Wargny Matthieu, Goronflot Thomas, Piriou Pierre-Guillaume, Pouriel Mathilde, Bastien Alexandre, Prax Julie, Leux Christophe, Riche Valéry-Pierre, Trochu Jean-Noël, Béliard Sophie, Costa Nadège, Ferrières Jean, Duret Stéphanie, Cariou Bertrand
Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, F-44000 Nantes, France; Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000 Nantes, France.
Nantes Université, CHU Nantes, Pôle Hospitalo-Universitaire 11: Santé Publique, Clinique des données, INSERM, CIC 1413, F-44000 Nantes, France.
Diabetes Metab. 2025 May;51(3):101638. doi: 10.1016/j.diabet.2025.101638. Epub 2025 Mar 16.
According to international guidelines, lowering LDL-cholesterol is the cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention. However, observational studies have identified current gaps in the implementation of lipid-lowering therapy (LLT). This whole-population study aimed to evaluate the prevalence and determinants of LLT use in ASCVD patients.
Using the national health data system, all French adults with established ASCVD between 2012 and 2021 were identified using specific ICD-10 and/or procedure codes. LLT use was defined as ≥1 dispensing in the last quarter of 2021. Logistic regression was used to identify factors associated with the absence of LLT use.
In 2021, 2,206,305 individuals (4.89 % among 45,082,270 adults) had established ASCVD (mean age: 72.2 years; 36.9 % women), including 56.1 % with coronary artery disease, 40.4 % with cerebrovascular disease, and 14.5 % with revascularized peripheral artery disease (PAD). Among the 2,056,354 patients alive on 31st December 2021, 32.5 % did not receive any LLT, while 64.8 % received a statin (27.0 % a high-intensity statin), 13.0 % a combination of statin and ezetimibe, and 0.25 % a PCSK9 inhibitor. The absence of LLT use was significantly associated with female sex (adjusted odds ratio [aOR]:1.42, 95 %CI, 1.41-1.43); lowest/highest ages: < 50 years (aOR (/65-74 years): 2.23, 95 %CI 2.20-2.27) and ≥ 85 years (aOR: 2.10, 95 %CI 2.08-2.13); and stroke and PAD, compared to myocardial infarction (aOR: 2.21, 95 %CI 2.19-2.23 and 1.88, 95 %CI 1.86-1.91, respectively).
In real life, one-third of French ASCVD patients was not regularly treated with LLT, highlighting the urgent need to develop implementation strategies for lipid management.
根据国际指南，降低低密度脂蛋白胆固醇是预防动脉粥样硬化性心血管疾病（ASCVD）的基石。然而，观察性研究发现了降脂治疗（LLT）实施方面目前存在的差距。这项全人群研究旨在评估ASCVD患者中LLT的使用情况及其决定因素。
利用国家卫生数据系统，通过特定的ICD-10和/或手术编码识别出2012年至2021年间所有确诊ASCVD的法国成年人。LLT的使用定义为在2021年最后一个季度至少有一次配药。采用逻辑回归来确定与未使用LLT相关的因素。
2021年，2206305人（在45082270名成年人中占4.89%）确诊患有ASCVD（平均年龄：72.2岁；36.9%为女性），其中56.1%患有冠状动脉疾病，40.4%患有脑血管疾病，14.5%患有血管重建的外周动脉疾病（PAD）。在2021年12月31日存活的2056354名患者中，32.5%未接受任何LLT治疗，而64.8%接受了他汀类药物治疗（27.0%接受高强度他汀类药物治疗），13.0%接受了他汀类药物与依折麦布的联合治疗，0.25%接受了PCSK9抑制剂治疗。未使用LLT与女性性别（调整后的优势比[aOR]：1.42，95%置信区间[CI]，1.41 - 1.43）、最低/最高年龄组：<50岁（aOR（/65 - 74岁）：2.23，95%CI 2.20 - 2.27）和≥85岁（aOR：2.10，95%CI 2.08 - 2.13）以及与心肌梗死相比的中风和PAD显著相关（aOR分别为：2.21，95%CI 2.19 - 2.23和1.88，95%CI 1.86 - 1.91）。
在现实生活中，三分之一的法国ASCVD患者未接受规律的LLT治疗，凸显了制定脂质管理实施策略的迫切需求。
