近期研究显示，在ATP III指南的推荐建议下，外周动脉疾病(PAD)患者的最佳血脂控制情况差于冠脉疾病(CAD)患者。于美国心脏病学会年会(ACC2015)上公布的一项研究也证实了上述观点。该研究表明，PAD患者接受指南推荐降脂治疗的比率显著低于CAD患者和合并PAD的CAD患者;研究者建议，临床医生需对PAD患者实施更积极的血脂控制策略。

此项回顾性病历评阅研究运用2013年新指南，对11134例PAD和CAD患者的血脂管理进行了比较。获取人口统计学、血脂水平和他汀类药物应用信息。基于新指南将他汀类药物治疗分为高、中、低强度治疗。

结果显示，受试者平均年龄为69±11岁，女性占35%，患 者占33%。

PAD患者的总胆固醇、低密度脂蛋白(LDL)和甘油三酯均显著高于CAD患者。PAD和CAD患者分别有76%和100%接受他汀类药物治疗;仅有178例(30%)PAD患者实现LDL<70 mg/dl的目标，实现LDL<100 mg/dl的PAD患者为371例(62%)。

依据新指南，PAD患者的治疗不足情况显著高于CAD患者，并且在年龄≤75岁患者中尤为显著。

相关文章公布于美国心脏学会科学年会（ACC2015）上。

1178-101 -Disparities in Lipid Management in Patients with Peripheral Artery Disease versus Coronary Artery Disease: Comparison Between ATP III and 2013 AHA/ACC Guidelines
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March 15, 2015, 9:45 - 10:30 AM
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Disclosures
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Authors
Vinodh Jeevanantham, Suresh Sharma, Rashmi Thapa, Taylor Myers, James Vacek, Buddhadeb Dawn, Kamal Gupta, University of Kansas Medical Center, Kansas City, KS, USA
Abstract
Background: Recent studies using ATP III guidelines show that peripheral artery disease (PAD) patients have less optimal lipid control compared to those with coronary artery disease (CAD). Our study aimed to compare lipid management in patients with PAD, CAD and CAD with PAD by applying the new 2013 guidelines.
Methods: A retrospective chart review of patients with CAD and PAD seen at our institution between Jan 2009 to March 2012 was performed. Demographic data, lipid levels and statin use information were obtained. Based on the new guidelines we classified statin therapy into high, moderate and low intensity therapy.
Results: There were a total of 11134 subjects. Average age was 69±11 yrs, 35% were women, and 33% had diabetes. Patients with PAD had significantly higher total cholesterol, LDL and triglycerides compared to patients with CAD (Table 1A). While 76% of PAD patients were on statin therapy compared to a 100% of CAD patients (p <0.001), only 178 PAD patients (30%) achieved a LDL goal of <70 mg/dl and 371 PAD patients (62%) achieved a LDL goal of <100 mg/dl. Application of the new guidelines showed that PAD patients were significantly undertreated compared to CAD groups, especially in patients aged ≤75 years (Table 1B).
Conclusion: Application of new guidelines showed that PAD patients have significantly less guideline recommended lipid treatment compared with those with CAD and CAD with PAD. Physicians need to be more aggressive with lipid control in patients with PAD.

参考文献：Vinodh Jeevanantham,et al. Abstract 1178-101，Presented at: American College of Cardiology Scientific Session & Expo;March 15, 2015, 9:45 - 10:30 AM