动脉粥样硬化性心血管疾病风险因素与他汀类药物处方模式之间的相关性
Correlation Between Atherosclerotic Cardiovascular Disease Risk Factors and Statin Prescribing Patterns.
作者信息
Ahmed Fahamina, Gross Shelby, Hammad Samah, Wilson Candice, Nawas George, Zeini Batool
机构信息
Clinical Assistant Professor, Division of Clinical and Administrative Sciences, Xavier University of Louisiana, New Orleans.
PGY-1 Pharmacy Resident, University Medical Center New Orleans.
出版信息
Am Health Drug Benefits. 2021 Dec;14(4):140-146.
BACKGROUND
In 2018, the American College of Cardiology and the American Heart Association published an updated guideline introducing risk-enhancing factors and promoting a highly individualized approach to the primary prevention of atherosclerotic cardiovascular disease (ASCVD). Although the benefit of the primary prevention of ASCVD is well-established within the literature, there are disparities that exist in statin prescribing patterns.
OBJECTIVE
To assess the use of optimal statin therapy for the primary prevention of ASCVD in high-risk populations, including patients with diabetes mellitus or with elevated low-density lipoprotein (LDL), according to the average number of ASCVD risk factors.
METHODS
This single-center, retrospective chart review was conducted between January 2015 and November 2018 at a family medicine clinic. This study included 262 patients who were eligible for statin therapy based on the presence of diabetes, which was defined as an A level of ≥6.5% or an LDL level of ≥190 mg/dL. The primary outcome was the mean number of risk factors between these 2 groups of interest. These 2 groups were further classified by their 10-year ASCVD risk into 2 subgroups-patients with an ASCVD risk of ≥7.5% and patients with an ASCVD risk of <7.5%.
RESULTS
The subgroup with the highest average number of cardiovascular risk factors was patients with diabetes and an ASCVD risk of ≥7.5%. The mean number of risk factors for that group versus the group with an LDL level of ≥190 mg/dL and an ASCVD risk of ≥7.5% was nonsignificant, but the prescribing patterns for the 2 groups were different. Only 53.3% of patients in the diabetes group with an ASCVD risk of ≥7.5% were receiving a high-intensity statin, despite their increased number of risk factors. The difference in statin prescribing patterns between the diabetes group and the elevated LDL group was significant, at 70.6% versus 50%, respectively ( = .002).
CONCLUSION
Patients with diabetes were more likely to be prescribed a statin than patients with an LDL level of ≥190 mg/dL. However, no significant difference was seen in optimal statin therapies between the 2 groups. Future research is warranted to identify the barriers to optimal statin therapy and to implement methods to improve statin use for the primary prevention of ASCVD in patients who are at significant risk.
背景
2018年，美国心脏病学会和美国心脏协会发布了一份更新指南，引入了风险增强因素，并提倡采用高度个体化的方法进行动脉粥样硬化性心血管疾病（ASCVD）的一级预防。尽管ASCVD一级预防的益处已在文献中得到充分证实，但他汀类药物的处方模式仍存在差异。
目的
根据ASCVD风险因素的平均数量，评估高危人群（包括糖尿病患者或低密度脂蛋白（LDL）升高的患者）中用于ASCVD一级预防的最佳他汀类药物治疗的使用情况。
方法
2015年1月至2018年11月期间，在一家家庭医学诊所进行了这项单中心回顾性病历审查。本研究纳入了262例符合他汀类药物治疗条件的患者，这些患者基于糖尿病的存在，糖尿病定义为糖化血红蛋白（A1C）水平≥6.5%或LDL水平≥190mg/dL。主要结局是这两组感兴趣人群之间的风险因素平均数量。这两组根据其10年ASCVD风险进一步分为两个亚组——ASCVD风险≥7.5%的患者和ASCVD风险<7.5%的患者。
结果
心血管风险因素平均数量最高的亚组是糖尿病患者且ASCVD风险≥7.5%。该组与LDL水平≥190mg/dL且ASCVD风险≥7.5%的组之间的风险因素平均数量无显著差异，但两组的处方模式不同。在ASCVD风险≥7.5%的糖尿病组中，只有53.3%的患者接受高强度他汀类药物治疗，尽管他们的风险因素数量增加。糖尿病组和LDL升高组之间他汀类药物处方模式的差异显著，分别为70.6%和50%（P = 0.002）。
结论
糖尿病患者比LDL水平≥190mg/dL的患者更有可能被处方他汀类药物。然而，两组之间在最佳他汀类药物治疗方面未观察到显著差异。有必要进行未来研究，以确定最佳他汀类药物治疗的障碍，并实施方法来改善他汀类药物在有显著风险患者中用于ASCVD一级预防的使用情况。
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