Pauff Brandy R, Jiroutek Michael R, Holland Melissa A, Sutton Beth S
College of Pharmacy and Health Sciences, Campbell University, Buies Creek, North Carolina.
College of Pharmacy and Health Sciences, Campbell University, Buies Creek, North Carolina.
Clin Ther. 2015 Jun 1;37(6):1329-39. doi: 10.1016/j.clinthera.2015.03.020. Epub 2015 Apr 11.
In 2008, the American Diabetes Association (ADA) recommended that patients aged >40 years with diabetes and cardiovascular disease or with ≥1 cardiovascular disease risk factor be prescribed a statin. This study assessed statin prescribing patterns in patients with diabetes, per the ADA guideline, using data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey-Outpatient Department for the years 2005 to 2010. This study also examined patients' demographic characteristics associated with statin prescribing, including sex, age, ethnicity, race, insurance type, body mass index, region, primary care provider, hypertension and hyperlipidemia.
This retrospective, cross-sectional, observational study included data dated between 2005 and 2010 from patients aged ≥18 years with diabetes and without contraindications to statin use. Associations between statin prescribing and variables of interest were analyzed using χ(2) tests. A multivariate logistic regression model included 2 groups stratified by 3-year observation period (2005-2007 and 2008-2010) plus all variables with an overall χ(2) test result of P < 0.2. P values, odds ratios (ORs) and 95% CIs are reported.
The majority of patients were aged ≥40 years (93.1%), had a body mass index of ≥30 (58.7%), had hypertension (65.6%), and did not have hyperlipidemia (54.0%). A low percentage of patients were prescribed a statin (35.1%), but it appears that this percentage is on the rise. During 2005-2007, 31.9% of patients received a statin, whereas 37.7% of patients received a statin during 2008-2010. After adjustment for covariates included in the multivariate logistic regression model, those with hypertension (vs none [reference]: OR = 1.31; 95% CI, 1.12-1.53) and/or hyperlipidemia (vs none [reference]: OR = 4.44; 95% CI, 3.70-5.33) were significantly more likely to have been prescribed a statin, whereas those in age group 18-<40 years (vs 40-<65 years [reference]: OR = 0.45; 95% CI, 0.31-0.65) and Hispanic/Latino patients (vs non-Hispanic/Latino patients [reference]: OR = 0.77; 95% CI, 0.61-0.97) were significantly less likely to have been prescribed a statin.
Despite the call in the latest ADA recommendations for prescribing statins in many diabetic patients, an unexpectedly low percentage of patients were receiving them. Health disparities in age and ethnicity were also evident. The findings from this study highlight the need for further research into low statin prescribing rates.
2008年，美国糖尿病协会（ADA）建议，年龄大于40岁且患有糖尿病和心血管疾病或具有≥1种心血管疾病危险因素的患者应服用他汀类药物。本研究利用2005年至2010年的国家门诊医疗护理调查和国家医院门诊医疗护理调查-门诊部的数据，按照ADA指南评估了糖尿病患者的他汀类药物处方模式。本研究还调查了与他汀类药物处方相关的患者人口统计学特征，包括性别、年龄、族裔、种族、保险类型、体重指数、地区、初级保健提供者、高血压和高脂血症。
这项回顾性、横断面观察性研究纳入了2005年至2010年间年龄≥18岁且无他汀类药物使用禁忌证的糖尿病患者的数据。使用χ²检验分析他汀类药物处方与感兴趣变量之间的关联。多变量逻辑回归模型包括按3年观察期分层的2组（2005 - 2007年和2008 - 2010年）以及所有χ²检验总体结果P < 0.2的变量。报告了P值、比值比（OR）和95%置信区间（CI）。
大多数患者年龄≥40岁（93.1%），体重指数≥30（58.7%），患有高血压（65.6%），且没有高脂血症（54.0%）。接受他汀类药物处方的患者比例较低（35.1%），但这一比例似乎在上升。在2005 - 2007年期间，31.9%的患者接受了他汀类药物，而在2008 - 2010年期间，37.7%的患者接受了他汀类药物。在对多变量逻辑回归模型中纳入的协变量进行调整后，患有高血压（与无高血压[参照组]相比：OR = 1.31；95% CI，1.12 - 1.53）和/或高脂血症（与无高脂血症[参照组]相比：OR = 4.44；95% CI，3.70 - 5.33）的患者明显更有可能被开具他汀类药物处方，而年龄在18 - <40岁组的患者（与40 - <65岁组[参照组]相比：OR = 0.45；95% CI，0.31 - 0.65）以及西班牙裔/拉丁裔患者（与非西班牙裔/拉丁裔患者[参照组]相比：OR = 0.77；95% CI，0.61 - 0.97）被开具他汀类药物处方的可能性明显更低。
尽管最新的ADA建议呼吁为许多糖尿病患者开具他汀类药物，但接受他汀类药物治疗的患者比例意外地低。年龄和种族方面的健康差异也很明显。本研究结果凸显了对他汀类药物低处方率进行进一步研究的必要性。
