Department of Family Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
J Cancer Surviv. 2020 Aug;14(4):434-443. doi: 10.1007/s11764-020-00865-z. Epub 2020 Feb 19.
Cardiovascular disease (CVD) is a major non-cancer cause of mortality among cancer survivors, and statin therapy is the mainstay of cardiovascular risk management. However, little is known about adherence to statin therapy relative to current guidelines for the management of cholesterol among cancer survivors. We investigated the prevalence of statin-eligible but untreated individuals among cancer survivors and factors associated with underuse of statins.
We used US National Health and Nutrition Examination Survey data (2011-2016) and identified 706 cancer survivors and matched controls (1:2) by age and sex. We identified participants who met the American College of Cardiology/American Heart Association (2018) guidelines but were not currently in treatment. We estimated the proportion of patients who were statin-eligible but untreated and performed multivariable logistic regression analysis to identify the factors associated with underuse of statins.
The mean age of the total sample was 62.2 years (standard deviation, 9.1). Among the total participants, 37.5% of cancer survivors and 37.2% of controls were statin-eligible but untreated. The crude statin-eligible untreated proportion was 41.2% among cancer survivors who had received a cancer diagnosis within 3 years and 40.3% among long-term survivors of 10 years or more. In multivariate analysis, old age, male sex, lack of a usual source of care, current smoking, and low household income were significantly associated with statin-eligible untreated status.
More than one-third of cancer survivors were statin-eligible but untreated under current guidelines. There is room for improvement to reduce the burden of non-cancer mortality by managing traditional cardiovascular risk factors.
心血管疾病（CVD）是癌症幸存者的主要非癌症死亡原因，而他汀类药物治疗是心血管风险管理的主要方法。然而，对于癌症幸存者中相对于当前胆固醇管理指南的他汀类药物治疗依从性知之甚少。我们调查了癌症幸存者中符合他汀类药物治疗条件但未接受治疗的个体的流行率，以及与他汀类药物低使用率相关的因素。
我们使用美国国家健康和营养检查调查（2011-2016 年）的数据，并按年龄和性别与 706 名癌症幸存者和匹配对照（1:2）进行匹配。我们确定了符合美国心脏病学会/美国心脏协会（2018 年）指南但目前未接受治疗的参与者。我们估计了符合他汀类药物治疗条件但未接受治疗的患者比例，并进行了多变量逻辑回归分析，以确定与他汀类药物低使用率相关的因素。
总样本的平均年龄为 62.2 岁（标准差为 9.1）。在总参与者中，37.5%的癌症幸存者和 37.2%的对照者符合他汀类药物治疗条件但未接受治疗。在癌症诊断后 3 年内接受治疗的癌症幸存者中，未经治疗的符合他汀类药物治疗条件的比例为 41.2%，而 10 年或以上的长期幸存者中为 40.3%。在多变量分析中，年龄较大、男性、缺乏常规医疗服务来源、当前吸烟和低家庭收入与符合他汀类药物治疗条件但未经治疗的状态显著相关。
超过三分之一的癌症幸存者根据当前指南符合他汀类药物治疗条件但未接受治疗。通过管理传统心血管危险因素，可以进一步提高减少非癌症死亡率的负担。
