Abstract：
UNASSIGNED: Long-term control of cardiovascular risk factors after acute coronary syndrome (ACS) is the cornerstone for preventing recurrence. We investigated the extent of cardiovascular risk factor management in males and females with and without familial hypercholesterolemia (FH) 5 years after ACS.
UNASSIGNED: We studied patients hospitalized for ACS between 2009 and 2017 in a Swiss multicenter prospective cohort study. FH was defined based on clinical criteria from the Dutch Lipid Clinic Network and Simon Broome definitions. Five years post-ACS, we assessed low-density lipoprotein-cholesterol (LDL-c) levels, lipid-lowering therapy (LLT), and other cardiovascular risk factors, comparing males to females with and without FH using generalized estimating equations.
UNASSIGNED: A total of 3139 patients were included; mean age was 61.4 years (SD, 12.1), 620 (19.8%) were female, and 747 (23.5%) had possible FH. Compared with males at 5-years post-ACS, females were more likely to not use statins (odds ratio, 1.61 [95% CI, 1.28-2.03]) and less likely to have combination LLT (odds ratio, 0.72 [95% CI, 0.55-0.93]), without difference between patients with FH and without FH. Females in both FH and non-FH groups less frequently reached LDL-c values ≤1.8 mmol/L (odds ratio, 0.78 [95% CI, 0.78-0.93]). Overall, patients with FH were more frequently on high-dose statins compared with patients without FH (51.0% versus 42.9%; P=0.001) and presented more frequently with a combination of 2 or more LLT compared with patients without FH (33.8% versus 17.7%; P<0.001), but less frequently reached LDL-c targets of ≤1.8 mmol/L (33.5% versus 44.3%; P<0.001) or ≤2.6 mmol/L (70.2% versus 78.1%; P=0.001).
UNASSIGNED: Five years after ACS, females had less intensive LLT and were less likely to reach target LDL-c levels than males, regardless of FH status. Males and females with FH had less optimal control of LDL-c despite more frequently taking high-dose statins or combination LLT compared with patients without FH. Long-term management of patients with ACS and FH, especially females, warrants optimization.
UNASSIGNED: We studied patients hospitalized for ACS between 2009 and 2017 in a Swiss multicenter prospective cohort study. FH was defined based on clinical criteria from the Dutch Lipid Clinic Network and Simon Broome definitions. Five years post-ACS, we assessed low-density lipoprotein-cholesterol (LDL-c) levels, lipid-lowering therapy (LLT), and other cardiovascular risk factors, comparing males to females with and without FH using generalized estimating equations.
UNASSIGNED: A total of 3139 patients were included; mean age was 61.4 years (SD, 12.1), 620 (19.8%) were female, and 747 (23.5%) had possible FH. Compared with males at 5-years post-ACS, females were more likely to not use statins (odds ratio, 1.61 [95% CI, 1.28-2.03]) and less likely to have combination LLT (odds ratio, 0.72 [95% CI, 0.55-0.93]), without difference between patients with FH and without FH. Females in both FH and non-FH groups less frequently reached LDL-c values ≤1.8 mmol/L (odds ratio, 0.78 [95% CI, 0.78-0.93]). Overall, patients with FH were more frequently on high-dose statins compared with patients without FH (51.0% versus 42.9%; P=0.001) and presented more frequently with a combination of 2 or more LLT compared with patients without FH (33.8% versus 17.7%; P<0.001), but less frequently reached LDL-c targets of ≤1.8 mmol/L (33.5% versus 44.3%; P<0.001) or ≤2.6 mmol/L (70.2% versus 78.1%; P=0.001).
UNASSIGNED: Five years after ACS, females had less intensive LLT and were less likely to reach target LDL-c levels than males, regardless of FH status. Males and females with FH had less optimal control of LDL-c despite more frequently taking high-dose statins or combination LLT compared with patients without FH. Long-term management of patients with ACS and FH, especially females, warrants optimization.
摘要：
■急性冠脉综合征（ACS）后心血管危险因素的长期控制是预防复发的基石。我们调查了ACS后5年有或没有家族性高胆固醇血症（FH）的男性和女性的心血管危险因素管理程度。
■我们在瑞士的一项多中心前瞻性队列研究中研究了2009年至2017年间因ACS住院的患者。根据荷兰脂质诊所网络和SimonBroome定义的临床标准定义FH。ACS后五年，我们评估了低密度脂蛋白胆固醇（LDL-c）水平，降脂治疗（LLT），和其他心血管危险因素，使用广义估计方程将有和没有FH的男性与女性进行比较。
■共纳入3139例患者；平均年龄为61.4岁（SD，12.1),620人（19.8%）为女性，747（23.5%）有可能的FH。与ACS后5年的男性相比，女性更有可能不使用他汀类药物(赔率比，1.61[95%CI，1.28-2.03])，并且不太可能出现组合LLT(赔率比，0.72[95%CI，0.55-0.93])，FH患者和无FH患者之间无差异。FH和非FH组的女性较少达到LDL-c值≤1.8mmol/L（比值比，0.78[95%CI，0.78-0.93]）。总的来说,与没有FH的患者相比，FH患者使用高剂量他汀类药物的频率更高（51.0％对42.9％;P=0.001），并且与没有FH的患者相比，使用2种或更多种LLT的组合的频率更高（33.8％对17.7％;P<0.001），但达到LDL-c目标≤1.8mmol/L(33.5%对44.3%;P<0.001)或≤2.6mmol/L(70.2%对78.1%;P=0.001)的频率较低。
■ACS五年后，与男性相比，女性的LLT强度较低，达到目标LDL-c水平的可能性较小，不管FH状态如何。与没有FH的患者相比，尽管服用高剂量他汀类药物或组合LLT的频率更高，但患有FH的男性和女性对LDL-c的最佳控制较少。ACS和FH患者的长期管理，尤其是女性,保证优化。
■我们在瑞士的一项多中心前瞻性队列研究中研究了2009年至2017年间因ACS住院的患者。根据荷兰脂质诊所网络和SimonBroome定义的临床标准定义FH。ACS后五年，我们评估了低密度脂蛋白胆固醇（LDL-c）水平，降脂治疗（LLT），和其他心血管危险因素，使用广义估计方程将有和没有FH的男性与女性进行比较。
■共纳入3139例患者；平均年龄为61.4岁（SD，12.1),620人（19.8%）为女性，747（23.5%）有可能的FH。与ACS后5年的男性相比，女性更有可能不使用他汀类药物(赔率比，1.61[95%CI，1.28-2.03])，并且不太可能出现组合LLT(赔率比，0.72[95%CI，0.55-0.93])，FH患者和无FH患者之间无差异。FH和非FH组的女性较少达到LDL-c值≤1.8mmol/L（比值比，0.78[95%CI，0.78-0.93]）。总的来说,与没有FH的患者相比，FH患者使用高剂量他汀类药物的频率更高（51.0％对42.9％;P=0.001），并且与没有FH的患者相比，使用2种或更多种LLT的组合的频率更高（33.8％对17.7％;P<0.001），但达到LDL-c目标≤1.8mmol/L(33.5%对44.3%;P<0.001)或≤2.6mmol/L(70.2%对78.1%;P=0.001)的频率较低。
■ACS五年后，与男性相比，女性的LLT强度较低，达到目标LDL-c水平的可能性较小，不管FH状态如何。与没有FH的患者相比，尽管服用高剂量他汀类药物或组合LLT的频率更高，但患有FH的男性和女性对LDL-c的最佳控制较少。ACS和FH患者的长期管理，尤其是女性,保证优化。
