合并ASCVD极高危和高危的心房颤动患者血脂异常的现况分析

Analysis of dyslipidemia management status in atrial fibrillation patients with very high and high risk of atherosclerotic cardiovascular disease

目的分析中国心房颤动(房颤)登记研究(Chinese Atrial Fibrillation Registry,CAFR)中动脉粥样硬化性心血管疾病(ASCVD)极高危和高危的房颤患者他汀类药物使用和低密度脂蛋白胆固醇(LDL-C)水平达标情况。方法从CAFR研究2015年1月1日至2018年12月31日入选的9119例房颤患者中筛选出ASCVD极高危和高危患者,收集患者人口统计学数据、疾病病史、心血管危险因素以及实验室检验结果。将极高危患者LDL-C<1.8 mmol/L定义为血脂控制达标,高危患者LDL-C<2.6 mmol/L定义为血脂控制达标。分析患者他汀类药物使用情况和LDL-C达标率。结果共筛选出3833例ASCVD极高危和高危患者,其中ASCVD极高危的房颤患者1912例(21.0%),ASCVD高危的房颤患者1921例(21.1%)。ASCVD极高危和高危房颤患者服用他汀比例分别为60.2%(1151/1912)和38.6%(741/1921),LDL-C达标率分别为26.7%(511/1912)和36.4%(700/1912)。结论ASCVD极高危和高危的房颤患者服用他汀类药物比例和LDL-C血脂达标率均较低,应该进一步加强房颤患者的综合管理,尤其应强化心血管危险分层极高危和高危的房颤患者心血管疾病一级预防。

Objective To analyze the status of statins use and low-density lipoprotein cholesterol(LDL-C)management in patients with atrial fibrillation(AF)and very high/high risk of atherosclerotic cardiovascular disease(ASCVD)from Chinese Atrial Fibrillation Registry(CAFR).Methods A total of 9119 patients with AF were recruited in CAFR between January 1,2015 to December 31,2018,patients at very high and high risk of ASCVD were included in this study.Demographics,medical history,cardiovascular risk factors,and laboratory test results were collected.In patients with very high-risk,a threshold of 1.8 mmol/L was used as LDL-C management target and in patients with high risk,a threshold of 2.6 mmol/L was used as LDL-C management target.Statins use and LDL-C compliance rate were analyzed,multiple regression analysis was performed to explore the influencing factors of statins use.Results 3833 patients were selected(1912(21.0%)in very high risk of ASCVD group and 1921(21.1%)in high risk of ASCVD group).The proportion of patients with very high and high risk of ASCVD taking statins was 60.2%(1151/1912)and 38.6%(741/1921),respectively.Attainment rate of LDL-C management target in patients with very high and high risk were 26.7%(511/1912)and 36.4%(700/1921),respectively.Conclusion The proportion of statins use and attainment rate of LDL-C management target are low in AF patients with very high and high risk of ASCVD in this cohort.The comprehensive management in AF patients should be further strengthened,especially the primary prevention of cardiovascular disease in AF patients with very high and high risk of ASCVD.