Lipidmanagement in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry
Lipidmanagement in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry
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DOI：
10.1016/j.ahj.2017.08.005
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发表时间：
2017-11-01
影响因子：
4.8
通讯作者：
Peterson, Eric D.
中科院分区：
文献类型：
--
作者：
Navar, Ann Marie;Wang, Tracy Y.;Peterson, Eric D.
最新的胆固醇指南已将重点从实现低密度脂蛋白胆固醇（LDLC）目标转向以动脉粥样硬化性心血管疾病（ASCVD）风险为指导的他汀类药物的使用和强度。方法对来自138家PALM注册诊所的5905名符合他汀类药物一级或二级预防标准的患者进行他汀类药物使用和强度评估。结果：总体而言，74.7%的符合条件的成年人服用他汀类药物；只有42.4%达到了指南推荐的强度。相对于初级预防患者，ASCVD患者更可能使用他汀类药物（83.6% vs 63.4%, P < 0.0001）和指南推荐的强度（47.3% vs 36.0%, P < 0.0001）。男性比女性更倾向于一级预防（优势比[OR] 1.87, 95% CI 1.49-2.34）和二级预防（OR 1.47, 95% CI 1.26-1.70）的推荐强度。在一级预防中，年龄增加、糖尿病、肥胖、高血压和较低的10年ASCVD风险与接受推荐强度的几率增加相关。在ASCVD患者中，冠状动脉疾病患者比脑血管或外周血管疾病患者更有可能达到推荐的强度（or为1.71,95% CI 1.41-2.09），心脏病专家也发现了这一点（or为1.43,95% CI 1.12-1.83）。中位LDL-C水平在未接受他汀类药物治疗的患者中最高（124.0 mg/dL），在低于推荐剂量的患者中略高于推荐治疗的患者（分别为88.0和84.0 mg/dL）
Background The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDLC) targets toward statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk.Methods Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices.Results Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs 63.4%, P < .0001) and guideline-recommended intensity (47.3% vs 36.0%, P < .0001). Men were more likely than women to be prescribed recommended intensity for primary (odds ratio [OR] 1.87, 95% CI 1.49-2.34) and secondary (OR 1.47, 95% CI 1.26-1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41-2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12-1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL) and slightly higher among those on lower-than-recommended intensity compared with recommended-therapy recipients (88.0 and 84.0 mg/dL, respectively; P