- 期刊
某醫學中心心肌梗塞降血脂藥物開立情形與血脂達標率分析
Analysis of Lipid-Lowering Therapy and Lipid Goal Attainment Rate in Acute Myocardial Infarction in a Medical Center
摘要
目的：急性心肌梗塞（acute myocardial infarction, AMI）患者再次發生心血管疾病的風險極高，不同國家指引皆建議AMI族群開立高強度降血脂藥以降低心血管疾病風險，但對於血脂達標率的定義有些許不同。本研究欲評估本院AMI族群降血脂藥處方型態及血脂達標率。方法：本回顧性研究，收錄2020/1/1至2020/12/31出院的AMI患者，以出院日為納入日，追蹤至最後一筆就醫資料、死亡，或至資料收集截止日2021/6/30。由五位藥師收集患者的基本資料、用藥、血脂數據，分析降血脂藥物處方型態和血脂達標率隨時間的變化。結果：共收錄182名AMI患者，出院時statin類藥物開立率95.1%，高／超高強度降血脂藥物開立率為87.9%。追蹤期間超高強度降血脂藥物的開立率由0.5%增加至8.4%，中強度由7.1%增加至13.7%，高強度則是由87.4%降至71.6%。低密度脂蛋白（low density lipoprotein cholesterol, LDL-C）治療後顯著下降，但達標率不如預期，以LDL-C < 70mg/dL、LDL-C <55mg/dL、LDL-C降幅達50%以上、LDL-C < 70mg/dL且同時降幅達50%以上作為目標值，達標率分別為59.9%、34.1%、34.1%、26.9%。其他可能影響達標率的原因包括出院時降血脂藥物強度，與初始值LDL-C數值高低。結論：為改善AMI患者的血脂達標率，不僅需要提高患者的服藥配合度，醫師也應主動調整降血脂藥物的劑量和策略，包括提高statin劑量、併用ezetimibe，甚至考慮使用PCSK9抑制劑，亦須考慮家族性高膽固醇血症的可能性。
並列摘要
Objective: Patients with acute myocardial infarction (AMI) face a significantly increased risk of recurrent cardiovascular disease. Various international guidelines recommend prescribing high-intensity lipid-lowering therapy to reduce the risk of cardiovascular disease, but definitions of lipid goal attainment vary. This study aims to evaluate the prescription patterns of lipid-lowering therapy and the rate of lipid goal attainment among AMI patients in our hospital. Methods: This retrospective study included AMI patients discharged from January 1, 2020, to December 31, 2020, with the discharge date as the index date. Patients were followed until their last medical record, death, or data cutoff on June 30, 2021. Data collected by five pharmacists included demographics, medications, and lipid profiles. The analysis focused on patterns of lipid-lowering therapy prescriptions and the rate of lipid goal attainment over time. Results: A total of 182 AMI patients were included in the study. At discharge, 95.1% were prescribed statins, and 87.9% were prescribed high- /very-high intensity lipid-lowering therapy. Over the follow-up period, prescriptions for very high-intensity therapy increased from 0.5% to 8.4%, moderate-intensity from 7.1% to 13.7%, while high-intensity decreased from 87.4% to 71.6%. Low-density lipoprotein cholesterol (LDL-C) levels significantly decreased after treatment, but the lipid goal attainment rates were below expectations: < 70mg/dL (59.9%), < 55mg/dL (34.1%), ≥ 50% reduction (34.1%), < 70mg/dL with ≥ 50% reduction (26.9%). Other factors affecting lipid goal attainment rates included the intensity of lipid-lowering therapy at discharge and the initial LDL-C values. Conclusion: Improving lipid goal attainment rates in AMI patients requires not only enhanced patient adherence but also proactive adjustments to lipid-lowering therapy dosages and strategies by healthcare providers. This may involve increasing statin dosages, combining with ezetimibe, and even considering PCSK9 inhibitors, while also considering the possibility of familial hypercholesterolemia.