Adherence to Drugs That Prevent Cardiovascular Disease: Meta-analysis on 376,162 Patients
Adherence to Drugs That Prevent Cardiovascular Disease: Meta-analysis on 376,162 Patients
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DOI：
10.1016/j.amjmed.2011.12.013
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发表时间：
2012-09-01
影响因子：
5.9
通讯作者：
Wald, David S.
中科院分区：
文献类型：
--
作者：
Naderi, Sayed H.;Bestwick, Jonathan P.;Wald, David S.
目的：联合治疗，特别是与阿司匹林、胆固醇和降压药联合治疗，可以显著降低冠心病的风险，但只有无限期地继续治疗，才能实现全面的预防效果。我们的目标是根据有心肌梗死(二级预防)和无一级预防(一级预防)的人的药物类别和使用情况，提供预防冠心病药物依从性的概要估计。方法：对来自20项研究的376,162名患者的数据进行了荟萃分析，评估了以下7种药物类别的依从性：阿司匹林、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β-阻滞剂、钙通道阻滞剂、噻嗪和他汀类药物。结果：在中位时间24个月后，所有研究的依从性总估计为57%(95%可信区间[CI]，50-)。一级预防和二级预防的依从性差异有统计学意义：分别为50%(CI，45-56)和66%(CI，56-75)(P=.012)。在一级预防中，噻嗪类药物的依从性(42%)低于血管紧张素受体阻滞剂(61%)(P=0.02)。在一级或二级预防研究中，任何药物类别之间没有其他统计上的显著差异。服药依从性下降0.15个百分点/月(P=0.07)，且与年龄及患者是否付费无关。结论：预防治疗依从性差，与药物类别关系不大，提示副作用不是主要原因。需要采取一般性的措施，而不是针对特定的类别，以提高遵从性。(C)2012 Elsevier Inc.保留所有权利。《美国医学杂志》(2012)125,882-887
OBJECTIVE: Combination therapy, specifically with aspirin, cholesterol and blood pressure-lowering drugs, substantially reduces the risk of coronary heart disease, but the full preventive effect is only realized if treatment continues indefinitely. Our objective was to provide a summary estimate of adherence to drugs that prevent coronary heart disease, according to drug class and use in people who have had a myocardial infarction (secondary prevention) and people who have not (primary prevention).METHODS: A meta-analysis of data on 376,162 patients from 20 studies assessing adherence using prescription refill frequency for the following 7 drug classes was performed: aspirin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, calcium-channel blockers, thiazides, and statins. Meta-regression was used to examine the effects of age, payment, and treatment duration.RESULTS: The summary estimate for adherence across all studies was 57% (95% confidence interval [CI], 50-64) after a median of 24 months. There were statistically significant differences in adherence between primary and secondary prevention: 50% (CI, 45-56) and 66% (CI, 56-75), respectively (P = .012). Adherence was lower for thiazides (42%) than for angiotensin receptor blockers (61%) in primary prevention (P = .02). There were no other statistically significant differences between any of the drug classes in primary or secondary prevention studies. Adherence decreased by 0.15% points/month (P = .07) and was unrelated to age or whether patients paid for their pills.CONCLUSION: Adherence to preventive treatment is poor and little related to class of drug, suggesting that side effects are not the main cause. General, rather than class-specific, measures at improving adherence are needed. (C) 2012 Elsevier Inc. All rights reserved. The American Journal of Medicine (2012) 125, 882-887