| 摘要: | 隨著高齡化社會伴隨著慢性代謝性疾病，血管衰老與阻塞程度讓心血管疾病發生機率上升，全球十大死因排名第一為缺血性心臟病 ; 在臺灣，心臟疾病位居國人十大死因第二位，心肌梗塞屬於急性且嚴重心臟疾病，高血脂所引起的動脈粥狀硬化是主要原因，因此積極降低血脂達到治療指引目標能降低重大心血管事件風險。本研究探討心肌梗塞病人降血脂藥物選擇與血脂達標率的相關性。
本研究以某醫學中心在2018/06-2020/06出院診斷為急性心肌梗塞的病人進行回溯性世代研究，依照出院時開立降血脂藥物分為五組，分別為高強度statins + ezetimibe、單用高強度statins、中強度statins + ezetimibe、單用中強度statins、其他降血脂藥物等。追蹤治療一年血脂控制情形，統計方式以ANOVA與Pearson χ2 檢定各組間基本血脂特徵，卡方檢定分析不同藥物選擇組別血脂達標情形，成對樣本t檢定比較治療後血脂平均值與入院時差異。
進入血脂達標分析人數共465人，以男性佔多數，所有病人皆有高血壓、高血脂等慢性疾病，入院時病人血脂基本平均值各組間並無顯著差異，經過十二個月各組血脂平均值皆有不同程度下降，但各組間並無統計學上差異 ; 使用高強度statins相較其他組別有較好的血脂達標率，約在50%左右 ; 使用中強度statins血脂達標率偏低，單獨使用達標率45%，併用ezetimibe達標率僅有25% ; 所有組別LDL-C平均值皆未達到指引建議目標( < 70mg/dL)。
臺灣在2022年更新血脂治療指引，對於已發生粥狀動脈硬化事件的病人，依照LDL-C與臨床狀況使用中或高強度statins或中強度statins + ezetimibe，LDL-C控制目標 < 70mg/dL，若未達標應合併其他non-statins治療。本研究血脂達標情況不盡理想，是否與醫師開處方習慣以及病人用藥遵醫囑性有關仍需更近一步了解。本研究結果將提供臨床醫師參考，也期待國內有大型研究數據探討單用statins或合併使用non-statins治療的族群選擇與次級預防效果，作為治療指引更新依據。
As the aging society is accompanied by chronic metabolic diseases, the degree of vascular aging and obstruction increases cardiovascular diseases. Globally, ischemic heart disease ranks first among the top ten causes of death; in Taiwan, heart disease ranks second among the top ten causes of death, with myocardial infarction being an acute and severe heart disease. Atherosclerosis caused by hyperlipidemia is the main reason. Therefore, lipids lowering to meet treatment guidelines can reduce the risk of major cardiovascular events. This study investigates the relationship between lipid-lowering treatment choices and the achievement of lipid targets in patients with myocardial infarction.
This retrospective cohort study was conducted on patients diagnosed with acute myocardial infarction who were discharged from a medical center between June 2018 and June 2020. The patients were divided into five groups based on the lipid-lowering drugs prescribed at discharge: high-intensity statins + ezetimibe, high-intensity statins alone, moderate-intensity statins + ezetimibe, moderate-intensity statins alone, and other lipid-lowering medications. The lipid control over a one-year treatment period was tracked. Statistical methods including ANOVA and Pearson χ2 tests were used to compare basic lipid characteristics between groups. Chi-square tests analyzed the achievement of lipid targets among different drug groups, and paired sample t-tests compared the differences in average lipid levels before and after treatment.
A total of 465 patients were included in the lipid target analysis, with a majority being male. All patients had chronic diseases such as hypertension and hyperlipidemia. At admission, there were no significant differences in the baseline average lipid data between groups. After twelve months, the average lipid data in each group decreased to varying degrees, but there were no statistically significant differences between the groups. The group using high-intensity statins had a better lipid target achievement rate, approximately 50%, compared to other groups. The group using moderate-intensity statins had a lower achievement rate, with a single-use rate of 45% and a combined use with ezetimibe rate of only 25%. The average LDL-C levels in all groups did not meet the guideline recommended target (< 70 mg/dL).
Taiwan updated its lipid treatment guidelines in 2022. For patients who have experienced atherosclerotic events, high or moderate-intensity statins or moderate-intensity statins + ezetimibe should be used based on LDL-C levels and clinical conditions, with an LDL-C control target of < 70 mg/dL. If the target is not met, other non-statins treatments should be added on. The lipid target achievement rate in this study was not ideal. Whether it is related to the prescribing habits of physicians and patients' adherence to medication requires further understanding. The results of this study will provide a reference for clinicians and encourage large-scale Taiwan’s research data to explore the selection and secondary prevention effects of using statins alone or combined with non-statins, as a basis for updating treatment guidelines. |
