[Low-density lipoprotein cholesterol levels and lipid-lowering treatment status among young and middle-aged ultra-high-risk patients with acute coronary syndrome in China].

Objective: To assess low-density lipoprotein cholesterol (LDL-C) levels and use of lipid-lowering treatment among young and middle-aged ultra-high-risk patients with acute coronary syndrome (ACS) in China. Methods: The study was based on the"Improving Care for Cardiovascular Disease in China (CCC)-ACS"project, a collaborative registry by and Chinese Society of Cardiology (CSC) and the American Heart Association. Hospitalized-patients with ACS were consecutively enrolled from 159 tertiary and 82 secondary hospitals across China, related clinical information was collected. This study included young and middle-aged hospitalized patients (18-59 years) with ACS from November 2014 to December 2019 registered in CCC-ACS project. Ultra-high-risk was defined according to Chinese expert consensus on lipid management of ultra-high-risk atherosclerotic cardiovascular disease (ASCVD) patients of CSC. The mean LDL-C levels at admission, pre-hospital lipid-lowering therapy and proportion of patients with LDL-C target achieved were analyzed. Results: A total of 42 230 patients younger than 60 years with ACS were included in this study. The mean age was (50.4±6.9) years, and 86.8% (36 676/42 230) of the ACS patients were male. Among them, 86.9% (36 687/42 230) met the criteria of ultra-high-risk. The mean level of LDL-C at admission was (2.8±1.0)mmol/L, only 5.3 % (1 948/36 687) patients achieved the targeted goal of LDL-C<1.4 mmol/L. Among the ultra-high-risk ASCVD patients, 17.5% (6 430/36 687) received lipid-lowering drugs before hospitalization, 96.4% (6 198/6 430) of whom received statins monotherapy. Among patients receiving pre-hospital statins, only 9.9% (626/6 323) patients reached an LDL-C<1.4 mmol/L at admission. Conclusions: The majority of young and middle-aged hospitalized patients with ACS are ultra-high-risk patients for ASCVD in China. Pre-hospital lipid-lowering drugs use is lower in these ultra-high-risk ASCVD patients and most patients do not reach the new LDL-C target level at admission.目的： 了解中国中青年超高危急性冠状动脉综合征（ACS）患者低密度脂蛋白胆固醇（LDL-C）水平及降胆固醇药物使用现状。 方法： 本研究基于中华医学会心血管病学分会（CSC）和美国心脏协会（AHA）合作的中国心血管疾病医疗质量改善（CCC）项目。该项目在全国159家三级医院和82家二级医院连续入选ACS住院患者，系统收集患者临床相关信息。本研究纳入CCC项目2014年11月至2019年12月入选的中青年（年龄18~59岁）ACS住院患者，根据CSC《超高危动脉粥样硬化性心血管疾病患者血脂管理中国专家共识》超高危患者的界定标准，分析超高危ACS患者LDL-C平均水平及院前接受调脂治疗情况。 结果： 研究共纳入42 230例中青年ACS住院患者，年龄（50.4±6.9）岁，男性86.8%（36 676/42 230）。86.9%（36 687/42 230）的患者符合超高危标准。超高危ACS患者入院时LDL-C水平为（2.8±1.0）mmol/L，仅有5.3%（1 948/36 687）的患者达到1.4 mmol/L的目标值。超高危患者中，17.5%（6 430/36 687）的患者院前服用调脂药物，其中96.4%（6 198/6 430）的患者采用他汀单药治疗。接受他汀治疗的超高危患者中，9.9%（626/6 323）的患者LDL-C<1.4 mmol/L。 结论： 中青年ACS住院患者中绝大多数属于超高危，需要采用更低的LDL-C降脂治疗目标。超高危患者院前较少服用降胆固醇药物，大部分患者入院时LDL-C水平高于推荐的目标值且距目标值的差距较大。.