近期研究顯示，在ATP III指南的推薦建議下，外周動脈疾病(PAD)患者的最佳血脂控製情況差於冠脈疾病(CAD)患者。於美國心髒病學會年會(ACC2015)上公布的一項研究也證實了上述觀點。該研究表明，PAD患者接受指南推薦降脂治療的比率顯著低於CAD患者和合並PAD的CAD患者;研究者建議，臨床醫生需對PAD患者實施更積極的血脂控製策略。

此項回顧性病曆評閱研究運用2013年新指南，對11134例PAD和CAD患者的血脂管理進行了比較。獲取人口統計學、血脂水平和他汀類藥物應用信息。基於新指南將他汀類藥物治療分為高、中、低強度治療。

結果顯示，受試者平均年齡為69±11歲，女性占35%，患糖尿病者占33%。

PAD患者的總膽固醇、低密度脂蛋白(LDL)和甘油三酯均顯著高於CAD患者。PAD和CAD患者分別有76%和100%接受他汀類藥物治療;僅有178例(30%)PAD患者實現LDL<70 mg/dl的目標，實現LDL<100 mg/dl的PAD患者為371例(62%)。

依據新指南，PAD患者的治療不足情況顯著高於CAD患者，並且在年齡≤75歲患者中尤為顯著。

相關文章公布於美國心髒學會科學年會（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.

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