Witte Julian, Batram Manuel, Lutz Magnus, Philipp Anika-Anina, Greiner Wolfgang, Weingärtner Oliver
Vandage GmbH, Bielefeld, Germany (Drs Witte, Batram); Universität Bielefeld, Lehrstuhl für Gesundheitsökonomie und Gesundheitsmanagement, Bielefeld, Germany (Dr Witte).
Vandage GmbH, Bielefeld, Germany (Drs Witte, Batram); Universität Bielefeld, Lehrstuhl für Ökonometrie, Bielefeld, Germany (Dr Batram).
J Clin Lipidol. 2024 Oct 19. doi: 10.1016/j.jacl.2024.10.007.
2019 ESC/EAS guidelines on management of dyslipidemia outline treatment goals of LDL-C reduction in patients with high and very high cardiovascular (CV) risk.
To describe the proportion, clinical characteristics, and treatment practices of adult patients with dyslipidemia and high or very high CV risk in Germany.
Based on German claims data from 2010 to 2019, a retrospective cross-sectional study on prevalence, incidence, and treatment pathways in patients with dyslipidemia and high and very high CV risk is performed.
Between 2010 and 2019, there were 213 to 233 adult patients per 1,000 with prevalent dyslipidemia based on ICD 10 codes. Annual incidence ranged from 31.7 to 40.2 per 1,000. In 2019, 1.2% and 22.8% of the prevalent patients are classified to high or very high CV risk. Out of these patients, 61.7% and 78.5% received lipid lowering treatments (LLT). Among incidence patients, prescription rates are further apart between high-risk and very-high-risk patients, at 56.6% and 79.2%. Cross-sectional analysis showed that in 2019 statin monotherapy is the most common LLT (87.2%) administered mainly at moderate dose (59.9%). In that year, 2.7% and 8.4% of the patients received ezetimibe as monotherapy or in combination with statins. The proportion of treatment pause, or discontinuation was 56.6% over time, with subsequent re-initiation for 42.0% of patients.
Analysis indicates that despite recommendations, intensive treatment therapies are underutilized in clinical practice even in high and very high CV risk patients with primary hypercholesterolemia/mixed dyslipidemia, who may have benefited from LLT optimization.
2019年欧洲心脏病学会/欧洲动脉粥样硬化学会血脂异常管理指南概述了心血管（CV）风险高和极高的患者降低低密度脂蛋白胆固醇（LDL-C）的治疗目标。
描述德国血脂异常且心血管风险高或极高的成年患者的比例、临床特征及治疗情况。
基于2010年至2019年德国的索赔数据，对血脂异常且心血管风险高和极高的患者的患病率、发病率及治疗途径进行回顾性横断面研究。
2010年至2019年期间，根据国际疾病分类第10版代码，每1000名成年人中血脂异常的患病率为213至233人。年发病率为每1000人31.7至40.2人。2019年，1.2%和22.8%的血脂异常患者被归类为心血管风险高或极高。在这些患者中，61.7%和78.5%接受了降脂治疗（LLT）。在新发患者中，高危和极高危患者的处方率差异更大，分别为56.6%和79.2%。横断面分析显示，2019年他汀类药物单药治疗是最常见的降脂治疗（87.2%），主要以中等剂量给药（59.9%）。同年，2.7%和8.4%的患者接受依折麦布单药治疗或与他汀类药物联合治疗。随着时间的推移，治疗中断或停药的比例为56.6%，随后42.0%的患者重新开始治疗。
分析表明，尽管有相关建议，但在临床实践中，即使是心血管风险高和极高的原发性高胆固醇血症/混合性血脂异常患者，强化治疗方案的使用也不足，这些患者可能会从优化降脂治疗中获益。
