Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Jan Waldenströms gata 35, 20502 Malmö, Sweden.
Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet (KI), Nobels väg 12A, 17165 Solna, Sweden.
Eur Heart J Cardiovasc Pharmacother. 2021 Mar 15;7(2):141-147. doi: 10.1093/ehjcvp/pvaa010.
Experiencing an acute myocardial infarction (AMI) is a life-threatening event and use of statins can reduce the probability of recurrence and improve long-term survival. However, the effectiveness of statins in the real-world setting may be lower than the reported efficacy in randomized clinical trials. Therefore, we aimed to investigate whether low statin treatment adherence during the year following an AMI episode is associated with increased 2nd-year mortality.
We analysed all 54 872 AMI patients aged ≥45 years, admitted to Swedish hospitals between 2010 and 2012, and who survive at least 1 year after the AMI episode. We defined low adherence as a medication possession ratio <50% or non-use of statins. Applying inverse probability of treatment weighting (IPTW), we investigated the association between low adherence and all-cause, cardiovascular disease (CVD), and non-CVD mortality during the 2nd year. Overall, 20% of the patients had low adherence during the 1st year and 8% died during the 2nd year. In the IPTW analysis, low adherence was associated with an increased risk of all-cause [absolute risk difference (ARD) = 0.048, number needed to harm (NNH) = 21, relative risk (RR) = 1.71], CVD (ARD = 0.035, NNH = 29, RR = 1.62), and non-CVD mortality (ARD = 0.013, NNH = 77, RR = 2.17).
In the real-world setting, low statin adherence during the 1st year after an AMI episode is associated with increased mortality during the 2nd year. Our results reaffirm the importance of achieving a high adherence to statin treatment after suffering from an AMI.
经历急性心肌梗死（AMI）是危及生命的事件，使用他汀类药物可以降低复发的概率并改善长期生存。然而，他汀类药物在真实环境中的有效性可能低于随机临床试验报告的疗效。因此，我们旨在研究 AMI 发作后第一年他汀类药物治疗依从性低是否与第二年死亡率增加有关。
我们分析了所有 54872 名年龄≥45 岁的 AMI 患者，这些患者于 2010 年至 2012 年期间在瑞典医院住院，并且在 AMI 发作后至少存活 1 年。我们将低依从性定义为药物占有比率<50%或不使用他汀类药物。应用逆概率治疗加权（IPTW），我们研究了低依从性与第二年全因、心血管疾病（CVD）和非 CVD 死亡率之间的关系。总体而言，20%的患者在第一年存在低依从性，8%的患者在第二年死亡。在 IPTW 分析中，低依从性与全因死亡风险增加相关[绝对风险差异（ARD）=0.048，危害比（HR）=1.71]，CVD（ARD=0.035，HR=1.62）和非 CVD 死亡率（ARD=0.013，HR=2.17）。
在真实环境中，AMI 发作后第一年他汀类药物治疗依从性低与第二年死亡率增加有关。我们的结果再次证实了在发生 AMI 后实现他汀类药物治疗高依从性的重要性。
