Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08, Bratislava, Slovakia.
Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia.
Drugs Aging. 2019 Sep;36(9):863-873. doi: 10.1007/s40266-019-00689-2.
Secondary prevention of peripheral arterial disease includes administration of statins regardless of the patient's serum cholesterol level. Our study aimed to identify patient-associated risk factors for statin non-persistence and comparison of the explanatory power of models based on clusters of patient-associated characteristics.
Our study cohort (n = 8330) was assembled from the database of the largest health insurance provider in the Slovak Republic. Statin users aged ≥ 65 years in whom peripheral arterial disease was diagnosed during 2012 were included. Patients were followed for 5 years; those with a treatment gap period of at least 6 months without statin prescription were classified as "non-persistent". The risk factors for non-persistence were identified within six models (sociodemographic, cardiovascular events, comorbid conditions, statin-related characteristics, cardiovascular co-medication and full model) using Cox regression. The explanatory power of models was assessed using Harrell's C-index.
At the end of the follow-up, 35.7% of patients were found to be non-persistent. The full model had the highest explanatory power (C = 0.632). Female sex, atorvastatin and rosuvastatin as initially administered statins, being a new statin user and an increasing co-payment were associated with an increased risk for non-persistence. Increasing age, history of ischaemic stroke, diabetes mellitus, general practitioner as index prescriber, increasing overall number of medications and co-administration of certain cardiovascular co-medications were associated with a lower likelihood for non-persistence.
Patients identified as high risk for non-persistence require special attention aimed at the improvement of their persistence with statin treatment.
外周动脉疾病的二级预防包括使用他汀类药物，无论患者的血清胆固醇水平如何。我们的研究旨在确定与他汀类药物不持续相关的患者相关危险因素，并比较基于患者相关特征聚类的模型的解释能力。
我们的研究队列（n=8330）是从斯洛伐克共和国最大的医疗保险提供商的数据库中组建的。纳入 2012 年诊断为外周动脉疾病且年龄≥65 岁的他汀类药物使用者。对患者进行了 5 年的随访；那些有至少 6 个月未服用他汀类药物且无他汀类药物处方的治疗空白期的患者被归类为“不持续”。使用 Cox 回归在六个模型（社会人口统计学、心血管事件、合并症、他汀类药物相关特征、心血管合并用药和全模型）中确定了不持续的危险因素。使用 Harrell 的 C 指数评估模型的解释能力。
在随访结束时，发现 35.7%的患者为不持续。全模型具有最高的解释能力（C=0.632）。女性、初始使用阿托伐他汀和瑞舒伐他汀、作为新的他汀类药物使用者以及共付额增加与不持续的风险增加相关。年龄增加、缺血性脑卒中史、糖尿病、全科医生作为指数处方医生、用药总数增加以及同时使用某些心血管合并药物与不持续的可能性降低相关。
被确定为不持续高风险的患者需要特别关注，旨在提高他们对他汀类药物治疗的持续依从性。
