Does LDL-C determination method affect statin prescribing for primary prevention? A register-based study in Southern Denmark.

IF 5.3 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal - Cardiovascular Pharmacotherapy Pub Date : 2024-10-04 DOI:10.1093/ehjcvp/pvae043
Anton Pottegård, Lars Ulrik Gerdes, Jakob Langballe Wetche, Wade Thompson
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Abstract

Aims: Examine whether the low-density lipoprotein cholesterol (LDL -C) determination method influences the rate of statin initiation for primary prevention of cardiovascular disease.

Methods and results: We conducted a register-based retrospective study in the Region of Southern Denmark. Two hospital-based laboratories in the region directly measure LDL -C whereas four laboratories calculate LDL -C using Friedewald's formula. Physicians do not choose which method is used. We included all statin-naïve patients ≥40 years with no history of cardiovascular disease, diabetes, or chronic kidney disease, who had their LDL -C determined during 2018-2019. There were 202 807 people who had LDL -C determined during the study period (median age 59 years, 44% women) of which 37% had a direct LDL -C measurement. The median reported LDL -C was 3.40 mmol/L [interquartile range (IQR) 2.90-4.00] for those with a direct measurement vs. 3.00 mmol/L (IQR 2.40-3.50) for those with calculated LDL -C. For those with direct measurement, re-calculated LDL -C (using Friedewald's formula) was 0.35 mmol/L lower than the reported direct LDL -C measurement. Among those with directly measured LDL -C, 3.6% initiated statins compared with 2.7% of those with a calculated LDL -C. Direct LDL -C measurement led to higher odds of having a statin initiated compared with calculated LDL -C (adjusted odds ratio 1.23, 95% CI 1.17-1.30); for those with triglycerides >1.7 mmol/L the adjusted odds ratio was 1.41 (95% CI 1.30-1.52).

Conclusion: Differences in the reporting of LDL -C from laboratories using different methods have a substantial influence on physician's decisions to prescribe statins.

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低密度脂蛋白胆固醇(LDL-C)的测定方法会影响他汀类药物的一级预防处方吗?一项基于丹麦南部登记册的研究。
目的:研究低密度脂蛋白胆固醇(LDL-C)的测定方法是否会影响他汀类药物在心血管疾病一级预防中的使用率:我们在南丹麦大区开展了一项基于登记的回顾性研究。该地区有两家医院实验室直接测量低密度脂蛋白胆固醇,有四家实验室使用弗里德瓦尔德公式计算低密度脂蛋白胆固醇。医生不能选择使用哪种方法。我们纳入了所有年龄≥40 岁、无心血管疾病、糖尿病或慢性肾病史、在 2018-2019 年期间测定过低密度脂蛋白胆固醇的他汀类药物无效患者。在研究期间,共有 202 807 人测定了低密度脂蛋白胆固醇(中位年龄为 59 岁,44% 为女性),其中 37% 直接测定了低密度脂蛋白胆固醇。直接测量者报告的低密度脂蛋白胆固醇中位数为 3.40 mmol/L(IQR 2.90 至 4.00),而计算得出的低密度脂蛋白胆固醇中位数为 3.00 mmol/L(IQR 2.40 至 3.50)。在直接测量的人群中,重新计算的低密度脂蛋白胆固醇(使用弗里德瓦尔德公式)比报告的直接低密度脂蛋白胆固醇测量值低 0.35 mmol/L。在直接测量低密度脂蛋白胆固醇的人群中,有 3.6% 的人开始服用他汀类药物,而在计算低密度脂蛋白胆固醇的人群中,只有 2.7% 的人开始服用他汀类药物。与计算出的 LDL-C 相比,直接测量出的 LDL-C 使开始服用他汀类药物的几率更高(调整后的几率比为 1.23,95% CI 为 1.17 至 1.30);甘油三酯大于 1.7 mmol/L 者的调整后几率比为 1.41(95% CI 为 1.30 至 1.52):结论:采用不同方法的实验室在报告低密度脂蛋白胆固醇方面的差异对医生开具他汀类药物处方的决定有很大影响。
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来源期刊
European Heart Journal - Cardiovascular Pharmacotherapy
European Heart Journal - Cardiovascular Pharmacotherapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
10.10
自引率
14.10%
发文量
65
期刊介绍: The European Heart Journal - Cardiovascular Pharmacotherapy (EHJ-CVP) is an international, peer-reviewed journal published in English, specifically dedicated to clinical cardiovascular pharmacology. EHJ-CVP publishes original articles focusing on clinical research involving both new and established drugs and methods, along with meta-analyses and topical reviews. The journal's primary aim is to enhance the pharmacological treatment of patients with cardiovascular disease by interpreting and integrating new scientific developments in this field. While the emphasis is on clinical topics, EHJ-CVP also considers basic research articles from fields such as physiology and molecular biology that contribute to the understanding of cardiovascular drug therapy. These may include articles related to new drug development and evaluation, the physiological and pharmacological basis of drug action, metabolism, drug interactions, and side effects.
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