Department of Pharmacology, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
Drug Policy Service, Emilia-Romagna Regional Health Authority, Viale Aldo Moro 21, 40127, Bologna, Italy.
Eur J Clin Pharmacol. 2011 Apr;67(4):407-414. doi: 10.1007/s00228-010-0958-3. Epub 2010 Dec 9.
In the general population, lack of adherence to statin therapy remains a widespread phenomenon and an important matter of concern both in terms of cost-effectiveness and risk-benefit profile. This study aimed to evaluate the occurrence of cardiovascular events in Italian statin recipients, focussing on the relationship between degree of adherence to therapy and occurrence of events in a 3-year follow-up.
Our cohort consisted of all patients from Emilia Romagna (4,027,275 inhabitants) who received statin prescriptions in January-February 2005 and who were followed for up to 36 months for cardiovascular hospital admission (i.e. coronary disease, cerebrovascular accidents, peripheral arthropathy), adherence to statin treatment (proportion of days covered: ≥ 80%) and use of other cardiovascular drugs. The relationship between adherence and cardiovascular events was analysed by multivariate logistic regression; age, sex, other cardiovascular drugs and previous events were covariates of the model.
Patients non-adherent to a statin regimen over the 3-year period (76% of the cohort) had higher odds of events, irrespective of risk factors, by more than 40% when compared with adherent patients. Odds of events were in particular: strongly non-adherent, adjOR=1.19 (CI95% 1.15-1.23), slightly non-adherent, adjOR =1.25 (1.21-1.30), highly variable in the amount of statins received, adjOR=1.69 (1.62-1.77).
This study shows the key role of adherence to statins in cardiovascular prevention at any level of risk. Appropriateness of statin use needs not only careful selection of patients to be treated, but also cooperation between patient and physician to ensure continued drug use whenever treatment is appropriate.
在普通人群中，他汀类药物治疗的依从性仍然是一个普遍存在的现象，无论是从成本效益还是风险效益的角度来看，都是一个重要的关注点。本研究旨在评估意大利他汀类药物使用者的心血管事件发生情况，重点关注 3 年随访期间治疗依从程度与事件发生之间的关系。
我们的队列包括 2005 年 1 月至 2 月期间在艾米利亚-罗马涅（4027275 名居民）接受他汀类药物处方的所有患者，并对他们进行了长达 36 个月的心血管住院（即冠心病、脑血管意外、外周关节病）、他汀类药物治疗依从性（覆盖率天数：≥80%）和其他心血管药物使用情况的随访。采用多变量逻辑回归分析依从性与心血管事件之间的关系；年龄、性别、其他心血管药物和既往事件是模型的协变量。
在 3 年期间不遵守他汀类药物治疗方案的患者（队列的 76%），无论风险因素如何，其发生事件的几率都比遵守治疗方案的患者高出 40%以上。与遵守治疗方案的患者相比，事件发生的几率尤其为：不遵守治疗方案的患者，调整后的比值比（adjOR）为 1.19（95%可信区间为 1.15-1.23）；稍微不遵守治疗方案的患者，adjOR=1.25（1.21-1.30）；他汀类药物用量变化较大的患者，adjOR=1.69（1.62-1.77）。
本研究表明，他汀类药物治疗的依从性在任何风险水平的心血管预防中都起着关键作用。他汀类药物的使用不仅需要仔细选择需要治疗的患者，还需要患者和医生之间的合作，以确保在适当的情况下继续使用药物。
