1 Department of Medicine University of Colorado School of Medicine Aurora CO.
4 Veterans Affairs Eastern Colorado Healthcare System Denver CO.
J Am Heart Assoc. 2019 Feb 5;8(3):e011448. doi: 10.1161/JAHA.118.011448.
Background Cardioprotective medication adherence can mitigate the risk of recurrent cardiovascular events and mortality after acute myocardial infarction ( AMI ). We examined the associations of diabetes mellitus status and glycemic control with cardioprotective medication adherence after AMI . Methods and Results We performed a retrospective observational cohort study of 14 517 US veterans who were hospitalized for their first AMI between 2011 and 2014 and prescribed a beta-blocker, 3-hydroxy-3-methyl-glutaryl-CoA-reductase inhibitor, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The primary exposure was a diagnosis of type 2 diabetes mellitus; in diabetes mellitus patients, hemoglobin A1c (HbA1c) was a secondary exposure. The primary outcome was 1-year adherence to all 3 medication classes, defined as proportion of days covered ≥0.8, assessed using adjusted risk differences and multivariable Poisson regression. Of 14 517 patients (mean age, 66.3 years; 98% male), 52% had diabetes mellitus; 9%, 31%, 24%, 15%, and 21% had HbA1c <6%, 6% to 6.9%, 7% to 7.9%, 8% to 8.9%, and ≥9%, respectively. Diabetes mellitus patients were more likely to be adherent to all 3 drug classes than those without diabetes mellitus (adjusted difference in adherence, 2.1% [0.5, 3.7]). Relative to those with HbA1c 6% to 6.9%, medication adherence declined with increasing HbA1c (risk ratio of achieving proportion of days covered ≥0.8, 0.99 [0.94, 1.04], 0.93 [0.87, 0.99], 0.82 [0.77, 0.88] for HbA1c 7-7.9%, 8-8.9%, and ≥9%, respectively). Conclusions Although diabetes mellitus status had a minor positive impact on cardioprotective medication adherence after AMI , glycemic control at the time of AMI may help identify diabetes mellitus patients at risk of medication nonadherence who may benefit from adherence interventions after AMI .
心脏保护药物的依从性可以降低急性心肌梗死（AMI）后复发性心血管事件和死亡的风险。我们研究了糖尿病状态和血糖控制与 AMI 后心脏保护药物依从性的关系。
我们对 2011 年至 2014 年间因首次 AMI 住院并开处β受体阻滞剂、3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂和血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂的 14517 名美国退伍军人进行了回顾性观察队列研究。主要暴露因素是 2 型糖尿病的诊断；在糖尿病患者中，血红蛋白 A1c（HbA1c）是次要暴露因素。主要结局是所有 3 种药物类别的 1 年依从性，定义为覆盖天数比例≥0.8，使用调整后的风险差异和多变量泊松回归评估。在 14517 名患者（平均年龄 66.3 岁；98%为男性）中，52%患有糖尿病；9%、31%、24%、15%和 21%的患者 HbA1c<6%、6%至 6.9%、7%至 7.9%、8%至 8.9%和≥9%。与无糖尿病患者相比，糖尿病患者更有可能同时服用 3 种药物（调整后依从性差异为 2.1%[0.5，3.7]）。与 HbA1c 6%至 6.9%的患者相比，HbA1c 水平升高与药物依从性下降相关（达到覆盖天数比例≥0.8 的风险比，0.99[0.94，1.04]、0.93[0.87，0.99]、0.82[0.77，0.88]，分别为 HbA1c 7-7.9%、8-8.9%和≥9%）。
尽管糖尿病状态对 AMI 后心脏保护药物的依从性有轻微的积极影响，但 AMI 时的血糖控制可能有助于识别药物依从性差的糖尿病患者，这些患者可能受益于 AMI 后的依从性干预。
