Background

Low-density lipoprotein cholesterol (LDL-C) and non–high-density lipoprotein cholesterol (non–HDL-C) are targets for prevention of atherosclerotic cardiovascular disease (ASCVD). The American Heart Association and American College of Cardiology recently modified recommendations for clinical management of cholesterol in secondary and primary prevention. Accordingly, the present article examines the need for cholesterol-lowering drugs in the U.S. population with ASCVD.

Objective

This study examines trends in non–HDL-C and LDL-C levels in a free living population of ASCVD subjects between 1999 and 2016.

Methods

National Health and Nutrition Examination Surveys database included 4920 adults with ASCVD aged 40 to 85 years. Complete data were available for 4226. Trend analysis of changes in lipids is shown in box plots.

Results

Mean age was 67 years with 57% males. Over 17 years, LDL-C decreased significantly by 24% and non–HDL-C by 21%. Over the period of study, reported intake of cholesterol-lowering drugs rose from 37% in 1999-2000 to 69% in 2015 to 2016. Over this same period, serum triglycerides decreased by 29% (P < .001) and HDL-C rose by 6%.

Conclusions

The changes in LDL-C and non–HDL-C in patients with ASCVD over a 17-year period probably are related to increased treatment with statins. However, the changes are too small to be explained by widespread use of high-intensity statins, which is the current recommendation for patients with ASCVD. These findings pose a challenge for professional education to support implementation of current guidelines for cholesterol-lowering therapies.

中文翻译：

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成年人动脉粥样硬化性心血管疾病中非HDL胆固醇和LDL胆固醇水平的当前趋势。

背景

低密度脂蛋白胆固醇（LDL-C）和非高密度脂蛋白胆固醇（non-HDL-C）是预防动脉粥样硬化性心血管疾病（ASCVD）的目标。美国心脏协会和美国心脏病学会最近修改了二级预防和一级预防中胆固醇临床管理的建议。因此，本文探讨了在患有ASCVD的美国人群中是否需要降低胆固醇的药物。

客观的

这项研究调查了1999年至2016年间ASCVD受试者的自由生活人群中非HDL-C和LDL-C水平的趋势。

方法

全国健康和营养检查调查数据库包括4920名40至85岁的成人ASCVD。完整的数据可用于4226。脂质变化的趋势分析显示在方框图中。

结果

平均年龄为67岁，男性为57％。在过去的17年中，LDL-C显着下降了24％，非HDL-C下降了21％。在研究期间，报告的降低胆固醇的药物的摄入量从1999-2000年的37％上升到2015年至2016年的69％。在同一时期，血清甘油三酸酯下降了29％（P  <.001）和HDL-C上升了6％。

结论

ASCVD患者17年内LDL-C和非HDL-C的变化可能与他汀类药物治疗增加有关。但是，变化很小，无法通过广泛使用高强度他汀类药物来解释，这是目前对ASCVD患者的建议。这些发现对专业教育提出了挑战，以支持当前有关降低胆固醇疗法的指导方针的实施。