老年患者应用不同类型他汀类药物的疗效及安全性评价

目的观察不同剂量和类型他汀类药物在老年高脂血症患者中应用的疗效与安全性。方法回顾性分析456例老年高脂血症患者服用他汀类药物情况,根据服药情况分为:阿托伐他汀组(169例)、辛伐他汀组(110例)、普伐他汀组(137例)和氟伐他汀组(40例);又根据《中国成人血脂异常防治指南》将患者分为中危(41例)、高危(232例)和极高危(183例)。观察治疗8周后血脂水平及不良反应。结果与治疗前比较,阿托伐他汀组、辛伐他汀组、普伐他汀组和氟伐他汀组治疗8周后血清TC、LDL-C水平均明显降低(P0.05,P0.01)。4组治疗前后血清TG水平差异无统计学意义(P0.05)。阿托伐他汀组、辛伐他汀组治疗8周后血清TC、LDL-C变化率与普伐他汀组、氟伐他汀组比较差异有统计学意义(P0.05)。各组中高危患者服用标准剂量他汀类药物治疗后,LDL-C达标率均在80%以上,极高危患者达标率为44.1%～55.7%。结论多数老年高脂血症患者服用小剂量和(或)标准剂量他汀类药物血脂即可达标。且治疗安全性好,无严重不良反应发生。     

老年患者调脂治疗达标状况分析

目的初步了解2007年血脂异常防治指南颁布后老年患者的调脂治疗达标情况。方法选择2009年2～7月在我院老年病房住院并服用他汀类药物治疗4周以上的男性患者144例,按照2007年中国成人血脂异常防治指南危险分层方案,分为高危组(65例)和极高危组(79例),并按指南规定的不同危险分层血脂控制目标值,判断调脂治疗是否达标,分析可能影响达标率的因素。结果高危组与极高危组患者多数服用阿托伐他汀治疗,平均治疗剂量差异无统计学意义。服药4周后,2组间TC、LDL-C、TG及HDL-C水平差异无统计学意义。TC总达标率为41.7%,LDL-C总达标率为54.9%,TC+LDL-C总达标率为41.7%。高危组TC、LDL-C及TC+LDL-C达标率分别为67.7%、70.8%和66.2%;极高危组达标率分别为20.3%、41.8%和21.5%(P0.05)。多因素logistic回归分析显示,极高危组达标率与年龄、冠心病、高血压、糖尿病、周围血管疾病及糖尿病控制情况无明显相关性。结论目前,老年患者的调脂治疗达标率仍较低,与指南要求存在较大差距,其中的影响因素值得进一步探讨。     

118例高胆固醇血症患者调脂治疗达标情况分析

目的 调查高胆固醇血症患药物治疗达标率。方法 对现行调脂治疗持续时间≥2个月的118例高胆固醇血症患进行血脂检查,并根据1997年我国制定的《血脂异常防治建议》确定血脂是否达标。结果 总胆固醇（TC）和低密度脂蛋白胆固醇（LDL－C）总达标率分别为23．7％、38．1％,他汀类药物LDL－C总达标率高于海鱼油和绞股兰每日20mg辛伐他汀LDL－C达标率高于每日20mg氟伐他汀。结论 现行调脂治疗达标率较低,可能与选择药物的种类和药物剂量有关。     

根据《中国成人血脂异常防治指南(2016年修订版)》再分析DYSIS-China横断面调查

目的探讨中国血脂异常患者降脂治疗后血脂状况和特征。方法应用《中国成人血脂异常防治指南(2016年修订版)》的标准对DYSIS-China数据库进行再分析。DYSIS-China数据库共纳入25317例接受至少1种降脂药物治疗至少3个月的中国血脂异常患者。对这些患者的低密度脂蛋白胆固醇(LDL-C)和非高密度脂蛋白胆固醇(非-HDL-C)达标率,以及血脂水平与目标值之间的差距等数据进行描述性统计。结果中国血脂异常患者中96.6%为高危和极高危,总体LDL-C达标率仅为37.3%。极高危、高危、中危和低危患者的LDL-C达标率分别为26.9%、44.1%、78.5%和99.7%。东北地区LDL-C达标率和非-HDL-C达标率低于其他地区。就诊三级医院和心血管内科的患者的LDL-C和非-HDL-C达标率高于其他级别的医院和科室。LDL-C水平距离目标值的平均差距在极高危和高危患者中分别是39.7 mg/dl和33.9 mg/dl。87.7%的患者使用他汀单药治疗,最常用辛伐他汀和阿托伐他汀,以中等强度的辛伐他汀20~40 mg/d或等价他汀为主。结论中国血脂异常患者经降脂治疗后LDL-C达标率仍然很低,尤其是高危和极高危患者的LDL-C与目标值之间仍然存在巨大差距。     

