Association between adherence to calcium-channel blocker and statin medications and likelihood of cardiovascular events among US managed care enrollees
Association between adherence to calcium-channel blocker and statin medications and likelihood of cardiovascular events among US managed care enrollees
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DOI：
10.1186/1471-2261-10-29
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发表时间：
2010-06-17
影响因子：
2.1
通讯作者：
Roberts, Craig S.
中科院分区：
文献类型：
--
作者：
Chapman, Richard H.;Yeaw, Jason;Roberts, Craig S.
背景：先前的研究发现，服用单片氨氯地平/阿托伐他汀（SPAA）的患者在6个月时的依从性高于服用2片钙通道阻滞剂和他汀类药物联合（CCB/他汀）的患者。本研究探讨了这种依从性是否能减少心血管事件的发生。方法：回顾性队列研究使用来自IMS LifeLink：美国健康计划索赔数据库的行政索赔数据，确定在2004年4月1日至2005年8月31日期间，已经服用CCB或他汀类药物（但不是两者都服用）的成年人，他们有开始使用SPAA治疗或将CCB加入他汀类药物（反之亦然）的指标事件。纳入标准包括：年龄18岁以上，在开始治疗前和开始治疗后至少连续入组6个月，诊断为bbb1高血压，6个月前无SPAA处方声明或添加CCB或他汀类药物。排除标准包括bbb1索赔，缺少或无效天数，年龄65岁以上且未参加医疗保险优惠，或既往CV事件史，癌症诊断或慢性肾衰竭。主要结局指标是指标日期后6至18个月的CV事件（心肌梗死、心力衰竭、心绞痛、其他缺血性心脏病、中风、外周血管疾病或血运重建术）的发生率，在三个水平上进行分析：1)所有坚持服用与非坚持服用的患者，2)SPAA与双药患者（无论坚持水平），3)坚持服用SPAA、坚持服用双药和非坚持服用SPAA的患者与非坚持服用双药的患者。结果：在1537例SPAA患者中，56.5%的患者在6个月时坚持服用，而在17910例CCB/他汀类药物患者中，这一比例为21.4% （p < 0.001）。Logistic回归发现SPAA患者比CCB/他汀类药物患者更有可能坚持治疗（OR = 4.7, p < 0.001）。在Cox比例风险模型中，坚持任何一种方案都与显著降低的CV事件风险相关（HR = 0.77, p = 0.003）。SPAA与CCB/他汀类药物患者也有类似的效果（HR = 0.68, p = 0.02）。在联合模型中，CCB/他汀类药物依从性患者（HR = 0.79, p = 0.01）和SPAA依从性患者（HR = 0.61, p = 0.03）的CV事件风险显著低于非CCB/他汀类药物依从性患者。结论：接受SPAA治疗的患者比接受2片CCB/他汀类药物治疗的患者更有可能坚持服用。反过来，坚持CCB和他汀类药物与初级预防患者心血管事件的风险降低有关。
Background: Prior studies have found that patients taking single-pill amlodipine/atorvastatin (SPAA) have greater likelihood of adherence at 6 months than those taking 2-pill calcium-channel blocker and statin combinations (CCB/statin). This study examines whether this adherence benefit results in fewer cardiovascular (CV) events.Methods: A retrospective cohort study was conducted using administrative claims data from the IMS LifeLink: US Health Plan Claims database, identifying adults already taking CCB or statin (but not both) who had an index event of either initiating treatment with SPAA or adding CCB to statin (or vice versa) between April 1, 2004 to August 31, 2005. Inclusion criteria included age 18+ years, continuously enrolled for minimum of 6 months prior and 18 months following treatment initiation, >1 diagnosis of hypertension, and no prescription claims for SPAA or added CCB or statin for 6 months prior. Exclusion criteria included >1 claim with missing or invalid days supplied, age 65+ years and not enrolled in Medicare Advantage, or history of prior CV events, cancer diagnosis, or chronic renal failure. The primary outcome measure was the rate of CV events (myocardial infarction, heart failure, angina, other ischemic heart disease, stroke, peripheral vascular disease, or revascularization procedure) from 6 to 18 months following index date, analyzed at three levels: 1) all adherent vs. non-adherent patients, 2) SPAA vs. dual-pill patients (regardless of adherence level), and 3) adherent SPAA, adherent dual-pill, and non-adherent SPAA patients vs. non-adherent dual-pill patients.Results: Of 1,537 SPAA patients, 56.5% were adherent at 6 months, compared with 21.4% of the 17,910 CCB/statin patients (p < 0.001). Logistic regression found SPAA patients more likely to be adherent (OR = 4.7, p < 0.001) than CCB/statin patients. In Cox proportional hazards models, being adherent to either regimen was associated with significantly lower risk of CV event (HR = 0.77, p = 0.003). A similar effect was seen for SPAA vs. CCB/statin patients (HR = 0.68, p = 0.02). In a combined model, the risk of CV events was significantly lower for adherent CCB/statin patients (HR = 0.79, p = 0.01) and adherent SPAA patients (HR = 0.61, p = 0.03) compared to non-adherent CCB/statin patients.Conclusions: Patients receiving SPAA rather than a 2-pill CCB/statin regimen are more likely to be adherent. In turn, adherence to CCB and statin medications is associated with lower risk of CV events in primary prevention patients.