University of Western Australia, Royal Perth Hospital, Lipid Disorders Clinic, Department of Internal Medicine, Australia.
Expert Opin Pharmacother. 2009 Dec;10(18):2973-85. doi: 10.1517/14656560903376186.
Hypercholesterolemia is a major risk factor for atherosclerosis and cardiovascular disease, the leading cause of death worldwide. In the last twenty years, effective lipid-lowering therapies, particularly statins, have become widely available to prevent and reverse the progression of disease. However, there is a significant gap between expected and actual benefits; this may be attributed to poor adherence to statin therapy.
To define the extent, causes (including psychological aspects), consequences and management of non-adherence to statins.
Literature using PubMed and Medline up to and including 30 July 2009.
Adherence to statin therapy is suboptimal in both primary and secondary prevention of cardiovascular disease. Causes vary, and include patient factors (e.g., comorbidities, financial constraints, psychological issues), practitioner factors (e.g., poor knowledge of adherence, time constraints, poor communication skills and patient-doctor working alliance) and system factors (e.g., medication costs, lack of clinical monitoring, drug side effects). Non-adherence is associated with adverse health outcomes and increased costs of healthcare. A framework, based on a multidisciplinary approach, for addressing non-adherence, including managing the statin-intolerant patient, is presented.
Non-adherence to statins is a significant issue for the prevention and treatment of cardiovascular disease. Increased awareness of the causes and solutions for overcoming non-adherence, including safer prescribing, improvement in physician-patient alliance and reduction in drug costs, will enhance the cost-effectiveness of the use of statins and significantly improve patient care and outcomes.
高胆固醇血症是动脉粥样硬化和心血管疾病的一个主要危险因素，也是全球范围内导致死亡的主要原因。在过去的二十年中，有效的降脂疗法，特别是他汀类药物，已经广泛应用于预防和逆转疾病的进展。然而，期望的和实际的益处之间存在着显著的差距；这可能归因于他汀类药物治疗的依从性差。
定义他汀类药物不依从的程度、原因（包括心理方面）、后果和管理。
使用 PubMed 和 Medline 文献，截至 2009 年 7 月 30 日。
他汀类药物治疗的依从性在心血管疾病的一级和二级预防中都不理想。原因包括患者因素（如合并症、经济限制、心理问题）、医生因素（如对依从性的了解不足、时间限制、沟通技巧差和医患工作联盟不佳）和系统因素（如药物费用、缺乏临床监测、药物副作用）。不依从与不良健康结果和增加医疗保健成本有关。提出了一个基于多学科方法的框架，用于解决不依从问题，包括管理他汀类药物不耐受的患者。
他汀类药物不依从是预防和治疗心血管疾病的一个重大问题。提高对不依从的原因和解决办法的认识，包括更安全的处方、改善医患联盟和降低药物成本，将提高他汀类药物使用的成本效益，并显著改善患者的护理和结果。