不同起始剂量阿托伐他汀治疗高胆固醇血症的疗效与安全性

目的　观察不同起始剂量阿托伐他汀治疗高胆固醇血症的达标率与安全性。方法　入选2012年2月至7月在我院门诊就诊的高胆固醇血症患者122例作为实验组，患者按心血管病危险因素分为4组：低危组（29例）、中危组（33例）、高危组（32例）及极高危组（28例），根据心血管病危险分层及低密度脂蛋白胆固醇水平确定个体化阿托伐他汀起始剂量；另选同期39例高胆固醇血症患者作为对照组，常规给予阿托伐他汀治疗；6周后所有入选患者低密度脂蛋白胆固醇不达标者每天加阿托伐他汀10　mg；均观察12周，同时记录不良事件。结果　实验组的低危组、中危组、高危组、极高危组患者在6周时低密度脂蛋白胆固醇达标率分别为75.9%、72.7%、71.9%、57.1%，12周时各组的达标率增至89.7%、81.8%、78.1%、71.4%；实验组患者低密度脂蛋白胆固醇总的达标率在6周及12周分别为69.7%及81.1%。对照组患者6周及12周达标率分别为48.7%及66.7%。实验组6周及12周达标率均显著高于对照组（分别为P<0.01，P<0.05）。所有患者均耐受治疗剂量。结论　根据心血管病危险分层及低密度脂蛋白胆固醇水平个体化确定阿托伐他汀治疗起始剂量，患者的达标率显著高于常规治疗的对照组，安全有效，值得推广。     

急性心肌梗死患者胆固醇不高者如何使用他汀类药物？

2007年《中国成人血脂异常防治指南》根据中国成人血脂特点,将低密度脂蛋白胆固醇（LDL-C）〈2．08mmol／L（1mmol/L=0．026mg／dL）设定为极高危患者的降脂目标。极高危患者指的是急性冠状动脉综合征或缺血性心血管病合并糖尿病。急性心肌梗死患者是冠状动脉粥样硬化性心脏病（冠心病）的极高危人群,如果胆固醇水平不高,需了解LDL—C的水平。对于LDL-C高于目标值的患者,应积极给予他汀类药物治疗,从而减少心血管事件的发生。     

中国急性心肌梗死患者发病前动脉粥样硬化性心血管疾病危险分层分析

目的:探究急性心肌梗死患者发病前的动脉粥样硬化性心血管疾病(ASCVD)危险分层情况和应用他汀类药物进行预防治疗的现状。方法:纳入2013年1月1日至2016年1月30日入选中国急性心肌梗死注册研究(CAMI)的1型急性心肌梗死患者,依据中国成人血脂异常防治指南(2016年修订版),评估其发病前的ASCVD危险分层情况,并调查不同危险分层患者使用他汀类药物的情况。结果:在30 952例急性心肌梗死患者中,11 950例(38.6%)患者为ASCVD低危人群,5 360例(17.3%)患者为ASCVD中危人群,ASCVD高危、极高危人群分别占25.8%(7 990例)和18.3%(5 652例)。仅5.7%的高危患者服用他汀类药物治疗,低密度脂蛋白胆固醇(LDL-C)达标率为22.4%;极高危患者中仅16.4%应用他汀类药物进行ASCVD二级预防,LDL-C达标率仅18.3%。结论:我国超半数急性心肌梗死患者发病前为ASCVD低中危患者,高危和极高危患者使用他汀类药物进行一级、二级预防的比例均较低。     

选择性胆固醇吸收抑制剂临床应用中国专家共识(2011版)

