在不同的现实世界队列中,在重血管化后实现LDL-C目标的差异
Garred S Greenberg1, Daniel Lorenzatti1, Annalisa Filtz1
1Cardiology Division, Montefiore Health System/Albert Einstein College of Medicine. Bronx, NY, USA.
许多患有动脉样硬化心血管疾病 (ASCVD) 的患者正在接受再血管化,缺乏及时的低密度脂蛋白胆固醇 (LDL-C) 测试,阻碍了降脂疗法 (LLT) 的使用. 女性和非西班牙裔黑人患者实现LDL-C目标的可能性较低.
科学领域:
- 心脏病学 心脏病学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 动脉样性心血管疾病 (ASCVD) 的管理依赖于通过降脂疗法 (LLT) 降低低密度脂蛋白胆固醇 (LDL-C).
- 最佳的LDL-C测试和LLT利用对于高风险ASCVD患者的二次预防至关重要.
研究的目的:
- 评估LDL-C测试和LLT使用模式在ASCVD患者的多样化,现实世界队列中,这些患者接受了再血管化.
- 确定与达到目标LDL-C水平 (<70 mg/dL) 相关的因素.
主要方法:
- 对6405名接受皮肤穿冠状动脉干预 (PCI),冠状动脉旁路移植 (CABG) 或外周动脉疾病 (PAD) 重血管化 (2018-2023) 的患者进行了回顾性队列研究.
- 从电子健康记录中提取的数据;用于评估关联的多变量逻辑回归.
- 分析了后续的LDL-C测试率,测试时间和LDL-C目标的实现.
主要成果:
- 67%的患者进行了随访LDL-C测试,平均时间为11个月;只有35%在6个月内进行了测试.
- 早期的LDL-C测试与增加使用高强度他类药物,ezetimibe和PCSK9抑制剂有关.
- 52%的人达到LDL-C <70 mg/dL;女性性别 (OR 0.70) 和非西班牙裔黑人种族/种族 (OR 0.57) 与较低的成绩率有关.
结论:
- 复血管化ASCVD患者中很大一部分人缺乏及时的后续LDL-C测试,这影响了LLT的有效性.
- 实现LDL-C目标仍然不够理想,在女性和非西班牙裔黑人人口中观察到差异.
- 需要制定战略来改善LDL-C的监测和LLT的遵守,特别是在代表性不足的群体.
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