评估LDL-C在动脉粥样硬化性心血管疾病二级预防中的目标实现：来自印度LAI-LCARE调查的见解

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.089

Kunal Mahajan MD, Manish Bansal MD, Rajeev Agarwala MD, Rajeev Gupta MD, Akshaya Pradhan MD, Neil Bardoloi MD, P Manoria MD, Chabby Satpathy MD, Nagaraj Desai MD, S Iyengar MD, Asha Mahilmaran MD, Sheeba George MD, Dorairaj Prabhakar MD, Raman Puri MD

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引用次数: 0

摘要

背景/概要尽管低密度脂蛋白胆固醇（LDL-C）水平较低，但印度人动脉粥样硬化性心血管疾病发生较早。印度脂质协会（LAI）建议对已确诊冠心病（CAD）的患者进行积极的降脂治疗（LLT），目标是LDL-C水平低于50 mg/dL，在存在其他危险因素的情况下甚至更低。需要印度实现低密度脂蛋白- c目标的当代数据。目的/目的印度脂质协会-冠心病ldl -胆固醇优化调查旨在探讨印度冠心病患者二级预防中的脂质管理和LDL-C目标实现情况。作为一项横断面观察性研究，LAI-LCARE调查包括印度25个邦/联邦属地的多个心脏病学中心。在稳定的LLT（≥1个月）期间，连续有血管造影证实为阻塞性CAD的门诊患者，并在稳定的LLT期间直接测量LDL-C水平。排除了他汀类药物使用不规律或近期LLT改变的患者。在单次访问期间（2024年5月至12月）收集数据，重点关注稳定LLT时LDL-C目标的实现情况。结果印度112名心脏病专家共纳入10417名患者。队列的平均年龄为60.7±11.1岁，男性占76.7%。糖尿病和高血压患病率分别为44.6%和56%。68.3%的参与者有急性冠状动脉综合征病史，77.1%的参与者曾接受过经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）。约72.3%接受高强度他汀类药物治疗。国际肝病协会推荐的LDL-C目标为50 mg/dL仅为24.4%，而<；52.1%的患者达到70 mg/dL。他汀类药物联合依折麦贝、苯甲醚酸或PCSK9抑制剂的LLT使用率为11.9%，达到<的成功率更高（43.7%）；50mg /dL的目标。结论：这项广泛的调查是印度对二级冠心病预防LDL-C目标实现情况的最大评估，揭示了LDL-C目标实现的实质性不足。尽管高强度他汀类药物的使用非常普遍，但只有不到四分之一的患者达到了推荐的LDL-C目标。尽管参与者中合并症和pci /CABG后状态的患病率很高，但联合治疗的使用率明显较低。鉴于联合治疗可提高LDL-C目标的实现，应将其作为二级预防策略的标准做法，以有效改善患者预后。

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Assessing LDL-C goal attainment in secondary prevention of atherosclerotic cardiovascular disease: Insights from the LAI-LCARE survey in India

Background/Synopsis

Atherosclerotic cardiovascular disease occurs earlier in Indians despite lower low-density lipoprotein cholesterol (LDL-C) levels. The Lipid Association of India (LAI) recommends aggressive lipid-lowering therapy (LLT) for patients with established coronary artery disease (CAD), targeting LDL-C levels below 50 mg/dL, and even lower in the presence of additional risk factors. Contemporary data on LDL-C goal attainment in India is needed.

Objective/Purpose

The LAI-LCARE (Lipid Association of India- LDL-Cholesterol optimization in Coronary ARtEry disease) survey aimed to address lipid management and LDL-C goal attainment in secondary prevention among Indian patients with CAD.

Methods

Designed as a cross-sectional, observational study, the LAI-LCARE survey included multiple cardiology centers in 25 Indian states/union-territories. Consecutive outpatients with angiography-confirmed obstructive CAD on stable LLT (≥ 1 month) and direct LDL-C levels measured during stabilized LLT were enrolled. Patients with irregular statin use or recent alterations in LLT were excluded. Data, focusing on LDL-C target achievement while on stabilized LLT, was collected during a single visit (May-December 2024).

Results

A total of 10,417 patients were enrolled by 112 cardiologists throughout India. The mean age of the cohort was 60.7 ± 11.1 years, with males constituting 76.7% of the population. Diabetes mellitus and hypertension were prevalent in 44.6% and 56% of patients, respectively. A history of prior acute coronary syndrome was documented in 68.3% of participants, while 77.1% had undergone previous percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Approximately 72.3% were receiving high-intensity statin therapy. The LAI-recommended LDL-C target of < 50 mg/dL was achieved by only 24.4%, while < 70 mg/dL was attained by 52.1% of patients. Combination LLT involving statins with ezetimibe, bempedoic acid, or PCSK9 inhibitors was utilized by 11.9%, with a higher success rate (43.7%) in achieving the < 50 mg/dL target among this subgroup.

Conclusions

This extensive survey represents the largest assessment of LDL-C goal attainment in secondary CAD prevention within India, revealing substantial inadequacies in LDL-C target attainment. Despite the high prevalence of high-intensity statin use, fewer than one-quarter of patients reached recommended LDL-C targets. The use of combination therapy was notably low despite the high prevalence of comorbidities and post-PCI/CABG status among participants. Given that combination therapy enhances LDL-C goal achievement, it should be integrated as a standard practice in secondary prevention strategies to improve patient outcomes effectively.

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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. Sections of Journal of clinical lipidology 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.