Shalev Varda, Weil Clara, Raz Raanan, Goldshtein Inbal, Weitzman Dahlia, Chodick Gabriel
Medical Division, Maccabi Healthcare Services, 27 Ha'Mered Street, Tel Aviv, 68125, Israel.
Eur J Clin Pharmacol. 2014 May;70(5):557-64. doi: 10.1007/s00228-013-1637-y. Epub 2014 Jan 25.
The aim of this population-based study is to describe trends in the characteristics and treatment patterns of statin initiators over the first decade of the 21st century.
New statin use was studied retrospectively using the database of Maccabi Healthcare Services (MHS), a large Israeli health maintenance organization. Statin initiators were defined as MHS members aged ≥ 30 years who first purchased statins between 2000 and 2010. The starting dose was calculated in simvastatin equivalents based on the World Health Organization's daily defined dose index. Persistence was calculated as the percentage of days covered (PDC) with statins during the first year of therapy.
Statin initiation peaked in 2005 and decreased from 38.6 to 18.6 per 1,000 in the period 2005-2010. The average age at therapy initiation decreased from 58.9 (± 12.0) to 54.5 (± 11.7) years, and the average (SD) baseline low-density lipoprotein cholesterol (LDL-C) decreased from 4.2 (± 1.1) to 4.0 (± 0.9) mmol/l during the study period. Women were on average 3 years older than men at treatment initiation, with a higher baseline LDL-C. Among statin initiators, the prevalence of ischemic heart disease (IHD) decreased from 17.8 to 6.7 %, and diabetes prevalence increased from 8.6 to 15.7 %, peaking in 2008 (18.0 %). The PDC with statins ranged between 52.9 and 57.7 %. Simvastatin use at initiation increased from 27.5 % in 2000 to >90 % since 2002. Starting dose increased from 18.5 (± 8.9) to 24.3 (± 13.7) mg simvastatin equivalent.
Among the study population, statin initiators were increasingly characterized by a lower cardiovascular risk-namely, younger individuals without IHD and with a lower baseline LDL-C. These trends underscore the important shift towards statin initiation for primary prevention, as well as the need to balance between benefits and the potential side effect of statins.
这项基于人群的研究旨在描述21世纪头十年中他汀类药物起始使用者的特征和治疗模式的变化趋势。
利用以色列大型健康维护组织马卡比医疗服务公司（MHS）的数据库对新使用他汀类药物的情况进行回顾性研究。他汀类药物起始使用者定义为2000年至2010年间首次购买他汀类药物的年龄≥30岁的MHS成员。起始剂量根据世界卫生组织每日规定剂量指数以辛伐他汀等效剂量计算。持续用药率以治疗第一年使用他汀类药物的覆盖天数百分比（PDC）计算。
他汀类药物起始使用量在2005年达到峰值，在2005 - 2010年期间从每1000人38.6例降至18.6例。治疗起始时的平均年龄从58.9（±12.0）岁降至54.5（±11.7）岁，研究期间平均（标准差）基线低密度脂蛋白胆固醇（LDL-C）从4.2（±1.1）mmol/L降至4.0（±0.9）mmol/L。治疗起始时女性平均比男性大3岁，基线LDL-C更高。在他汀类药物起始使用者中，缺血性心脏病（IHD）患病率从17.8%降至6.7%，糖尿病患病率从8.6%升至15.7%，在2008年达到峰值（18.0%）。他汀类药物的PDC在52.9%至57.7%之间。起始使用辛伐他汀的比例从2000年的27.5%增至2002年以来的>90%。起始剂量从18.5（±8.9）mg辛伐他汀等效剂量增至24.3（±13.7）mg。
在研究人群中，他汀类药物起始使用者越来越具有心血管风险较低的特征，即更年轻、无IHD且基线LDL-C较低。这些趋势凸显了向他汀类药物起始用于一级预防的重要转变，以及在他汀类药物益处和潜在副作用之间取得平衡的必要性。
