Under-prescription of statins in patients with non-alcoholic fatty liver disease
Under-prescription of statins in patients with non-alcoholic fatty liver disease
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DOI：
10.1016/j.numecd.2016.09.011
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发表时间：
2017-02-01
影响因子：
3.9
通讯作者：
Angelico, F.
中科院分区：
文献类型：
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作者：
Del Ben, M.;Baratta, F.;Angelico, F.
背景与目的：非酒精性脂肪性肝病(NAFLD)是一种常见的心血管疾病。血脂异常的处理在预防心血管事件中起着关键作用，他汀类药物已被证明在这些患者中是安全的。然而，在日常的临床实践中，由于医生对副作用的担忧，他汀类药物的处方有时是有限的。该研究的目的是调查NAFLD的存在是否会影响大量心脏代谢紊乱患者的降脂治疗处方。方法和结果：根据ESC/EAS指南，在605名成年可疑代谢性疾病筛查对象中定义了心血管风险和低密度脂蛋白胆固醇指标。肝脏脂肪变性按超声滨口标准进行评估。在整个队列中，442名患者有降胆固醇治疗的适应症。230例(52.0%)患者缺乏他汀类药物处方。在这些患者中，77例(33.5%)为极高危患者，48例(20.8%)为高危患者，105例(45.6%)为中等风险患者。在有他汀类药物治疗指征的NAFLD患者中，只有44%的人在接受治疗。接受他汀类药物治疗的非酒精性脂肪肝患者的ALT值显著低于未接受治疗的患者(p<；0.05)。结论：我们的研究结果显示，大约50%的有他汀类药物适应症的患者没有接受任何降胆固醇药物治疗。在NAFLD受试者中，他汀类药物使用不足的情况尤其严重。在NAFLD的情况下，应鼓励使用他汀类药物，因为在这种情况下，他汀类药物可以改善血脂状况并降低心血管风险。(C)2016年意大利糖尿病学会、意大利动脉粥样硬化研究学会、意大利人类营养学会和费德里科二世大学临床内外科。爱思唯尔出版，版权所有。
Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is a common disease associated with high cardiovascular risk. Management of dyslipidaemia plays a pivotal role in the prevention of CV events and statins have proved to be safe in these patients. However, in everyday clinical practice statin prescription is sometimes limited because of the concern of physicians about side-effects. The aim of the study was to investigate if the presence of NAFLD affects the prescription of lipid-lowering treatment in a large series of patients with cardio-metabolic disorders.Methods and Results: Cardiovascular risk and LDL-C targets were defined according to ESC/ EAS Guidelines in 605 consecutive adult subjects referred for screening of suspected metabolic diseases. Liver steatosis was assessed by ultrasound Hamaguchi criteria. In the whole cohort, 442 patients had indication for cholesterol-lowering treatment. Lack of statin prescription was present in 230 (52.0%) patients. Of these, 77 (33.5%) were very high-risk, 48 (20.8%) high-risk, and 105 (45.6%) moderate risk patients. Only 44% of the NAFLD patients with indication for statin treatment were on therapy. NAFLD patients on statin treatment had significantly lower ALT values as compared to those not on treatment (p < 0.05).Conclusions: Our findings show that about 50% of patients with indication to statin treatment do not receive any cholesterol-lowering medication. Statin under-use was particularly high in subjects with NAFLD. Use of statin treatment should be encouraged in the context of NAFLD, as it may improve lipid profile and reduce the cardiovascular risk in this setting. (C) 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.