不同ASCVD危险分层患者LDL-C达标及影响因素分析(1)
[摘要] 目的 分析不同動脉粥样硬化性心血管疾病(ASCVD)危险分层患者低密度脂蛋白胆固醇(LDL-C)达标情况及影响因素。 方法 本研究纳入2018年6月～2019年3月至大连解放军第967医院就诊的既往给予他汀类药物治疗的患者为研究对象，通过询问并记录的方式收集、整理患者的一般情况和临床资料。根据《中国成人血脂异常防治指南(2016修订版)》将入选患者分为极高危(n=242)、高危(n=207)、低中危(n=139)三组。将极高危患者LDL-C达标定义为坚持或间断服用他汀类药物且LDL-C<1.8 mmol/L，高危组及低中危组达标分别定义为LDL-C<2.6 mmol/L和<3.4 mmol/L，无论是否使用他汀类药物。采用单因素分析影响他汀服药依从性的相关变量，并建立Logistic回归模型进行多因素分析以探讨影响他汀服药依从性的独立影响因素。 结果 ①LDL-C达标率在极高危患者为42.1%，高危患者为59.4%，低中危患者为81.3%;不同危险分层患者LDL-C达标率比较，差异有统计学意义(P=0.000)。②极高危和高危患者LDL-C不达标原因包括联合使用降脂药物(他汀类药物联合依折麦布)比例低(10.0%和2.4%)、使用低剂量他汀类药物(37.9%和31.0%)及不按医嘱服药(26.4%和56.0%);低中危患者LDL-C不达标原因主要为使用低剂量他汀类药物(23.1%)和不按医嘱服药(76.9%)。③单因素分析显示，年龄≤65岁、使用药物种类≤3种和对药物认知良好的患者服药依从性显著增高(均P<0.05);独居状态、低收入及易被非医疗机构保健信息影响的患者服药依从性明显偏低(均<0.05)。④多因素Logistic回归分析显示，使用药物种类少、对药物认知程度良好可以增加他汀类药物服药依从性;低收入、独居状态和非医疗机构保健信息影响可降低他汀类药物服药依从性。 结论 改善ASCVD危险患者LDL-C达标率需强化医生对降脂药物的合理使用和提高患者服药依从性。
[关键词] 动脉粥样硬化性心血管疾病;低密度脂蛋白胆固醇;他汀类药物;药物依从性
[中图分类号] R743;R54 [文献标识码] A [文章编号] 1673-9701(2020)28-0045-06
Analysis of LDL-C attainment rate and influencing factors in patients with different ASCVD risk stratification
SANG Pengcheng1 SUN Fei2
1.Department of Cardiovascular Medicine， Jinzhou Medical University Postgraduate Training Base of PLA 967th Hospital， Dalian 116011， China; 2.Department of Circulation， Zhongshan Hospital Affiliated to Dalian University， Dalian 116001， China
[Abstract] Objective To analyze the attainment of low-density lipoprotein cholesterol(LDL-C) in patients with different atherosclerotic cardiovascular disease(ASCVD) risk stratification and its influencing factors. Methods This study included the patients who were given statin treatment from June 2018 to March 2019 in PLA 967th Hospital as the research object， and collected and organized the general situation and clinical data of the patients by way of inquiry and recording. According to Chinese Guidelines for the Prevention and Treatment of Dyslipidemia in Adults(2016 Revision)， the enrolled patients were divided into three groups： extremely high-risk group(n=242)， high-risk group(n=207) and low and moderate-risk group(n=139). LDL-C attainment in extremely high-risk patients was defined as adherence to or intermittent use of statins and LDL-C<1.8 mmol/L; LDL-C attainment in high-risk group and low and moderate-risk group was defined as LDL-C<2.6 mmol/L and<3.4 mmol/L with or without statins. Univariate analysis was used to identify variables related to statin adherence， and Logistic regression model was established for multivariate analysis to explore independent factors affecting statin adherence. Results ①The LDL-C attainment rate was 42.1% in extremely high-risk patients， 59.4% in high-risk patients， and 81.3% in low and moderate-risk patients. LDL-C attainment rate of patients with different risk stratification was significantly different(P=0.000). ② The reasons for LDL-C non-attainment in extremely high-risk and high-risk patients included the low proportion of lipid-lowering drugs(statin combined with etheiblum)(10.0% and 2.4%)， the use of low-dose statin drugs(37.9% and 31.0%) and not following the prescribed medicine(26.4% and 56.0%). The main reasons for LDL-C failure in low and moderate-risk patients were the use of low-dose statins(23.1%) and not following the prescribed medicine(76.9%). ③ Univariate analysis showed that the medication adherence of patients with age ≤65 years old， drug use ≤3 types and good drug cognition was significantly increased(all P<0.05). The medication adherence of patients who lived alone， had low income and were easily affected by the health information of non-medical institutions was significantly lower(all P<0.05). ④ Multivariate Logistic regression analysis showed that the use of few drugs and good cognition of drugs could increase the compliance with statins. Low income， solitary status， and the influence of non-health care information could reduce adherence to statins. Conclusion It is necessary to strengthen the doctor's rational use of lipid-lowering drugs and improve patient compliance with medication in order to improve the LDL-C adherence rate of ASCVD risk patients., 百拇医药(桑鹏程 孙飞)
