Lane Dan, Patel Prashanth, Khunti Kamlesh, Gupta Pankaj
Leicester Diabetes Centre, University of Leicester, Leicester General Hospital, Leicester, UK,
Department of Chemical Pathology and Metabolic Diseases, Leicester Royal Infirmary, Leicester, UK,
Patient Prefer Adherence. 2019 Apr 12;13:537-547. doi: 10.2147/PPA.S162215. eCollection 2019.
Cardiometabolic diseases are among the most prevalent and harmful conditions worldwide. They are complex, comorbid conditions that require polypharmacy - a known contributor to non-adherence in cardiovascular disease (CVD) and diabetes mellitus (DM). Suboptimal adherence is associated with poor disease control, which increases the risk of hospitalizations, mortality, and preventable financial implications. However, until recently, the lack of a gold standard for non-adherence testing in cardiometabolic diseases has been the major barrier for understanding true prevalence and mortality consequences. Recent European guidelines have endorsed biochemical testing as the preferred measure for non-adherence in CVD, with urinary screening methods being the most clinically widespread. The diagnostic and therapeutic benefits incurred to health service resources by use of biochemical non-adherence testing are vast, as hospitalizations and associated economic burdens are reduced, and tailored therapies are increased. However, biochemical testing can only signify a snap shot of adherence behavior, and true adherence may be skewed by pharmacokinetic factors. This review summarizes current literature regarding the prevalence, impact, and reasons of non-adherence in cardiometabolic disease. The benefits of current adherence diagnostic tools have been appraised, where urine in biochemical testing has been focused upon and evaluated against other matrices.
心血管代谢疾病是全球最普遍且危害最大的疾病之一。它们是复杂的共病状况，需要联合用药，而联合用药是导致心血管疾病（CVD）和糖尿病（DM）患者不依从治疗的一个已知因素。依从性欠佳与疾病控制不佳相关，这会增加住院风险、死亡率以及可避免的经济负担。然而，直到最近，心血管代谢疾病中缺乏不依从检测的金标准一直是了解真实患病率和死亡率后果的主要障碍。欧洲最近的指南认可生化检测作为心血管疾病中不依从治疗的首选测量方法，其中尿液筛查方法在临床上最为广泛应用。通过使用生化不依从检测为卫生服务资源带来的诊断和治疗益处是巨大的，因为住院率和相关经济负担降低了，且量身定制的治疗增加了。然而，生化检测只能表明依从行为的一个瞬间情况，真正的依从性可能会受到药代动力学因素的影响而产生偏差。本综述总结了当前关于心血管代谢疾病中不依从治疗的患病率、影响及原因的文献。对当前依从性诊断工具的益处进行了评估，其中重点关注了生化检测中的尿液，并与其他样本基质进行了比较。
