Karlsson Sofia Axia, Hero Christel, Svensson Ann-Marie, Franzén Stefan, Miftaraj Mervete, Gudbjörnsdottir Soffia, Eeg-Olofsson Katarina, Eliasson Björn, Andersson Sundell Karolina
Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
BMJ Open. 2018 Mar 30;8(3):e020309. doi: 10.1136/bmjopen-2017-020309.
To analyse the association between refill adherence to lipid-lowering medications, and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes mellitus.
Cohort study.
National population-based cohort of Swedish patients with type 2 diabetes mellitus.
86 568 patients aged ≥18 years, registered with type 2 diabetes mellitus in the Swedish National Diabetes Register, who filled at least one prescription for lipid-lowering medication use during 2007-2010, 87% for primary prevention.
Refill adherence of implementation was assessed using the medication possession ratio (MPR), representing the proportion of days with medications on hand during an 18-month exposure period. MPR was categorised by five levels (≤20%, 21%-40%, 41%-60%, 61%-80% and >80%). Patients without medications on hand for ≥180 days were defined as non-persistent. Risk of CVD (myocardial infarction, ischaemic heart disease, stroke and unstable angina) and mortality by level of MPR and persistence was analysed after the exposure period using Cox proportional hazards regression and Kaplan-Meier, adjusted for demographics, socioeconomic status, concurrent medications and clinical characteristics.
The hazard ratios for CVD ranged 1.33-2.36 in primary prevention patients and 1.19-1.58 in secondary prevention patients, for those with MPR ≤80% (p<0.0001). The mortality risk was similar regardless of MPR level. The CVD risk was 74% higher in primary prevention patients and 33% higher in secondary prevention patients, for those who were non-persistent (p<0.0001). The mortality risk was 6% higher in primary prevention patients and 18% higher in secondary prevention patients, for non-persistent patients (p<0.0001).
Higher refill adherence to lipid-lowering medications was associated with lower risk of CVD in primary and secondary prevention patients with type 2 diabetes mellitus.
分析2型糖尿病患者降脂药物的续方依从性与心血管疾病（CVD）风险及死亡率之间的关联。
队列研究。
基于瑞典全国2型糖尿病患者的人群队列。
86568名年龄≥18岁的患者，在瑞典国家糖尿病登记处登记为2型糖尿病患者，他们在2007 - 2010年期间至少开具过一次降脂药物处方，其中87%用于一级预防。
使用药物持有率（MPR）评估续方依从性，MPR代表18个月暴露期内手头有药物的天数比例。MPR分为五个水平（≤20%、21% - 40%、41% - 60%、61% - 80%和>80%）。手头无药≥180天的患者被定义为非持续用药者。在暴露期后，使用Cox比例风险回归和Kaplan - Meier分析按MPR水平和持续性划分的CVD（心肌梗死、缺血性心脏病、中风和不稳定型心绞痛）风险及死亡率，并对人口统计学、社会经济状况、同时使用的药物和临床特征进行调整。
在一级预防患者中，MPR≤80%者的CVD风险比为1.33 - 2.36，二级预防患者中为1.19 - 1.58（p<0.0001）。无论MPR水平如何，死亡风险相似。对于非持续用药的一级预防患者，CVD风险高74%，二级预防患者高33%（p<0.0001）。对于非持续用药患者，一级预防患者的死亡风险高6%，二级预防患者高18%（p<0.0001）。
在2型糖尿病的一级和二级预防患者中，更高的降脂药物续方依从性与较低的CVD风险相关。
