Korhonen Maarit Jaana, Pentti Jaana, Hartikainen Juha, Kivimäki Mika, Vahtera Jussi
Department of Public Health, University of Turku, Turku, Finland; Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
Finnish Institute of Occupational Health, Turku, Finland.
Int J Cardiol. 2016 Jul 1;214:493-9. doi: 10.1016/j.ijcard.2016.04.003. Epub 2016 Apr 10.
The association between anxiety and nonadherence to preventive therapies remains unclear. We investigated whether somatic symptoms of anxiety predict statin nonadherence.
This is a prospective cohort study of 1924 individuals who responded to a questionnaire survey on health status and initiated statin therapy after the survey during 2008-2010. We followed the cohort for nonadherence, defined as the proportion of days covered <80%, during the 365days since the first dispensation after the survey. We used log-binomial regression to estimate the predictors of nonadherence.
18% of participants reported no experience of the eight somatic symptoms of anxiety (palpitation without exercise, irregular heartbeat, chest pain upon anger or emotion, sweating without exercise, flushing, tremor of hands or voice, muscle twitching) before the statin initiation, and 16% had experienced at least one symptom on average weekly to daily. 49% of respondents were nonadherent. Weekly to daily occurrence of these symptoms predicted a 33% increase in the risk of nonadherence (risk ratio [RR] 1.33, 95% confidence interval, CI, 1.13-1.57) compared to no symptoms when adjusted for sociodemographics, lifestyle risks, cardiovascular comorbidities, and depression. Particularly, chest pain upon anger or emotion (RR 1.21, 95% CI 1.01-1.46) and muscle twitching (RR 1.24, 95% CI 1.08-1.42) predicted an increased risk of nonadherence to statin therapy. Psychological symptoms of anxiety were not associated with nonadherence when adjusted for somatic symptoms.
Somatic anxiety-related symptoms predicted nonadherence to statin therapy. Information on pre-existing somatic symptoms may help identifying patients at increased risk of statin nonadherence.
焦虑与不坚持预防性治疗之间的关联尚不清楚。我们调查了焦虑的躯体症状是否能预测他汀类药物治疗的不依从性。
这是一项对1924名个体进行的前瞻性队列研究，这些个体回应了关于健康状况的问卷调查，并在2008年至2010年调查后开始他汀类药物治疗。我们对该队列随访其不依从情况，不依从定义为自调查后首次配药起365天内服药天数覆盖率<80%的比例。我们使用对数二项回归来估计不依从的预测因素。
18%的参与者在开始服用他汀类药物之前报告没有经历过焦虑的八种躯体症状（无运动时心悸、心跳不规则、生气或情绪激动时胸痛、无运动时出汗、脸红、手部或声音颤抖、肌肉抽搐），16%的参与者平均每周至每天经历至少一种症状。49%的受访者不依从。在对社会人口统计学、生活方式风险、心血管合并症和抑郁进行调整后，与无症状相比，这些症状每周至每天出现预测不依从风险增加33%（风险比[RR]1.33，95%置信区间[CI]1.13 - 1.57）。特别是，生气或情绪激动时胸痛（RR 1.21，95% CI 1.01 - 1.46）和肌肉抽搐（RR 1.24，95% CI 1.08 - 1.42）预测他汀类药物治疗不依从风险增加。调整躯体症状后，焦虑的心理症状与不依从无关。
与躯体焦虑相关的症状预测了他汀类药物治疗的不依从性。关于既往存在的躯体症状的信息可能有助于识别他汀类药物治疗不依从风险增加的患者。
