Department of Medicine, University of Iowa, 200 Hawkins Drive SE 21C GH, Iowa City, IA 52242, USA.
J Clin Lipidol. 2010 Jan-Feb;4(1):36-45. doi: 10.1016/j.jacl.2009.12.006.
Women's long-term patterns of evidence-based preventive medication utilization following a coronary heart disease (CHD) diagnosis have not been sufficiently studied.
Postmenopausal women 50-79 years were eligible for randomization in the Women's Health Initiative's (WHI) hormone trials if they met inclusion and exclusion criteria and were >80% adherent during a placebo-lead-in period and in the dietary modification trial if they were willing to follow a 20% fat diet. Those with adjudicated myocardial infarction or coronary revascularization after the baseline visit were included in the analysis (n=2627). Baseline visits occurred between 1993 and 1998, then annually until the trials ended in 2002 through 2005; medication inventories were obtained at baseline and years 1, 3, 6 and 9.
Utilization at the first WHI visit following a CHD diagnosis increased over time for statins (49% to 72%; p<0.0001), beta-blockers (49% to 62%; p=0.003), and angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers (ACEI/ARBs ) [26 to 43%; p<0.0001]. Aspirin use remained stable at 76% (p=0.09). Once women reported using a statin, aspirin, or beta-blocker, 84-89% reported use at 1 or more subsequent visits, with slightly lower rates for ACEI/ARBS (76%). Statin, aspirin, beta-blocker, or ACEI/ARB use was reported at 2 or more consecutive visits by 57%, 66%, 48%, and 28% respectively. These drugs were initiated or resumed at a later visit by 24%, 17%, 15%, and 17%, respectively, and were never used during the period of follow-up by 19%, 10%, 33%, and 49% respectively.
Efforts to improve secondary prevention medication utilization should target both drug initiation and restarting drugs in patients who have discontinued them.
针对女性冠心病（CHD）诊断后长期循证预防药物使用模式，研究尚不充分。
参加女性健康倡议（WHI）激素试验的绝经后女性，如果符合纳入和排除标准，并且在安慰剂导入期内和饮食改良试验中达到 80%以上的依从性，年龄在 50-79 岁，可进行随机分组。如果愿意遵循 20%脂肪饮食，则可以参加饮食改良试验。在基线就诊后，通过裁定判定为心肌梗死或冠状动脉血运重建的患者纳入分析（n=2627）。基线就诊时间为 1993 年至 1998 年，然后每年就诊一次，直到 2002 年至 2005 年试验结束；在基线和第 1、3、6 和 9 年时获得药物清单。
在 WHI 第一次就诊时，CHD 诊断后他汀类药物（49%至 72%；p<0.0001）、β受体阻滞剂（49%至 62%；p=0.003）和血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体阻滞剂（ACEI/ARB）[26%至 43%；p<0.0001]的使用率随时间增加。阿司匹林使用率保持稳定在 76%（p=0.09）。一旦女性报告使用他汀类药物、阿司匹林或β受体阻滞剂，84-89%的女性在 1 次或多次后续就诊时报告使用，ACEI/ARB 的报告使用率略低（76%）。分别有 57%、66%、48%和 28%的女性报告连续 2 次或更多次就诊时使用了他汀类药物、阿司匹林、β受体阻滞剂或 ACEI/ARB。分别有 24%、17%、15%和 17%的女性在后续就诊时重新开始使用这些药物，而在随访期间从未使用过的药物分别为 19%、10%、33%和 49%。
提高二级预防药物使用率的工作应同时针对已经停药的患者启动和重新开始使用药物。
