Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester. England.
School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, England.
PLoS One. 2019 Jan 17;14(1):e0201196. doi: 10.1371/journal.pone.0201196. eCollection 2019.
Previous research has shown that statin adherence for the primary prevention of CVD is lower compared to secondary prevention populations. Therefore the aim of this systematic review was to review predictors of statin adherence for the primary prevention of CVD.
A systematic search of papers published between Jan 1984 and May 2017 was conducted in PubMed, PsycINFO, EMbase and CINAHL databases. A study was eligible for inclusion if; 1) it was a study of the general population or of patients with familial hypercholesterolemia, hypertension, diabetes or arthritis; 2) statins were prescribed; 3) adherence was defined and measured as the extent to which patients followed their statin regimen during the period of prescription, and 4) it was an original trial or observational study (excluding case reports). A study was subsequently excluded if 1) results were not presented separately for primary prevention; 2) it was a trial of an intervention (for example patient education). Papers were reviewed by two researchers and consensus agreed with a third. A quality assessment (QA) tool was used to formally assess each included article. To evaluate the effect of predictors, data were quantitatively and qualitatively synthesised.
In total 19 studies met the inclusion criteria and nine were evaluated as high quality using the QA tool. The proportion of patients classed as "adherent" ranged from 17.8% to 79.2%. Potential predictors of statin adherence included traditional risk factors for CVD such as age, being male, diabetes and hypertension. Income associated with adherence more strongly in men than women, and highly educated men were more likely and highly educated women less likely to be adherent. Alcohol misuse and high BMI associated with non-adherence. There was no association between polypharmacy and statin adherence. The evidence base for the effect of other lifestyle factors and health beliefs on statin adherence was limited.
Current evidence suggests that patients with more traditional risk factors for CVD are more likely to be adherent to statins. The implications for future research are discussed.
先前的研究表明，与二级预防人群相比，用于 CVD 一级预防的他汀类药物的依从性较低。因此，本系统综述的目的是综述 CVD 一级预防中他汀类药物依从性的预测因素。
在 PubMed、PsycINFO、EMbase 和 CINAHL 数据库中进行了 1984 年 1 月至 2017 年 5 月期间发表的论文的系统检索。如果符合以下标准，则一项研究有资格被纳入：1）研究对象为一般人群或家族性高胆固醇血症、高血压、糖尿病或关节炎患者；2）开了他汀类药物处方；3）定义和测量了依从性，即患者在处方期间遵循他汀类药物治疗方案的程度；4）为原始试验或观察性研究（不包括病例报告）。如果以下情况之一，则排除研究：1）结果未单独报告一级预防；2）为干预试验（例如患者教育）。由两位研究人员对论文进行了审查，并与第三位研究人员达成共识。使用质量评估 (QA) 工具对所有纳入的文章进行了正式评估。为了评估预测因素的影响，对数据进行了定量和定性综合分析。
共有 19 项研究符合纳入标准，其中 9 项研究使用 QA 工具评估为高质量。被归类为“依从”的患者比例从 17.8%到 79.2%不等。他汀类药物依从性的潜在预测因素包括 CVD 的传统危险因素，如年龄、男性、糖尿病和高血压。收入与男性的依从性相关性更强，而与女性的相关性较弱，受教育程度较高的男性更有可能依从，而受教育程度较高的女性更不可能依从。酒精滥用和高 BMI 与不依从相关。多药治疗与他汀类药物的依从性之间没有关联。其他生活方式因素和健康信念对他汀类药物依从性的影响的证据基础有限。
目前的证据表明，CVD 传统危险因素较多的患者更有可能遵守他汀类药物治疗方案。讨论了对未来研究的影响。
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