Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.
Palo Alto Medical Foundation Research Institute, Palo Alto, California, USA.
J Am Geriatr Soc. 2021 Apr;69(4):979-985. doi: 10.1111/jgs.16975. Epub 2021 Jan 7.
BACKGROUND/OBJECTIVES: Older adults (>75 years of age) represent two-thirds of atherosclerotic cardiovascular disease (ASCVD) deaths. The 2013 and 2018 American multi-society cholesterol guidelines recommend using at least moderate intensity statins for older adults with ASCVD. We examined annual trends and statin prescribing patterns in a multiethnic population of older adults with ASCVD.
Retrospective longitudinal study using electronic health record (EHR) data from 2007 to 2018.
A large multi-specialty health system in Northern California.
A total of 24,651 adults older than 75 years with ASCVD.
Statin prescriptions for older adults with known ASCVD were trended over time. Multivariable regression models were used to identify predictors of statin prescription (logistic) after controlling for relevant demographic and clinical factors.
The study cohort included 24,651 patients older than 75 years; 48% were women. Although prescriptions for moderate/high intensity statins increased over time for adults over 75, fewer than half of the patients (45%) received moderate/high intensity statins in 2018. Women (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.74, 0.80), patients who had heart failure (OR = 0.69; 95% CI = 0.65, 0.74), those with dementia (OR = 0.88; 95% CI = 0.82, 0.95) and patients who were underweight (OR = 0.64; 95% CI = 0.57, 0.73) were less likely to receive moderate/high intensity statins.
Despite increasing prescription rates between 2007 and 2018, guideline-recommended statins remained underused in older adults with ASCVD, with more pronounced disparities among women and those with certain comorbidities. Future studies are warranted to examine reasons for statin underuse in older adults with ASCVD.
背景/目的：老年人（>75 岁）占动脉粥样硬化性心血管疾病（ASCVD）死亡人数的三分之二。2013 年和 2018 年美国多学会胆固醇指南建议对患有 ASCVD 的老年人使用至少中等强度的他汀类药物。我们在一个多民族的 ASCVD 老年人群中检查了年度趋势和他汀类药物的处方模式。
使用 2007 年至 2018 年的电子健康记录（EHR）数据进行回顾性纵向研究。
北加州的一个大型多专业医疗系统。
共有 24651 名年龄大于 75 岁的 ASCVD 成人。
对已知 ASCVD 的老年人的他汀类药物处方随时间的趋势进行了研究。在控制了相关的人口统计学和临床因素后，使用多变量回归模型来确定他汀类药物处方（逻辑）的预测因素。
研究队列包括 24651 名年龄大于 75 岁的患者；48%为女性。尽管 75 岁以上成年人的中/高强度他汀类药物处方随着时间的推移而增加，但在 2018 年，只有不到一半的患者（45%）接受了中/高强度他汀类药物治疗。女性（比值比（OR）=0.77；95%置信区间（CI）=0.74，0.80）、心力衰竭患者（OR=0.69；95%CI=0.65，0.74）、痴呆患者（OR=0.88；95%CI=0.82，0.95）和体重不足的患者（OR=0.64；95%CI=0.57，0.73）接受中/高强度他汀类药物治疗的可能性较小。
尽管 2007 年至 2018 年之间处方率有所增加，但 ASCVD 老年患者仍未充分使用推荐的他汀类药物，女性和某些合并症患者的差异更为明显。需要进一步研究以检查 ASCVD 老年患者他汀类药物使用不足的原因。
