Changes in adherence to statins and subsequent lipid profiles during and following breast cancer treatment
Changes in adherence to statins and subsequent lipid profiles during and following breast cancer treatment
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DOI：
10.1007/s10549-013-2424-2
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发表时间：
2013-02-01
影响因子：
3.8
通讯作者：
Loggers, Elizabeth T.
中科院分区：
文献类型：
--
作者：
Calip, Gregory S.;Boudreau, Denise M.;Loggers, Elizabeth T.
乳腺癌往往发生在老年妇女谁也负担与合并症，如心血管疾病（CVD）。越来越多的乳腺癌幸存者和老龄化人口需要更好地了解CVD管理和坚持预防性治疗。我们评估了乳腺癌诊断前一年或基线、治疗期间以及乳腺癌幸存者随后几年临床管理中他汀类药物和治疗目标血脂值的依从性。我们从1990年至2008年诊断为早期（I，II）浸润性乳腺癌的4，221名女性中抽取了女性样本，并参加了一项大型综合团体实践健康计划。在普遍的他汀类药物使用者（N = 1,393）中，通过药物拥有率（MPR）、%依从性（MPR < 0.80）和停药率来衡量药物依从性和持续性。获得了同期LDL和HDL的实验室数据。他汀类药物使用的平均MPR（0.78 vs. 0.68; P < 0.001）和依从性比例（67.0 vs. 51.9%; P < 0.001）从基线到治疗期下降。平均LDL（143 mg/dL基线vs. 150 mg/dL治疗期; P < 0.001）和未达到LDL目标的比例（60.1 vs. 70.8%; P < 0.001）与依从性降低一致。在治疗期间，非依从性他汀类药物使用者的平均LDL最高（160.4 mg/dL），总体上未达到目标LDL的比例（91.8%）。依从性在治疗后的几年中没有恢复到基线水平，尽管LDL水平恢复了。HDL没有不同的兴趣或坚持水平的时期。该人群对他汀类药物的依从性较差，特别是在治疗期间，并且在恢复至基线方面滞后。了解生活事件（如癌症诊断和治疗）对合并症管理和坚持预防性治疗的影响，对于不断增长的乳腺癌幸存者人群非常重要。
Breast cancer tends to arise in older women who are also burdened with comorbidities such as cardiovascular disease (CVD). Increasing numbers of breast cancer survivors and an aging population warrant a better understanding of CVD management and adherence to preventive therapies. We estimated adherence to statins and therapeutic goal lipid values during the year before breast cancer diagnosis or baseline, treatment period, and in subsequent years of clinical management among breast cancer survivors. We sampled women from an existing cohort of 4,221 women diagnosed with incident early stage (I, II) invasive breast cancer from 1990 to 2008 and enrolled in a large integrated group practice health plan. Among prevalent statin users (N = 1,393), medication adherence and persistence were measured by medication possession ratio (MPR), % adherent (MPR < 0.80), and discontinuation rates. Laboratory data on LDL and HDL were obtained for the coinciding periods. Mean MPR for statin use (0.78 vs. 0.68; P < 0.001) and proportion adherent (67.0 vs. 51.9 %; P < 0.001) declined from baseline to the treatment period. Mean LDL (143 mg/dL baseline vs. 150 mg/dL treatment period; P < 0.001) and proportion not at LDL goal (60.1 vs. 70.8 %; P < 0.001) coincided with decreases in adherence. During treatment, non-adherent statin users had the highest mean LDL (160.4 mg/dL) and proportion not at goal LDL (91.8 %) overall. Adherence did not return to baseline in subsequent years following treatment although LDL levels did. HDL did not differ by periods of interest or adherence levels. Adherence to statins in this population was poor, particularly in the treatment period, and lagged in returning to baseline. Understanding the influence of life events such as cancer diagnosis and treatment on management of comorbidities and adherence to preventive therapies are important to the growing population of breast cancer survivors.