Cardiovascular event rates and trajectories of LDL-cholesterol levels and lipid-lowering therapy in patients with atherosclerotic cardiovascular disease: A population-based cohort study
Cardiovascular event rates and trajectories of LDL-cholesterol levels and lipid-lowering therapy in patients with atherosclerotic cardiovascular disease: A population-based cohort study
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DOI：
10.1016/j.thromres.2019.09.034
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发表时间：
2019-11-01
影响因子：
7.5
通讯作者：
Sorensen, Henrik Toft
中科院分区：
文献类型：
--
作者：
Sundboll, Jens;Larsen, Anders Peter;Sorensen, Henrik Toft
背景：需要了解动脉粥样硬化性心血管疾病患者的心血管事件发生率和低密度脂蛋白胆固醇 (LDL-C) 水平和轨迹，以评估治疗目标和对指南的遵守情况。方法：我们在丹麦北部和中部地区进行了一项基于人群的队列研究。确定了 2006 年至 2009 年期间患有流行的动脉粥样硬化性心血管疾病（心肌梗死、非出血性中风或外周动脉疾病）的患者。所有患者均接受降脂治疗（他汀类药物或依折麦布），基线时（2010 年 1 月 1 日）LDL-C 水平≥1.8 mmol/L。我们对患者进行了 6 年的随访，直到出现心血管死亡、心肌梗塞、非出血性中风、不稳定心绞痛住院或冠状动脉血运重建等主要复合结局。此外，我们还分析了随访期间 LDL-C 水平的变化和他汀类药物的使用情况。结果：该研究纳入了 10,772 名患者（中位年龄 69.2 岁，60.4% 为男性）。主要结局的总体事件率为每 1000 人年 62.7 例（95% 置信区间：59.2-66.2）。男性的这一事件发生率高于女性，并且随着年龄和基线 LDL-C 水平的增加而增加。随访期间进行 LDL-C 测量的患者中，约 25% 的 LDL-C 水平低于 1.8 mmol/L。在随访结束时使用他汀类药物的大约三分之二的患者中，几乎所有患者 (97%) 都接受了高强度治疗。 结论：在这一患有动脉粥样硬化性心血管疾病的患者群体中，我们发现心血管事件发生率很高，并且随着基线 LDL-C 水平的升高而增加。尽管大多数患者在随访结束时接受高强度他汀类药物治疗，但只有四分之一的患者达到了指南推荐的目标 LDL-C 水平
Background: An understanding of cardiovascular event rates and low-density lipoprotein cholesterol (LDL-C) levels and trajectories in patients with atherosclerotic cardiovascular disease is needed to evaluate treatment goals and adherence to guidelines.Methods: We conducted a population-based cohort study in the North and Central Denmark Regions. Patients with prevalent atherosclerotic cardiovascular disease (myocardial infarction, non-hemorrhagic stroke, or peripheral artery disease) during 2006-2009 were identified. All patients received lipid-lowering therapy (statins or ezetimibe) and had LDL-C levels >= 1.8 mmol/L at baseline (January 1, 2010). We followed patients for 6 years until a primary composite outcome of cardiovascular death, myocardial infarction, non-hemorrhagic stroke, hospitalization for unstable angina, or coronary revascularization. Additionally, we characterized changes in LDL-C levels and use of statins during follow-up.Results: The study included 10,772 patients (median age 69.2 years, 60.4% male). The overall event rate for the primary outcome was 62.7 (95% confidence interval: 59.2-66.2) per 1000 person-years. This event rate was higher among men than among women and increased with age and baseline LDL-C levels. Approximately 25% of patients with LDL-C measurements during follow-up achieved LDL-C levels below 1.8 mmol/L. Of the approximately two-thirds of patients using statins at the end of follow-up, nearly all patients (97%) received high-intensity therapy.Conclusions: In this population of patients with atherosclerotic cardiovascular disease, we found high cardiovascular event rates, which increased with baseline LDL-C levels. Although most patients were on high-intensity statin therapy at end of follow-up, only one-quarter reached the guideline-recommended target LDL-C level