Pharmacology, Vascular and Metabolic Diseases Section of the Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Eur J Clin Pharmacol. 2014 Apr;70(4):391-7. doi: 10.1007/s00228-013-1640-3. Epub 2014 Jan 22.
Familial hypercholesterolemia (FH) is an autosomal dominant disorder associated with a high risk of premature coronary heart disease (CHD). CHD prevention consists of lifestyle changes combined with lifelong statin treatment. Good adherence to statins reduces the risk of events substantially. This study was designed to identify determinants of non-adherence and to develop a model predicting non-adherence.
A single centre survey included all consecutive heterozygous FH patients above age 18 years, who were treated by a specialized team in the outpatient clinic of a university hospital in The Netherlands between 2008 and 2009. In addition to clinical data, patients completed a questionnaire concerning medication adherence.
We analyzed 321 patients (169 women) with a statin prescription whose mean age was 46 ± 14 years (± S.D.), and 13 % of the patients had CHD. The untreated mean total cholesterol was 10 ± 2.3 mmol/l. On average, patients were ten years on cholesterol-lowering therapy (range 1-29 years). Adherence was reported by 89 % of the patients (> 90 % adherence). Non-adherence was associated with younger age (OR = 10.64, 95 % CI 2.86-39.68), high total cholesterol level during prescription (OR = 4.29, 95 % CI 1.86-9.89) and a relatively low untreated total cholesterol level (OR = 3.94 95 % CI 1.39-11.14). A prediction model based on these three determinants had a c-index of 0.78 and a calibration with P = 0.88.
Based on three independent determinants, a prediction model is developed to identify non-adherent FH patients. This model needs to be tested in future prospective research. It might be a first step in improving statin adherence in this extremely high risk group.
家族性高胆固醇血症（FH）是一种常染色体显性遗传疾病，与早发性冠心病（CHD）的风险增加相关。CHD 的预防包括生活方式的改变和终身他汀类药物治疗。他汀类药物的良好依从性可显著降低事件风险。本研究旨在确定不依从的决定因素，并开发预测不依从的模型。
一项单中心调查纳入了 2008 年至 2009 年期间在荷兰一所大学医院的门诊由专门团队治疗的所有年龄大于 18 岁的杂合子 FH 患者。除了临床数据外，患者还完成了一份关于药物依从性的问卷。
我们分析了 321 名（169 名女性）接受他汀类药物治疗的患者，他们的平均年龄为 46 ± 14 岁（± S.D.），13%的患者患有 CHD。未治疗时的平均总胆固醇为 10 ± 2.3 mmol/L。平均而言，患者接受降脂治疗的时间为 10 年（范围 1-29 年）。89%的患者报告了依从性（> 90%的依从性）。不依从与较年轻的年龄（OR = 10.64，95%CI 2.86-39.68）、处方期间的总胆固醇水平较高（OR = 4.29，95%CI 1.86-9.89）和相对较低的未治疗总胆固醇水平（OR = 3.94 95%CI 1.39-11.14）相关。基于这三个决定因素的预测模型的 c 指数为 0.78，校准 P = 0.88。
基于三个独立的决定因素，开发了一个预测模型来识别不依从的 FH 患者。该模型需要在未来的前瞻性研究中进行测试。它可能是提高该极高风险人群他汀类药物依从性的第一步。
