Swindle Jason P, Potash Jesse, Kulakodlu Mahesh, Kuznik Andreas, Buikema Ami
OptumInsight, Eden Prairie, Minnesota, Pfizer, New York, USA.
Am J Geriatr Pharmacother. 2011 Dec;9(6):471-82. doi: 10.1016/j.amjopharm.2011.09.004. Epub 2011 Oct 21.
Hydroxymethylglutaryl coenzyme-A reductase inhibitors simvastatin and atorvastatin are effective at lowering LDL-C levels and reducing the risk of cardiovascular (CV) events.
The objective of this study was to examine differences in drug utilization and CV event risk among elderly patients newly initiated on simvastatin versus atorvastatin.
This was a retrospective analysis using pharmacy and medical claims from a US health plan database. Enrollees aged ≥65 years, newly initiated on simvastatin or atorvastatin (index drugs) from July 1, 2006 to November 30, 2008 were identified for study inclusion. Patients were excluded if they had any prescriptions for clopidogrel, nitrates, or other dyslipidemia medication, or any CV events before index drug initiation. Adherence was calculated by proportion of days covered with index medication. CV events (myocardial infarction, ischemic heart disease, cerebrovascular disease, peripheral vascular disease, aortic aneurysm, revascularization, or heart failure) were identified from medical claims.
There were 11,470 atorvastatin initiators and 20,132 simvastatin initiators identified. Mean age of these patients was 72 years; 40% were male; nearly half had hypertension; and more than a quarter had diabetes. The majority of statin therapy (77%) was prescribed by primary care physicians. Forty-nine percent of atorvastatin patients were initiated on a 10 mg-dose and 61% of simvastatin patients on 5-, 10-, or 20-mg doses. A larger percentage of patients in the simvastatin cohort were adherent to index therapy than patients in the atorvastatin cohort (43% vs 36%, respectively). Multivariate regression adjusting for patient characteristics revealed no significant difference in CV events between patients receiving atorvastatin versus simvastatin.
In this study of elderly statin patients without recent evidence of CV events, the majority of patients started on low-dose therapy and did not achieve sufficient adherence. After controlling for patient and clinical characteristics, no statistically significant difference in risk of CV event was observed based on initiation with atorvastatin versus simvastatin.
羟甲基戊二酰辅酶A还原酶抑制剂辛伐他汀和阿托伐他汀在降低低密度脂蛋白胆固醇（LDL-C）水平及降低心血管（CV）事件风险方面有效。
本研究的目的是探讨新开始使用辛伐他汀与阿托伐他汀的老年患者在药物使用及CV事件风险上的差异。
这是一项利用美国健康计划数据库中的药房和医疗理赔数据进行的回顾性分析。纳入2006年7月1日至2008年11月30日期间新开始使用辛伐他汀或阿托伐他汀（索引药物）的年龄≥65岁的参保者进行研究。如果患者在索引药物开始使用前有氯吡格雷、硝酸盐或其他血脂异常药物的任何处方，或有任何CV事件，则排除在外。依从性通过索引药物覆盖天数的比例来计算。CV事件（心肌梗死、缺血性心脏病、脑血管疾病、外周血管疾病、主动脉瘤、血运重建或心力衰竭）从医疗理赔数据中识别。
共识别出11470名开始使用阿托伐他汀的患者和20132名开始使用辛伐他汀的患者。这些患者的平均年龄为72岁；40%为男性；近一半患有高血压；超过四分之一患有糖尿病。大多数他汀类药物治疗（77%）由初级保健医生开具。49%的阿托伐他汀患者起始剂量为10毫克，61%的辛伐他汀患者起始剂量为5、10或20毫克。辛伐他汀队列中依从索引治疗的患者比例高于阿托伐他汀队列（分别为43%和36%）。对患者特征进行多变量回归调整后发现，接受阿托伐他汀与辛伐他汀治疗的患者在CV事件方面无显著差异。
在这项针对近期无CV事件证据的老年他汀类药物患者的研究中，大多数患者开始接受低剂量治疗且依从性不足。在控制患者和临床特征后，基于起始使用阿托伐他汀与辛伐他汀，未观察到CV事件风险有统计学显著差异。
