Adherence with statin therapy in elderly patients with and without acute coronary syndromes
Adherence with statin therapy in elderly patients with and without acute coronary syndromes
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DOI：
10.1001/jama.288.4.462
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发表时间：
2002-07-24
影响因子：
120.7
通讯作者：
Tu, JV
中科院分区：
文献类型：
--
作者：
Jackevicius, CA;Mamdami, M;Tu, JV
具有里程碑意义的临床试验已经证明了他汀类药物的生存益处，通常在治疗1至2年后开始获益。在这些老年降脂药试验之前的研究表明，1年依从性较低。目的比较3组患者开始使用他汀类药物后的2年依从性：近期急性冠状动脉综合征（ACS）患者，慢性冠状动脉疾病（CAD）患者，而那些没有冠心病的人（一级预防）.设计和设置队列研究使用连锁人群-基于安大略的管理数据。患者所有在1994年1月至1995年12月期间接受至少1次他汀类药物处方的66岁或以上患者1998年，并且在前一年没有他汀类药物处方的患者从他们的第一次他汀类药物处方开始随访2年。ACS患者22379例，慢性CAD患者36106例，一级预防队列患者85020例。主要结果测量他汀类药物依从性，定义为在索引处方后至少每120天分发一次他汀类药物，持续2年。一级预防占25.4%。相对于ACS队列，接受他汀类药物治疗的慢性CAD患者（相对危险度[ERR]，1.14; 95%CI，1.11 -1.16）和一级预防队列（RR，1.92; 95%CI，1.87-1.96）的不依从性更高。这表明，许多开始他汀类药物治疗的患者可能因为过早停药而无法从他汀类药物中获益或获益有限。
Context Landmark clinical trials have demonstrated the survival benefits of statins, with benefits usually starting after 1 to 2 years of treatment. Research prior to these trials of older lipid-lowering agents demonstrated low levels of 1-year adherence.Objective To compare 2-year adherence following statin initiation in 3 cohorts of patients: those with recent acute coronary syndrome (ACS), those with chronic coronary artery disease (CAD), and those without coronary disease (primary prevention).Design and Setting Cohort study using linked population-based administrative data from Ontario.Patients All patients aged 66 years or older who received at least 1 statin prescription between January 1994 and December 1998 and who did not have a statin prescription in the prior year were followed up for 2 years from their first statin prescription. There were 22379 patients in the ACS, 36106 in the chronic CAD, and 85020 in the primary prevention cohorts.Main Outcome Measures Adherence to statins, defined as a statin being dispensed at least every 120 days after the index prescription for 2 years.Results Two-year adherence rates in the cohorts were only 40.1% for ACS, 36.1% for chronic CAD, and 25.4% for primary prevention. Relative to the ACS cohort, nonadherence was more likely among patients receiving statins in the chronic CAD (relative risk ERR], 1.14; 95% Cl, 1,11-1.16) and primary prevention cohorts (RR, 1,92; 95% Cl, 1.87-1.96).Conclusions Elderly patients with and without recent ACS have low rates of adherence to statins. This suggests that many patients initiating statin therapy may receive no or limited benefit from statins because of premature discontinuation.