OMEDIT Grand Est, Regional Health Agency, Strasbourg, France.
Department of Public Health, University Hospitals of Strasbourg, Strasbourg, France.
Drugs Aging. 2019 Oct;36(10):947-955. doi: 10.1007/s40266-019-00695-4.
Although compelling evidence exists supporting statins (HMG-CoA reductase inhibitors) for secondary prevention in older patients with clinical atherosclerotic diseases, the same cannot be said for primary prevention.
The objectives of this study were to estimate the frequency of potential statin overuse in older patients, the potential drug cost savings if corrected, and the associated factors.
A retrospective cross-sectional study was conducted in Alsace and Lorraine (France) from 1 January to 30 April 2017. All statin users aged 80 years or over living in the community (including nursing homes) and identified from the French health insurance database were analyzed. Potential statin overuse was defined according to the STOPP/START (Screening Tool of Older People's Prescriptions/Screening Tool to Alert to Right Treatment) criteria.
Among the 38,268 aged insured, 23,228 (60.7%) had potential statin overuse. Of those living in the community, 22,132 (60.0%) patients had potential statin overuse: 12,352 (55.8%) for primary and 9780 (44.2%) for secondary prevention. Among nursing home residents, 1096 (79.0%) had potential statin overuse: 394 (35.9%) for primary and 702 (64.1%) for secondary prevention. The potential drug cost savings associated with the adjustment of potential statin overuse were €924,100 for the study period. Living in nursing home [adjusted odds ratio (OR) 3.91, 95% confidence interval (CI) 2.82-5.41] and being a female (OR 2.84, 95% CI 2.54-3.17) were the main risk factors associated with potential statin overuse.
The frequency of potential statin overuse is very high among older people aged 80 years or over, highlighting the need to re-evaluate statin therapy and consider deprescribing, particularly for primary prevention and in nursing homes.
尽管有大量证据支持他汀类药物（HMG-CoA 还原酶抑制剂）用于有临床动脉粥样硬化疾病的老年患者的二级预防，但对于一级预防却并非如此。
本研究旨在评估高龄患者中潜在他汀类药物过度使用的频率、如果纠正潜在药物过度使用可节省的潜在药物费用，以及相关因素。
本研究为 2017 年 1 月 1 日至 4 月 30 日期间在阿尔萨斯和洛林（法国）进行的回顾性横断面研究。从法国医疗保险数据库中分析了所有年龄在 80 岁及以上、居住在社区（包括养老院）的他汀类药物使用者。根据 STOPP/START（老年人用药筛查工具/提醒正确治疗的筛查工具）标准定义潜在他汀类药物过度使用。
在 38268 名参保老年人中，23228 人（60.7%）存在潜在他汀类药物过度使用。在社区居住的患者中，22132 人（60.0%）存在潜在他汀类药物过度使用：12352 人（55.8%）用于一级预防，9780 人（44.2%）用于二级预防。在养老院居住的患者中，1096 人（79.0%）存在潜在他汀类药物过度使用：394 人（35.9%）用于一级预防，702 人（64.1%）用于二级预防。在研究期间，调整潜在他汀类药物过度使用后，潜在药物节省成本为 924100 欧元。居住在养老院（调整后的优势比[OR]3.91，95%置信区间[CI]2.82-5.41）和女性（OR 2.84，95%CI 2.54-3.17）是与潜在他汀类药物过度使用相关的主要危险因素。
80 岁及以上老年人中潜在他汀类药物过度使用的频率非常高，这突出表明需要重新评估他汀类药物治疗，并考虑减少用药，尤其是一级预防和在养老院。
