Statin underuse and low prevalence of LDL-C control among U.S. adults at high risk of coronary heart disease.
Statin underuse and low prevalence of LDL-C control among U.S. adults at high risk of coronary heart disease.
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DOI：
10.1097/maj.0000000000000292
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发表时间：
2014-08
期刊：
影响因子：
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通讯作者：
Muntner P
中科院分区：
文献类型：
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作者：
Gamboa CM;Safford MM;Levitan EB;Mann DM;Yun H;Glasser SP;Woolley JM;Rosenson R;Farkouh M;Muntner P
在有冠心病病史或风险相当的个体中，他汀类药物可降低患冠心病的风险。10年的冠心病风险&>20%被认为是等同的风险，但通常没有被检测到。他汀类药物的使用和低密度脂蛋白胆固醇(LDL-C)的控制在全国范围内卒中地理和种族差异(RECONS)研究(n=8,812)中对患有冠心病或风险相当的参与者进行了检查。参与者被分为4个相互排斥的组：(1)冠心病病史(n=4,025)，(2)没有冠心病病史但有中风和/或腹主动脉瘤(AAA)病史(n=946)，(3)没有冠心病或中风/AAA病史但有糖尿病(n=3)，或(4)(1)至(3)中没有病史但有10年Framingham CHD风险评分(FRS)和GT；20%使用ATP-III积分系统计算(n=707)。他汀类药物在冠心病组中的使用率为58.4%，在中风/AAA组、糖尿病组和FRS>；20%组中分别为41.7%、40.4%和20.1%。在服用他汀类药物的患者中，65.1%的人低密度脂蛋白胆固醇水平为100 mg/dL，在冠心病、中风/AAA或糖尿病组之间没有差异。然而，与冠心病组相比，低密度脂蛋白胆固醇100 mg/dL在FRS>；20%组的参与者中较少(多变量调整后的患病率：0.72；95%CI：0.62-0.85)。使用2013年ACC/AHA胆固醇治疗指南的结果类似。这些数据表明，许多冠心病风险较高的人，特别是那些FRS>；20%的人，没有接受与指南一致的降脂治疗，也没有达到100 mg/dL的低密度脂蛋白。
Statins reduce the risk of coronary heart disease (CHD) in individuals with a history of CHD or risk equivalents. A 10-year CHD risk >20% is considered a risk equivalent but is frequently not detected. Statin use and low density lipoprotein cholesterol (LDL-C) control were examined among participants with CHD or risk equivalents in the nationwide Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (n=8,812). Participants were categorized into 4 mutually exclusive groups: (1) history of CHD (n=4,025), (2) no history of CHD but with a history of stroke and/or abdominal aortic aneurysm (AAA) (n=946), (3) no history of CHD or stroke/AAA but with diabetes mellitus (n=3,134), or (4) no history of the conditions in (1) through (3) but with 10-year Framingham CHD risk score (FRS) >20% calculated using the ATP-III point scoring system (n=707). Statins were used by 58.4% of those in the CHD group and 41.7%, 40.4%, and 20.1% of those in the stroke/AAA, diabetes, and FRS>20% groups, respectively. Among those taking statins, 65.1% had LDL-C <100mg/dL, with no difference between the CHD, stroke/AAA, or diabetes groups. However, compared to those in the CHD group, LDL-C <100mg/dL was less common among participants in the FRS>20% group (multivariable adjusted prevalence ratio: 0.72; 95% CI: 0.62 – 0.85). Results were similar using the 2013 ACC/AHA cholesterol treatment guideline. These data suggest many people with high CHD risk, especially those with a FRS>20%, do not receive guideline-concordant lipid-lowering therapy and do not achieve an LDL-C <100mg/dL.