Du Liping, Cheng Zhongwei, Zhang Yuxuan, Li Ying, Mei Dan
1 Department of Pharmacy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
2 Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
Eur J Prev Cardiol. 2017 Jun;24(9):962-970. doi: 10.1177/2047487317695628. Epub 2017 Jan 1.
Background Long-term use of evidence-based medications is recommended by international guidelines for the management of stable coronary artery disease, however, non-adherence to medications is common. This meta-analysis aims to systematically evaluate the impact of medication adherence on clinical outcomes in patients with stable coronary artery disease. Methods Articles from January 1960-December 2015 were retrieved from the MEDLINE and EMBASE databases without any language restriction. A meta-analysis was performed to investigate the risk ratios of all-cause mortality, cardiovascular mortality, and myocardial infarction/hospitalization between groups with good medication adherence and poor medication adherence. Studies were independently reviewed by two investigators. Data from eligible studies were extracted, and the meta-analysis was performed using R Version 3.1.0 software. Results A total of 10 studies were included in the analysis, with a total of 106,002 coronary artery disease patients. The results showed that good adherence to evidence-based medication regimens, including β-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, antiplatelet drugs, and statins, was related to a lower risk of all-cause mortality(risk ratio 0.56; 95% confidence interval: 0.45-0.69), cardiovascular mortality(risk ratio 0.66; 95% confidence interval: 0.51-0.87), and cardiovascular hospitalization/myocardial infarction(risk ratio 0.61; 95% confidence interval: 0.45-0.82). Conclusions This meta-analysis confirms the significant impact of good medication adherence on clinical outcomes in patients with stable coronary artery disease. More strategy and planning are needed to improve medication adherence.
国际指南推荐对稳定型冠状动脉疾病患者长期使用循证药物，然而，不坚持用药的情况很常见。本荟萃分析旨在系统评估用药依从性对稳定型冠状动脉疾病患者临床结局的影响。方法：从MEDLINE和EMBASE数据库中检索1960年1月至2015年12月的文章，无语言限制。进行荟萃分析以研究用药依从性良好组和用药依从性差组之间全因死亡率、心血管死亡率以及心肌梗死/住院的风险比。由两名研究人员独立审查研究。提取符合条件研究的数据，并使用R 3.1.0版本软件进行荟萃分析。结果：分析共纳入10项研究，总计106,002例冠状动脉疾病患者。结果显示，良好坚持使用包括β受体阻滞剂、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、抗血小板药物和他汀类药物在内的循证药物治疗方案，与全因死亡率风险较低（风险比0.56；95%置信区间：0.45 - 0.69）、心血管死亡率（风险比0.66；95%置信区间：0.51 - 0.87）以及心血管住院/心肌梗死（风险比0.61；95%置信区间：0.45 - 0.82）相关。结论：本荟萃分析证实了良好的用药依从性对稳定型冠状动脉疾病患者临床结局的显著影响。需要更多策略和规划来提高用药依从性。
