Department of Cardiology, St. Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Parkville, Melbourne, Australia.
Department of Cardiology, St. Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Parkville, Melbourne, Australia.
J Clin Lipidol. 2019 Jan-Feb;13(1):163-169. doi: 10.1016/j.jacl.2018.11.004. Epub 2018 Nov 15.
Rural patients with atherosclerotic cardiovascular disease (ASCVD) experience greater cardiovascular morbidity and mortality than their urban counterparts. Statin therapy is a key component of ASCVD treatment. The extent to which there may be regional differences in long-term adherence to statins is unknown.
To assess long-term rates of adherence to statins in a high-risk ASCVD cohort, and whether regional differences exist between rural and urban patients.
Follow-up was conducted in patients who underwent coronary angiography at a single tertiary center between 2009 and 2013. Adherence was defined as consumption of prescribed statin ≥6 days per week. Patients were divided into remoteness areas (RAs), classified as RA1 (major city), RA2 (inner regional), and RA3 (outer regional) based on the Australian Standard Geographical Classification.
Five hundred twenty-five patients (69% male, mean age 64 ± 11 years) were followed-up after a median of 5.3 years. Baseline characteristics were similar between RAs. Overall adherence was 83%; however, rural patients were significantly more adherent to their statin therapy (80% in RA1, 83% in RA2, and 93% in RA3, P = .04). Living in RA3 independently predicted greater statin adherence than living in RA1 (odds ratio: 2.75, 95% CI: 1.1-7.8, P = .03). All-cause mortality was significantly higher in RA3 than other regional areas (6% RA1, 12% RA2, and 18% RA3, P = .01).
Despite higher all-cause mortality, rural patients with ASCVD demonstrate significantly greater long-term adherence to statins than urban patients. Other factors, such as reduced access to health care and delayed diagnosis may explain the gap in outcomes between rural and urban patients.
农村患有动脉粥样硬化性心血管疾病（ASCVD）的患者比城市患者经历更大的心血管发病率和死亡率。他汀类药物治疗是 ASCVD 治疗的关键组成部分。他汀类药物长期依从性是否可能存在地区差异尚不清楚。
评估高危 ASCVD 队列中他汀类药物的长期服用率，以及农村和城市患者之间是否存在地区差异。
对 2009 年至 2013 年间在一家三级中心接受冠状动脉造影的患者进行随访。依从性定义为每周至少服用规定剂量的他汀类药物 6 天。根据澳大利亚标准地理分类，患者分为偏远地区（RA），分为 RA1（主要城市）、RA2（内部区域）和 RA3（外部区域）。
525 例患者（69%为男性，平均年龄 64±11 岁）在中位随访 5.3 年后进行了随访。RA 之间的基线特征相似。总体依从率为 83%；然而，农村患者的他汀类药物治疗依从性显著更高（RA1 为 80%，RA2 为 83%，RA3 为 93%，P=0.04）。与居住在 RA1 相比，居住在 RA3 独立预测更高的他汀类药物依从性（比值比：2.75，95%置信区间：1.1-7.8，P=0.03）。RA3 的全因死亡率明显高于其他地区（RA1 为 6%，RA2 为 12%，RA3 为 18%，P=0.01）。
尽管全因死亡率较高，但 ASCVD 的农村患者对他汀类药物的长期依从性明显高于城市患者。其他因素，如医疗保健获取减少和诊断延迟，可能解释了农村和城市患者之间结局的差距。
