Ma Tian-Tian, Wong Ian C K, Whittlesea Cate, Mackenzie Isla S, Man Kenneth K C, Lau Wallis, Brauer Ruth, Wei Li
Research Department of Practice and Policy, UCL School of Pharmacy, London, UK.
Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Br J Clin Pharmacol. 2021 Mar;87(3):1043-1055. doi: 10.1111/bcp.14463. Epub 2020 Jul 23.
The aim of this study was to investigate the initial cardiovascular prescription patterns in patients after their first cardiovascular events, and to identify factors associated with cardiovascular polypharmacy.
This was a cross-sectional study including patients aged ≥ 45 years with the first record of coronary heart disease (CHD) or stroke between 2007 and 2016 using The Health Improvement Network database. This study investigated the patterns of cardiovascular drugs prescribed during the first 90 days after the first cardiovascular events. Logistic regression was used to examine the association between patients' baseline characteristics and cardiovascular polypharmacy (≥5 cardiovascular drugs).
A total of 121,600 (59,843 CHD and 61,757 stroke) patients were included in the study. The mean age was 69.5 ± 11.9 years. The proportion of patients who were prescribed 0-1, 2-3, 4-5 drugs and ≥6 drugs were 11.0%, 29.8%, 38.6% and 20.5%, respectively. Factors associated with cardiovascular polypharmacy were sex (female: OR 0.74, 95% CI 0.72-0.76 vs male), age (75-84 years old: OR 0.50, 0.47-0.53 vs 45-54 years old), smoking status (current smoking: OR 1.29, 1.15-1.24 vs never), body mass index (obesity: OR 1.38, 1.34-1.43 vs normal), deprivation status (most deprived: OR 1.09, 1.04-1.14 vs least deprived) and Charlson comorbidity index (index ≥5: OR 1.25, 1.16-1.35 vs index 0).
Multiple cardiovascular drugs treatment was common in patients with CVD in the UK. High-risk factors of CVD were also associated with cardiovascular polypharmacy. Further studies are warranted to assess the impact of cardiovascular polypharmacy and its interaction on CVD recurrence and mortality.
本研究旨在调查首次发生心血管事件后患者的初始心血管药物处方模式，并确定与心血管多药联合治疗相关的因素。
这是一项横断面研究，使用健康改善网络数据库纳入了2007年至2016年间首次记录患有冠心病（CHD）或中风且年龄≥45岁的患者。本研究调查了首次心血管事件后前90天内开具的心血管药物模式。采用逻辑回归分析来检验患者基线特征与心血管多药联合治疗（≥5种心血管药物）之间的关联。
本研究共纳入121,600名患者（59,843例冠心病患者和61,757例中风患者）。平均年龄为69.5±11.9岁。开具0 - 1种、2 - 3种、4 - 5种和≥6种药物的患者比例分别为11.0%、29.8%、38.6%和20.5%。与心血管多药联合治疗相关的因素包括性别（女性：比值比0.74，95%置信区间0.72 - 0.76，男性对照）、年龄（75 - 84岁：比值比0.50，0.47 - 0.53，45 - 54岁对照）、吸烟状况（当前吸烟者：比值比1.29，1.15 - 1.24，从不吸烟者对照）、体重指数（肥胖：比值比1.38，1.34 - 1.43，正常对照）、贫困状况（最贫困：比值比1.09，1.04 - 1.14，最不贫困对照）以及查尔森合并症指数（指数≥5：比值比1.25，1.16 - 1.35，指数0对照）。
在英国，心血管疾病患者中多种心血管药物治疗很常见。心血管疾病的高危因素也与心血管多药联合治疗相关。有必要进一步开展研究以评估心血管多药联合治疗及其相互作用对心血管疾病复发和死亡率的影响。
