Division of Nephrology, Department of Medicine, Stanford University, Palo Alto, California, USA.
Clin J Am Soc Nephrol. 2012 Apr;7(4):604-11. doi: 10.2215/CJN.11441111. Epub 2012 Feb 16.
Persons with kidney disease often have cardiovascular disease, but they are less likely to use recommended medications for secondary prevention. The hypothesis was that participants with reduced estimated GFR have lower use of medications recommended for secondary prevention of cardiovascular events (antiplatelet agents, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, β-blockers, and statins) and lower medication adherence than participants with preserved estimated GFR.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this cross-sectional analysis, we analyzed data from 6913 participants in the Reasons for Geographic and Racial Differences in Stroke study with a history of cardiovascular disease. Medication use was ascertained by an in-home pill bottle review. Medication adherence was assessed using a validated four-item scale.
Among participants with a history of cardiovascular disease, 59.8% used antiplatelet agents, 49.9% used angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, 41.6% used β-blockers, and 53.0% used statins. Compared with the referent group (estimated GFR ≥60 ml/min per 1.73 m(2)), participants with estimated GFR <45 ml/min per 1.73 m(2) were more likely to use angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (adjusted prevalence ratio=1.14, 95% confidence interval=1.06-1.23), β-blockers (adjusted prevalence ratio=1.20, 95% confidence interval=1.09-1.32), and statins (adjusted prevalence ratio=1.10, 95% confidence interval=1.01-1.19). Antiplatelet agent use did not differ by estimated GFR category; 30% of participants reported medication nonadherence across all categories of estimated GFR.
Among participants with a history of cardiovascular disease, mild to moderate reductions in estimated GFR were associated with similar and even more frequent use of medications for secondary prevention compared with participants with preserved estimated GFR. Overall medication use and adherence were suboptimal.
患有肾脏疾病的人常常患有心血管疾病，但他们使用推荐的二级预防药物的可能性较低。本研究假设估算肾小球滤过率降低的参与者使用二级预防心血管事件的药物（抗血小板药物、血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂、β-受体阻滞剂和他汀类药物）的比例低于估算肾小球滤过率正常的参与者，且药物依从性也较低。
设计、地点、参与者和测量：在这项横断面分析中，我们分析了有心血管疾病史的 6913 名“地理和种族差异导致中风原因”研究参与者的数据。药物使用情况通过家庭药瓶审查确定。使用经过验证的四项量表评估药物依从性。
在有心血管疾病史的参与者中，59.8%使用抗血小板药物，49.9%使用血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂，41.6%使用β-受体阻滞剂，53.0%使用他汀类药物。与参照组（估算肾小球滤过率≥60ml/min/1.73m²）相比，估算肾小球滤过率<45ml/min/1.73m²的参与者更有可能使用血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂（调整后患病率比=1.14，95%置信区间=1.06-1.23）、β-受体阻滞剂（调整后患病率比=1.20，95%置信区间=1.09-1.32）和他汀类药物（调整后患病率比=1.10，95%置信区间=1.01-1.19）。抗血小板药物的使用与估算肾小球滤过率类别无关；在所有估算肾小球滤过率类别中，有 30%的参与者报告药物不依从。
在有心血管疾病史的参与者中，与估算肾小球滤过率正常的参与者相比，轻度至中度估算肾小球滤过率降低与二级预防药物的使用相似，甚至更频繁。总体药物使用和依从性不理想。
