Brandts Julia, Barkas Fotios, De Bacquer Dirk, Jennings Catriona, De Backer Guy G, Kotseva Kornelia, Ryden Lars, Lip Gregory Y H, Erlund Iris, Ganly Sandra, Vihervaara Terhi, Adamska Agnieszka, Abreu Ana, Almahmeed Wael, Ambari Ade Meidian, Ge Junbo, Hasan-Ali Hosam, Huo Yong, Jankowski Piotr, Jimenez Rodney M, Li Yong, Zuhdi Ahmad Syadi Mahmood, Makubi Abel, Mbakwem Amam Chinyere, Mbau Lilian, Estrada Jose Luis Navarro, Ogah Okechukwu Samuel, Ogola Elijah Nyainda, Quintero-Baiz Adalberto, Sani Mahmoud Umar, Liprandi Maria Ines Sosa, Tan Jack Wei Chieh, Triana Miguel Alberto Urina, Yeo Tee Joo, Wood David, McEvoy John William, Ray Kausik K
Department of Public Health and Primary Care, Imperial College London, 90 Wood Lane, London W12 0BZ, UK.
Department of Internal Medicine I-Cardiology, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
Eur J Prev Cardiol. 2025 Aug 12. doi: 10.1093/eurjpc/zwaf388.
To quantify international variations in lipid-lowering therapies (LLT) use among patients with coronary heart disease (CHD) and attainment of European guideline-recommended lipid goals.
INTERASPIRE is an observational study (2020-23) covering 14 countries from all WHO regions. Patients (18-79 years) hospitalized in the preceding 6-36 months with CHD were invited for standardized interviews and examination, with central laboratory analyses for low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and apolipoprotein B (apoB). Valid lipid data meeting quality control standards were available from 13 countries. Lipid goals followed the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology: LDL-C < 1.4 mmol/L, non-HDL-C < 2.2 mmol/L, and apoB <65 mg/dL.Among 4061 patients (78.8% male, mean age 60.3 years), between index event and interview, 66.3% had no change in treatment intensity. LLT use at interview was largely statin monotherapy: 49.6% high-intensity (inter-country range 5.3%-77.3%) and 24.1% low/moderate-intensity (inter-country range 5.1%-70.1%). Otherwise, 12.2% (inter-country range 0.2%-41.1%) were on combination therapy, and 12.7% on no LLT (inter-country range 3.5%-36.7%). Goal attainment for LDL-C was 17.5%. Corresponding non-HDL-C and apoB goals were achieved by 29.9% and 29.2%, respectively. Higher-income countries (defined by the World Bank's 2024-25 classification of income levels) did better in goal attainment than lower-middle-income countries.
In this international study, contemporary lipid goals were not achieved in most CHD patients, with lower-middle-income countries having the worst goal attainment. Contributory factors include absence of any LLT use, low use of combinations and a failure to up-titrate LLT to achieve guideline targets.
量化冠心病（CHD）患者降脂治疗（LLT）使用情况的国际差异以及欧洲指南推荐的血脂目标的实现情况。
INTERASPIRE是一项观察性研究（2020 - 2023年），涵盖来自世界卫生组织所有区域的14个国家。邀请在过去6 - 36个月因冠心病住院的患者（18 - 79岁）接受标准化访谈和检查，并进行中心实验室分析低密度脂蛋白胆固醇（LDL - C）、非高密度脂蛋白胆固醇（non - HDL - C）和载脂蛋白B（apoB）。13个国家有符合质量控制标准的有效血脂数据。血脂目标遵循欧洲动脉粥样硬化学会和欧洲心脏病学会2019年指南：LDL - C < 1.4 mmol/L，non - HDL - C < 2.2 mmol/L，apoB < 65 mg/dL。在4061例患者（78.8%为男性，平均年龄60.3岁）中，从索引事件到访谈期间，66.3%的患者治疗强度无变化。访谈时LLT的使用主要是他汀类单药治疗：49.6%为高强度（国家间范围5.3% - 77.3%），24.1%为低/中等强度（国家间范围5.1% - 70.1%）。否则，12.2%（国家间范围0.2% - 41.1%）接受联合治疗，12.7%未接受LLT治疗（国家间范围3.5% - 36.7%）。LDL - C目标达成率为17.5%。相应的non - HDL - C和apoB目标达成率分别为29.9%和29.2%。高收入国家（根据世界银行2024 - 2025年收入水平分类定义）在目标达成方面比中低收入国家做得更好。
在这项国际研究中，大多数冠心病患者未实现当代血脂目标，中低收入国家的目标达成情况最差。促成因素包括未使用任何LLT、联合治疗使用少以及未能上调LLT剂量以达到指南目标。
