Chaure-Pardos Armando, Malo Sara, Rabanaque María José, Arribas Federico, Moreno-Franco Belén, Aguilar-Palacio Isabel
Department of Preventive Medicine and Public Health, University of Zaragoza, 50009 Zaragoza, Spain.
Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009 Zaragoza, Spain.
J Clin Med. 2020 Nov 27;9(12):3850. doi: 10.3390/jcm9123850.
In this study, we investigated the relationship between sociodemographic, clinical, anthropometric, and lifestyle characteristics and the type of statin prescribed for primary prevention of cardiovascular disease (CVD). We conducted an observational study in workers who began statin treatment. Statin therapy was categorized as "high-intensity" or "low-moderate-intensity". Workers were classified according to the alignment of their statin therapy with the recommended management practices. Logistic regression models were used to evaluate the association between the different variables studied and the probability of being prescribed high-intensity statins. The only variables associated with a higher probability of being treated with high-intensity statins were increased physical activity (>40 versus <20 METs (metabolic equivalent of task) h/wk; odds ratio (OR), 1.65; 95%CI, 1.08-2.50) and, in diabetics, higher low-density lipoprotein cholesterol (LDL-C) levels (≥155 mg/dL versus <155 mg/dL; OR, 4.96; 95%CI, 1.29-19.10). The model that best predicted treatment intensity included LDL-C, diabetes, hypertension, smoking, and age (area under the Receiver Operating Characteristic curve (AUC), 0.620; 95%CI, 0.574-0.666). The prescribing and type of statin used in primary CVD prevention did not correspond with the indications in current guidelines. The probability of receiving high-intensity statins was higher in diabetics with high LDL-C levels and in more physically active individuals. These findings underscore the great variability and uncertainty in the prescribing of statins.
在本研究中，我们调查了社会人口学、临床、人体测量学和生活方式特征与用于心血管疾病（CVD）一级预防的他汀类药物处方类型之间的关系。我们对开始他汀类药物治疗的工人进行了一项观察性研究。他汀类药物治疗被分类为“高强度”或“低 - 中等强度”。根据工人的他汀类药物治疗与推荐管理实践的一致性进行分类。使用逻辑回归模型评估所研究的不同变量与开具高强度他汀类药物的概率之间的关联。与接受高强度他汀类药物治疗的较高概率相关的唯一变量是身体活动增加（每周代谢当量任务（MET）小时数>40 与<20；优势比（OR），1.65；95%置信区间（CI），1.08 - 2.50），并且在糖尿病患者中，低密度脂蛋白胆固醇（LDL - C）水平较高（≥155 mg/dL 与<155 mg/dL；OR，4.96；95%CI，1.29 - 19.10）。最能预测治疗强度的模型包括 LDL - C、糖尿病、高血压、吸烟和年龄（受试者工作特征曲线下面积（AUC），0.620；95%CI，0.574 - 0.666）。用于 CVD 一级预防的他汀类药物的处方和类型与当前指南中的适应症不相符。LDL - C 水平高的糖尿病患者和身体活动较多的个体接受高强度他汀类药物的概率更高。这些发现强调了他汀类药物处方的巨大变异性和不确定性。
