Hsiao Fei-Yuan, Li Yi-Heng, Lai Hsi-Yu, Meng Lin-Chieh, Chuang Hui-Min, Chen Ho-Min, Shih Chung-Liang, Chen Wen-Jone
Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Int J Cardiol Heart Vasc. 2025 Jul 16;60:101749. doi: 10.1016/j.ijcha.2025.101749. eCollection 2025 Oct.
This nationwide study aimed to analyze temporal trends in hospitalized atherosclerotic cardiovascular disease (ASCVD) incidence, evaluate lipid testing patterns and goal attainment rates, and assess healthcare utilization among ASCVD patients in Taiwan.
Using Taiwan's National Health Insurance database linked with laboratory data (2017-2023), we identified patients with incident hospitalized ASCVD. We calculated age-standardized incidence rates and analyzed lipid-lowering therapy patterns, low-density lipoprotein cholesterol (LDL-C) testing, and healthcare utilizations during index hospitalization and one-year follow-up.
Among 687,212 patients with incident ASCVD, age-standardized incidence decreased by 10% (from 256.3 to 231.8 per 100,000 person-years) from 2017 to 2023, with marked sex disparities (male-to-female ratio: 1.73). Concerning increases in incidence were observed among adults aged 20-29 (12.6%) and 70-79 (19.0%). Among all subtypes of ASCVD, ischemic heart disease (IHD) showed the highest adjusted incidence (99.86 per 100,000 person-years). LDL-C testing rates were suboptimal during index hospitalization (64.8%), with significant variation across ASCVD subtypes (highest in stroke: 80.2% and lowest in peripheral artery disease: 39.2%). Only 34.1% achieved LDL-C <70 mg/dL at one year post-discharge. Lipid-lowering therapy initiation was low during hospitalization (48.9%), peaked at 3 months (60.9%), then stabilized at 57%. Within one year post-discharge, 40.8% had emergency department visits, 40.6% were rehospitalized, and one-year mortality rate reached 13.2%.
Our findings reveal substantial gaps in ASCVD care and lipid management in Taiwan's healthcare system, highlighting critical opportunities for improving preventive strategies and optimizing cardiovascular outcomes in this high-risk population.
这项全国性研究旨在分析台湾地区住院动脉粥样硬化性心血管疾病（ASCVD）发病率的时间趋势，评估血脂检测模式和目标达成率，并评估ASCVD患者的医疗资源利用情况。
利用与实验室数据相链接的台湾全民健康保险数据库（2017 - 2023年），我们确定了首次住院的ASCVD患者。我们计算了年龄标准化发病率，并分析了降脂治疗模式、低密度脂蛋白胆固醇（LDL-C）检测情况以及首次住院期间和一年随访期内的医疗资源利用情况。
在687,212例首次发生ASCVD的患者中，2017年至2023年年龄标准化发病率下降了10%（从每10万人年256.3例降至231.8例），存在明显的性别差异（男女比例：1.73）。20 - 29岁（12.6%）和70 - 79岁（19.0%）的成年人发病率有所上升。在ASCVD的所有亚型中，缺血性心脏病（IHD）的调整发病率最高（每10万人年99.86例）。首次住院期间LDL-C检测率不理想（64.8%），不同ASCVD亚型之间存在显著差异（中风最高：80.2%，外周动脉疾病最低：39.2%）。出院一年后只有34.1%的患者LDL-C<70mg/dL。住院期间降脂治疗的起始率较低（48.9%），在3个月时达到峰值（60.9%），然后稳定在57%。出院后一年内，40.8%的患者到急诊科就诊，40.6%的患者再次住院，一年死亡率达到13.2%。
我们的研究结果揭示了台湾医疗体系中ASCVD护理和血脂管理方面存在的巨大差距，凸显了改善这一高危人群预防策略和优化心血管结局的关键机会。
