Turner Richard M, Yin Peng, Hanson Anita, FitzGerald Richard, Morris Andrew P, Stables Rod H, Jorgensen Andrea L, Pirmohamed Munir
Department of Molecular & Clinical Pharmacology, University of Liverpool, Liverpool, Merseyside, UK.
Department of Biostatistics, University of Liverpool, Liverpool, Merseyside, UK.
J Clin Lipidol. 2017 Jan-Feb;11(1):204-214. doi: 10.1016/j.jacl.2016.12.007. Epub 2016 Dec 28.
High-potency statin therapy is recommended in the secondary prevention of cardiovascular disease but discontinuation, dose reduction, statin switching, and/or nonadherence occur in practice.
To determine the prevalence and predictors of deviation from high-potency statin use early after a non-ST elevation acute coronary syndrome (NSTE-ACS) and its association with subsequent major adverse cardiovascular events (MACE) and all-cause mortality (ACM).
A total of 1005 patients from a UK-based prospective NSTE-ACS cohort study discharged on high-potency statin therapy (atorvastatin 80 mg, rosuvastatin 20 mg, or 40 mg daily) were included. At 1 month, patients were divided into constant high-potency statin users, and suboptimal users incorporating statin discontinuation, dose reduction, switching statin to a lower equivalent potency, and/or statin nonadherence. Follow-up was a median of 16 months.
There were 156 suboptimal (∼15.5%) and 849 constant statin users. Factors associated in multivariable analysis with suboptimal statin occurrence included female sex (odds ratio 1.75, 95% confidence interval [CI] 1.14-2.68) and muscular symptoms (odds ratio 4.28, 95% CI 1.30-14.08). Suboptimal statin use was associated with increased adjusted risks of time to MACE (hazard ratio 2.10, 95% CI 1.25-3.53, P = .005) and ACM (hazard ratio 2.46, 95% CI 1.38-4.39, P = .003). Subgroup analysis confirmed that the increased MACE/ACM risks were principally attributable to statin discontinuation or nonadherence.
Conversion to suboptimal statin use is common early after NSTE-ACS and is partly related to muscular symptoms. Statin discontinuation or non-adherence carries an adverse prognosis. Interventions that preserve and enhance statin utilization could improve post NSTE-ACS outcomes.
在心血管疾病的二级预防中推荐使用高强度他汀类药物治疗，但在实际应用中会出现停药、减量、更换他汀类药物和/或不依从的情况。
确定非ST段抬高型急性冠状动脉综合征（NSTE-ACS）后早期偏离高强度他汀类药物使用的患病率和预测因素，及其与随后的主要不良心血管事件（MACE）和全因死亡率（ACM）的关联。
纳入了来自英国一项前瞻性NSTE-ACS队列研究的1005例患者，这些患者出院时接受高强度他汀类药物治疗（阿托伐他汀80毫克、瑞舒伐他汀20毫克或每日40毫克）。在1个月时，患者被分为持续高强度他汀类药物使用者，以及包括他汀类药物停药、减量、更换为等效低强度他汀类药物和/或他汀类药物不依从的非最佳使用者。随访时间中位数为16个月。
有156例非最佳使用者（约15.5%）和849例持续他汀类药物使用者。多变量分析中与非最佳他汀类药物使用相关的因素包括女性（比值比1.75，95%置信区间[CI]1.14-2.68）和肌肉症状（比值比4.28，95%CI1.30-14.08）。非最佳他汀类药物使用与MACE发生时间的调整后风险增加相关（风险比2.10，95%CI1.25-3.53，P=0.005）和ACM（风险比2.46，95%CI1.38-4.39，P=0.003）。亚组分析证实，MACE/ACM风险增加主要归因于他汀类药物停药或不依从。
NSTE-ACS后早期转换为非最佳他汀类药物使用很常见，且部分与肌肉症状有关。他汀类药物停药或不依从具有不良预后。保持和提高他汀类药物使用的干预措施可能改善NSTE-ACS后的结局。
