Evaluation of Aspirin and Statin Therapy Use and Adherence in Patients With Premature Atherosclerotic Cardiovascular Disease
Evaluation of Aspirin and Statin Therapy Use and Adherence in Patients With Premature Atherosclerotic Cardiovascular Disease
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DOI：
10.1001/jamanetworkopen.2020.11051
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发表时间：
2020-08-20
影响因子：
13.8
通讯作者：
Virani, Salim S.
中科院分区：
文献类型：
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作者：
Mahtta, Dhruv;Ramsey, David J.;Virani, Salim S.
关于过早和极早动脉粥样硬化性心血管疾病（ASCVD）患者二级预防治疗的使用和坚持的研究尚缺乏。目的评价和比较早发或极早发ASCVD患者与非早发ASCVD患者的阿司匹林使用、任何他汀类药物使用、高强度他汀类药物使用和他汀依从性。设计、环境和参与者本多中心横断面研究使用美国退伍军人事务部（VA）的临床和管理数据集，以确定2014年10月1日至2015年9月30日期间在VA医疗保健系统中至少进行过一次初级保健就诊的成年患者。研究队列包括ASCVD（缺血性心脏病、外周动脉疾病或缺血性脑血管疾病）患者，他们登记在过早动脉粥样硬化退伍军人（VITAL）登记处。排除出生日期或性别资料缺失和预期寿命有限的患者。数据分析时间为2019年11月1日至2020年1月1日。过早（女性第一次ASCVD事件发生在65岁）ASCVD和极度过早（第一次ASCVD事件发生在0.8岁）。结果在1248158例患者中，13703例（10.9%）有早发性ASCVD（平均[SD]年龄49.6[5.8]岁；116739例男性[86.0%]），1112455例（89.1%）有非早发性ASCVD（平均[SD]年龄69.6[8.9]岁；1104318例（99.3%）），7716例（0.6%）有极度早发性ASCVD（平均[SD]年龄34.2[4.3]岁；6576例（85.2%））。早发ASCVD患者与非早发ASCVD患者阿司匹林使用率较低(96 468例[71.1%]vs 860 726例[77.4%]
IMPORTANCE Studies on the use of and adherence to secondary prevention therapies in patients with premature and extremely premature atherosclerotic cardiovascular disease (ASCVD) are lacking.OBJECTIVE To evaluate and compare aspirin use, any statin use, high-intensity statin use, and statin adherence among patients with premature or extremely premature ASCVD compared with patients with nonpremature ASCVD.DESIGN, SETTING, AND PARTICIPANTS This multicenter cross-sectional study used the clinical and administrative data sets of the US Department of Veterans Affairs (VA) to identify adult patients with at least 1 primary care visit in the VA health care system between October 1, 2014, and September 30, 2015. The study cohort comprised patients with ASCVD (ischemic heart disease, peripheral arterial disease, or ischemic cerebrovascular disease) who were enrolled in the Veterans With Premature Atherosclerosis (VITAL) registry. Patients with missing data for date of birth or sex and those with limited life expectancy were excluded. Data were analyzed from November 1, 2019, to January 1, 2020.EXPOSURES Premature (the first ASCVD event occurred at age = 65 years for women) ASCVD and extremely premature (the first ASCVD event occurred at age = 0.8).RESULTS Of the 1 248 158 patients identified, 135 703 (10.9%) had premature ASCVD (mean [SD] age, 49.6 [5.8] years; 116 739 men [86.0%]), 1 112 455 (89.1%) had nonpremature ASCVD (mean [SD] age, 69.6 [8.9] years; 1 104 318 men [99.3%]), and 7716 (0.6%) had extremely premature ASCVD (mean [SD] age, 34.2 [4.3] years; 6576 men [85.2%]). Patients with premature ASCVD vs those with nonpremature ASCVD had lower rates of aspirin use (96 468 [71.1%] vs 860 726 [77.4%]; P