1 Duke Clinical Research Institute Duke University School of Medicine Durham NC.
2 Department of Medicine Duke University School of Medicine Durham NC.
J Am Heart Assoc. 2019 Feb 5;8(3):e010241. doi: 10.1161/JAHA.118.010241.
Background The 2013 American College of Cardiology/American Heart Association Cholesterol Treatment Guideline increased the number of primary prevention patients eligible for statin therapy, yet uptake of these guidelines has been modest. Little is known of how primary care provider ( PCP ) beliefs influence statin prescription. Methods and Results We surveyed 164 PCP s from a community-based North Carolina network in 2017 about statin therapy. We evaluated statin initiation among the PCP s' statin-eligible patients between 2014 and 2015 without a previous prescription. Seventy-two PCP s (43.9%) completed the survey. The median estimate of the relative risk reduction for high-intensity statins was 45% (interquartile range, 25%-50%). A minority of providers (27.8%) believed statins caused diabetes mellitus, and only 16.7% reported always/very often discussing this with patients. Most PCPs (97.2%) believed that statins cause myopathy, and 72.3% reported always/very often discussing this with patients. Most (77.7%) reported always/very often using the 10-year atherosclerotic cardiovascular disease risk calculator, although many reported that in most cases other risk factors or patient preferences influenced prescribing (59.8% and 43.1%, respectively). Of 6172 statin-eligible patients, 22.3% received a prescription for a moderate- or high-intensity statin at follow-up. Providers reporting greater reliance on risk factors beyond atherosclerotic cardiovascular disease risk were less likely to prescribe statins. Conclusions Although beliefs and approaches to statin discussions vary among community PCP s, new prescription rates are low and minimally associated with those beliefs. These results highlight the complexity of increasing statin prescriptions for primary prevention and suggest that strategies to facilitate standardized discussions and to address external influences on patient beliefs warrant future study.
2013 年美国心脏病学会/美国心脏协会胆固醇治疗指南增加了适合他汀类药物治疗的一级预防患者数量，但这些指南的采用率一直较低。人们对初级保健提供者（PCP）的信念如何影响他汀类药物的处方知之甚少。
我们在 2017 年调查了北卡罗来纳州一个社区网络中的 164 名 PCP 关于他汀类药物治疗的情况。我们评估了 2014 年至 2015 年期间没有他汀类药物处方的 PCP 可使用他汀类药物的患者中他汀类药物的起始使用情况。72 名 PCP（43.9%）完成了调查。高强度他汀类药物相对风险降低的中位数估计值为 45%（四分位距，25%-50%）。少数提供者（27.8%）认为他汀类药物会导致糖尿病，只有 16.7%的人报告经常/非常经常与患者讨论这一点。大多数 PCP（97.2%）认为他汀类药物会导致肌病，72.3%的人报告经常/非常经常与患者讨论这一点。大多数（77.7%）报告经常/非常经常使用 10 年动脉粥样硬化性心血管疾病风险计算器，尽管许多人报告说在大多数情况下，其他风险因素或患者偏好会影响处方（分别为 59.8%和 43.1%）。在 6172 名可使用他汀类药物的患者中，22.3%在随访时开了中等强度或高强度他汀类药物的处方。报告更多依赖动脉粥样硬化性心血管疾病风险以外的风险因素的提供者不太可能开他汀类药物的处方。
尽管社区 PCP 之间的他汀类药物讨论信念和方法有所不同，但新处方率较低，与这些信念的关联很小。这些结果突出了增加一级预防中他汀类药物处方的复杂性，并表明促进标准化讨论和解决患者信念中外部影响的策略值得未来研究。
