School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Ann Pharmacother. 2013 Jul-Aug;47(7-8):984-92. doi: 10.1345/aph.1S050. Epub 2013 Jun 18.
The impact of evidence-based guidelines and controlled trial data on use of cholesterol-lowering medications in older adults is unclear.
To examine whether utilization patterns of cholesterol-lowering medications in community-dwelling older adults changed following the release of the National Cholesterol Education Program Adult Treatment Panel III guidelines and results from the Prospective Study of Pravastatin in the Elderly at Risk in 2002.
Community-dwelling elderly individuals who were enrolled in the Health, Aging and Body Composition Study in 1997-1998 were followed for up to 11 years. An interrupted time series analysis with multivariable generalized estimating equations (GEEs) was used to examine changes in level and trend in cholesterol-lowering medication use before and after 2002, adjusting for sociodemographics, health-related behaviors, and health status.
Cholesterol-lowering medication use increased nearly 3-fold from 14.9% in 1997-1998 to 42.6% in 2007-2008, with statins representing the most common class used (87-94%). Multivariable GEE results revealed no significant difference in the level of cholesterol-lowering medication use after 2002 (adjusted OR 0.95; 95% CI 0.89-1.02). Multivariable GEE results revealed that trend changes in the rate of increase in cholesterol-lowering medication declined after 2002 (adjusted ratio of ORs 0.92; 95% CI 0.89-0.95).
The use of cholesterol-lowering medication increased substantially over a decade in community-dwelling elderly individuals but was not related to a change in level or trend following the release of the guidelines and evidence-based data.
基于证据的指南和对照试验数据对老年患者使用降胆固醇药物的影响尚不清楚。
研究在 2002 年国家胆固醇教育计划成人治疗专家组 III 版指南发布和前瞻性研究普伐他汀在高危老年患者中的结果公布后，社区居住的老年患者使用降胆固醇药物的模式是否发生了变化。
在 1997-1998 年参加健康、衰老和身体成分研究的社区居住的老年个体中进行了长达 11 年的随访。采用多变量广义估计方程（GEE）的中断时间序列分析，调整社会人口统计学、健康相关行为和健康状况，来检测 2002 年前后降胆固醇药物使用水平和趋势的变化。
降胆固醇药物的使用从 1997-1998 年的 14.9%增加到 2007-2008 年的 42.6%，增加了近 3 倍，他汀类药物是最常用的药物（87-94%）。多变量 GEE 结果显示，2002 年后降胆固醇药物使用水平无显著差异（调整后的比值比为 0.95；95%可信区间为 0.89-1.02）。多变量 GEE 结果还显示，2002 年后增加降胆固醇药物的速度呈下降趋势（调整后的比值比为 0.92；95%可信区间为 0.89-0.95）。
在过去十年中，社区居住的老年患者中降胆固醇药物的使用显著增加，但与指南和循证数据发布后的水平或趋势变化无关。
