Predictors of cholesterol treatment discussions and statin prescribing for primary cardiovascular disease prevention in community health centers
Predictors of cholesterol treatment discussions and statin prescribing for primary cardiovascular disease prevention in community health centers
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DOI：
10.1016/j.ypmed.2016.04.011
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发表时间：
2016-07-01
影响因子：
5.1
通讯作者：
Persell, Stephen D.
中科院分区：
文献类型：
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作者：
Karmali, Kunal N.;Lee, Ji-Young;Persell, Stephen D.
背景。尽管胆固醇指南强调心血管疾病（CVD）的风险来指导一级预防，但他汀类药物在实践中使用的预测因素尚不清楚。我们的目的是确定与高危人群胆固醇治疗讨论和他汀类药物处方相关的因素。我们使用的数据来自一项在社区卫生中心进行的试验，参与者没有心血管疾病或糖尿病，10年冠心病（CHD）风险>= 10%。6个月时评估胆固醇治疗讨论，1年时评估他汀类药物处方。我们使用逻辑回归来确定与每个结果相关的因素。我们分析了646名参与者（89%为男性，平均年龄60±9.5岁）。19%的参与者讨论过胆固醇治疗，12%的参与者讨论过他汀类药物的处方。在未调整的模型中，10年冠心病风险与治疗讨论无关（OR为1.11 / 1 SD增加，95% CI 0.91-1.33），但与他汀类药物处方相关（OR为1.41 / 1 SD增加，95% CI为1.13-1.75）。在调整了导致冠心病风险的传统心血管疾病危险因素后，低密度脂蛋白胆固醇（LDL-C）与他汀类药物处方独立相关（OR为1.82 / 1 SD增加，95% CI为1.66-1.99）。降压药物的使用与胆固醇治疗讨论（OR 3.68, 95% CI 2.35-5.75）和他汀类药物处方（OR 3.98, 95% CI 3.30-4.81）独立相关。CVD风险的其他驱动因素（年龄、吸烟和收缩压）与他汀类药物的使用无关。单一风险因素管理强烈影响胆固醇治疗讨论和他汀类药物处方模式。促进基于风险的他汀类药物使用的干预措施是必要的。(C) 2016 Elsevier Inc.版权所有。
Background. Although cholesterol guidelines emphasize cardiovascular disease (CVD) risk to guide primary prevention, predictors of statin use in practice are unknown. We aimed to identify factors associated with a cholesterol treatment discussion and statin prescribing in a high-risk population.Methods. We used data from a trial conducted among participants in community health centers without CVD or diabetes and a 10-year coronary heart disease (CHD) risk >= 10%. Cholesterol treatment discussion was assessed at 6 months and statin prescription at 1 year. We used logistic regressions to identify factors associated with each outcome.Results. We analyzed 646 participants (89% male, mean age 60 +/- 9.5 years). Cholesterol treatment discussion occurred in 19% and statin prescription in 12% of participants. Ten-year CHD risk was not associated with treatment discussion (OR 1.11 per 1 SD increase, 95% CI 0.91-1.33) but was associated with statin prescription (OR 1.41 per 1 SD increase, 95% CI 1.13-1.75) in unadjusted models. After adjusting for traditional CVD risk factors that contribute to CHD risk, low-density lipoprotein cholesterol (LDL-C) was independently associated with statin prescription (OR 1.82 per 1 SD increase, 95% CI 1.66-1.99). Antihypertensive medication use was independently associated with both cholesterol treatment discussion (OR 3.68, 95% CI 2.35-5.75) and statin prescription (OR 3.98, 95% CI 3.30-4.81). Other drivers of CVD risk (age, smoking, and systolic blood pressure) were not associated with statin use.Conclusions. Single risk factor management strongly influences cholesterol treatment discussions and statin prescribing patterns. Interventions that promote risk-based statin utilization are needed. (C) 2016 Elsevier Inc. All rights reserved.