Status of lipid-lowering therapy prescribed based on recommendations in the 2002 report of the Japan Atherosclerosis Society Guideline for Diagnosis and Treatment of Hyperlipiclemia in Japanese Adults: A study of the Japan Lipid Assessment Program (J-LAP)
Status of lipid-lowering therapy prescribed based on recommendations in the 2002 report of the Japan Atherosclerosis Society Guideline for Diagnosis and Treatment of Hyperlipiclemia in Japanese Adults: A study of the Japan Lipid Assessment Program (J-LAP)
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DOI：
10.1016/j.curtheres.2005.04.004
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发表时间：
2005-03-01
影响因子：
1.9
通讯作者：
Mabuchi, H
中科院分区：
文献类型：
--
作者：
Teramoto, T;Kashiwagi, A;Mabuchi, H
背景资料：日本动脉粥样硬化学会（JAS）在其1997年《日本成人高血压诊断和治疗指南》及后续修订版中，建议根据冠心病（CHD）风险分类制定血脂管理目标（SLMG）。一项文献检索显示，目前日本JAS推荐的降脂治疗状况尚未得到评估。目的：本研究的目的是评估目前降脂治疗方案的疗效，并根据目前JAS推荐，通过识别冠心病发生的危险因素，为高脂血症患者提供最佳治疗策略。方法：这项多中心、回顾性研究使用了来自日本12，500家随机选择的机构的医生护理患者的数据。医生接受了一项关于降脂治疗的调查，每位医生提供了10例连续的高脂血症成人患者的数据。在调查前至少接受了3个月的降脂治疗，并且正在门诊接受常规随访。医生提供了患者的人口统计学和临床数据，包括JAS定义的CHD风险分类、冠状动脉危险因素和治疗前和治疗后（>= 3个月后）的血脂水平，以及患者当前和既往治疗方案中的药物类型和剂量。这些数据被用来评估降脂方案的疗效和患者达到SLMG的JAS.Results推荐的比率：共有2540名医生参加了调查，并从24,893名日本高脂血症患者（平均[SD]年龄，65.8 [10.5]岁）的数据被纳入研究。家族性高脂血症患者（845/24，893 [3.4%]）从大多数分析中排除，留下24，048例原发性高脂血症患者。最常见的冠状动脉风险因素包括年龄（21，902 [91.1%]）、高血压（14，275 [59.4%]）、2型糖尿病和/或糖耐量受损（6346 [26.4%]）和吸烟（3841 [16.0%]）。共有20，948例患者（87.1%）的CHD风险分类为B（即>= 1个冠状动脉风险因素，但无CHD病史）。在调查时，22，080名患者（91.8%）的降脂方案包括他汀类药物。SLMG的实现率如下：总胆固醇（TC），12，659/23，840例患者（53.1%）;低密度脂蛋白胆固醇（LDL-C），14025/22121（63.4%）;高密度脂蛋白胆固醇，19,702/21,279（92.6%）;甘油三酯（TG），14,892/23,569（63.2%）。风险类别A、B1和B2（即，0-2个冠状动脉风险因素;低至中度风险）中的大多数患者（>= 61.1%）达到了TC和LDL-C目标，但低比例的患者（= 3个冠状动脉风险因素或CHD病史;高风险）达到了TC和LDL-C目标。在高风险组（n = 10，515）中，4059例患者（38.6%）达到TC目标。接受阿托伐他汀治疗的患者达到TC和LDL-C目标的百分比显著较高（分别为5133/7928 [64.7%]和5487/7426 [73.9%]），与推荐起始剂量的任何其他他汀类药物处方患者的比率相比（均P < 0.05）。这项针对接受降脂治疗以预防CHD的日本患者的研究结果表明，根据JAS指南中的建议，TC、LDL-C降低不足，冠心病高危患者的血脂和TG水平以及此类患者更积极的降脂治疗的必要性。版权所有（c）2005 Excerpta Medica，Inc.
Background: In its 1997 Guideline for Diagnosis and Treatment of Hyperlipidemia in Japanese Adults and subsequent revisions, the Japan Atherosclerosis Society (JAS) recommends serum lipid management goals (SLMGs) based on a coronary heart disease (CHD) risk classification. A literature search revealed that the status of lipid-lowering therapy based on the current JAS recommendations in Japan has not been assessed.Objective: The aim of this study was to evaluate the efficacy of current lipid-lowering regimens, and to provide the best possible therapeutic strategies for patients with hyperlipidemia by identifying risk factors for the development of CHD, based on the current JAS recommendations.Methods: This multicenter, retrospective study was conducted using data from patients under the care of physicians at 12,500 randomly selected institutions across Japan. Physicians received a survey concerning lipid-lowering therapy, on which each physician provided data from 10 consecutive adult patients with hyperlipidemia. who had been prescribed lipid-lowering therapy for at least 3 months before the survey was administered, and who were undergoing routine follow-up on an outpatient basis. Physicians provided patients' demographic and clinical data, including JAS-defined CHD risk classification, coronary risk factors and pre- and posttreatment (after >= 3 months) serum lipid levels, and the types and dosages of drugs in patients' current and prior treatment regimens. These data were used to assess the efficacy of lipid-lowering regimens and rates of patients achieving the SLMGs recommended by the JAS.Results: A total of 2540 physicians participated in the survey, and data from 24,893 Japanese patients (mean [SD] age, 65.8 [10.5] years) with hyperlipidemia were included in the study. Patients with familial hyperlipidemia (845/24,893 [3.4%]) were excluded from most of the analyses, leaving 24,048 patients with primary hyperlipidemia. The most prevalent coronary risk factors included age (21,902 [91.1%]), hypertension (14,275 [59.4%]), diabetes mellitus type 2 and/or impaired glucose tolerance (6346 [26.4%]), and smoking (3841 [16.0%]). A total of 20,948 patients (87.1%) had a CHD risk classification of B (ie, >= 1 coronary risk factor but no history of CHD). At the time of the survey, the lipid-lowering regimens of 22,080 patients (91.8%) included a statin. The rates of achievement of SLMGs were as follows: total cholesterol (TC), 12,659/23,840 patients (53.1%); low-density lipoprotein cholesterol (LDL-C), 14,025/22,121 (63.4%); high-density lipoprotein cholesterol, 19,702/21,279 (92.6%); and triglycerides (TG), 14,892/23,569 (63.2%). TC and LDL-C goals were achieved by most patients (>= 61.1%) in risk categories A, B1, and B2 (ie, 0-2 coronary risk factors; low to moderate risk) but by a low percentage of patients (= 3 coronary risk factors or history of CHD; high risk). In the high-risk group (n = 10,515), the TC goal was achieved by 4059 patients (38.6%). The TC and LDL-C goals were achieved by significantly higher percentages of patients prescribed atorvastatin (5133/7928 [64.7%] and 5487/7426 [73.9%], respectively) compared with the rates of patients prescribed any other statin at the recommended starting doses (all, P < 0.05).Conclusions: The results of this study of Japanese patients undergoing lipid-lowering therapy for the prevention of CHD, prescribed based on the recommendations in the JAS guideline, suggest insufficient reduction of TC, LDL-C, and TG in patients at high risk for CHD and the need for more aggressive lipid-lowering therapy in such patients. Copyright (c) 2005 Excerpta Medica, Inc.