Li S T, Xu J Y, Huang R C
Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116011, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2016 Aug 24;44(8):684-90. doi: 10.3760/cma.j.issn.0253-3758.2016.08.009.
To evaluate the impact of different adherence mode to statins on cardiovascular adverse events in patients with coronary artery disease (CAD).
Electronic searches, including PubMed, Scopus, Ovid MEDLINE, Ovid EMBASE, Ovid EBM Reviews CENTRAL, CINAHL, The Cochrane Library, Ovid PsycInfo, Wanfang data, CNKI and Science & Technology Magazine Online, were performed and all related literatures of all languages were retrieval till to March 1, 2015. The full text was obtained through manual retrieval, inter-library loan and document delivery service, or by contacting the author directly. According to inclusion and exclusion criteria, data was extracted dependently by two raters. The high adherence to statin was use defined by the ratio of statins cover time and the total time (proportion of days covered, PDC≥80%). Data were analyzed quantitatively using RevMan 5.1. Then implement subgroup analysis was made according to different statin adherence and classification of clinical outcomes. The impact of adherence to statin on cardiovascular events (all-cause mortality, non-fatal myocardial infarction, hospitalization due to unstable angina pectoris, heart insufficiency attack) in CAD patients was evaluated.
Present analysis enrolled eight relevant retrospective and observational studies. Because there were only few literatures describing the impact of statin adherence on clinical outcomes, we also included literatures with low adherence group (4 studies in PDC<80%, 2 studies in PDC<40% and 2 studies in PDC<20%). High adherence group includes 189 556 cases; low adherence group includes 11 384 cases. Compare with low adherence group, cardiovascular events rate reduced by 32% in high adherence group (OR=0.68, 95%CI 0.58-0.80, P<0.001). Subgroup analysis with 4 literatures with PDC≥80% or<80% showed that the cardiovascular events prominently decreased in high adherence group compared to low adherence group (OR=0.63, 95%CI 0.53-0.76, P<0.001). According to 5 literatures with all-cause mortality parameter, we also found a borderline decrease in all-cause mortality in high adherence group compared to low adherence group ( OR=0.67, 95%CI 0.44-1.02, P=0.06), while non-fatal cardiovascular events were significantly reduced by 18% in high adherence group (OR=0.82, 95%CI 0.77-0.87, P<0.001).
High adherence to statins is related to significantly lower cardiovascular events in CAD patients.
评估不同他汀类药物依从模式对冠心病（CAD）患者心血管不良事件的影响。
进行电子检索，包括PubMed、Scopus、Ovid MEDLINE、Ovid EMBASE、Ovid循证医学综述中心数据库、CINAHL、考克兰图书馆、Ovid心理学文摘数据库、万方数据、中国知网和维普资讯，检索截至2015年3月1日的所有语言的相关文献。通过手工检索、馆际互借和文献传递服务，或直接联系作者获取全文。根据纳入和排除标准，由两名评价员独立提取数据。他汀类药物高依从性定义为他汀类药物覆盖时间与总时间的比值（覆盖天数比例，PDC≥80%）。使用RevMan 5.1进行定量数据分析。然后根据不同的他汀类药物依从性和临床结局分类进行亚组分析。评估CAD患者中他汀类药物依从性对心血管事件（全因死亡率、非致命性心肌梗死、因不稳定型心绞痛住院、心力衰竭发作）的影响。
目前的分析纳入了八项相关的回顾性和观察性研究。由于描述他汀类药物依从性对临床结局影响的文献较少，我们还纳入了低依从性组的文献（PDC<80%的研究4项，PDC<40%的研究2项，PDC<20%的研究2项）。高依从性组包括189556例；低依从性组包括11384例。与低依从性组相比，高依从性组的心血管事件发生率降低了32%（OR=0.68，95%CI 0.58-0.80，P<0.001）。对4项PDC≥80%或<80%的文献进行亚组分析显示，与低依从性组相比，高依从性组的心血管事件显著减少（OR=0.63，95%CI 0.53-0.76，P<0.001）。根据5项具有全因死亡率参数的文献，我们还发现与低依从性组相比，高依从性组的全因死亡率有临界性降低（OR=0.67，95%CI 0.44-1.02，P=0.06），而高依从性组的非致命性心血管事件显著减少了18%（OR=0.82，95%CI 0.77-0.87，P<0.001）。
CAD患者对他汀类药物的高依从性与显著更低的心血管事件相关。
