Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA) - Gender, ethnicity, and coronary artery calcium
Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA) - Gender, ethnicity, and coronary artery calcium
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DOI：
10.1161/circulationaha.105.552737
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发表时间：
2006-02-07
期刊：
影响因子：
37.8
通讯作者：
Psaty, BM
中科院分区：
文献类型：
--
作者：
Goff, DC;Bertoni, AG;Psaty, BM
背景-为了评估国家胆固醇教育计划成人治疗小组第三次报告（ATP III）的实施挑战，我们确定了血脂异常的患病率，治疗和控制，包括种族和性别差异，在没有已知临床心血管疾病（CVD）的人群中。此外，本报告提供了关于存在的冠状动脉钙（CAC）跨组定义的风险和建议使用的降脂drugs.Methods和结果-动脉粥样硬化的多种族研究（梅萨）是一个多中心队列研究的6814人年龄在45至84岁的人是免费的临床心血管疾病在基线（2000 - 2002年）。对具有完整空腹血脂谱的参与者（n = 6704）进行了CVD风险和自我报告的降脂治疗使用情况的评估。通过CT评估CAC。根据ATP III定义药物治疗阈值和目标。构建模型，以调整年龄，临床部位，风险因素，社会经济特征，和医疗服务的访问变量使用泊松回归。总体而言，29.3%（1964/6704）有血脂异常，其中54.0%（1060/1964）报告了降脂药物治疗。在75.2%（797/1060）接受治疗的血脂异常受试者和40.6%（797/1964）的血脂异常受试者中观察到ATP III目标的控制。男性比女性更有可能有资格接受药物治疗，而不太可能接受治疗和控制。相对于非西班牙裔白人，华裔美国人不太可能有资格接受药物治疗，但治疗和控制率没有差异。黑人和西班牙裔美国人的血脂异常患病率与非西班牙裔白人相当，但接受治疗和控制的可能性较小。通过调整医疗保健获取变量，种族差异大幅减弱;然而，尽管调整了风险因素，社会经济特征和医疗保健获取变量，性别差异仍然存在。与低危组相比，CVD高危组和中危组中血脂异常的控制率较低。在高危人群中，19.7%不符合降脂药物治疗条件的患者CAC > 400。没有接受药物治疗的合格人群的比例因CAC的存在和严重程度而异，48.0%，46.8%和39.6%的合格人群没有CAC，CAC > 0和< 400，以及CAC > 400没有接受治疗，分别为（P差异= 0.04）。血脂异常的护理质量总体上不太理想，并且因心血管疾病风险组、种族和性别而异。将CAC筛查纳入危险分层和治疗过程的效用应根据目前被归类为不需要治疗的CAC患者的大部分进行调查。需要研究和质量改进计划来优化血脂异常的管理。
Background - To assess the implementation challenge facing the Third Report of the Adult Treatment Panel (ATP III) of the National Cholesterol Education Program, we determined the prevalence, treatment, and control of dyslipidemia, including ethnic and gender differences, in persons free of known clinical cardiovascular disease (CVD). In addition, this report provides information about the presence of coronary artery calcium (CAC) across groups defined by risk and recommendations for the use of lipid-lowering drugs.Methods and Results - The Multi-Ethnic Study of Atherosclerosis (MESA) is a multicenter cohort study of 6814 persons aged 45 to 84 years who were free of clinical CVD at baseline (2000 - 2002). Participants with complete fasting lipid profiles (n = 6704) were evaluated for CVD risk and self-reported use of lipid-lowering therapy. CAC was assessed by CT. Drug treatment thresholds and goals were defined according to ATP III. Models were constructed to adjust for age, clinic site, risk factors, socioeconomic characteristics, and healthcare access variables with the use of Poisson regression. Overall, 29.3% (1964/6704) had dyslipidemia, among whom lipid-lowering drug therapy was reported by 54.0% (1060/1964). Control to ATP III goal was observed in 75.2% (797/1060) of participants with treated dyslipidemia and 40.6% (797/1964) of participants with dyslipidemia. Men were more likely than women to qualify for drug therapy and less likely to be treated and controlled. Relative to non-Hispanic whites, Chinese Americans were less likely to qualify for drug treatment, but no differences in treatment and control rates were observed. Black and Hispanic Americans had prevalence of dyslipidemia that was comparable to that of non-Hispanic whites but were less likely to be treated and controlled. Ethnic disparities were attenuated substantially by adjustment for healthcare access variables; however, the gender disparities persisted despite adjustment for risk factors, socioeconomic characteristics, and healthcare access variables. Control of dyslipidemia was achieved less commonly in the CVD high- and intermediate-risk groups than in the low-risk group. Among high-risk individuals, 19.7% of those who did not qualify for lipid-lowering drug treatment had CAC > 400. The proportion of drug treatment-qualifying persons who were not treated differed by presence and severity of CAC, with 48.0%, 46.8%, and 39.6% of eligible persons with no CAC, with CAC > 0 and < 400, and with CAC > 400 not receiving treatment, respectively (P for difference = 0.04).Conclusions - Dyslipidemia is common among persons without CVD. The quality of care for dyslipidemia is suboptimal in general and variable by CVD risk group, ethnicity, and gender. The utility of incorporating CAC screening into the risk stratification and treatment process should be investigated in light of the substantial proportions of persons with CAC who are currently classified as not requiring treatment. Research and quality improvement programs are needed to optimize management of dyslipidemia.