高危患者血脂检测率和治疗目标完成情况的真实世界评估：2018年AHA/ACC实践指南发布后

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2024-07-01 DOI:10.1016/j.jacl.2024.04.016

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引用次数: 0

摘要

背景/简介2018 AHA/ACC 临床实践指南为动脉粥样硬化性心血管疾病（ASCVD）和/或 2 型糖尿病（T2DM）患者的治疗选择和降低低密度脂蛋白胆固醇（LDL-C）设定了标准。Objective/Purpose To assess the rates of lipid testing among patients with ASCVD and/or T2DM pre and post initiating statins or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and the extent of LDL-C target attainment in 12 months after initiated after GDT versus non-GDT post released of practice guidelines.目标/目的评估他汀类药物或9型丙脯氨酸转化酶(PCSK9i)抑制剂使用前后ASCVD和/或T2DM患者的血脂检测率，以及使用GDT与未使用GDT后12个月内LDL-C目标的实现程度。方法从医疗保健综合研究数据库中找出2019年1月1日至2020年12月31日期间开始服用他汀类药物或PCSK9i的成人，这些成人之前有证据表明患有ASCVD和/或T2DM，并在12个月前和12个月后的指数药房索赔日期（他汀类药物或PCSK9i）加入了医疗保险。根据程序代码或可用的实验室结果，研究了血脂检测模式和 LDL-C 目标达标率（70 毫克/分升）。GDT的定义是：有ASCVD的患者开始服用高强度他汀类药物；无ASCVD的T2DM患者开始服用中度或高强度他汀类药物；有ASCVD的患者在高强度他汀类药物基础上加用PCSK9i；在12个月的随访期间持续服用高强度他汀类药物，同时持续服用PCSK9i。结果共纳入了 71581 名患有 ASCVD/T2DM 的他汀类药物入选者和 3038 名患有 ASCVD 的 PCSK9i 入选者（平均年龄：61-65 岁；男性：55-60%）。在他汀类药物入选者和曾患 ASCVD 的 PCSK9i 入选者中，分别有 72% 和 79% 的人在 12 个月的基线期间进行了血脂检测，69% 和 75% 的人在 12 个月的随访期间进行了血脂检测。在至少进行过一次有效低密度脂蛋白胆固醇测量的患者子集中，启动后 12 个月的低密度脂蛋白胆固醇目标达标率如下：曾患 ASCVD 的他汀类药物 GDT 启动者的达标率为 53%，而非 GDT 为 35%；曾患 T2DM 但未患 ASCVD 的他汀类药物 GDT 启动者的达标率为 35%，而非 GDT 为 16%；曾患 ASCVD 的他汀类药物 GDT PCSK9i 启动者的达标率为 65%，而非 GDT 为 53%；曾患 ASCVD 并持续服用高强度他汀类药物同时持续服用 PCSK9i 的患者的达标率为 80%，而非持续服用 PCSK9i/ 司他汀的患者的达标率为 64%。根据2018年AHA/ACC指南（即GDT）进行血脂检测的高危患者的LDL-C达标率与非GDT相比略有提高。提高血脂检测率的干预措施可增加根据指南进行治疗调整的机会，并更好地实现低密度脂蛋白胆固醇目标，帮助降低心血管事件风险。

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Real-World Evaluation of Lipid Testing Rate and Treatment Target Attainment Among High-Risk Patients: Post Release of the 2018 AHA/ACC Practice Guidelines

Background/Synopsis

The 2018 AHA/ACC clinical practice guidelines set standards for treatment selection and low-density lipoprotein cholesterol (LDL-C) lowering among patients with atherosclerotic cardiovascular disease (ASCVD) and/or type 2 diabetes mellitus (T2DM). However, real-world evidence on rates of lipid testing and LDL-C target attainment following guideline directed treatment (GDT) post-release of practice guidelines is limited.

Objective/Purpose

To assess the rates of lipid testing among patients with ASCVD and/or T2DM pre and post initiating statins or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) and the extent of LDL-C target attainment in 12 months post-initiation after GDT versus non-GDT post-release of practice guidelines.

Methods

Adults initiating statins or PCSK9i between 01/01/2019 and 12/31/2020 with prior evidence of ASCVD and/or T2DM, and health plan enrollment for 12-month pre- and post-index pharmacy claim date (either statin or PCSK9i) were identified from the Healthcare Integrated Research Database. Lipid testing patterns and LDL-C target attainment rates (<70mg/dL) based on procedure codes or available lab results were examined. GDT was defined as high-intensity statin initiation in patients with ASCVD, moderate- or high-intensity statin initiation in patients with T2DM without ASCVD, PCSK9i in patients with ASCVD added to high-intensity statin and sustained high-intensity statin while persistent on PCSK9i during the 12 months follow-up period. Descriptive statistics were reported, and no statistical testing was performed.

Results

In total, 71,581 statin initiators with ASCVD/T2DM, and 3,038 PCSK9i initiators with ASCVD were included (mean age: 61-65 years; males: 55-60%). Among statin initiators and PCSK9i initiators with prior ASCVD, 72% and 79% had lipid testing during 12-month baseline, and 69% and 75% during 12-month follow-up, respectively. LDL-C target attainment rates during 12-month post-initiation among a subset of patients with at least one valid LDL-C measurement is as follows: 53% in GDT statin initiators with prior ASCVD versus 35% for non-GDT, 35% in GDT statin initiators with prior T2DM without ASCVD versus 16% for non-GDT, 65% among GDT PCSK9i initiators with prior ASCVD versus 53% for non-GDT, and 80% among patients with prior ASCVD with sustained high-intensity statin while persistent on PCSK9i versus 64% for non-persistent PCSK9i/statin.

Conclusions

Lipid testing rates were moderate. LDL-C target attainment in high-risk patients with lipid testing treated per 2018 AHA/ACC guidelines (i.e., GDT) were modestly improved versus non-GDT. Interventions to improve lipid testing rate may increase opportunities for treatment modification based on guidelines and better LDL-C target attainment to help reduce the risk of cardiovascular events.

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.