Zhongguo quanke yixue (Sep 2023)
Lipid Goal Attainment Rate and Influencing Factors in 45-year-old or Younger Acute Coronary Syndrome Patients with an Ultra-high Risk of Atherosclerotic Cardiovascular Disease after Lipid-lowering Treatment
Abstract
Background Acute coronary syndrome (ACS) is a group of critical conditions commonly encountered clinically, showing a trend of younger age of onset in recent years. Effective lipid-lowering therapy can improve the prognosis of patients. Various guidelines are increasingly strict on lipid-lowering targets, and the lipid-lowering efficacy in young ACS patients with an ultra-high risk atherosclerotic cardiovascular disease (ASCVD) needs further evaluation.Objective To evaluate the rate of lipid goal attainment and influencing factors in young acute coronary syndrome ACS patients (≤45 years old) with an ultra-high risk of ASCVD after lipid-lowering treatment.Methods Patients with ACS aged 18-45 years who were hospitalized in Fuwai Central China Cardiovascular Hospital from January 2019 to October 2021 were enrolled. Patient baseline data were collected through the electronic medical record system. Venous samples were collected after eight hours of fasting, and serum lipid〔including total cholesterol (TC) , triacylglycerol (TG) , low-density lipoprotein cholesterol (LDL-C) , high-density lipoprotein cholesterol (HDL-C) 〕in which were analyzed using a fully automated biochemistry analyzer, and non-HDL-C was calculated. All patients underwent blood lipid detection again in the outpatient or inpatient department of our hospital 1 month after discharge. In this study, the first blood lipid record was adopted 1 month after discharge, and the last follow-up date was November 30, 2021. Among the patients, 445 cases were found with an ultra-high risk ASCVD, and 84 of them were detected with attained lipid goals (attainment group) , and the other 361 with poor attainment of lipid goals (non-attainment group) . Spearman rank correlation analysis was used to measure the correlation of lipid goal attainment with various other parameters. Univariate and multivariate Logistic regression were used to analyze the influencing factors of lipid goal attainment in ASCVD patients.Results Patients with an ultra-high risk of ASVCD accounted for 87.4% (445/509) of ACS patients, and 18.9% (84/445) of them had achieve the LDL-C target after lipid-lowering treatment. A total of 29 patients received statins combined with evolocumab, of whom 24 reached the lipid goals. Attainment and non-attainment groups had statistically significant differences in the ratio of having a diabetes history, prevalence of previous acute myocardial infarction (AMI) , results of adenosine triphosphate-binding cassette subfamily B member 1 (ABCB1) and solute carrier organic anion transporter family member 1B1 (SLCO1B1) , levels of TC and TG, and baseline levels of LDL-C and non-HDL-C, as well as lipid-lowering therapies (P<0.05) . In comparison with non-attainment group, attainment group had lower prevalence of using the moderate-intensity statin therapy, and higher prevalence of using the therapy with statin and evolocumab (P<0.05) . Spearman rank correlation analysis showed that diabetes history, previous AMI, ABCB1-positive, SLCO1B1-positive, TC, TG, baseline LDL-C and non-HDL-C were weakly positively correlated with lipid goal attainment (P<0.05) , and the therapy with statin combined with evolocumab was moderately positively correlated with lipid goal attainment (P<0.05) . There was a moderate negative correlation between moderate-intensity statin therapy and lipid goal attainment (P<0.05) . Multivariate Logistic regression analysis showed that diabetes history〔OR=1.806, 95%CI (1.049, 3.110) 〕, previous AMI〔OR=2.245, 95%CI (1.288, 3.913) 〕, and the therapy with statins combined with evolocumab〔OR=31.635, 95%CI (11.386, 87.896) 〕were associated with lipid goal attainment in ASCVD patients (P<0.05) .Conclusion The majority of young ACS patients had an ultra-high risk of ASCVD, but only less than one fifth of them attained the lipid goal. Those with a history of diabetes, AMI, or using the therapy with statins and evolocumab were more likely to achieve the LDL-C target.
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