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从指南到实践：极高心血管风险患者的低密度脂蛋白胆固醇达标情况——EDHIPO MARCA注册研究分析

From guidelines to practice: LDL-C achievement in very high cardiovascular risk patients - analysis of the EDHIPO MARCA registry.

作者信息

Cordoba-Melo Brayan Daniel, Seni-Molina Sebastián, Arango-Ibanez Juan Pablo, Ayala Milton René, Tatis-Méndez José Fidel, Quintero Yepez Viviana, Mejía Cadavid Luz Aída, Cruz-Cuevas José D, Ariza-Ordóñez Nicolás, Buitrago Andrés, Lopez-Lopez Jose Patricio, Hinestrosa Alfredo, Sabogal Jorge, Reyes-Vargas Cristian, Herrera-Escandon Álvaro, Hurtado Juan Sebastián, Velásquez Osorio Juan Fernando, Londoño Sergio, Salamanca Carlos, Vallecilla Liliana, Leon-Giraldo Hoover, Ruiz Alvaro J, Molina Dora Inés, Gomez-Mesa Juan Esteban

机构信息

Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.

Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia.

出版信息

Lipids Health Dis. 2025 Sep 2;24(1):275. doi: 10.1186/s12944-025-02657-9.

DOI:10.1186/s12944-025-02657-9

PMID:40898170

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12406369/

Abstract

BACKGROUND

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, with dyslipidemia playing a key role in its progression. Despite advances in lipid-lowering therapy (LLT), LDL-C (Low-Density Lipoprotein Cholesterol) goal achievement remains suboptimal. This study evaluated LDL-C goal attainment in Colombian patients with very high cardiovascular risk (CVR) due to coronary artery disease (CAD) following ESC/EAS guidelines updates.

METHODS

EDHIPO MARCA (Evaluación De adherencia a la terapia HIPOlipemiante en pacientes de Muy Alto Riesgo CArdiovascular) is a retrospective, multicenter study assessing LDL-C goal achievement in patients with CAD. Data were collected from previous coronary angiogram reports and medical records across 11 Colombian healthcare institutions with certified interventional cardiology services. Patients with CAD who had at least one follow-up LDL-C measurement and an LLT prescription within 12 months post-angiogram were included. LDL-C goal attainment was assessed across three periods-2011-2012, 2016-2017, and 2021-2022-corresponding to the updates of ESC/EAS guidelines (2011, 2016, and 2019, respectively). The LDL-C goals were <70 mg/dL for the first two periods and <55 mg/dL for the most recent one. LDL-C was measured or estimated using the Friedewald equation. Descriptive analyses were performed.

RESULTS

A total of 1,788 patients were included, with a median age of 66 years (IQR: 59-74), and 70.7% were male. Hypertension (67.5%) and overweight (40.8%) were the most common comorbidities. At discharge, statins were prescribed in 84.1% (95% CI: 82.4-85.8%) of patients, increasing to 99.1% (95% CI: 98.6-99.5%) at the end of follow-up (median 6.8 months); PCSK9 inhibitors were prescribed in 1.5%, exclusively in 2019. At the end of follow-up, 36.6% (95% CI: 34.3%, 38.8%) achieved LDL-C goals. By guideline period, goal attainment was 12.1% (95% CI: 5.4%, 18.8%) in 2011, 42.3% (95% CI: 37.9%, 46.8%) in 2016, and 36.2% (95% CI: 33.5%, 38.9%) in 2019. By number of follow-ups, LDL-C goal achievement increased from 32.9% (1 follow-up) to 44.0% (4 follow-ups).

CONCLUSIONS

Despite widespread LLT use, LDL-C target achievement remains suboptimal. Frequent follow-up and greater use of combination therapy beyond statins may be essential to improve lipid control in very high CVR patients.

摘要

背景

心血管疾病仍然是全球发病和死亡的主要原因，血脂异常在其进展中起关键作用。尽管降脂治疗（LLT）取得了进展，但低密度脂蛋白胆固醇（LDL-C）目标达成情况仍不尽人意。本研究评估了遵循欧洲心脏病学会/欧洲动脉粥样硬化学会（ESC/EAS）指南更新后，哥伦比亚因冠状动脉疾病（CAD）而具有极高心血管风险（CVR）的患者的LDL-C目标达成情况。

方法

EDHIPO MARCA（评估极高心血管风险患者的降脂治疗依从性）是一项回顾性多中心研究，评估CAD患者的LDL-C目标达成情况。数据收集自哥伦比亚11家拥有认证介入心脏病学服务的医疗机构之前的冠状动脉造影报告和病历。纳入在血管造影后12个月内至少有一次LDL-C随访测量且有LLT处方的CAD患者。在对应ESC/EAS指南更新（分别为2011年、2016年和2019年）的三个时期——2011 - 2012年、2016 - 2017年和2021 - 2022年，评估LDL-C目标达成情况。前两个时期的LDL-C目标为<70mg/dL，最近一个时期为<55mg/dL。使用Friedewald方程测量或估算LDL-C。进行描述性分析。

结果

共纳入1788例患者，中位年龄66岁（四分位间距：59 - 74岁），70.7%为男性。高血压（67.5%）和超重（40.8%）是最常见的合并症。出院时，84.1%（95%CI：82.4 - 85.8%）的患者开具了他汀类药物，随访结束时（中位6.8个月）增至99.1%（95%CI：98.6 - 99.5%）；2019年仅有1.5%的患者开具了前蛋白转化酶枯草溶菌素9（PCSK9）抑制剂。随访结束时，36.6%（95%CI：34.3%，38.8%）的患者达到了LDL-C目标。按指南时期划分，2011年目标达成率为12.1%（95%CI：5.4%，18.8%），2016年为42.3%（95%CI：37.9%，46.8%），2019年为36.2%（95%CI：33.5%，38.9%）。按随访次数划分，LDL-C目标达成率从32.9%（一次随访）增至44.0%（四次随访）。