Wawruch Martin, Zatko Dusan, Wimmer Gejza, Luha Jan, Hricak Vasil, Murin Jan, Kukumberg Peter, Tesar Tomas, Hloska Adam, Shah Rashmi
Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.
General Health Insurance Company, Bratislava, Slovakia.
Pharmacoepidemiol Drug Saf. 2017 Feb;26(2):201-207. doi: 10.1002/pds.4148. Epub 2016 Dec 9.
This study was aimed at evaluating the extent of non-persistence with statin therapy in elderly patients after an ischemic stroke and identifying patient-related characteristics that are risk factors for non-persistence.
The evaluable study cohort (n = 2748) was derived from the database of the largest health insurance provider in the Slovak Republic. Patients aged ≥65 years who were initiated on statin therapy following the diagnosis of an ischemic stroke during one full year (1 January 2010 to 31 December 2010) constituted this cohort. Each patient was followed for a period of 3 years from the date of the first statin prescription. Patients with a continuous treatment gap of 6 months without statin prescription were designated as non-persistent. The Cox proportional hazard model was applied to determine patient-associated characteristics that influenced the likelihood of non-persistence.
During the 3-year follow-up period, 39.7% of patients in the study cohort became non-persistent. Factors associated with decreased probability of a patient becoming non-persistent were age ≥75 years (hazard ratio (HR) 0.75), polypharmacy (concurrent use of ≥6 drugs) (HR 0.79), diabetes mellitus (HR 0.80), dementia (HR 0.81) and hypercholesterolemia (HR 0.50). On the other hand, the presence of anxiety disorders (HR 1.33) predicted an increased likelihood of a patient being non-persistent.
Our findings suggest that patients aged ≥75 years or those with the presence of diabetes mellitus, dementia, hypercholesterolemia or polypharmacy were likely to be persistent with statin therapy, whereas those with anxiety disorders may need greater assistance with persistence of statin therapy. Copyright © 2016 John Wiley & Sons, Ltd.
本研究旨在评估老年缺血性脑卒中患者他汀类药物治疗的不持续性程度，并确定与不持续性相关的患者特征风险因素。
可评估的研究队列（n = 2748）来自斯洛伐克共和国最大的健康保险提供商数据库。该队列由2010年1月1日至2010年12月31日一整年中，在诊断为缺血性脑卒中后开始他汀类药物治疗的年龄≥65岁的患者组成。从首次开具他汀类药物处方之日起，对每位患者进行为期3年的随访。他汀类药物处方连续中断6个月的患者被认定为治疗不持续。采用Cox比例风险模型确定影响不持续性可能性的患者相关特征。
在3年的随访期内，研究队列中39.7%的患者治疗不持续。与患者治疗不持续可能性降低相关的因素包括年龄≥75岁（风险比（HR）0.75）、多重用药（同时使用≥6种药物）（HR 0.79）、糖尿病（HR 0.80）、痴呆（HR 0.81）和高胆固醇血症（HR 0.50）。另一方面，焦虑症的存在（HR 1.33）预示患者治疗不持续的可能性增加。
我们的研究结果表明，年龄≥75岁或患有糖尿病、痴呆、高胆固醇血症或多重用药的患者他汀类药物治疗可能持续，而患有焦虑症的患者在他汀类药物治疗持续性方面可能需要更多帮助。版权所有© 2016约翰威立父子有限公司。
