Xie Gaoqiang, Sun Yihong, Myint Phyo Kyaw, Patel Anushka, Yang Xingzi, Li Min, Li Xian, Wu Tao, Li Shenshen, Gao Runlin, Wu Yangfeng
Peking University Clinical Research Institute, Beijing, China.
Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China.
Lipids Health Dis. 2017 Aug 15;16(1):155. doi: 10.1186/s12944-017-0544-0.
The evidence of adherence to statin decreasing risk of major adverse cardiovascular events (MACEs) is still lack among patients discharged with acute coronary syndrome (ACS). Our objective is to determine the relationship between six-month adherence to statins and subsequent risk of MACEs in patients discharged with ACS.
Using two prospective registry cohorts (CPACS-1 and -2), we analyzed data from 12,516 consecutive patients with ACS who were prescribed statin at hospital discharge and survived beyond 6 months without recurrent myocardial infarction (MI) or stroke. Adherence to statin was defined as good (using statin at discharge and 6 months without declined dosage) and poor adherence groups (using statin at discharge but declining dosage or stopping at 6 months). We compared the hazard ratios of all-cause mortality and MACE in subsequent 6 months between groups, using Cox-regression models, adjusting for multiple potential confounders.
Seventy two percent of patients adhered to statin therapy at 6 months. The incident MACE in the poor adherence group was significantly higher than in good adherence group (2.7% vs. 1.8%, p = 0.002). Compared with poor adherence group, the good adherence group showed a 27% lower relative risk of MACE during the 6 month follow up (fully-adjusted hazard ratio (HR) = 0.73; 95%CI: 0.56-0.97). The protective effects of good adherence were similar in groups with different statin dose as well as groups by other baseline clinical characteristics and treatments (p > 0.05 for interaction).
Our study highlights the importance of adherence to statin therapy in prevention of MACE and clinicians should aim to achieve higher dosage if tolerable.
CPACS2 was registered on URL: http://www.anzctr.org.au/default.aspx and unique identifier is ACTRN12609000491268 . CPACS1 was not a clinical trial and thus not registered.
在急性冠状动脉综合征（ACS）出院患者中，关于坚持服用他汀类药物可降低主要不良心血管事件（MACE）风险的证据仍然不足。我们的目的是确定ACS出院患者他汀类药物六个月的依从性与随后发生MACE风险之间的关系。
利用两个前瞻性登记队列（CPACS-1和-2），我们分析了12516例连续的ACS患者的数据，这些患者在出院时被处方使用他汀类药物，并且存活超过6个月，没有复发性心肌梗死（MI）或中风。他汀类药物的依从性被定义为良好（出院时使用他汀类药物且6个月内未减量）和依从性差的组（出院时使用他汀类药物但减量或在6个月时停药）。我们使用Cox回归模型，在调整多个潜在混杂因素后，比较了两组在随后6个月内全因死亡率和MACE的风险比。
72%的患者在6个月时坚持他汀类药物治疗。依从性差的组中发生MACE的比例显著高于依从性好的组（2.7%对1.8%，p = 0.002）。与依从性差的组相比，依从性好的组在6个月随访期间MACE的相对风险降低了27%（完全调整后的风险比（HR）= 0.73；95%CI：0.56 - 0.97）。在不同他汀类药物剂量组以及其他基线临床特征和治疗组中，良好依从性的保护作用相似（交互作用p > 0.05）。
我们的研究强调了坚持他汀类药物治疗对预防MACE的重要性，临床医生应在可耐受的情况下争取更高剂量。
CPACS2在网址：http://www.anzctr.org.au/default.aspx上注册，唯一标识符是ACTRN12609000491268。CPACS1不是临床试验，因此未注册。
