Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Academic Teaching Hospital, University of Cologne, Cologne, Germany.
Certara, Evidence and Access (Previously-Analytica Laser), London, UK.
Adv Ther. 2021 May;38(5):2532-2541. doi: 10.1007/s12325-021-01697-8. Epub 2021 Apr 8.
Patients with a history of myocardial infarction (MI) are at very high risk of subsequent cardiovascular events. This study evaluated the association of treatment intensity and adherence to lipid-lowering therapies (LLT) with major adverse cardiovascular events (MACE) among post-MI patients in Germany.
We carried out a retrospective cohort study using German health claims data (2010-2015). We included patients ≥ 18 years, with a history of MI and who started an LLT (statin and/or ezetimibe), between 2011 and 2013. The follow-up period started 1 year after the second LLT prescription and continued until MACE, all-cause death or December 31, 2015, whichever occurred first. Treatment intensity was classified based on expected low-density lipoprotein cholesterol reduction; adherence was measured by the proportion of days covered using prescription data. A combined adherence-adjusted intensity variable was created by multiplying intensity and adherence. We used Cox proportional hazards models to control for age, sex, Charlson Comorbidity Index and other cardiovascular risk factors at baseline.
A total of 14,944 patients were included. Mean age was 66.7 (SD = 13.0) years; 68.7% of patients were men. Each 10% increase in treatment intensity, adherence, or adherence-adjusted intensity was associated with a decrease in the risk of MACE of 17% (HR = 0.83, 95% CI 0.79-0.87), 5% (HR = 0.95, 95% CI 0.94-0.97), and 14% (HR = 0.86, 95% CI 0.83-0.90), respectively.
Higher treatment intensity and/or adherence of LLT was associated with significantly lower risk of MACE in post-MI patients. Strategies to tailor intensity to patient profiles and improve adherence could reduce the risk of cardiovascular events.
心肌梗死（MI）病史患者发生后续心血管事件的风险极高。本研究评估了德国 MI 后患者降脂治疗（LLT）的治疗强度和依从性与主要不良心血管事件（MACE）之间的关联。
我们使用德国健康索赔数据（2010-2015 年）进行了一项回顾性队列研究。我们纳入了年龄≥18 岁、有 MI 病史且在 2011 年至 2013 年间开始接受 LLT（他汀类药物和/或依泽替米贝）治疗的患者。随访期从第二次 LLT 处方后 1 年开始，持续至 MACE、全因死亡或 2015 年 12 月 31 日，以先发生者为准。治疗强度根据预期的低密度脂蛋白胆固醇降低水平进行分类；依从性通过使用处方数据测量的覆盖天数来衡量。通过将强度和依从性相乘，创建了一个调整后的依从性强度综合变量。我们使用 Cox 比例风险模型控制了基线时的年龄、性别、Charlson 合并症指数和其他心血管危险因素。
共纳入 14944 名患者。平均年龄为 66.7（标准差=13.0）岁；68.7%的患者为男性。治疗强度、依从性或调整后的依从性每增加 10%，MACE 的风险分别降低 17%（风险比[HR]=0.83，95%置信区间[CI]0.79-0.87）、5%（HR=0.95，95%CI 0.94-0.97）和 14%（HR=0.86，95%CI 0.83-0.90）。
较高的 LLT 治疗强度和/或依从性与 MI 后患者的 MACE 风险显著降低相关。针对患者特征调整强度和提高依从性的策略可能会降低心血管事件的风险。
