NHS Mid Essex, Swift House, Chelmsford, Essex CM2 5PF, UK.
J Epidemiol Community Health. 2010 Feb;64(2):109-13. doi: 10.1136/jech.2009.091033.
In everyday practice, adherence to preventive medication for cardiovascular disease (CVD) is lower than in clinical trials and appears to decline to approximately 50% by about 5 years. The UK body for the evaluation of health technologies, NICE, currently recommends that persons with a >20% 10-year risk of incident cardiovascular disease receive statins.
Publications on adherence to statin medication in clinical trials and in normal practice were systematically reviewed. Data on CVD-free members of a large southern hemisphere cohort study were used to simulate the expected benefits of contrasting strategies to increase the use of statins. Risks of incident CVD and death from CVD were estimated.
A strategy to enhance statin adherence among cohort members meeting NICE statin-prescribing guidelines resulted in about twice as large a reduction in the aggregate risk of CVD death as did a strategy to lower treatment thresholds.
The benefits from increased spending on statin medication will be much greater if they result from enhanced adherence rather than from lowering the medication threshold.
在日常实践中，心血管疾病（CVD）预防药物的依从性低于临床试验，并且在大约 5 年内似乎下降到约 50%。英国健康技术评估机构 NICE 目前建议，具有 >20%的 10 年心血管疾病发病风险的患者应服用他汀类药物。
系统地回顾了临床试验和常规实践中他汀类药物用药依从性的出版物。利用南半球一个大型队列研究中 CVD 无发病成员的数据，模拟了增加他汀类药物使用的对比策略所带来的预期获益。估计了 CVD 发病和 CVD 死亡的风险。
在符合 NICE 他汀类药物处方指南的队列成员中，增强他汀类药物的依从性的策略导致 CVD 死亡的总风险降低了近两倍，而降低治疗阈值的策略则降低了风险。
如果他汀类药物的花费增加是由于依从性提高而不是降低药物治疗阈值，那么其带来的获益将更大。
