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Am Heart J：高脂血症急性心梗患者LDL-C达标率堪忧

2013-01-22 Am Heart J CMT 高晓方 编译

高脂血症急性心梗LDL-C达标率
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　　美国学者的一项研究发现，在基线伴有高脂血症的急性心肌梗死（AMI）患者中，有1/3在心梗后6个月时未实现低密度脂蛋白胆固醇（LDL-C）指南推荐目标。研究进一步支持了在患者接受AMI照护的临界期对其进行靶向干预，促进医生对出院患者处方可承受的他汀药物并提高患者的药物治疗持久性和依从性，以及心脏康复参与程度。论文发表于《美国心脏杂志》[Am Heart J 2013

　　美国学者的一项研究发现，在基线伴有高脂血症的急性心肌梗死（AMI）患者中，有1/3在心梗后6个月时未实现低密度脂蛋白胆固醇（LDL-C）指南推荐目标。研究进一步支持了在患者接受AMI照护的临界期对其进行靶向干预，促进医生对出院患者处方可承受的他汀药物并提高患者的药物治疗持久性和依从性，以及心脏康复参与程度。论文发表于《美国心脏杂志》[Am Heart J 2013；165（1）：26]。

　　此项研究共美国24所医院的观察性登记库中纳入366例AMI患者；受试者的基线LDL-C水平≥100 mg/dL，并且均接受6个月LDL-C再评估。主要转归为急性心梗6个月后未能实现LDL-C <100 mg/dL的指南推荐目标。

　　结果显示，初始评估LDL-C的患者中有1/3未能在6个月时实现LDL-C目标。与实现LDL-C目标的患者相比，未实现者出院时未应用他汀类的比率较高（21%对9%，P<0.001），尽管其中仅有4%伴有禁忌证。未实现LDL-C目标的患者更有可能在6个月时停用他汀类药物（24%对6%，P<0.001）。多变量模型显示，出院时未开具他汀类以及他汀类药物治疗持续性缺如为未实现LDL-C目标的最显著独立相关因素。其他独立危险因素包括患者自报未依从治疗、未参加心脏康复、非白种人以及未参加保险。


Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction

Background
Although controversial, reducing low-density lipoprotein cholesterol (LDL-C) to target levels remains a common therapeutic goal after acute myocardial infarction (AMI). We sought to illuminate patient and provider characteristics associated with LDL-C goal nonattainment after AMI.
Methods
In an observational registry of 24 US hospitals, we included 366 patients with AMI who had baseline LDL-C levels ≥100 mg/dL and underwent 6-month fasting LDL-C reassessment. Our primary outcome was failure to reach the guideline-recommended LDL-C goal of <100 mg/dL at 6 months post-AMI.
Results
One in 3 patients with AMI with initially elevated LDL-C failed to attain LDL-C goal at 6 months. Compared with those who attained LDL-C goal, those who did not were more often discharged without a statin (21% vs 9%, P < .001), despite only 4% having documented contraindications. Patients not achieving LDL-C goal also more frequently discontinued statin use by 6 months (24% vs 6%, P < .001). Multivariable modeling (c index, 0.78) revealed the absence of a statin prescription at discharge and lack of persistence on statin therapy as the strongest independent factors associated with failure to reach LDL-C goal. Additional independent risk factors were patient report of not consistently adhering to prescribed medications, not participating in cardiac rehabilitation, nonwhite race, and lack of insurance.
Conclusions
One-third of patients with AMI with baseline hyperlipidemia do not attain the LDL-C goal of <100 mg/dL at 6 months. Our findings support targeted interventions in the transition of AMI care to promote affordable statin prescription at discharge, medication persistence and adherence, and cardiac rehabilitation participation.

    

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  1. [GetPortalCommentsPageByObjectIdResponse(id=2049439, encodeId=d251204943910, content=<a href='/topic/show?id=5c2e5106290' target=_blank style='color:#2F92EE;'>#心梗患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51062, encryptionId=5c2e5106290, topicName=心梗患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e6a1280, createdName=zhanglin3079, createdTime=Sat Jan 26 21:51:00 CST 2013, time=2013-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1308308, encodeId=67da1308308ee, content=<a href='/topic/show?id=8323522e503' target=_blank style='color:#2F92EE;'>#急性心梗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52275, encryptionId=8323522e503, topicName=急性心梗)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fa4f352, createdName=chenlianhui, createdTime=Thu Jan 24 02:51:00 CST 2013, time=2013-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1355727, encodeId=36b81355e2760, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Jan 24 02:51:00 CST 2013, time=2013-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422503, encodeId=3ac4142250345, content=<a href='/topic/show?id=58b810e5814' target=_blank style='color:#2F92EE;'>#LDL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10758, encryptionId=58b810e5814, topicName=LDL)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=382c3719677, createdName=zhwj, createdTime=Thu Jan 24 02:51:00 CST 2013, time=2013-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562134, encodeId=94bb15621349d, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Jan 24 02:51:00 CST 2013, time=2013-01-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1574532, encodeId=1ad315e4532b7, content=<a href='/topic/show?id=9b56102616bb' target=_blank style='color:#2F92EE;'>#高脂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102616, encryptionId=9b56102616bb, topicName=高脂)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c3b716021149, createdName=pcw111, createdTime=Thu Jan 24 02:51:00 CST 2013, time=2013-01-24, status=1, ipAttribution=)]
    2013-01-26 zhanglin3079

    #心梗患者#

    0

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    2013-01-24 chenlianhui

    #急性心梗#

    0

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    2013-01-24 zhaojie88

    #ART#

    0

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    2013-01-24 zhwj

    #LDL#

    0

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    2013-01-24 slcumt

    #HEART#

    0

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    2013-01-24 pcw111

    #高脂#

    0

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