Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.
Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Melbourne, Australia.
J Gerontol A Biol Sci Med Sci. 2018 May 9;73(6):798-805. doi: 10.1093/gerona/glx256.
Older individuals (aged ≥65 years) are commonly prescribed statins but may experience a range of barriers in adhering to therapy. The factors associated with poor statin adherence and/or discontinuation among this population have not been comprehensively reviewed.
We conducted a systematic review to identify English articles published through December 12, 2016 that reported factors associated with nonadherence and/or discontinuation of statins among older persons. Data were pooled via random-effects meta-analysis techniques.
Forty-five articles reporting data from more than 1.8 million older statin users from 13 countries were included. The factors associated with increased statin nonadherence were black/non-white race (odds ratio [OR] 1.66, 95% confidence interval [CI] 1.39-1.98), female gender (OR 1.08, 95% CI 1.03-1.13), current smoker (OR 1.12, 95% CI 1.03-1.21), higher copayments (OR 1.38, 95% CI 1.25-1.52), new user (OR 1.58, 95% CI 1.21-2.07), lower number of concurrent cardiovascular medications (OR 1.08, 95% CI 1.06-1.09), primary prevention (OR 1.49, 95% CI 1.40-1.59), having respiratory disorders (OR 1.17, 95% CI 1.12-1.23) or depression (OR 1.11, 95% CI 1.06-1.16), and not having renal disease (OR 1.09, 95% CI 1.04-1.14). The factors associated with increased statin discontinuation were lower income status (OR 1.20, 95% CI 1.06-1.36), current smoker (OR 1.14, 95% CI 1.06-1.23), higher copayment (OR 1.61, 95% CI 1.53-1.70), higher number of medications (OR 1.04, 95% CI 1.01-1.06), presence of dementia (OR 1.18, 95% CI 1.02-1.36), cancer (OR 1.22, 95% CI 1.11-1.33) or respiratory disorders (OR 1.19, 95% CI 1.05-1.34), primary prevention (OR 1.66, 95% CI 1.24-2.22), and not having hypertension (OR 1.13, 95% CI 1.07-1.20) or diabetes (OR 1.09, 95% CI 1.04-1.15).
Interventions that target potentially modifiable factors including financial and social barriers, patients' perceptions about disease risk as well as polypharmacy may improve statin use in the older population.
老年人（年龄≥65 岁）常被开具他汀类药物，但在坚持治疗方面可能会遇到一系列障碍。尚未全面审查该人群中与他汀类药物不依从和/或停药相关的因素。
我们进行了一项系统评价，以确定截至 2016 年 12 月 12 日发表的英文文章，报告了与老年人他汀类药物不依从和/或停药相关的因素。通过随机效应荟萃分析技术汇总数据。
纳入了来自 13 个国家的超过 180 万老年他汀类药物使用者的 45 篇文章的数据。与他汀类药物不依从相关的因素包括黑/非白人种族（比值比[OR]1.66，95%置信区间[CI]1.39-1.98）、女性（OR 1.08，95%CI 1.03-1.13）、当前吸烟者（OR 1.12，95%CI 1.03-1.21）、更高的共付额（OR 1.38，95%CI 1.25-1.52）、新使用者（OR 1.58，95%CI 1.21-2.07）、同时使用的心血管药物数量较少（OR 1.08，95%CI 1.06-1.09）、初级预防（OR 1.49，95%CI 1.40-1.59）、患有呼吸系统疾病（OR 1.17，95%CI 1.12-1.23）或抑郁症（OR 1.11，95%CI 1.06-1.16），且无肾脏疾病（OR 1.09，95%CI 1.04-1.14）。与他汀类药物停药相关的因素包括收入较低（OR 1.20，95%CI 1.06-1.36）、当前吸烟者（OR 1.14，95%CI 1.06-1.23）、更高的共付额（OR 1.61，95%CI 1.53-1.70）、同时使用的药物数量较多（OR 1.04，95%CI 1.01-1.06）、痴呆（OR 1.18，95%CI 1.02-1.36）、癌症（OR 1.22，95%CI 1.11-1.33）或呼吸系统疾病（OR 1.19，95%CI 1.05-1.34）、初级预防（OR 1.66，95%CI 1.24-2.22）和无高血压（OR 1.13，95%CI 1.07-1.20）或糖尿病（OR 1.09，95%CI 1.04-1.15）。
针对潜在可改变的因素（包括财务和社会障碍、患者对疾病风险的认知以及多药治疗）的干预措施可能会改善老年人群中他汀类药物的使用。
