Editor's note
Under the current severe situation of cardiovascular disease prevention and treatment, lipid management, as a key link in reducing the risk of cardiovascular events in patients with acute coronary syndrome (ACS), has always received great attention. During this year's ACC conference, the team of Academician Ge Junbo and Professor Wang Zhen from Zhongshan Hospital of Fudan University released important research results showing that the Lipid Quality Improvement Project (ACS Lipid Control Pioneer) has effectively helped more than 16 000 ACS patients improve their lipid management.
Project Background
At present, the control rate of low-density lipoprotein cholesterol (LDL-C) in Chinese ACS patients is not ideal. In order to address this challenge, the China Cardiovascular Alliance launched the "ACS Lipid Control Pioneer" project in 2021, aiming to improve doctors' awareness and attention to the clinical standard pathway of blood lipid management and improve the compliance rate of LDL-C through consensus education and clinical practice guidance.
Study Design and Methods
In this study, we included and analyzed data from 25 centers participating in the ACS Lipid Control Pioneer program and 733 centers not participating in the program from the China Cardiovascular Alliance-Chest Pain Center. The propensity score matching (PSM) method was used to ensure the consistency of baseline characteristics between the project group and the control group. The primary endpoint of the study was to assess the LDL-C attainment rate (LDL-C<1.4 mmol/L) at 1 month follow-up.
Findings:
After PSM, 16 560 patients were included in the project group and the control group, for a total of 294 367 patients with ACS who were admitted to the hospital.
At 1-month follow-up, the overall LDL-C attainment rate of the participating project group was significantly higher than that of the control group (33.10% vs. 28.12%, P=0.043) (Fig. 1).
ACS patients in the project group were more likely to receive proprotein convertase subtilisin 9 inhibitor (PCSK9i) combined with lipid-lowering therapy (17.78% vs. 2.32%, P<0.001).
Logistic regression analysis showed that participation in the "ACS Lipid Control Pioneer" (OR 1.26, 95%CI: 1.01~1.59, P=0.043) and treatment with PCSK9i (OR 4.59, 95%CI: 3.57~5.93, P<0.001) was significantly associated with LDL-C < 1.4 mmol/L at 1-month follow-up.
Among the participating project groups, the rates of LDL-C < 1.4 mmol/L were significantly different among the participating project groups: the lipid attainment rates of medium-dose statin, statin + mibe, statin + PCSK9i, and statin + mibes + PCSK9i were 26.55%, 33.23%, 64.10%, and 70.93%, respectively (Fig. 2).
Figure 1. LDL-C attainment rate of the project group and the control group at 1 month
Figure 2. LDL-C attainment rate of different lipid-lowering regimens at 1 month
Clinical significance
The research data confirms that through the clinical consensus education and practical guidance of the Chest Pain Center project, we can effectively improve the understanding and implementation of blood lipid management by doctors. The wide clinical application of PCSK9i after entering the medical insurance in China provides strong support for achieving stricter blood lipid control goals, and is expected to reduce the risk of recurrence of cardiovascular events in ACS patients in the long term.
Looking to the future
The ACS Lipid Control Pioneers program has provided us with a valuable lesson: through systematic education and practical guidance, we can improve lipid management in cardiovascular patients across the country. This model is not only applicable to China, but also provides a model for other countries with large populations.
Expert Profile
Wang Zhen is the deputy chief physician
Zhongshan Hospital Affiliated to Fudan University
doctor
Department of Cardiology, Zhongshan Hospital, Fudan University
Deputy Chief Physician, Department of Cardiology, Zhongshan Hospital, Fudan University
HE RECEIVED HIS MASTER'S DEGREE FROM FUDAN UNIVERSITY MEDICAL SCHOOL IN 2002 AND HIS M.D. DEGREE FROM DUISBURG-ESSEN UNIVERSITY IN GERMANY IN 2009.
Therapeutic areas: drug treatment of heart diseases such as dyslipidemia, coronary heart disease, and hypertension. Participated in a number of large-scale domestic and international clinical studies. As the first author, he has published several papers in SCI journals and core journals at home and abroad, and participated in the compilation of many professional treatises, translations and textbooks, as well as the compilation of many popular science books.
参考文献：Wang Z,et al. FROM CONSENSUS PATHWAY TO PRACTICE: EVALUATING THE IMPACT OF A QUALITY IMPROVEMENT PROJECT ON LIPID MANAGEMENT IN MORE THAN 16,000 CHINESE ACS PATIENTS. Presented at ACC.24.