生活方式因素作为有无心血管合并症患者他汀类药物治疗依从性的预测指标。
Lifestyle factors as predictors of nonadherence to statin therapy among patients with and without cardiovascular comorbidities.
作者信息
Halava Heli, Korhonen Maarit Jaana, Huupponen Risto, Setoguchi Soko, Pentti Jaana, Kivimäki Mika, Vahtera Jussi
机构信息
Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK
Departments of Public Health (Halava, Vahtera) and Pharmacology, Drug Development and Therapeutics (Korhonen, Huupponen), University of Turku, and Turku University Hospital (Huupponen Vahtera), Turku, Finland; Duke Clinical Research Institute (Setoguchi), Duke University School of Medicine, Durham, NC; the Finnish Institute of Occupational Health (Pentti, Vahtera), Turku, Finland; the Department of Epidemiology and Public Health (Kivimäki), University College London, London, UK.
出版信息
CMAJ. 2014 Sep 2;186(12):E449-56. doi: 10.1503/cmaj.131807. Epub 2014 Jun 23.
BACKGROUND
Easily detectable predictors of nonadherence to long-term drug treatment are lacking. We investigated the association between lifestyle factors and nonadherence to statin therapy among patients with and without cardiovascular comorbidities.
METHODS
We included 9285 participants from the Finnish Public Sector Study who began statin therapy after completing the survey. We linked their survey data with data in national health registers. We used prescription dispensing data to determine participants' nonadherence to statin therapy during the first year of treatment (defined as < 80% of days covered by filled prescriptions). We used logistic regression to estimate the association of several lifestyle factors with nonadherence, after adjusting for sex, age and year of statin initiation.
RESULTS
Of the participants without cardiovascular comorbidities (n = 6458), 3171 (49.1%) were nonadherent with their statin therapy. Obesity (adjusted odds ratio [OR] 0.86, 95% confidence interval [CI] 0.74-0.99), overweight (adjusted OR 0.88, 95% CI 0.79-0.98) and former smoking (adjusted OR 0.82, 95% CI 0.74-0.92) predicted a reduced risk of nonadherence in this group after adjustment for sex, age and year of statin initiation. Of the participants with cardiovascular comorbidities (n = 2827), 1155 (40.9%) were nonadherent. In this group, high alcohol consumption (adjusted OR 1.55, 95% CI 1.12-2.15), extreme drinking occasions (adjusted OR 1.48, 95% CI 1.11-1.97) and a cluster of 3-4 lifestyle risks (adjusted OR 1.61, 95% CI 1.15-2.27) predicted increased odds of nonadherence after adjustment for sex, age and year of statin initiation.
INTERPRETATION
People with cardiovascular comorbidities who had risky drinking behaviours or a cluster of lifestyle risks were at increased risk of nonadherence. Among individuals without cardiovascular comorbidities, information on lifestyle factors was unhelpful in identifying those at increased risk of nonadherence; that overweight, obesity and former smoking were predictors of better adherence in this group provides insight into mechanisms of adherence to preventive medication that deserve further study.
背景
缺乏易于检测的长期药物治疗不依从性预测指标。我们调查了有无心血管合并症患者的生活方式因素与他汀类药物治疗不依从性之间的关联。
方法
我们纳入了芬兰公共部门研究中的9285名参与者，他们在完成调查后开始他汀类药物治疗。我们将他们的调查数据与国家健康登记册中的数据相链接。我们使用处方配药数据来确定参与者在治疗的第一年中对他汀类药物治疗的不依从性（定义为所开处方覆盖天数的<80%）。在调整了性别、年龄和开始使用他汀类药物的年份后，我们使用逻辑回归来估计几种生活方式因素与不依从性之间的关联。
结果
在没有心血管合并症的参与者（n = 6458）中，3171人（49.1%）他汀类药物治疗不依从。肥胖（调整后的比值比[OR] 0.86，95%置信区间[CI] 0.74 - 0.99）、超重（调整后的OR 0.88，95% CI 0.79 - 0.98）和既往吸烟（调整后的OR 0.82，95% CI 0.74 - 0.92）在调整了性别、年龄和开始使用他汀类药物的年份后，预测该组不依从风险降低。在有心血管合并症的参与者（n = 2827）中，1155人（40.9%）不依从。在该组中，高酒精摄入量（调整后的OR 1.55，95% CI 1.12 - 2.15）、极端饮酒情况（调整后的OR 1.48，95% CI 1.11 - 1.97）以及一组3 - 4种生活方式风险因素（调整后的OR 1.61，95% CI 1.15 - 2.27）在调整了性别、年龄和开始使用他汀类药物的年份后，预测不依从几率增加。
解读
有心血管合并症且存在危险饮酒行为或一组生活方式风险因素的人不依从风险增加。在没有心血管合并症的个体中，生活方式因素信息无助于识别不依从风险增加的人群；超重、肥胖和既往吸烟是该组更好依从性的预测因素，这为预防性药物依从性机制提供了值得进一步研究的见解。
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