Johansen Michael E, Hefner Jennifer L, Foraker Randi E
Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
Am J Cardiol. 2015 Jun 1;115(11):1507-12. doi: 10.1016/j.amjcard.2015.02.052. Epub 2015 Mar 12.
Antiplatelets and statins are efficacious for preventing future cardiovascular events in patients with coronary heart disease. Disparity in cardiovascular outcomes exists by race/ethnicity and gender; however, few studies have explored potential disparities in long-term antiplatelet and statin use by race/ethnicity and gender. We conducted a repeated cross-sectional analysis using the nationally representative Medical Expenditure Panel Survey from 2003 to 2012. The sample consisted of 14,334 men and women >29 years with coronary heart disease. We identified antiplatelet and statin use, medical conditions, and sociodemographic characteristics. Rates of use did not change for statins or the combination of statins and antiplatelets from 2003 to 2012 but decreased for antiplatelets (p = 0.015). Of the total sample, 70.9% (95% confidence interval [CI] 69.7 to 72.1) reported use of antiplatelets, 52.5% (95% CI 51.1 to 53.8) reported statin use, and 43.1% (95% CI 41.8 to 44.4) reported the combination. Use of antiplatelets and statins were associated with one another (odds ratio 3.22; 95% CI 2.87 to 3.62). From 2009 to 2012, black and Hispanic men along with all race/ethnicities of women were less likely to report use of statins, antiplatelets, and the combination of the 2 compared with white men, even after controlling for sociodemographics. Changing the definition of a medication use, inclusion of cardiovascular risk factors, or the inclusion of warfarin in the antiplatelet category did not substantially change the results. Future practice and policy goals should focus on increasing the number of high-risk patients on appropriate preventative medications while focusing particular attention on decreasing the identified disparity.
抗血小板药物和他汀类药物对预防冠心病患者未来的心血管事件有效。心血管疾病的结局存在种族/族裔和性别的差异；然而，很少有研究探讨种族/族裔和性别在长期使用抗血小板药物和他汀类药物方面的潜在差异。我们使用2003年至2012年具有全国代表性的医疗支出面板调查进行了重复横断面分析。样本包括14334名年龄大于29岁的冠心病男性和女性。我们确定了抗血小板药物和他汀类药物的使用情况、医疗状况以及社会人口学特征。2003年至2012年期间，他汀类药物或他汀类药物与抗血小板药物联合使用的比例没有变化，但抗血小板药物的使用比例有所下降（p = 0.015）。在总样本中，70.9%（95%置信区间[CI] 69.7至72.1）报告使用抗血小板药物，52.5%（95%CI 51.1至53.8）报告使用他汀类药物，43.1%（95%CI 41.8至44.4）报告联合使用。抗血小板药物和他汀类药物的使用相互关联（比值比3.22；95%CI 2.87至3.62）。从2009年到2012年，黑人男性和西班牙裔男性以及所有种族/族裔的女性与白人男性相比，即使在控制了社会人口学因素后，报告使用他汀类药物、抗血小板药物以及两者联合使用的可能性也较小。改变药物使用的定义、纳入心血管危险因素或在抗血小板类别中纳入华法林并没有实质性改变结果。未来的实践和政策目标应侧重于增加使用适当预防药物的高危患者数量，同时特别关注减少已发现的差异。
