Division of Endocrinology, Brigham and Women's Hospital, Boston, Massachusetts.
Pharmacy Department, Tufts Medical Center, Boston, Massachusetts.
JAMA Netw Open. 2023 Feb 1;6(2):e231047. doi: 10.1001/jamanetworkopen.2023.1047.
Many patients at high cardiovascular risk-women more commonly than men-are not receiving statins. Anecdotally, it is common for patients to not accept statin therapy recommendations by their clinicians. However, population-based data on nonacceptance of statin therapy by patients are lacking.
To evaluate sex disparities in nonacceptance of statin therapy and assess their association with low-density lipoprotein (LDL) cholesterol control.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted from January 1, 2019, to December 31, 2022, of statin-naive patients with atherosclerotic cardiovascular disease, diabetes, or LDL cholesterol levels of 190 mg/dL (to convert to millimoles per liter, multiply by 0.0259) or more who were treated at Mass General Brigham between January 1, 2000, and December 31, 2018.
Recommendation of statin therapy by the patient's clinician, ascertained from the combination of electronic health record prescription data and natural language processing of electronic clinician notes.
Time to achieve an LDL cholesterol level of less than 100 mg/dL.
Of 24 212 study patients (mean [SD] age, 58.8 [13.0] years; 12 294 women [50.8%]), 5308 (21.9%) did not accept the initial recommendation of statin therapy. Nonacceptance of statin therapy was more common among women than men (24.1% [2957 of 12 294] vs 19.7% [2351 of 11 918]; P < .001) and was similarly higher in every subgroup in the analysis stratified by comorbidities. In multivariable analysis, female sex was associated with lower odds of statin therapy acceptance (0.82 [95% CI, 0.78-0.88]). Patients who did vs did not accept a statin therapy recommendation achieved an LDL cholesterol level of less than 100 mg/dL over a median of 1.5 years (IQR, 0.4-5.5 years) vs 4.4 years (IQR, 1.3-11.1 years) (P < .001). In a multivariable analysis adjusted for demographic characteristics and comorbidities, nonacceptance of statin therapy was associated with a longer time to achieve an LDL cholesterol level of less than 100 mg/dL (hazard ratio, 0.57 [95% CI, 0.55-0.60]).
This cohort study suggests that nonacceptance of a statin therapy recommendation was common among patients at high cardiovascular risk and was particularly common among women. It was associated with significantly higher LDL cholesterol levels, potentially increasing the risk for cardiovascular events. Further research is needed to understand the reasons for nonacceptance of statin therapy by patients and to develop methods to ensure that all patients receive optimal therapy in accordance with their preferences and priorities.
许多处于高心血管风险的患者 - 女性比男性更为常见 - 并未接受他汀类药物治疗。据推测，患者通常不接受临床医生推荐的他汀类药物治疗。然而，缺乏关于患者不接受他汀类药物治疗的基于人群的数据。
评估性别在他汀类药物治疗不接受方面的差异，并评估其与低密度脂蛋白（LDL）胆固醇控制的关系。
设计、设置和参与者：这是一项回顾性队列研究，于 2019 年 1 月 1 日至 2022 年 12 月 31 日期间对有动脉粥样硬化性心血管疾病、糖尿病或 LDL 胆固醇水平为 190 mg/dL（换算为毫摩尔/升，乘以 0.0259）或更高的他汀类药物初治患者进行，这些患者在 2000 年 1 月 1 日至 2018 年 12 月 31 日期间在 Mass General Brigham 接受治疗。
患者临床医生推荐他汀类药物治疗，通过电子健康记录处方数据和电子临床医生笔记的自然语言处理来确定。
达到 LDL 胆固醇水平低于 100 mg/dL 的时间。
在 24212 名研究患者中（平均[标准差]年龄为 58.8[13.0]岁；12294 名女性[50.8%]），有 5308 名（21.9%）患者未接受初始他汀类药物治疗建议。与男性相比，女性更不接受他汀类药物治疗（24.1%[2957 名 12294 名] vs 19.7%[2351 名 11918 名]；P<0.001），并且在按合并症分层的分析的每个亚组中，这种情况同样更高。多变量分析显示，女性性别与他汀类药物治疗接受率较低相关（0.82[95%CI，0.78-0.88]）。与接受他汀类药物治疗建议的患者相比，不接受他汀类药物治疗建议的患者达到 LDL 胆固醇水平低于 100 mg/dL 的中位数时间为 1.5 年（IQR，0.4-5.5 年）vs 4.4 年（IQR，1.3-11.1 年）（P<0.001）。在调整人口统计学特征和合并症的多变量分析中，不接受他汀类药物治疗与达到 LDL 胆固醇水平低于 100 mg/dL 的时间延长相关（风险比，0.57[95%CI，0.55-0.60]）。
这项队列研究表明，高危心血管风险患者普遍不接受他汀类药物治疗建议，女性尤其常见。它与 LDL 胆固醇水平显著升高有关，可能增加心血管事件的风险。需要进一步研究以了解患者不接受他汀类药物治疗的原因，并开发方法以确保所有患者按照其偏好和优先事项接受最佳治疗。
