Lipid Management and 2-Year Clinical Outcomes in Japanese Patients with Acute Coronary Syndrome: EXPLORE-J.
Lipid Management and 2-Year Clinical Outcomes in Japanese Patients with Acute Coronary Syndrome: EXPLORE-J.
复制标题
DOI：
10.5551/jat.59543
复制
发表时间：
2021-12-01
影响因子：
4.4
通讯作者：
Harada-Shiba M
中科院分区：
文献类型：
--
作者：
Nakamura M;Ako J;Arai H;Hirayama A;Nohara A;Murakami Y;Ozaki A;Harada-Shiba M
目的：由于代谢风险因素（包括血脂异常）的增加，日本动脉粥样硬化性心血管（CV）疾病的患病率有所上升。低密度脂蛋白胆固醇（LDL-C）水平、CV事件发生率和降脂治疗（LLT）的预防作用之间的正线性相关性已得到充分确立;然而，日本的数据有限。该分析评价了日本急性冠脉综合征（ACS）后患者当前的脂质管理实践和复发性CV事件的风险。 方法：EXPLORE-J是一项在日本住院ACS患者中进行的多中心、2年观察性研究。 结果如下：2年随访时（n =1944，平均年龄66岁，80.3%为男性），主要不良心血管事件的累积发生率（MACE;与心肌梗死/脑血管意外[CVA]和其他CV死亡、非致死性ACS和观察期内需要住院的非致死性CVA相关的死亡）为6.2%; CV死亡、非致死性ACS和CVA的发生率分别为0.7%、4.5%和1.7%。访视（V）1（第[D]1+14天）时，分别有93.6%、8.2%和3.9%的患者接受他汀类药物、强化他汀类药物和依折麦布处方，访视5（D 730 ±30天）时，分别有92.3%、10.5%和11.6%的患者接受他汀类药物、强化他汀类药物和依折麦布处方。平均LDL-C从ACS后首次测量值（121.3 mg/dL）降低至V5（79.8 mg/dL）。从V1-V5（14.4%-34.6%）达到LDL-C <70 mg/dL的患者数量有限; V1时LDL-C降低较大的患者发生MACE的概率较低，表明ACS后早期LDL-C降低的益处。 结论：指南推荐的日本ACS后LDL-C目标实现情况不理想，表明需要加强LLT。计划对研究人群的风险分层和脂质管理的获益进行额外分析。
Aim: The prevalence of atherosclerotic cardiovascular (CV) disease has risen in Japan due to increasing metabolic risk factors, including dyslipidemia. A positive linear correlation between low-density lipoprotein cholesterol (LDL-C) levels, incidence of CV events, and preventive effects of lipid-lowering therapy (LLT) is well established; however, data in Japan are limited. This analysis evaluated current lipid management practices and risk of recurrent CV events in Japanese post-acute coronary syndrome (ACS) patients. Methods: EXPLORE-J is a multicenter, 2-year observational study of hospitalized ACS patients in Japan. Results: At 2-year follow-up ( n =1944, mean age 66 years, 80.3% male), the cumulative incidence of major adverse cardiovascular events (MACE; death associated with myocardial infarction/cerebrovascular accident [CVA] and other CV death, non-fatal ACS, and non-fatal CVA requiring hospitalization during the observation period) was 6.2%; respective incidences of CV death, non-fatal ACS, and CVA were 0.7%, 4.5%, and 1.7%. Statin, intensive statin, and ezetimibe were prescribed for 93.6%, 8.2%, and 3.9% at visit (V)1 (Day[D]1＋14), and 92.3%, 10.5%, and 11.6% of patients at V5 (D730±30 days), respectively. Mean LDL-C was reduced from first post-ACS measurement (121.3 mg/dL) to V5 (79.8 mg/dL). A limited number of patients achieved LDL-C ＜70 mg/dL from V1–V5 (14.4%–34.6%); those with a greater LDL-C reduction by V1 had a lower probability of MACE, indicating the benefits of early LDL-C reduction post ACS. Conclusions: Guideline-recommended LDL-C target achievement post ACS in Japan is suboptimal, suggesting the need for LLT intensification. Additional analyses by risk stratification of the study population and the benefits of lipid management are planned.