二级心血管疾病预防缺陷持续多年:一项涉及希腊 1003 名连续患者的多中心横断面研究

R. Paparodis, Ioannis Androulakis, Dimitrios P Askitis, Ilias Perogamvros, Nicholas Angelopoulos, Andreas Rizoulis, S. Livadas, A. Boniakos
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引用次数: 0

摘要

目的:降脂治疗(LLTs)可降低动脉粥样硬化性心血管疾病(ASCVD)的风险。尽管有强效降脂药,但我们的临床观察结果表明,此类药物的使用并不充分。为了评估这种治疗缺陷,我们设计了本研究。研究方法我们查阅了所有在首次就诊前确诊为 ASCVD(冠状动脉疾病-CAD;颈动脉狭窄-CS;或外周动脉疾病-PAD)患者的病历。我们记录了他们的性别、年龄、ASCVD 危险因素(糖尿病、高血压、吸烟、体重指数)、就诊时的血脂值和使用的 LLT。我们按年份估算了达到指南特定血脂目标的比率,并评估了影响治疗成功可能性的因素。结果:总共招募了 1003 名受试者:CAD n = 703 (70.1%),PAD n = 168 (16.8%),CS n = 325 (32.4%);年龄 64.7 ± 11.2 岁;女性 n = 376 (37.5%);糖尿病患者 n = 642 (64.0%);高血压患者 n = 740 (73.8%);曾经吸烟者 n = 299 (29.8%),目前吸烟者 n = 367 (36.6%)。361名受试者(36.0%)接受了适当的低密度脂蛋白胆固醇治疗,159名受试者(15.9%)未接受任何治疗,483名受试者(48.2%)接受了不适当的治疗,434名受试者(43.3%)接受了高强度低密度脂蛋白胆固醇治疗,361名受试者(36.0%)达到了特定年份的低密度脂蛋白胆固醇目标。成功率从 5.7% 到 81.5%,最低的是 2020-2023 年(5.7%-14.5%),P < 0.001。联合使用 LLTs 和 PCSK9 抑制剂可提高低密度脂蛋白胆固醇目标的成功率(P < 0.001)。讨论:在日常临床实践中,近期的 ASCVD 二级风险预防指南的目标很少能实现,这在这一人群中造成了严重的治疗缺陷。需要更新的系统性干预措施来遏制这一公共卫生问题。
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Secondary Cardiovascular Disease Prevention Deficit Persists over the Years: A Multicenter Cross-Sectional Study Involving 1003 Consecutive Patients from Greece
Purpose: Lipid lowering treatments (LLTs) can reduce the risk of atherosclerotic cardiovascular disease (ASCVD). Despite the availability of potent LLTs, our clinical observations suggest an inadequate use of such agents. To evaluate this treatment deficit, we designed the present study. Methods: We reviewed the charts of all patients with a history of ASCVD (coronary artery disease—CAD; carotid stenosis—CS; or peripheral artery disease—PAD) diagnosed prior to their first visit to one of our clinics. We recorded their gender, age, ASCVD risk factors (diabetes, hypertension, tobacco use, body mass index), lipid values during that visit and the LLT used. We estimated the rates of the attainment of guideline-specific lipid goals by year, and assessed factors influencing the likelihood of treatment success. Results: Overall, n = 1003 subjects were recruited: CAD n = 703 (70.1%), PAD n = 168 (16.8%), CS n = 325 (32.4%); age 64.7 ± 11.2 years; n = 376 (37.5%) females; n = 642 (64.0%) had diabetes; n = 740 (73.8%) had hypertension; n = 299 (29.8%) were former and n = 367 (36.6%) were current smokers. An appropriate LLT was used in 361 (36.0%) subjects, n = 159 (15.9%) were on no treatment, n = 483 (48.2%) were receiving inadequate therapy, n = 434 (43.3%) were on a high-intensity LLT and n = 361 (36.0%) had achieved the year-specific LDL goals. Success rates ranged from 5.7% to 81.5%, with the lowest being 2020–2023 (5.7–14.5%), p < 0.001. The use of a combination of LLTs and PCSK9 inhibitors led to higher rates of LDL-C goals achievement (p < 0.001). Discussion: Recent secondary ASCVD risk prevention guidelines’ goals are rarely achieved in daily clinical practice, producing a major treatment deficit in this population. Newer systematic interventions are needed to curb this public health issue.
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