Marques V, Bowser S, Hendrickxs J, Ruffner R
Dept. of Medicine, Shadyside Hospital, Pittsburgh, Pennsylvania 15232, USA.
Rev Port Cardiol. 1996 Nov;15(11):787-91, 771-2.
Hypercholesterolemia is a known risk factor for coronary artery disease (CAD). Multiple studies have shown that its treatment will reduce the rate of progression of coronary atherosclerosis and lead to regression of the atherosclerotic process. Recent studies have also shown impact on mortality. Angioplasty (PTCA) is a well established revascularization procedure for many of these patients. In this study we investigated whether or not therapy for hypercholesterolemia in patients undergoing elective PTCA had been instituted and, if so, whether desirable cholesterol levels had been achieved.
We reviewed the charts of 129 patients (pts) who were consecutively admitted for elective PTCA between September 1993 and August 1994. All pts. had at least one PTCA in the past and all of them had the diagnosis of hypercholesterolemia. The list was made using a computer search of all pts. meeting the previous two diagnoses. Pts on whom PTCA was performed in the setting of acute ischemic events were excluded as well as pts with no known history of hypercholesterolemia.
In 13 out of 129 pts., it was not possible to find cholesterol levels. The 116 pts in whom cholesterol levels were available were divided in two groups. Group I (54 pts.-46.5%) included pts. not being treated with any lipid lowering agent and group II (62 pts.-53.5%) included pts being treated with at least one of those drugs. Both groups were further subdivided into "A" and "B", depending on whether the PTCA was being performed because of a "new" lesion or because of "restenosis", respectively. Group IA had a total of 31 pts, IB 23 pts, IIA 29 pts and IIB, 33 pts. Group I pts had an average of 3.40 PTCA's and a mean cholesterol level of 227 mg/dl. Group II pts had an average number of PTCA's of 3.34 and a mean cholesterol level of 228 mg/dl. Group IA had an average number of PTCA's of 3.65 and a mean cholesterol level of 221 mg/dl; for group IIA these values were, respectively, 3.17 and 221 mg/dl. Group IB had an average number of procedures of 3.09 while for group IIB this number was 3.49; the mean cholesterol levels were, respectively, 235 mg/dl and 234 mg/dl. None of these differences is statistically significant. Group I had 14 pts (26%) with cholesterol levels below 200 mg/dl while group II had 16 pts. with cholesterol levels below 200 mg/dl (26%). In group I, 8 pts (14%) had lipid profiles documented. Only 1 pt. had an LDL level below 100 mg/dl and only 3 pts had an LDL level below 130 mg mg/dl. In group II, 15 pts (24%) had a lipid profile documented. Of these, no pt. had an LDL level below 100 mg/dl and only 4 pts had an LDL level below 130 mg/dl.
A significant percentage of pts. undergoing multiple PTCA's are not being treated or monitored adequately for hypercholesterolemia despite aggressive invasive management.
高胆固醇血症是已知的冠状动脉疾病（CAD）危险因素。多项研究表明，对其进行治疗可降低冠状动脉粥样硬化的进展速度，并使动脉粥样硬化进程出现逆转。近期研究还显示其对死亡率有影响。血管成形术（PTCA）是许多此类患者已确立的血运重建方法。在本研究中，我们调查了接受择期PTCA的患者是否已开始针对高胆固醇血症进行治疗，若已治疗，是否达到了理想的胆固醇水平。
我们回顾了1993年9月至1994年8月期间连续收治的129例接受择期PTCA患者的病历。所有患者既往至少接受过一次PTCA，且均诊断为高胆固醇血症。该列表通过对所有符合前两项诊断的患者进行计算机检索生成。因急性缺血事件接受PTCA的患者以及无高胆固醇血症已知病史的患者被排除。
129例患者中有13例无法查到胆固醇水平。可查到胆固醇水平的116例患者分为两组。第一组（54例，占46.5%）包括未接受任何降脂药物治疗的患者，第二组（62例，占53.5%）包括接受至少一种此类药物治疗的患者。两组又根据PTCA是因“新”病变还是“再狭窄”分别进一步细分为“A”组和“B”组。IA组共有31例患者，IB组23例，IIA组29例，IIB组33例。第一组患者平均接受3.40次PTCA，平均胆固醇水平为227mg/dl。第二组患者平均接受PTCA次数为3.34次，平均胆固醇水平为228mg/dl。IA组平均接受PTCA次数为3.65次，平均胆固醇水平为221mg/dl；IIA组的这些值分别为3.17次和221mg/dl。IB组平均手术次数为3.09次，而IIB组为3.49次；平均胆固醇水平分别为235mg/dl和234mg/dl。这些差异均无统计学意义。第一组有14例患者（26%）胆固醇水平低于200mg/dl，而第二组有16例患者胆固醇水平低于200mg/dl（26%）。第一组中，有8例患者（14%）有血脂谱记录。只有1例患者的低密度脂蛋白水平低于100mg/dl，只有3例患者的低密度脂蛋白水平低于130mg/dl。第二组中，有15例患者（24%）有血脂谱记录。其中，没有患者的低密度脂蛋白水平低于100mg/dl，只有4例患者的低密度脂蛋白水平低于130mg/dl。
尽管进行了积极的侵入性治疗，但相当一部分接受多次PTCA的患者未得到充分的高胆固醇血症治疗或监测。
