Hallberg S, Banefelt J, Fox K M, Mesterton J, Johansson G, Levin L-Å, Sobocki P, Gandra S R
Quantify Research, Stockholm, Sweden.
Strategic Healthcare Solutions, LLC, Baltimore, MD, USA.
Int J Clin Pract. 2016 Mar;70(3):222-8. doi: 10.1111/ijcp.12769. Epub 2016 Jan 22.
The aim of this study was to assess treatment patterns of lipid-lowering therapy (LLT) in patients with hyperlipidaemia or prior cardiovascular (CV) events who experience new CV events.
A retrospective population-based cohort study was conducted using Swedish medical records and registers. Patients were included in the study based on a prescription of LLT or CV event history and followed up for up to 7 years for identification of new CV events and assessment of LLT treatment patterns. Patients were stratified into three cohorts based on CV risk level. All outcomes were assessed during the year following index (the date of first new CV event). Adherence was defined as medication possession ratio (MPR) > 0.80. Persistence was defined as no gaps > 60 days in supply of drug used at index.
Of patients with major cardiovascular disease (CVD) history (n = 6881), 49% were not on LLT at index. Corresponding data for CV risk equivalent and low/unknown CV risk patients were 37% (n = 3226) and 38% (n = 2497) respectively. MPR for patients on LLT at index was similar across cohorts (0.74-0.75). The proportions of adherent (60-63%) and persistent patients (56-57%) were also similar across cohorts. Dose escalation from dose at index was seen within all cohorts and 2-3% of patients switched to a different LLT after index while 5-6% of patients augmented treatment by adding another LLT.
Almost 50% of patients with major CVD history were not on any LLT, indicating a potential therapeutic gap. Medication adherence and persistence among patients on LLT were suboptimal.
本研究旨在评估高脂血症患者或既往有心血管（CV）事件且发生新的CV事件的患者的降脂治疗（LLT）模式。
使用瑞典医疗记录和登记系统进行了一项基于人群的回顾性队列研究。根据LLT处方或CV事件史将患者纳入研究，并随访长达7年，以确定新的CV事件并评估LLT治疗模式。根据CV风险水平将患者分为三个队列。所有结局均在索引后一年（首次新CV事件发生日期）内进行评估。依从性定义为药物持有率（MPR）> 0.80。持续性定义为索引时使用的药物供应无超过60天的中断。
有主要心血管疾病（CVD）病史的患者（n = 6881）中，49%在索引时未接受LLT治疗。CV风险相当患者和低/未知CV风险患者的相应数据分别为37%（n = 3226）和38%（n = 2497）。索引时接受LLT治疗的患者的MPR在各队列中相似（0.74 - 0.75）。各队列中依从性患者（60 - 63%）和持续性患者（56 - 57%）的比例也相似。在所有队列中均观察到从索引时的剂量开始增加剂量，2 - 3%的患者在索引后改用不同的LLT，而5 - 6%的患者通过添加另一种LLT加强治疗。
近50%有主要CVD病史的患者未接受任何LLT治疗，表明存在潜在的治疗缺口。接受LLT治疗的患者的药物依从性和持续性欠佳。
