Wawruch Martin, Zatko Dusan, Wimmer Gejza, Luha Jan, Wimmerova Sona, Matalova Petra, Kukumberg Peter, Murin Jan, Tesar Tomas, Havelkova Beata, Shah Rashmi
Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08, Bratislava, Slovakia.
General Health Insurance Company, Panónska cesta 2, 851 04, Bratislava, Slovakia.
Clin Drug Investig. 2017 Nov;37(11):1047-1054. doi: 10.1007/s40261-017-0559-3.
Non-persistence with secondary preventive measures, including medications such as statins, adversely affects the prospects of successful outcomes. This study was aimed at evaluating non-persistence with statin therapy in cohorts of young and elderly patients after a transient ischaemic attack (TIA) and identifying patient-associated characteristics that influence the risk for non-persistence.
The study cohorts included 797 adult patients who were initiated on statin therapy following a TIA diagnosis between 1 January 2010 and 31 December 2010. Patients were followed up for 3 years and those with a treatment gap of at least a 6-month period were considered 'non-persistent'. In order to identify any age-related differences, all analyses were conducted in the entire study cohort (n = 797) as well as separately in the 'younger' (aged <65 years, n = 267) and the 'older' (aged ≥65 years, n = 530) patients.
Non-persistence was significantly more common in younger patients compared to older patients (67.8% vs. 49.1%; p < 0.001). Factors that decreased the probability of non-persistence in younger and older patients included diabetes mellitus (hazard ratio [HR] = 0.72 and HR = 0.64, respectively) and hypercholesterolaemia (HR = 0.43 and HR = 0.62, respectively). Female gender (HR = 1.42) was associated with a higher and increasing number of medications taken (HR = 0.93), with lower probability for non-persistence in younger patients but not in the older patients.
Our results indicate that certain patients with TIA require special counselling to improve persistence with statin therapy. These include younger patients, especially females and those not on polypharmacy, and both younger and older patients without diabetes mellitus or hypercholesterolaemia.
不坚持二级预防措施，包括不坚持服用他汀类药物等，会对成功治疗的前景产生不利影响。本研究旨在评估短暂性脑缺血发作（TIA）后年轻和老年患者队列中他汀类药物治疗的持续性，并确定影响持续性风险的患者相关特征。
研究队列包括797名成年患者，这些患者在2010年1月1日至2010年12月31日期间因TIA诊断开始接受他汀类药物治疗。对患者进行了3年的随访，治疗间隔至少为6个月的患者被视为“不持续用药者”。为了确定任何与年龄相关的差异，所有分析在整个研究队列（n = 797）中进行，同时也分别在“年轻”（年龄<65岁，n = 267）和“老年”（年龄≥65岁，n = 530）患者中进行。
与老年患者相比，年轻患者中不持续用药的情况明显更为常见（67.8%对49.1%；p < 0.001）。降低年轻和老年患者不持续用药可能性的因素包括糖尿病（风险比[HR]分别为0.72和0.64）和高胆固醇血症（HR分别为0.43和0.62）。女性（HR = 1.42）与服用药物数量较多且不断增加有关（HR = 0.93），年轻患者不持续用药的可能性较低，但老年患者并非如此。
我们的结果表明，某些TIA患者需要特别的咨询，以提高他汀类药物治疗的持续性。这些患者包括年轻患者，尤其是女性和未服用多种药物的患者，以及没有糖尿病或高胆固醇血症的年轻和老年患者。