血脂异常与心血管疾病密切相关.过去10余年中,国内外先后完成了一系列里程碑式的血脂干预研究.这些研究结果有力证实,积极降低胆固醇水平可以显著降低心血管病高危人群的心血管事件发生率,因而降胆固醇达标被视为防治心血管疾病的核心策略.虽然确凿证据表明,他汀类药物在动脉粥样硬化性心血管疾病一、二级预防中具有重要地位,合理应用此类药物可显著降低心血管疾病的发病率与病死率,然而在临床实践中,许多患者在接受了较大剂量他汀类药物治疗后其胆固醇水平仍不能达到目标值,另有一些患者由于种种原因不能耐受他汀类药物治疗,这已成为提高血脂达标率的重要羁绊.中围第二次血脂治疗现状调研结果显示,高危、极高危心血管病患者LDL-C达标率仅为31％和22％,这一现状提示我们应采取更多的有效手段对胆固醇水平进行干预,以期给患者带来尽可能多的临床益处.降胆固醇新药选择性胆固醇吸收抑制剂的问世为降低胆固醇治疗提供了一种新手段.     

血脂异常患者单项血脂及血脂比值与心血管疾病的相关性探讨

目的 比较单项血脂及血脂比值与心血管疾病发病危险的关系.方法 收集中国医科大学附属盛京医院门诊179例血脂异常患者,按照2007年中国成人血脂异常防治指南分为极高危、高危、中危、低危组,与41名健康人对照,探讨单项血脂及血脂比值与心血管疾病发病危险的关系.结果 血脂异常组总胆固醇(total cholesterol,T...     

老年患者服用血脂康的疗效与安全性分析

目的:观察我院老年患者应用血脂康的疗效与安全性。方法:回顾性分析我院236例服用血脂康的老年患者,依据2007年中国成人血脂异常防治指南推荐的心血管疾病危险分层方案和血脂控制目标对患者进行危险分层并判断患者血脂水平是否达标,观察患者的血脂达标率、达标剂量及不良反应情况。结果:服用血脂康的老年患者共236例,其中包括心血管疾病中危患者7例、高危者169例、极高危者60例。中危患者LDL-C、非HDL-C及TC达标率均为100%,高危患者LDL-C、非HDL-C及TC达标率分别为71.0%、78.1%及59.2%,极高危患者LDL-C、非HDL-C及TC达标率分别为53.3%、51.7%及16.7%。中、高、极高危患者血脂康平均使用剂量分别为0.9、1.0、0.9g/d。在236例患者中,2.2%出现ALT轻度升高,8.0%出现CK轻度升高,ALT及CK升高均未超过正常上限3倍。结论:老年心血管病中危及高危患者应用血脂康治疗血脂达标率较高,极高危患者血脂达标率偏低,血脂康治疗安全、有效。对于极高危患者血脂康的使用剂量偏低、达标率低的现状应引起重视。     

老年血脂异常患者调脂治疗的现状分析

目的分析老年血脂异常患者调脂治疗情况及影响血脂LDL-C达标率的可能因素。方法应用统一的调查表,调查2007年8月～2008年8月在我院住院的607例患者调脂治疗情况,按年龄分老年组(≥60岁,403例)和非老年组(60岁,204例)。对患者进行血脂异常危险分层,以LDL-C为判断标准,计算血脂控制达标率。结果与非老年组LDL-C达标率(36.8%)比较,老年组LDL-C达标率为42.4%,差异无统计学意义(P0.05)。老年组患者中低危、中危、高危和极高危LDL-C达标率分别为100%、77.4%、45.7%和21.5%,差异有统计学意义(P0.01)。血脂异常危险分层、医疗付费方式、有无合并疾病与血脂控制达标率显著相关。结论老年血脂异常患者调脂治疗与2007年新指南标准仍有差距,危险分层越高,达标率相对越低。     

Attainment of low-density lipoprotein cholesterol goals in statin treated patients: Real-world evidence from Australia

