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评估法国近期他汀类药物争议的影响:EVANS 研究。

Evaluation of the impact of the recent controversy over statins in France: the EVANS study.

机构信息

Division of Coronary Artery Disease and Intensive Cardiac Care, Georges-Pompidou European Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), University Paris-Descartes, 20, rue Leblanc, 75015 Paris, France.

出版信息

Arch Cardiovasc Dis. 2013 Oct;106(10):511-6. doi: 10.1016/j.acvd.2013.06.053. Epub 2013 Sep 27.

Abstract

BACKGROUND

The effect of statins on the prevention of cardiovascular events is well-established. However, a recent controversy in France questioned the value of statins, especially in primary prevention.

AIMS

To evaluate the impact of this controversy on patient adherence to statin therapy and its potential clinical impact.

METHODS

All patients on statins were recruited consecutively from consultations over a period of 1 month (from March 2013) by five physicians in three centres. Patient demographics and co-morbidities were collected and adherence to statin therapy was evaluated with a questionnaire. We estimated the number of deaths and major cardiovascular events that could be induced per year.

RESULTS

A total of 142 patients were included: 37 in primary prevention (mean age, 68.0±13.1 years; 41% women); 105 in secondary prevention (mean age, 67.6±12.1 years; 20% women). In primary prevention, 24.3% of patients intended to stop statins versus 8.6% in secondary prevention (P<0.001). In France, if the percentages of medication discontinuations following the controversy were actually similar to those we found in our survey, 4992 major cardiovascular events, including 1159 deaths, would be induced in 1 year.

CONCLUSION

Recent controversy over statins could induce a large proportion of patients to stop their medication and generate a large number of major cardiovascular events.

摘要

背景

他汀类药物对预防心血管事件的效果已得到充分证实。然而,法国最近的一场争议质疑了他汀类药物的价值,尤其是在一级预防方面。

目的

评估这场争议对患者遵从他汀类药物治疗的影响及其可能的临床影响。

方法

在一个月的时间内(2013 年 3 月),五位医生在三个中心连续招募所有正在服用他汀类药物的患者。收集患者的人口统计学和合并症数据,并通过问卷评估他汀类药物治疗的依从性。我们估计每年可能导致的死亡人数和主要心血管事件数。

结果

共纳入 142 名患者:37 名在一级预防(平均年龄 68.0±13.1 岁;41%为女性);105 名在二级预防(平均年龄 67.6±12.1 岁;20%为女性)。在一级预防中,24.3%的患者打算停止服用他汀类药物,而二级预防中只有 8.6%(P<0.001)。如果法国实际的停药比例与我们调查中发现的相似,那么在一年内,将导致 4992 例主要心血管事件,包括 1159 例死亡。

结论

最近他汀类药物的争议可能导致很大一部分患者停止用药,并产生大量主要心血管事件。

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