Department of Medicine, Emory University School of Medicine, Faculty Office Building, 49 Jesse Hill Jr. Drive SE, Atlanta, GA, USA.
J Clin Lipidol. 2013 Sep-Oct;7(5):472-83. doi: 10.1016/j.jacl.2013.03.001. Epub 2013 Mar 13.
Although statins have been shown to reduce cardiovascular disease mortality, less than half of U.S. adults achieve their low-density lipoprotein cholesterol goal. In many patients initiated on a statin, adherence rates decrease over time.
To characterize current and former statin users, identify reasons for the discontinuation or switching of statins, and identify factors associated with adherence.
The USAGE survey is a cross-sectional, self-administered Internet-based survey of 10,138 U.S. adults fielded September to October 2011. The following statin users were identified and compared: adherent nonswitchers, adherent switchers, non-adherent switchers, and discontinuers. Univariate and multivariate models using a priori covariates for adherence and discontinuation were examined.
Most participants were current statin users who adhered with their prescribed statin (82.5%, n = 8371). Former statin users or discontinuers (12%, n = 1220) cited muscle pain, a side effect, as the primary reason for discontinuation (60%), followed by cost (16%), and then perceived lack of efficacy (13%). Discontinuers were less satisfied with their physicians' explanation of cholesterol treatment, more likely to use the Internet to research statins, and less likely to undergo frequent cholesterol monitoring. Among adherent statin users, the primary reasons for switching were muscle side effects (33%) and cost (32%). Individuals at risk for non-adherence included those with low household income, those who experienced muscle pain as a side effect while on statin therapy, and those taking medication for cardiovascular disease.
Statin-related muscle side effects are common and contribute significantly to rates of discontinuation, switching, and non-adherence. Improved physician patient communication about side effects and benefits of statins are necessary to improve both adherence and outcomes.
尽管他汀类药物已被证明可降低心血管疾病死亡率，但仍有不足一半的美国成年人实现了其低密度脂蛋白胆固醇目标。在许多开始使用他汀类药物的患者中，随着时间的推移，其依从率会下降。
描述目前和既往他汀类药物使用者的特征，确定停用或转换他汀类药物的原因，并确定与依从性相关的因素。
USAGE 调查是一项横断面、基于互联网的美国成年人自我管理调查，于 2011 年 9 月至 10 月进行。确定并比较了以下他汀类药物使用者：依从性非转换者、依从性转换者、非依从性转换者和停药者。使用预先设定的依从性和停药的协变量进行了单变量和多变量模型分析。
大多数参与者为当前的他汀类药物使用者，他们坚持服用处方他汀类药物（82.5%，n=8371）。既往他汀类药物使用者或停药者（12%，n=1220）将肌肉疼痛等副作用作为停药的主要原因（60%），其次是费用（16%），然后是认为疗效不足（13%）。停药者对医生解释胆固醇治疗的满意度较低，更倾向于使用互联网研究他汀类药物，且较少接受频繁的胆固醇监测。在依从性他汀类药物使用者中，转换的主要原因是肌肉副作用（33%）和费用（32%）。依从性差的高危人群包括家庭收入低、使用他汀类药物治疗时出现肌肉疼痛副作用以及正在服用心血管疾病药物的患者。
他汀类药物相关的肌肉副作用很常见，且极大地导致了停药、转换和不依从的发生。需要改善医生与患者之间关于副作用和他汀类药物益处的沟通，以提高依从性和改善结局。