Little is known about the attainment of low-density lipoprotein cholesterol (LDL-C) targets in patients treated with statins in Australian primary healthcare setting that are at increased risk of cardiovascular disease. A retrospective cohort study was conducted using data from electronic medical records of patients treated by general practitioners across Australia. LDL-C target attainment was defined as LDL-C levels ≤ 2 mmol/L for all risk groups, in line with Australian guidelines. Multivariable logistic regression was used to identify the factors associated with LDL-C target attainment. Overall, 61,407 patients were included in the analysis. The mean age was 65 years (± standard deviation [SD] 12.1); 52.0% were males.. Overall, the median LDL-C level was 2.3 mmol/L (IQR = 1.8 - 2.8) and 36.0% of the study population met therapeutic targets. Increased likelihood to achieve LDL-C targets was observed in patients diagnosed with type 2 diabetes (OR 2.07, 95% CI 1.92 – 2.24), stroke (OR = 1.58, 95% CI 1.39 – 1.79, P < 0.001) or chronic heart disease (OR = 1.67, 95% CI 1.55 – 1.81, P < 0.001). Patients diagnosed with dyslipidemia (OR = 0.59, 95% CI 0.55 – 0.64, P < 0.001), hypertension (OR = 0.91, 95% CI 0.83 – 1.00, P < 0.05) and current smokers (OR = 0.71, 95% CI 0.71 – 1.00, P < 0.05), were less likely to attain LDL-C targets, regardless of the type, intensity and length of use of the prescribed statin. Longer duration and higher intensity statin were associated with more patients achieving targeted LDL-C goal, however nearly two thirds of Australians still failed to achieve targeted outcome even after 24 months of statin therapy.     

Lipid-lowering drug use is associated with reduced prevalence of atrial fibrillation in patients with left ventricular systolic dysfunction

BACKGROUND: Inflammation and oxidative stress have been implicated in the pathogenesis of atrial fibrillation (AF). Lipid-lowering drugs, particularly statins and fibrates, possess anti-inflammatory and antioxidant properties. OBJECTIVES: The purpose of this study was to assess the impact of lipid-lowering drug use on AF prevalence in patients with reduced left ventricular ejection fraction (LVEF). METHODS: Data were obtained from ADVANCENT(SM), a multicenter registry of patients with reduced LVEF (相似文献   

Prevalence of mixed dyslipidemia among Australian patients undergoing lipid-modifying therapy

BACKGROUND:

Few studies have assessed the prevalence of mixed dyslipidemia (MD) and the effectiveness of lipid-modifying therapy (LMT) for the treatment of abnormal levels of low-density lipoprotein cholesterol (LDL-C), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) in Australian clinical practice.

OBJECTIVE:

To estimate the prevalence of MD in Australian patients undergoing LMT.

METHODS:

Patients 35 years of age and older undergoing LMT for ≥1 year were enrolled from nine general practice and cardiologist/endocrinologist outpatient clinics in Australia between April 2007 and May 2008. Lipid levels, including LDL-C, HDL-C and TG levels, were prospectively collected at the enrollment date and from patient records one year before LMT was initiated. Normal lipid levels were assessed according to Australian guidelines. Multivariate logistic regression was used to evaluate predictors of normal lipid level attainment.

RESULTS:

Of 297 patients (mean age 60.1 years; 43% male), the prevalence of MD before LMT was 61%; 93% of patients had elevated LDL-C levels, 17% had low HDL-C levels and 62% had elevated TG levels. Following LMT (98.3% statins), 31% of patients had MD. The prevalence of elevated LDL-C levels, low HDL-C levels and elevated TG levels were 44%, 21% and 42%, respectively. Baseline lipid levels were significant predictors of attainment of normal LDL-C levels (OR 0.42 [95% CI 0.27 to 0.63]) and TG levels (OR 0.26 [95% CI 0.16 to 0.45]).

CONCLUSION:

Among Australian patients primarily treated with statins, nearly one-third had MD despite LMT. LMT considerably improved LDL-C goal attainment; however, a large proportion of patients did not achieve normal HDL-C and TG levels. Patients may benefit from a more comprehensive approach to lipid management that treats all three lipid risk factors, as suggested in clinical guidelines.     

