Mak Ying Hui, Chua Fionn, Koh Xuan Han, Tan Vern Hsen, Lee Zhong Hui, Lam Audrey, Tong Kim Leng, Yeo Colin, Chow Weien, Loh Wann Jia
Department of Pharmacy, Changi General Hospital, Singapore.
Dietetics Department, Changi General Hospital, Singapore.
Singapore Med J. 2025 Mar 1;66(3):154-162. doi: 10.4103/singaporemedj.SMJ-2024-172. Epub 2025 Mar 21.
Achieving low-density lipoprotein cholesterol (LDL-C) levels is key to preventing atherosclerotic cardiovascular events. However, many high-risk cardiovascular patients still experience poor LDL-C goal attainment and receive suboptimal lipid-lowering therapy (LLT) prescriptions. Herein, we evaluated LLT prescription patterns, LDL-C goal attainment and cardiovascular mortality among this population group in Singapore.
This prospective observational cohort study included 555 patients with ischaemic heart disease (IHD) admitted to the hospital in 2020. The LLT prescriptions, corresponding LDL-C levels and cardiovascular outcomes were assessed over a 24-month period.
Most participants were male (82.3%), with 48.5% identified as Chinese. High-intensity statin prescriptions increased from 45.4% at hospital admission to 87.1% at discharge and remained stable at approximately 80% at 6, 12, and 24 months post-discharge. Combination LLT prescriptions increased from 12.3% at discharge to 33.8% by 24 months. Ezetimibe was the most commonly prescribed second-line LLT (40.8%), followed by inclisiran (1.09%) and anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapies (0.87%). Over 24 months, LDL-C goal attainment rates were 22.1% for LDL-C < 1.4 mmol/L and 47.2% for LDL-C < 1.8 mmol/L. Multivariable Cox proportional hazards regression indicated that achieving LDL-C < 1.8 mmol/L goal was associated with a reduction in all-cause mortality at 24 months (hazard ratio 0.53, 95% confidence interval 0.30-0.94, P = 0.030).
Treatment gaps in lipid management persist in 80% of the study population, indicating that statin monotherapy alone is insufficient to achieve LDL-C goals. Greater efforts to improve LDL-C goal attainment rates in high-risk cardiovascular patients are imperative.
实现低密度脂蛋白胆固醇（LDL-C）水平达标是预防动脉粥样硬化性心血管事件的关键。然而，许多心血管高危患者的LDL-C目标达成情况仍不理想，且接受的降脂治疗（LLT）处方并不理想。在此，我们评估了新加坡这一人群的LLT处方模式、LDL-C目标达成情况及心血管死亡率。
这项前瞻性观察性队列研究纳入了2020年入院的555例缺血性心脏病（IHD）患者。在24个月的时间里评估LLT处方、相应的LDL-C水平及心血管结局。
大多数参与者为男性（82.3%），48.5%为华裔。高强度他汀类药物处方从入院时的45.4%增加至出院时的87.1%，出院后6个月、12个月和24个月时稳定在约80%。联合LLT处方从出院时的12.3%增加至24个月时的33.8%。依折麦布是最常用的二线LLT药物（40.8%），其次是英克西兰（1.09%）和前蛋白转化酶枯草溶菌素/kexin 9型单克隆抗体疗法（0.87%）。在24个月期间，LDL-C < 1.4 mmol/L时的目标达成率为22.1%，LDL-C < 1.8 mmol/L时的目标达成率为47.2%。多变量Cox比例风险回归表明，在24个月时实现LDL-C < 1.8 mmol/L目标与全因死亡率降低相关（风险比0.53，95%置信区间为0.30 - 0.94，P = 0.030）。
在80%的研究人群中，脂质管理的治疗差距依然存在，这表明仅用他汀类药物单药治疗不足以实现LDL-C目标。必须加大力度提高心血管高危患者的LDL-C目标达成率。
