Phan Kim, Gomez Yessica-Haydee, Elbaz Laura, Daskalopoulou Stella S
FRQS Chercheur-Boursier Clinicien, Associate Professor in Medicine, Department of Medicine, Division of Internal Medicine, McGill University, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, C2.101.4, Montreal, Quebec, Canada H3G 1A4.
Curr Pharm Des. 2014;20(40):6314-24. doi: 10.2174/1381612820666140620162629.
Statins are the most powerful lipid lowering drugs in clinical practice. However, the efficacy of statin therapy, as seen in randomized control trials, is undermined by the documented non-adherence observed in clinical practice. Understanding the clinical consequences of statin non-adherence is an important step in implementing successful interventions aimed at improving adherence. Our previous systematic review included a literature search up to January 2010 on the effects of statin non-adherence or discontinuation on cardiovascular (CV) and cerebrovascular outcomes. We provide an update to this publication and a review of promising interventions that have reported a demonstrated improvement in statin adherence. Through a systematic literature search of PubMed, Ovid Medline, Ovid Embase, CINAHL, Cochrane Library and Web of Science, out of the 3440 initially identified, 13 studies were selected. Non-adherence in a primary prevention population was associated with a graded increase in CV risk. Individuals taking statins for secondary prevention were at particular risk when taking statin with highly variable adherence. Moreover, particular attention is warranted for non-adherence in diabetic and rheumatoid arthritis populations, as non-adherence is significantly associated with CV risk as early as 1 month following discontinuation. Statin adherence, therefore, represents an important modifiable risk factor. Numerous interventions to improve adherence have shown promise, including copayment reduction, automatic reminders, mail-order pharmacies, counseling with a health professional, and fixed-dose combination therapy. Given the complexity of causes underlying statin non-adherence, successful strategies will likely need to be tailored to each patient.
他汀类药物是临床实践中最有效的降脂药物。然而，随机对照试验中所显示的他汀类药物治疗效果，在临床实践中因记录到的不依从性而大打折扣。了解他汀类药物不依从性的临床后果，是实施旨在提高依从性的成功干预措施的重要一步。我们之前的系统评价纳入了截至2010年1月关于他汀类药物不依从或停药对心血管（CV）和脑血管结局影响的文献检索。我们对本出版物进行更新，并对已报道能显著提高他汀类药物依从性的有前景的干预措施进行综述。通过对PubMed、Ovid Medline、Ovid Embase、CINAHL、Cochrane图书馆和科学网进行系统的文献检索，在最初识别出的3440项研究中，筛选出了13项研究。一级预防人群中的不依从性与CV风险的分级增加相关。接受他汀类药物二级预防的个体，在服用依从性高度可变的他汀类药物时尤其危险。此外，糖尿病和类风湿关节炎人群中的不依从性值得特别关注，因为早在停药后1个月，不依从性就与CV风险显著相关。因此，他汀类药物依从性是一个重要的可改变的风险因素。许多提高依从性的干预措施已显示出前景，包括降低自付费用、自动提醒、邮购药房、与健康专业人员咨询以及固定剂量联合治疗。鉴于他汀类药物不依从性背后原因的复杂性，成功的策略可能需要针对每个患者量身定制。
