在 5 年的随访中，高他汀类药物依从性与动脉粥样硬化性心血管疾病患者的心血管转归改善相关：来自 IMPRES 研究的结果。
High-statin adherence over 5 years of follow-up is associated with improved cardiovascular outcomes in patients with atherosclerotic cardiovascular disease: results from the IMPRES study.
机构信息
Intermountain Medical Center Heart Institute, 5121 S Cottonwood Dr, Murray, UT 84157, USA.
Department of Internal Medicine, University of Utah School of Medicine, 30 N Medical Dr, Salt Lake City, UT 84132, USA.
出版信息
Eur Heart J Qual Care Clin Outcomes. 2022 May 5;8(3):352-360. doi: 10.1093/ehjqcco/qcab024.
AIMS
Despite proven benefits of LDL-C lowering among those with atherosclerotic cardiovascular disease (ASCVD), statin adherence remains low. Very little real-world data exist on the effect of long-term statin adherence on cardiovascular outcomes.
METHODS AND RESULTS
A total of 7339 patients ≥18 years first diagnosed with ASCVD with a statin prescription within 12 months of diagnosis who had 5 years of continuous Select Health insurance or died during Years 2-5, while a member was studied. The proportion of days covered (PDC) was calculated using pharmacy claims for statin use by year, and patients were stratified into pre-defined categories: fully adherent [PDC ≥ 80% for Years 1-5 or until death, n = 353 (4.8%)], short-term-adherent [PDC ≥ 80% for Years 1-3, n = 330 (4.5%)], early-adherent only [PDC ≥ 80% for Year 1, n = 890 (12.1%)], complex-adherent (PDC ≥ 80% in any of Years 2-5, but not Year 1, n = 1292 [17.6%]), and non-adherent [PDC < 80% for Years 1-5 or until death, n = 3942 (72.1%)]. Patients were followed for major adverse clinical events (MACE = death, myocardial infarction, and stroke). Patients averaged 56.4 ± 9.6 years and 76.5% were male. During Year 1, statin adherence was poor, with PDC < 20% in 4007 (54.6%) patients and PDC ≥80% in 1573 (21.4%) patients, which dropped to 16.9% by Year 5. Increased adherence was associated with significantly fewer MACE (11.6%, 17.9%, 21.9%, 21.1%, and 26.4% for those fully adherent, short-term adherent, early-adherent only, complex-adherent, and non-adherent, respectively, P-trend < 0.0001). After adjustment, fully adherent was associated with a significant decrease in MACE (hazard ratio = 0.51, 0.37-0.71).
CONCLUSION
Among ASCVD patients with at least 5 years of continuous pharmacy benefits, long-term adherence to statins was associated with decreased long-term MACE in a linear-fashion.
目的
尽管已有研究证实 LDL-C 降低对动脉粥样硬化性心血管疾病（ASCVD）患者有益，但他汀类药物的依从性仍然较低。关于长期使用他汀类药物对心血管结局的影响，实际数据很少。
方法和结果
共有 7339 名年龄≥18 岁的患者首次被诊断为 ASCVD，他们在诊断后 12 个月内开具了他汀类药物处方，并在第 2-5 年期间连续投保 SelectHealth 保险或在第 2-5 年期间死亡。通过每年的药物使用药房数据计算患者的用药天数比例（PDC），并将患者分为以下预定义类别：完全依从（PDC≥80%，持续 1-5 年或直至死亡，n=353[4.8%]）、短期依从（PDC≥80%，持续 1-3 年，n=330[4.5%]）、仅早期依从（PDC≥80%，持续 1 年，n=890[12.1%]）、复杂依从（PDC≥80%，任何 2-5 年但不包括第 1 年，n=1292[17.6%]）和不依从（PDC<80%，持续 1-5 年或直至死亡，n=3942[72.1%]）。患者被随访主要不良临床事件（MACE=死亡、心肌梗死和中风）。患者平均年龄为 56.4±9.6 岁，76.5%为男性。在第 1 年，他汀类药物的依从性较差，有 4007 名（54.6%）患者的 PDC<20%，1573 名（21.4%）患者的 PDC≥80%，到第 5 年降至 16.9%。依从性的增加与 MACE 显著减少相关（完全依从、短期依从、仅早期依从、复杂依从和不依从的患者 MACE 发生率分别为 11.6%、17.9%、21.9%、21.1%和 26.4%，P 趋势<0.0001）。经调整后，完全依从与 MACE 显著减少相关（风险比=0.51，0.37-0.71）。
结论
在至少 5 年连续接受药物治疗的 ASCVD 患者中，他汀类药物的长期依从性与长期 MACE 呈线性下降相关。
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