Fonarow Gregg C, French William J, Frederick Paul D
UCLA Division of Cardiology, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles, CA 90095-1679, USA.
Am Heart J. 2009 Jan;157(1):185-194.e2. doi: 10.1016/j.ahj.2008.09.001. Epub 2008 Oct 29.
Compelling evidence demonstrates that certain lipid-lowering medications improve outcomes after acute myocardial infarction (AMI), but to what extent national utilization has increased in response to trials and guidelines has not been well studied. The objective of this study is to determine trends in the use of lipid-lowering medications at discharge for AMI.
A time trend analysis was conducted on treatment rates with lipid-lowering medications from 1998 to 2006 in 996,364 patients with AMI hospitalized in 1,669 hospitals participating in the National Registry of Myocardial Infarction (NRMI) 3, 4, and 5.
Between 1998 and 2006, use of lipid-lowering medications at discharge increased from 29.3% to 83.8%, (relative risk [RR] 2.86, 95% CI 2.84-2.89, P < .0001). Increased use was observed in men (RR 2.71) and women (RR 3.17); age younger than 65 years (RR 2.32) and 65 years or older (RR 3.46); teaching (RR 2.47) and nonteaching hospitals (RR 2.96); and in all regions of the country. After adjusting for multiple other independent predictors, the temporal increase in use of lipid-lowering medications remained highly significant (RR 2.70, 95% CI 2.68-2.73, P < .0001). A significant upward jump in the rate of lipid-lowering medication use was observed most notably in month 72, corresponding to the publication on the PROVE-IT trial (Pravastatin or Atorvastatin Evaluation and Infection Therapy trial).
Use of lipid-lowering medications in patients hospitalized with AMI has increased substantially in the United States in the past 8 years. The increase in the lipid-lowering medication use was possibly accelerated by certain randomized clinical trial evidence demonstrating improved outcomes in this high-risk population.
有力证据表明，某些降脂药物可改善急性心肌梗死（AMI）后的预后，但全国范围内因相关试验和指南而使药物使用增加的程度尚未得到充分研究。本研究的目的是确定AMI患者出院时降脂药物的使用趋势。
对1998年至2006年期间参与国家心肌梗死注册研究（NRMI）3、4和5的1669家医院收治的996364例AMI患者的降脂药物治疗率进行了时间趋势分析。
1998年至2006年期间，出院时降脂药物的使用从29.3%增至83.8%（相对危险度[RR]2.86，95%可信区间2.84 - 2.89，P <.0001）。男性（RR 2.71）和女性（RR 3.17）、年龄小于65岁（RR 2.32）和65岁及以上（RR 3.46）、教学医院（RR 2.47）和非教学医院（RR 2.96）以及全国所有地区的使用均有所增加。在对多个其他独立预测因素进行校正后，降脂药物使用的时间性增加仍然非常显著（RR 2.70，95%可信区间2.68 - 2.73，P <.0001）。降脂药物使用率最显著的大幅跃升出现在第72个月，这与PROVE-IT试验（普伐他汀或阿托伐他汀评价与感染治疗试验）的发表相对应。
在过去8年中，美国AMI住院患者的降脂药物使用显著增加。某些随机临床试验证据表明该高危人群的预后得到改善，这可能加速了降脂药物使用的增加。
