中国血脂异常门诊患者调脂治疗一级和二级预防达标现状：DYSIS—China亚组分析

Status of cholesterol goal attainment for the primary and secondary prevention of atherosclerotic cardiovascular disease in dyslipidemia patients receiving lipid-lowering therapy： DYSIS-Chinasubgroup analysis

目的分析国际血脂异常调查-中国研究（DYSIS-China）数据库中血脂异常患者心血管疾病一级预防和二级预防胆固醇达标的现状。方法根据2014中国胆固醇教育计划（CCEP）血脂异常防治专家建议结合2007年中国成人血脂异常防治指南，对于2012年3至10月实施的DYSIS-China研究入选的25 317例血脂异常患者按照动脉粥样硬化性心血管疾病（ASCVD）一级预防和二级预防定义进行危险分层，其中二级预防极高危、高危的总胆固醇（TC）目标值分别为小于3.11和4.14 mmol/L，低密度脂蛋白胆固醇（LDL-C）目标值分别为小于1.8和2.6 mmol/L。一级预防极高危、高危、中危和低危患者的TC目标值分别为小于3.11、4.14、5.18和6.22 mmol/L，LDL-C目标值分别为小于1.8、2.6、3.4和4.1 mmol/L。计算患者TC和LDL-C的达标百分率。结果25 317例患者中，71.09%（18 000例）属于极高危和高危，48.24%（12 213例）属于二级预防对象，51.76%（13 104例）为一级预防对象。血脂异常患者二级预防的LDL-C总体达标率为33.09%（4 041例），TC达标率为21.05%（2 571例）。一级预防LDL-C总达标率为52.40%（6 866例），TC总达标率为42.06%（5 511例）。多因素logistic回归分析显示合并糖尿病（OR值5.75和4.15，P〈0.05）、冠心病（OR值5.70和3.58，P〈0.001）、外周动脉疾病（OR值2.42和1.49，P〈0.05）分别是患者TC和LDL-C不达标的主要危险因素。结论按照2014 CCEP专家建议结合2007血脂指南，中国血脂异常患者二级预防的总体达标率和一级预防达标率仍然与指南有很大的差距。从医生和患者的角度，都应当更加重视通过合理的干预血脂抗动脉粥样硬化从而改善心血管高危患者的长期预后。

Objective To analyze the current status of cholesterol goal attainment for the primary and secondary prevention of cardiovascular disease in dyslipidemia patients using data from the DYSIS-China study. Methods Based on criteria defined in the 2014 China Cholesterol Education Program （CCEP） and the 2007 Chinese guidelines for the prevention and treatment of dyslipidemia in adults, 25 317 dyslipidemia patients enrolled in the DYSIS-China study （from March 2012 to October 2012 ） were stratified to the atheroselerotic cardiovascular disease （ASCVD） primary prevention and secondary prevention groups. The total cholesterol （TC） target goals were 〈 3.11,4. 14, 5.18, and 6.22 mmol/L, respectively, and the low- density lipoprotein cholesterol （LDL-C） therapeutic goals were less than 1.8, 2. 6, 3.4, and 4. 1 mmol/L, respectively, for the very high-risk, high-risk, moderate-risk, and low-risk patients in the primary prevention group. The TC targets for the very high-risk and high-risk patients were 〈 3. 11 and 〈 4. 14mmol/L, respectively, and the LDL-C targets were 〈 1.8 and 〈 2. 6 mmol/L, respectively, in the secondary prevention group. The TC and LDL-C goal attainment rates were calculated for the different risk groups according to the targets values. Results Totally, 71.09% （n = 18 000） of the dyslipidemia patients were grouped into very high and high risk groups, 51.76% （n = 13 104） and 48.24% （n = 12 213） patients were stratified to primary and secondary prevention of ASCVD. The LDL-C and TC goal attainment rates for the secondary prevention group were 33.09% （4 041 cases） and 21.05% （2 571 cases）, respectively. The LDL-C and TC goal attainment rates for the primary prevention group were 52.40% （6 866 cases） and 42. 06% （5 511 cases）, respectively. Multivariate logistic regression analysis showed that diabetes melhtus（OR =5.75,4. 15 ,P 〈0. 05）, coronary heart disease（ OR =5.70,3.58 ,P 〈0. 001 ）, and peripheral arterial disease（ OR = 2. 42,1.49 ,P 〈 0. 05 ） were risk factors for failure to achieve TC and LDL- C goals, respectively. Conclusions Despite the widespread application of the 2014 CCEP and 2007 Chinese dyslipidemia guidelines, LDL-C goal attainment among secondary and primary prevention patients remains suboptimal in China. More rigorous guideline adherence is therefore required to increase the LDL-C and TC goal attainment rates and improve the long-term cardiovascular outcomes in Chinese dyslipidemia patients.