Analysis of dyslipidemia in patients on chronic hemodialysis in Catalonia

Chronic hemodialysis patients show a high incidence and prevalence of cardiovascular disease of multifactorial etiology and an association between dyslipidemia and accelerated atherosclerosis. We analyzed characteristics of dyslipidemia in 1824 hemodialysis patients (59% men; mean age 65 +/- 15 years) in Catalonia and identified risk factors by logistic regression. Prevalence of dyslipidemia was high (63%). Most frequent lipid alterations were decreased HDL cholesterol (40%), hypertriglyceridemia (31%) and hypercholesterolemia (19%). Total cholesterol/HDL ratio was elevated in 23%. Body mass index (OR 1.08; 95% CI 1.05-1.11), diabetes mellitus (1.4; 1.09-1.79), ischemic heart disease (1.38, 1.08-1.75) and stroke (1.30; 1.0-1.69) were independent factors associated with dyslipidemia. Lengthy time (> 7 years) on dialysis (0.77; 0.59-0.99) and female sex (0.78; 0.64-0.96) were independent protective factors. A significant reduction in the risk of developing dyslipidemia was observed after the age of 50. Lipid-lowering drug use was low (19%), with statins being the most frequent (83%). The percentage of patients reaching target LDL levels according to individual cardiovascular risk (ATPIII) was unsatisfactory, particularly in high risk patients (52%). In light of the high prevalence of dyslipidemia and low adherence to target LDL goals, we conclude that strict control of dyslipidemia should be included in cardiovascular risk prevention strategies for chronic hemodialysis patients.     

Long-term achievement of the therapeutic objectives of lipid-lowering agents in primary prevention patients and cardiovascular outcomes: an observational study

AIMS: Lowering elevated cholesterol levels reduces cardiovascular (CV) morbidity and mortality. Nonetheless, most patients treated with lipid-lowering agents (LLA) do not reach recommended therapeutic objectives. In a setting of primary care in France, we investigated the association between LDL-cholesterol goal attainment and the occurrence of CV events in primary prevention patients with multiple CV risk factors (> or = 3). According to national guidelines, the therapeutic objective (TO) for such patients is an LDL-cholesterol value below 130 mg/dL. METHODS: 579 patients treated with LLA and with LDL-cholesterol values documented at least once a year over a period of at least 3 years (2000-2002) were allocated to three groups based on the number of years the TO was attained during the follow-up period: in all 3 years (TO+++: n=145), only part of the time (TO intermediate: n=256), and never (TO---: n=178). CV events (angina pectoris, myocardial infarction, heart failure, stroke, peripheral artery disease) occurring during the last year of observation (2002) were retrospectively collected. The occurrence risk (OR) of CV events was assessed based on TO status, with a logistic regression model to adjust for baseline differences in CV risk factors. RESULTS: Only a quarter of patients attained TO during all 3 study years. CV events during the third year of observation occurred in 5.5%, 10.5% and 12.9% of patients in the TO+++, TO intermediate and TO--- groups, respectively. Compared with TO+++ patients, the risk of CV events increased significantly in TO intermediate (OR=2.34, 95% CI=[1.01-5.39]) and TO--- patients (OR=2.99, 95% CI=[1.26-7.08]). CONCLUSION: In real practice, a prolonged attainment of TO is rarely observed in high CV risk patients treated with LLA as primary prevention. Therapeutic failure is related to an increased incidence of cardiovascular morbidity. Our data strongly support the need to improve adherence to treatment guidelines to achieve effective cardiovascular prevention.     

Managing dyslipidemia in chronic kidney disease

The incidence of chronic kidney disease (CKD) in the U.S. continues to increase, and now over 10% of the U.S. population has some form of CKD. Although some patients with CKD will ultimately develop renal failure, most patients with CKD will die of cardiovascular disease before dialysis becomes necessary. Patients with CKD have major proatherogenic lipid abnormalities that are treatable with readily available therapies. The severe derangements seen in lipoprotein metabolism in patients with CKD typically results in high triglycerides and low high-density lipoprotein (HDL) cholesterol. Because of the prevalence of triglyceride disorders in patients with CKD, after treating patients to a low-density lipoprotein goal, non-HDL should be calculated and used as the secondary goal of treatment. A review of the evidence from subgroup analysis of several landmark lipid-lowering trials supports treating dyslipidemia in mild to moderate CKD patients with HMG-CoA reductase inhibitors. The evidence to support treating dyslipidemia in hemodialysis patients, however, has been mixed, with several outcome trials pending. Patients with CKD frequently have mixed dyslipidemia and often require treatment with multiple lipid-lowering drugs. Although statins are the cornerstone of therapy for most patients with CKD, differences in their pharmacokinetic properties give some statins a safety advantage in patients with advanced CKD. Although most other lipid-lowering agents can be used safely with statins in combination therapy in patients with CKD, the fibrates are renally metabolized and require both adjustments in dose and very careful monitoring due to the increased risk of rhabdomyolysis. After reviewing the safety and dose alterations required in managing dyslipidemia in patients with CKD, a practical treatment algorithm is proposed.