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Bi LEI, Yi JY, Wu CQ, Lu JP, Zhang HB, Yang YANG, Li XI, Zheng XIN. Atherosclerotic cardiovascular risk and simulation of lipid-lowering therapy in China. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lipid-lowering therapy is a key strategy to reduce atherosclerotic cardiovascular disease (ASCVD) risk. However, little is known about the burden of lipid-lowering therapy in China.
Purpose
We aim to simulate the proportion of individuals in need of different lipid-lowering therapy regimens to reach diverse low-density lipoprotein cholesterol (LDL-C) goals based on the ASCVD risk stratification.
Methods
We used the data from China PEACE Million Persons Project, a national screening project covering 31 provinces in China. The ASCVD risk stratifications and LDL-C goals were based on the 2016 Chinese Guideline for the Management of Dyslipidemia in Adults. Stepwise lipid-lowering therapy (atorvastatin 20 mg, add-on ezetimibe and add-on evolocumab) was simulated by a Monte Carlo model based on individual's LDL-C level.
Results
We included 2,876,272 participants (89.7% of the screened) who were not receiving lipid-lowering therapy (mean age 55.8±9.9 years; 60.5% women). The proportion of participants at low, moderate, high and very high ASCVD risk were 57.9%, 17.5%, 22.3% and 2.3%, respectively. In individuals at low or moderate risk, 10.5% did not reach the goal of LDL-C<3.4mmol/L; after statin simulation, 99.8% met the goal. In high-risk patients, 49.0% did not reach LDL-C<2.6mmol/L; after statin monotherapy (82.7%), add-on ezetimibe (10.6%) and add-on evolocumab (6.7%), 99.7% met the goal. In very-high-risk patients, 72.2% did not reach LDL-C<1.8mmol/L; while 99.1% met the goal after all patients received the simulation: statin monotherapy (76.5%), add-on ezetimibe (13.0%) and add-on evolocumab (10.5%). In a total of 609,489 participants (21.2% of the overall participants) needing lipid-lowering therapy, 88.5% required statin monotherapy and 11.5% additional non-statin therapy (Figure).
Conclusions
Moderate-intensity statin therapy is pivotal in the lipid-lowering therapy in China; nearly 10% in need of lipid-lowering therapy required additional non-statin therapy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L E I Bi
- Fuwai Hospital, CAMS and PUMC, National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital, Beijing, China
| | - J Y Yi
- Fuwai Hospital, CAMS and PUMC, National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital, Beijing, China
| | - C Q Wu
- Fuwai Hospital, CAMS and PUMC, National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital, Beijing, China
| | - J P Lu
- Fuwai Hospital, CAMS and PUMC, National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital, Beijing, China
| | - H B Zhang
- Fuwai Hospital, CAMS and PUMC, National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital, Beijing, China
| | - Y A N G Yang
- Fuwai Hospital, CAMS and PUMC, National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital, Beijing, China
| | - X I Li
- Fuwai Hospital, CAMS and PUMC, National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital, Beijing, China
| | - X I N Zheng
- Fuwai Hospital, CAMS and PUMC, National Clinical Research Center for Cardiovascular Diseases,Fuwai Hospital, Beijing, China
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