心肌梗死后开始使用非他汀类降脂药物的种族/民族和性别差异。
Race/ethnic and sex differences in the initiation of non-statin lipid-lowering medication following myocardial infarction.
机构信息
Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave South, RPHB 527C, Birmingham, AL 35294-0013, USA.
Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA; Informatics, Decision Enhancement, and Surveillance (IDEAS) 2.0 Center, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
出版信息
J Clin Lipidol. 2021 Sep-Oct;15(5):665-673. doi: 10.1016/j.jacl.2021.08.001. Epub 2021 Aug 10.
BACKGROUND
Adults with atherosclerotic cardiovascular disease (ASCVD) at very high-risk for recurrent events who have low-density lipoprotein cholesterol ≥ 70 mg/dL despite maximally-tolerated statin therapy are recommended to initiate ezetimibe or a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor.
OBJECTIVE
Compare the initiation of ezetimibe and a PCSK9 inhibitor after a myocardial infarction (MI) among very high-risk ASCVD patients by race/ethnicity and sex.
METHODS
We analyzed data from 374,786 adults ≥ 66 years of age with Medicare fee-for-service coverage who had an MI between July 1, 2015 and December 31, 2018, were not taking ezetimibe or a PCSK9 inhibitor, and had very high-risk ASCVD defined by the 2018 American Heart Association/American College of Cardiology multi-society cholesterol guideline. Pharmacy claims through December 31, 2018 were used to determine ezetimibe and PCSK9 inhibitor initiation.
RESULTS
Overall, 6980 (1.9%) beneficiaries initiated ezetimibe, and 1433 (0.4%) initiated a PCSK9 inhibitor. Adjusted hazard ratios (aHR) for ezetimibe initiation among non-Hispanic Black, Hispanic, and Asian versus non-Hispanic White beneficiaries were 0.77 (95% confidence interval [95%CI]: 0.70-0.86), 0.92 (95%CI: 0.76-1.11) and 0.73 (95%CI: 0.59-0.89), respectively. Compared to non-Hispanic White beneficiaries, the aHRs for PCSK9 inhibitor initiation were 0.63 (95%CI: 0.48-0.81) among non-Hispanic Black, 0.70 (95%CI: 0.43-1.13) among Hispanic, and 0.93 (95%CI: 0.62-1.39) among Asian beneficiaries. The aHRs for ezetimibe and PCSK9 inhibitor initiation comparing women to men were 1.11 (95%CI: 1.06-1.17) and 1.13 (95%CI: 1.01-1.25), respectively.
CONCLUSION
There are race/ethnic and sex disparities in the initiation of ezetimibe and a PCSK9 inhibitor following MI among very high-risk ASCVD patients.
背景
尽管最大耐受剂量的他汀类药物治疗后，低密度脂蛋白胆固醇仍≥70mg/dL 的患有 ASCVD 的极高危复发事件成人患者，建议起始依折麦布或前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂。
目的
按种族/民族和性别比较极高危 ASCVD 患者心肌梗死后起始依折麦布和 PCSK9 抑制剂的情况。
方法
我们分析了 2015 年 7 月 1 日至 2018 年 12 月 31 日期间年龄≥66 岁且有 Medicare 收费服务覆盖的 374786 例成年人的数据，这些患者在接受心肌梗死后未服用依折麦布或 PCSK9 抑制剂，且根据 2018 年美国心脏协会/美国心脏病学会多学会胆固醇指南被定义为极高危 ASCVD。使用截至 2018 年 12 月 31 日的药房索赔数据来确定依折麦布和 PCSK9 抑制剂的起始用药。
结果
总体而言，有 6980 例（1.9%）受惠者起始服用依折麦布，有 1433 例（0.4%）受惠者起始服用 PCSK9 抑制剂。与非西班牙裔白人受惠者相比，非西班牙裔黑人、西班牙裔和亚洲裔受惠者起始服用依折麦布的调整后的危险比（aHR）分别为 0.77（95%置信区间[95%CI]：0.70-0.86）、0.92（95%CI：0.76-1.11）和 0.73（95%CI：0.59-0.89）。与非西班牙裔白人受惠者相比，起始服用 PCSK9 抑制剂的 aHR 分别为非西班牙裔黑人受惠者的 0.63（95%CI：0.48-0.81）、西班牙裔受惠者的 0.70（95%CI：0.43-1.13）和亚洲裔受惠者的 0.93（95%CI：0.62-1.39）。与男性受惠者相比，女性受惠者起始服用依折麦布和 PCSK9 抑制剂的 aHR 分别为 1.11（95%CI：1.06-1.17）和 1.13（95%CI：1.01-1.25）。
结论
极高危 ASCVD 患者心肌梗死后，依折麦布和 PCSK9 抑制剂的起始用药存在种族/民族和性别差异。
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