Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
Interuniversity Centre of Healthcare Research & Pharmacoepidemiology, Laboratory of Healthcare Research & Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy; Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy.
Eur J Intern Med. 2018 Jan;47:25-31. doi: 10.1016/j.ejim.2017.09.023. Epub 2017 Sep 27.
To assess whether in individuals aged 80years or older adherence to statins is accompanied by a reduced risk of all-cause mortality and major cardiovascular events.
A nested case-control study was carried out on a cohort of patients aged 80years or older (very elderly individuals), who were under treatment with statins between 2008 and 2009, using the database available for all citizenship (about 10 million) of Lombardy (Italy). Cases were the cohort members who experienced death or hospitalization for stroke, myocardial infarction or heart failure from the initial prescription until 2012. Up to five controls were randomly selected for each case. Logistic regression was used to model the outcome risk associated with the adherence to therapy with statins. Two younger patient cohorts aged 60 to 69years and 70 to 79years were taken for comparison. A set of sensitivity analyses was performed in order to account for sources of systematic uncertainty.
Among very elderly individuals, those who had high adherence to statins showed significant risk reductions of death (56%; 95% Confidence Interval, 54% to 59%), myocardial infarction (15%; 5% to 24%), stroke (13%; 0% to 24%) and heart failure (30%; 23% to 36%) with respect to those at very low adherence. Adherence-related risk reductions were only slightly better for younger cohort members.
Adherence to therapy with statins reduced the risk of both death and cardiovascular morbidity in patients aged 80years or older.
评估 80 岁及以上人群服用他汀类药物是否与全因死亡率和主要心血管事件风险降低相关。
对 2008 年至 2009 年接受他汀类药物治疗的 80 岁及以上（超高龄人群）队列患者进行巢式病例对照研究，该队列患者的数据库涵盖了意大利伦巴第大区（约 1000 万）的所有公民。病例为自初始处方起至 2012 年期间经历死亡或因中风、心肌梗死或心力衰竭住院的队列成员。每个病例随机选择 5 个对照。使用逻辑回归对与他汀类药物治疗依从性相关的结局风险进行建模。同时对年龄为 60-69 岁和 70-79 岁的两个年轻患者队列进行比较。进行了一系列敏感性分析，以考虑系统不确定性的来源。
在超高龄人群中，与他汀类药物低依从性相比，高依从性者的死亡风险（56%；95%置信区间，54%-59%）、心肌梗死（15%；5%-24%）、中风（13%；0%-24%）和心力衰竭（30%；23%-36%）风险显著降低。年轻队列成员的依从性相关风险降低幅度略小。
在 80 岁及以上患者中，他汀类药物治疗的依从性降低了死亡和心血管发病率的风险。