[关键词] 动脉粥样硬化性心血管疾病;低密度脂蛋白胆固醇;他汀类药物;药物依从性
[中图分类号] R743;R54 [文献标识码] A [文章编号] 1673-9701(2020)28-0045-06
Analysis of LDL-C attainment rate and influencing factors in patients with different ASCVD risk stratification
SANG Pengcheng1 SUN Fei2
1.Department of Cardiovascular Medicine， Jinzhou Medical University Postgraduate Training Base of PLA 967th Hospital， Dalian 116011， China; 2.Department of Circulation， Zhongshan Hospital Affiliated to Dalian University， Dalian 116001， China
[Abstract] Objective To analyze the attainment of low-density lipoprotein cholesterol(LDL-C) in patients with different atherosclerotic cardiovascular disease(ASCVD) risk stratification and its influencing factors. Methods This study included the patients who were given statin treatment from June 2018 to March 2019 in PLA 967th Hospital as the research object， and collected and organized the general situation and clinical data of the patients by way of inquiry and recording. According to Chinese Guidelines for the Prevention and Treatment of Dyslipidemia in Adults(2016 Revision)， the enrolled patients were divided into three groups： extremely high-risk group(n=242)， high-risk group(n=207) and low and moderate-risk group(n=139). LDL-C attainment in extremely high-risk patients was defined as adherence to or intermittent use of statins and LDL-C<1.8 mmol/L; LDL-C attainment in high-risk group and low and moderate-risk group was defined as LDL-C<2.6 mmol/L and<3.4 mmol/L with or without statins. Univariate analysis was used to identify variables related to statin adherence， and Logistic regression model was established for multivariate analysis to explore independent factors affecting statin adherence. Results ①The LDL-C attainment rate was 42.1% in extremely high-risk patients， 59.4% in high-risk patients， and 81.3% in low and moderate-risk patients. LDL-C attainment rate of patients with different risk stratification was significantly different(P=0.000). ② The reasons for LDL-C non-attainment in extremely high-risk and high-risk patients included the low proportion of lipid-lowering drugs(statin combined with etheiblum)(10.0% and 2.4%)， the use of low-dose statin drugs(37.9% and 31.0%) and not following the prescribed medicine(26.4% and 56.0%). The main reasons for LDL-C failure in low and moderate-risk patients were the use of low-dose statins(23.1%) and not following the prescribed medicine(76.9%). ③ Univariate analysis showed that the medication adherence of patients with age ≤65 years old， drug use ≤3 types and good drug cognition was significantly increased(all P<0.05). The medication adherence of patients who lived alone， had low income and were easily affected by the health information of non-medical institutions was significantly lower(all P<0.05). ④ Multivariate Logistic regression analysis showed that the use of few drugs and good cognition of drugs could increase the compliance with statins. Low income， solitary status， and the influence of non-health care information could reduce adherence to statins. Conclusion It is necessary to strengthen the doctor's rational use of lipid-lowering drugs and improve patient compliance with medication in order to improve the LDL-C adherence rate of ASCVD risk patients., 百拇医药(桑鹏程 孙飞)