Sedrakyan Surik, Nadeem Bilawal, Gaughran Diane, Sinauridze Ana, Georgy Ann, Sally Hurley, Lam Uyen
Department of Internal Medicine- St Elizabeth's Medical Center, Boston, Massachusetts.
Department of Internal Medicine- St Elizabeth's Medical Center, Boston, Massachusetts.
Am J Cardiol. 2025 Oct 15;253:1-9. doi: 10.1016/j.amjcard.2025.05.029. Epub 2025 Jun 2.
Effective lipid control is essential for secondary cardiovascular prevention, with an LDL-C target of <70 mg/dL recommended for high-risk patients. While novel lipid-lowering therapies have expanded treatment options, their real-world use and impact on LDL-C control remain uncertain. This retrospective cohort study included 19,108 patients with coronary artery disease across 7 hospitals in Massachusetts from January 2019 to March 2024. We evaluated the use of novel therapies, sex disparities in LDL-C goal attainment, and the influence of outpatient cardiology care and cardiac rehabilitation. Categorical associations were analyzed using chi-square tests, and multivariable logistic regression was conducted to account for confounding variables. In the final cohort, only 50.1% achieved LDL-C <70 mg/dL. Most (74.9%) were on monotherapy, among whom 53.1% met the target. Dual therapy use was low (12.2%). Females were less likely to meet LDL-C goals (OR 0.53, 95% CI 0.49 to 0.58), had higher mean LDL-C (76.9 vs 67.7 mg/dL; p <0.001), and were less likely to be on combination therapy (OR 0.77, 95% CI 0.68 to 0.86). Cardiology visits improved LDL-C goal attainment (OR 1.54, 95% CI 1.41 to 1.67), and cardiac rehabilitation significantly lowered LDL-C (from 89.1-66.1 mg/dL; p <0.001). In conclusion, despite expanded therapeutic options, many patients fail to achieve LDL-C targets, reflecting underutilization of available treatments. Specialist care and cardiac rehabilitation were associated with improved lipid control, but persistent disparities in women highlight the need for more equitable implementation of guideline-based care.
有效的血脂控制对于二级心血管预防至关重要，对于高危患者，推荐的低密度脂蛋白胆固醇（LDL-C）目标为<70mg/dL。虽然新型降脂疗法扩大了治疗选择，但它们在现实世界中的使用情况以及对LDL-C控制的影响仍不确定。这项回顾性队列研究纳入了2019年1月至2024年3月期间马萨诸塞州7家医院的19108例冠心病患者。我们评估了新型疗法的使用情况、LDL-C目标达成情况中的性别差异，以及门诊心脏病护理和心脏康复的影响。使用卡方检验分析分类关联，并进行多变量逻辑回归以考虑混杂变量。在最终队列中，只有50.1%的患者实现了LDL-C<70mg/dL。大多数（74.9%）患者接受单药治疗，其中53.1%达到了目标。双联疗法的使用率较低（12.2%）。女性达到LDL-C目标的可能性较小（比值比[OR]为0.53，95%置信区间[CI]为0.49至0.58），平均LDL-C水平较高（76.9mg/dL对67.7mg/dL；p<0.001），并且接受联合治疗的可能性较小（OR为0.77，95%CI为0.68至0.86）。心脏病就诊改善了LDL-C目标达成情况（OR为1.54，95%CI为1.41至1.67），心脏康复显著降低了LDL-C（从89.1mg/dL降至66.1mg/dL；p<0.001）。总之，尽管治疗选择有所增加，但许多患者未能达到LDL-C目标，这反映了现有治疗方法未得到充分利用。专科护理和心脏康复与改善血脂控制相关，但女性中持续存在的差异凸显了更公平地实施基于指南的护理的必要性。
