Intermountain Medical Center Heart Institute, Salt Lake City, UT; and.
Department of Internal Medicine, Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT.
J Cardiovasc Pharmacol. 2020 May;75(5):426-431. doi: 10.1097/FJC.0000000000000808.
Statins are among the most prescribed medications because of the well-documented benefits of safely lowering low-density lipoprotein cholesterol. However, many patients are unable or unwilling to continue statin therapy because of real or perceived adverse effects. This study sought to increase understanding about which patients are unlikely to tolerate statin therapy. The Intermountain Healthcare's electronic data repository was queried from January 1, 1999, to December 31, 2013, to identify all adults who survived their first encounter of coronary artery disease (CAD), cerebral vascular disease, or peripheral artery disease and received statin therapy during follow-up. Statin intolerance (SI) was identified by the documentation of clinician-noted intolerance or allergy or by the use of pitavastatin. Patients were followed up for ≥3 years or until death. Of the 48,997 patients evaluated, 3049 (6.2%) were documented with SI. Of those with SI, 9.8% were prescribed a low-intensity, 73.4% a moderate-intensity, and 16.8% a high-intensity statin dose. After adjustment for covariables, significant predictors of SI were female sex [odds ratio (OR) = 1.47, P < 0.0001], age (65-74 vs. <65: OR = 1.15, P = 0.002; ≥75 vs. <65: OR = 0.90, P = 0.03), hypertension (OR = 1.11, P = 0.01), hyperlipidemia (OR = 1.31, P < 0.0001), smoking (OR = 0.88, P = 0.001), renal failure (OR = 1.20, P = 0.009), heart failure (OR = 1.26, P < 0.0001), sleep apnea (OR = 1.22, P < 0.0001), prior malignancy (OR = 1.18, P = 0.007), depression (OR = 1.13, P = 0.04), and index atherosclerotic cardiovascular disease diagnosis (CAD vs. cerebral vascular disease: OR = 1.71, P < 0.0001; CAD vs. peripheral artery disease: OR = 1.23, P = 0.02). In this study, the strongest identified clinical predictor of future SI was female sex. Many standard cardiovascular risk factors were also associated with SI, suggesting that patients with multiple comorbidities are more likely to be vulnerable.
他汀类药物是最常被开的药物之一，因为其安全降低低密度脂蛋白胆固醇的功效已得到充分证实。然而，许多患者因实际或感知到的不良反应而无法或不愿继续接受他汀类药物治疗。本研究旨在增进对哪些患者不太可能耐受他汀类药物治疗的理解。从 1999 年 1 月 1 日至 2013 年 12 月 31 日，对 Intermountain Healthcare 的电子数据库进行了查询，以确定所有首次患有冠状动脉疾病（CAD）、脑血管疾病或外周动脉疾病并在随访期间接受他汀类药物治疗的成年人。通过记录临床医生注意到的不耐受或过敏或使用匹伐他汀，确定他汀类药物不耐受（SI）。患者的随访时间≥3 年或直至死亡。在评估的 48997 名患者中，有 3049 名（6.2%）被记录为 SI。在这些有 SI 的患者中，9.8%被开了低强度他汀类药物，73.4%开了中强度他汀类药物，16.8%开了高强度他汀类药物。调整协变量后，SI 的显著预测因素为女性（比值比[OR] = 1.47，P < 0.0001）、年龄（65-74 岁与<65 岁：OR = 1.15，P = 0.002；≥75 岁与<65 岁：OR = 0.90，P = 0.03）、高血压（OR = 1.11，P = 0.01）、高脂血症（OR = 1.31，P < 0.0001）、吸烟（OR = 0.88，P = 0.001）、肾衰竭（OR = 1.20，P = 0.009）、心力衰竭（OR = 1.26，P < 0.0001）、睡眠呼吸暂停（OR = 1.22，P < 0.0001）、既往恶性肿瘤（OR = 1.18，P = 0.007）、抑郁（OR = 1.13，P = 0.04）和指数动脉粥样硬化性心血管疾病诊断（CAD 与脑血管疾病：OR = 1.71，P < 0.0001；CAD 与外周动脉疾病：OR = 1.23，P = 0.02）。在这项研究中，未来 SI 的最强临床预测因素是女性。许多标准心血管危险因素也与 SI 相关，这表明患有多种合并症的患者更容易受到影响。
