International patterns in lipid management and implications for patients with coronary heart disease: results from the INTERASPIRE study.
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Brandts Julia, Barkas Fotios, De Bacquer Dirk, Jennings Catriona, De Backer Guy G, Kotseva Kornelia, Ryden Lars, Lip Gregory Y H, Erlund Iris, Ganly Sandra, Vihervaara Terhi, Adamska Agnieszka, Abreu Ana, Almahmeed Wael, Ambari Ade Meidian, Ge Junbo, Hasan-Ali Hosam, Huo Yong, Jankowski Piotr, Jimenez Rodney M, Li Yong, Zuhdi Ahmad Syadi Mahmood, Makubi Abel, Mbakwem Amam Chinyere, Mbau Lilian, Estrada Jose Luis Navarro, Ogah Okechukwu Samuel, Ogola Elijah Nyainda, Quintero-Baiz Adalberto, Sani Mahmoud Umar, Liprandi Maria Ines Sosa, Tan Jack Wei Chieh, Triana Miguel Alberto Urina, Yeo Tee Joo, Wood David, McEvoy John William, Ray Kausik K
Аннотация
METHODS AND RESULTS: INTERASPIRE is an observational study (2020-23) covering 14 countries from all WHO regions. Patients (18-79 years) hospitalized in the preceding 6-36 months with CHD were invited for standardized interviews and examination, with central laboratory analyses for low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and apolipoprotein B (apoB). Valid lipid data meeting quality control standards were available from 13 countries. Lipid goals followed the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology: LDL-C < 1.4 mmol/L, non-HDL-C < 2.2 mmol/L, and apoB <65 mg/dL.Among 4061 patients (78.8% male, mean age 60.3 years), between index event and interview, 66.3% had no change in treatment intensity. LLT use at interview was largely statin monotherapy: 49.6% high-intensity (inter-country range 5.3%-77.3%) and 24.1% low/moderate-intensity (inter-country range 5.1%-70.1%). Otherwise, 12.2% (inter-country range 0.2%-41.1%) were on combination therapy, and 12.7% on no LLT (inter-country range 3.5%-36.7%). Goal attainment for LDL-C was 17.5%. Corresponding non-HDL-C and apoB goals were achieved by 29.9% and 29.2%, respectively. Higher-income countries (defined by the World Bank's 2024-25 classification of income levels) did better in goal attainment than lower-middle-income countries.
CONCLUSION: In this international study, contemporary lipid goals were not achieved in most CHD patients, with lower-middle-income countries having the worst goal attainment. Contributory factors include absence of any LLT use, low use of combinations and a failure to up-titrate LLT to achieve guideline targets.