assess statin utilization and adherence to the 2018 ACC/AHA guidelines and the associated influence on MACE outcomes. Inferential statistical analyses, including chi-square tests and the Mann-Whitney test, were conducted to assess the associations between adherence to the guidelines, MACE rates, and LDL-C goal achievement. : The study included 1011 patients with ischemic heart disease (IHD), predominantly male (78.2%), with a mean age of 59 ± 10.9 years. Non-adherent patients had higher baseline LDL-C levels (3.0 ± 1.1 mmol/L vs. 2.7 ± 1.2 mmol/L; = 0.0005), while adherent patients were more likely to be on cardiovascular medications, including statins (78.4% vs. 57.4%), aspirin (74.2% vs. 56.3%), and P2Y12 inhibitors (69.5% vs. 48.4%), compared to non-adherent patients. Adherence was associated with lower non-fatal MI rates (9.3% vs. 21.1%, < 0.0001) and fewer revascularizations (9.3% vs. 16.8%; = 0.0024). Additionally, 49.2% of adherent patients achieved target LDL-C goals, compared to 30.5% of the non-adherent patients ( < 0.0001). Notably, there were no significant differences in stroke, peripheral arterial disease, or mortality rates. : The achievement of target LDL-C goals and reduced MACEs was observed with adherence to the 2018 ACC/AHA dyslipidemia guidelines. However, lipid management in IHD patients remains sub-optimal, highlighting opportunities for further enhancement.
本研究的目的是评估遵循美国心脏病学会/美国心脏协会（ACC/AHA）2018年血脂异常指南对缺血性心脏病（IHD）患者降脂治疗管理的影响，以及其与主要不良心血管事件（MACE）的相关性，MACE包括非致命性心肌梗死、中风、死亡、因血运重建住院和外周动脉疾病。
2019年1月至2020年12月期间，对IHD患者进行了一项多中心回顾性观察研究，随访两年。主要目的是评估他汀类药物的使用情况、对2018年ACC/AHA指南的遵循情况以及对MACE结局的相关影响。进行了包括卡方检验和曼-惠特尼检验在内的推断性统计分析，以评估遵循指南、MACE发生率和低密度脂蛋白胆固醇（LDL-C）目标达成之间的关联。
该研究纳入了1011例缺血性心脏病（IHD）患者，主要为男性（78.2%），平均年龄59±10.9岁。未遵循指南的患者基线LDL-C水平较高（3.0±1.1 mmol/L对2.7±1.2 mmol/L；P = 0.0005），而与未遵循指南的患者相比，遵循指南的患者更有可能使用心血管药物，包括他汀类药物（78.4%对57.4%）、阿司匹林（74.2%对56.3%）和P2Y12抑制剂（69.5%对48.4%）。遵循指南与较低的非致命性心肌梗死发生率（9.3%对21.1%，P < 0.0001）和较少的血运重建次数相关（9.3%对16.8%；P = 0.0024）。此外，49.2%的遵循指南的患者达到了LDL-C目标，而未遵循指南的患者为30.5%（P < 0.0001）。值得注意的是，中风、外周动脉疾病或死亡率方面没有显著差异。
遵循2018年ACC/AHA血脂异常指南可观察到LDL-C目标的达成和MACE的减少。然而，IHD患者的血脂管理仍未达到最佳状态，这凸显了进一步改善的机会。
