Pharmacoeconomics Section, Veterans Affairs San Diego Healthcare System, San Diego, California; UCSD Skaggs School of Pharmacy and Pharmaceutical Sciences, San Diego, California.
Pharmacotherapy. 2013 Oct;33(10):1044-52. doi: 10.1002/phar.1305. Epub 2013 Jun 6.
To investigate the association between statin adherence and changes in lipid panel outcomes from baseline in a veteran population.
Retrospective cohort study using multiple linear regression models.
Veterans Affairs health care system within the Veterans Integrated Service Network 22, a network of Veterans Affairs facilities in the southwest region of the United States that includes Los Angeles, San Diego, Loma Linda, and Long Beach, California, and Las Vegas, Nevada, with an enrollment of approximately 1.4 million veterans.
A total of 5365 patients who were new statin users between December 1, 2006, and November 30, 2007; 2674 patients were in the adherent group and 2691 were in the nonadherent group.
Adherence was determined by the medication possession ratio. Patients were categorized as adherent if the medication possession ratio at follow-up was 0.80 or more. Adherent patients exhibited significant differences in baseline demographic and clinical characteristics than nonadherent patients in our study sample. Baseline laboratory values for adherent patients were significantly lower for low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), non-high-density lipoprotein cholesterol (non-HDL), and total cholesterol levels. The primary outcome was change in LDL level from baseline at 12 months. Secondary outcomes were changes in non-HDL and total cholesterol levels from baseline at 12 months. Independent variables controlled for in the multiple linear regression included age, sex, body mass index, race-ethnicity, baseline lipid panel (LDL, HDL, total cholesterol, and triglycerides), statin copayment status, income quintile (according to ZIP code median household income), baseline medication count, statin prescribed, and comorbidities. Multiple linear regression revealed that adherent patients demonstrated significantly greater reductions in LDL of 20.98 mg/dl versus nonadherent patients (p<0.0001). Adherent patients similarly demonstrated larger reductions of 24.31 mg/dl in non-HDL and 24.06 mg/dl in total cholesterol versus nonadherent patients (p<0.0001 for both comparisons).
Patients adherent to statin therapy had significant associations with clinically relevant reductions in LDL, non-HDL, and total cholesterol from baseline at 12 months compared with nonadherent patients when controlling for potential confounders. Adherence to statin therapy may have important consequences in decreasing clinical outcomes such as myocardial infarctions, strokes, and mortality due to large reductions in lipid panel outcomes from baseline at 12 months.
在退伍军人人群中，调查他汀类药物依从性与基线时血脂指标变化之间的关联。
使用多元线性回归模型的回顾性队列研究。
美国西南部退伍军人整合服务网络 22 内的退伍军人医疗保健系统，该网络包括加利福尼亚州的洛杉矶、圣地亚哥、洛马林达和长滩以及内华达州的拉斯维加斯，共有约 140 万退伍军人，是退伍军人事务设施的网络。
2006 年 12 月 1 日至 2007 年 11 月 30 日期间，共有 5365 名新开始使用他汀类药物的患者；2674 名患者为依从组，2691 名患者为不依从组。
药物占有率决定了药物的依从性。如果在随访时药物占有率为 0.80 或更高，则将患者归类为依从性患者。与我们研究样本中的不依从性患者相比，依从性患者在基线人口统计学和临床特征方面存在显著差异。与不依从性患者相比，依从性患者的基线实验室值在 LDL、HDL、非 HDL 和总胆固醇水平方面明显较低。主要结果是在 12 个月时 LDL 水平从基线的变化。次要结果是在 12 个月时非 HDL 和总胆固醇水平从基线的变化。多元线性回归中控制的自变量包括年龄、性别、体重指数、种族-民族、基线血脂指标（LDL、HDL、总胆固醇和甘油三酯）、他汀类药物共付额状况、收入五分位数（根据邮政编码中位数家庭收入）、基线药物数量、开具的他汀类药物和合并症。多元线性回归显示，与不依从性患者相比，依从性患者 LDL 降低了 20.98mg/dl（p<0.0001）。与不依从性患者相比，依从性患者的非 HDL 降低了 24.31mg/dl，总胆固醇降低了 24.06mg/dl（p<0.0001）。
在控制潜在混杂因素后，与不依从性患者相比，他汀类药物治疗依从性患者的 LDL、非 HDL 和总胆固醇从基线到 12 个月的变化具有显著相关性，临床意义重大。他汀类药物治疗的依从性可能对降低血脂指标的临床结果（如心肌梗死、中风和死亡率）产生重要影响，因为从基线到 12 个月时的血脂指标变化较大。
