University of Alabama at Birmingham, Birmingham, Alabama.
Temple University, Philadelphia, Pennsylvania.
Am J Cardiol. 2018 Sep 1;122(5):768-774. doi: 10.1016/j.amjcard.2018.05.016. Epub 2018 Jun 2.
Guidelines recommend attempting to reinitiate statins in patients who discontinue treatment. Previous experiences while taking a statin, including side effects, may reduce a patient's willingness to reinitiate treatment. We determined the percentage of adults who are willing to reinitiate statin therapy after treatment discontinuation. Factors associated with willingness to reinitiate a statin were also examined. A statin questionnaire was administered and study examination conducted in black and white US adults enrolled in the nationwide REasons for Geographic And Racial Differences in Stroke study from 2013 to 2017. In participants who self-reported ever having taken a statin (n = 7,216, mean age 72 years, 53% women, 34% black), 1,081 (15%) reported having discontinued treatment. Among those who discontinued treatment, statin side effects, perceived lack of need for a statin, and cost were reported by 66%, 31%, and 3% of participants, respectively. Overall, 37% of participants who had discontinued treatment were willing to reinitiate statin therapy. Participants who discontinued treatment due to cost (prevalence ratio [PR] 1.61; 95% confidence interval (CI) 1.01, 2.57) were more likely to report a willingness to reinitiate therapy. Participants with a low-density lipoprotein-cholesterol ≥130 mg/dl versus <100 mg/dl (PR 0.69; 95% CI 0.53, 0. 88) and who discontinued treatment due to side effects (PR 0.51; 95% CI 0.41, 0.64) were less likely to report willingness to reinitiate statin therapy. In conclusion, a substantial proportion of participants who discontinued statin therapy were willing to reinitiate treatment. Healthcare providers should discuss reinitiation of statin therapy with their patients who have discontinued treatment.
指南建议在停止治疗的患者中尝试重新开始使用他汀类药物。患者以前服用他汀类药物的经历,包括副作用,可能会降低他们重新开始治疗的意愿。我们确定了愿意在停止治疗后重新开始他汀类药物治疗的成年人的比例。还检查了与重新开始他汀类药物治疗意愿相关的因素。2013 年至 2017 年,在美国全国范围内的地理和种族差异中风研究中招募了黑人和白人美国成年人,他们接受了他汀类药物问卷调查和研究检查。在自我报告曾经服用过他汀类药物的参与者中(n=7216,平均年龄 72 岁,53%为女性,34%为黑人),有 1081 人(15%)报告停止了治疗。在停止治疗的患者中,分别有 66%、31%和 3%的患者报告了他汀类药物的副作用、认为不需要他汀类药物和费用问题。总体而言,37%的停止治疗的参与者愿意重新开始他汀类药物治疗。由于费用而停止治疗的参与者(患病率比 [PR] 1.61;95%置信区间 [CI] 1.01,2.57)更有可能报告重新开始治疗的意愿。低密度脂蛋白胆固醇≥130mg/dl 与<100mg/dl 的参与者(PR 0.69;95%CI 0.53,0.88)和因副作用而停止治疗的参与者(PR 0.51;95%CI 0.41,0.64)不太可能报告愿意重新开始他汀类药物治疗。总之,相当一部分停止他汀类药物治疗的参与者愿意重新开始治疗。医疗保健提供者应与停止治疗的患者讨论重新开始他汀类药物治疗。