降脂治疗强度和依从性对近期心肌梗死患者心血管结局的影响：一项瑞典基于登记的研究。

Effects of lipid-lowering treatment intensity and adherence on cardiovascular outcomes in patients with a recent myocardial infarction: a Swedish register-based study.

机构信息

Department of Medical Sciences, Uppsala University, Uppsala, Sweden.

Amgen (Europe) GmbH, Suurstoffi 22, Rotkreuz, Switzerland.

出版信息

Ups J Med Sci. 2022 May 4;127. doi: 10.48101/ujms.v127.8296. eCollection 2022.

BACKGROUND

Oral lipid-lowering treatment (LLT) is the standard of care for patients with cardiovascular disease (CVD). However, insufficient treatment intensity and poor adherence can lead to suboptimal treatment benefit, rendering patients at increased risk of CVD.

AIMS

The objective of this study was to evaluate trends in LLT intensity and adherence in Sweden over time, and their association with major adverse cardiovascular events (MACE) after recent myocardial infarction (MI), and also to assess the impact of transition from secondary to primary care on intensity and adherence.

METHODS AND RESULTS

This retrospective observational cohort study used data from Swedish nationwide patient registers and included patients on LLT after an MI in the years 2010-2016 ( = 50,298; mean age, 68 years; 69% men). LLT intensity was evaluated over time (overall, for 2010-2013 and for 2014-2016) as the proportion of patients prescribed low-, moderate-, and high-intensity LLT. Adherence was assessed as the proportion of days covered. A combined measure of intensity and adherence was also considered. Differences in treatment patterns and MACE were assessed. Initiation of high-intensity LLT increased over the two time periods studied (2010-2013, 32%; 2014-2016, 91%). Adherence varied by LLT intensity and was highest in patients receiving high-intensity LLT (>80%), especially during the first time period. Little change in treatment intensity or the combined measure of intensity and adherence was observed after transition to primary care. There was a significant association between the combined measure of intensity and adherence and MACE reduction (hazard ratio [95% confidence interval] per 10% increase in the combined measure: 0.84 [0.82-0.86]; < 0.01).

CONCLUSION

The proportion of post-MI patients with high LLT intensity and adherence has increased in recent years, with little change after transfer from specialist to primary care. The combination of LLT intensity and adherence is important for preventing future cardiovascular events.

背景

口服降脂治疗（LLT）是心血管疾病（CVD）患者的标准治疗方法。然而，治疗强度不足和依从性差可能导致治疗效果不佳，使患者面临更高的 CVD 风险。

目的

本研究旨在评估瑞典 LLT 强度和依从性随时间的变化趋势，及其与近期心肌梗死（MI）后主要不良心血管事件（MACE）的关系，并评估从二级医疗向初级医疗过渡对强度和依从性的影响。

方法和结果

这是一项使用瑞典全国患者登记处数据的回顾性观察性队列研究，纳入了 2010-2016 年期间接受 MI 后 LLT 的患者（=50298；平均年龄 68 岁；69%为男性）。评估了随时间推移的 LLT 强度（总体、2010-2013 年和 2014-2016 年），即接受低、中、高强度 LLT 的患者比例。依从性评估为覆盖率天数。还考虑了强度和依从性的综合衡量标准。评估了治疗模式和 MACE 的差异。在研究的两个时间段内，高强度 LLT 的起始率均有所增加（2010-2013 年，32%；2014-2016 年，91%）。依从性随 LLT 强度的变化而变化，接受高强度 LLT 的患者（>80%）的依从性最高，尤其是在第一个时间段。向初级医疗过渡后，治疗强度或强度和依从性的综合衡量标准变化不大。强度和依从性的综合衡量标准与 MACE 减少之间存在显著相关性（每增加 10%的综合衡量标准，风险比[95%置信区间]：0.84[0.82-0.86]；<0.01）。