Statin Prescription Rates, Adherence, and Associated Clinical Outcomes Among Women with PAD and ICVD
Statin Prescription Rates, Adherence, and Associated Clinical Outcomes Among Women with PAD and ICVD
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DOI：
10.1007/s10557-020-07057-y
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发表时间：
2020-08-25
影响因子：
3.4
通讯作者：
Virani, Salim S.
中科院分区：
文献类型：
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作者：
Mahtta, Dhruv;Ahmed, Sarah T.;Virani, Salim S.
目的本研究旨在调查外周动脉疾病（PAD）和缺血性脑血管疾病（ICVD）患者中他汀类药物处方率和依从性的性别差异。方法我们确定了2013年至2014年期间在VA医疗保健系统中寻求初级保健的PAD或ICVD患者。我们评估了PAD或ICVD女性患者与男性患者的任何他汀类药物使用、高强度他汀类药物（HIS）使用和他汀类药物依从性。我们还比较了覆盖天数比例（PDC）作为他汀类药物依从性的指标; PDC >= 0.8被视为患者他汀类药物依从性。他汀类药物使用（或依从性）与12个月随访时死亡或心肌梗死（MI）几率之间的关系也得到了证实。结果我们的分析包括192,219名男性和3188名女性PAD患者和331,352名男性和10,490名女性ICVD患者。PAD患者的任何他汀类药物处方率均较低（68.5% vs. 78.7%，OR 0.68，95%置信区间（CI）0.62-0.75），HIS（21.1% vs. 23.7%，OR 0.88，95% CI 0.79-0.97），他汀类药物依从性较低（PDC >= 0.8：34.6% vs. 45.5%，OR 0.75，95% CI 0.69-0.82）。在ICVD患者中也观察到类似的差异。在患有PAD或ICVD的女性患者中，他汀类药物依从性与MI发生率较低相关（OR 0.76，95% CI 0.59-0.98），而使用任何他汀类药物（OR 0.71，95% CI 0.56-0.91）和HIS（OR 0.68，95% CI 0.48-0.97）与12个月时死亡率较低相关。结论PAD或ICVD患者接受他汀类药物治疗、HIS治疗或坚持他汀类药物治疗的几率较低。需要有针对性的临床医生和患者水平的干预措施来研究和解决PAD和ICVD患者之间的这些差异。
Purpose This study sought to investigate gender-based disparities in statin prescription rates and adherence among patients with peripheral arterial disease (PAD) and ischemic cerebrovascular disease (ICVD). Methods We identified patients with PAD or ICVD seeking primary care between 2013 and 2014 in the VA healthcare system. We assessed any statin use, high-intensity statin (HIS) use, and statin adherence among women with PAD or ICVD compared with men. We also compared proportion of days covered (PDC) as a measure of statin adherence; PDC >= 0.8 deemed a patient statin adherent. Association between statin use (or adherence) and odds of death or myocardial infarction (MI) at 12-month follow-up was also ascertained. Results Our analyses included 192,219 males and 3188 females with PAD and 331,352 males and 10,490 females with ICVD. Women with PAD had lower prescription rates of any statin (68.5% vs. 78.7%, OR 0.68, 95% confidence interval (CI) 0.62-0.75), HIS (21.1% vs. 23.7%, OR 0.88, 95% CI 0.79-0.97), and lower statin adherence (PDC >= 0.8: 34.6% vs. 45.5%, OR 0.75, 95% CI 0.69-0.82) compared with men. Similar disparities were seen in ICVD patients. Among female patients with PAD or ICVD, statin adherence was associated with lower odds of MI (OR 0.76, 95% CI 0.59-0.98), while use of any statin (OR 0.71, 95% CI 0.56-0.91) and HIS (OR 0.68, 95% CI 0.48-0.97) was associated with lower odds of death at 12 months. Conclusions Women with PAD or ICVD had lower odds of receiving any statins, HIS, or being statin adherent. Targeted clinician- and patient-level interventions are needed to study and address these disparities among patients with PAD and ICVD.