在真实世界的一级预防队列中，指南指导的他汀类药物处方对不同种族心血管结局的影响。
Impact of Guideline-Directed Statin Prescriptions on Cardiovascular Outcomes by Race in a Real-World Primary Prevention Cohort.
作者信息
Hay Eli J, Zhu Jianhui, Thoma Floyd W, Marroquin Oscar C, Muluk Pallavi, Countouris Malamo E, Smith Anson J, Saeed Gul J, Al Rifai Mahmoud, Johnson Amber E, Saeed Anum, Mulukutla Suresh R
机构信息
University of Pittsburgh Medical Center (UPMC) Department of Medicine, Division of Cardiology, Pittsburgh, Pennsylvania, USA.
UPMC Heart and Vascular Institute, Department of Medicine, Division of Cardiology, Pittsburgh, Pennsylvania, USA.
出版信息
JACC Adv. 2024 Sep 10;3(10):101231. doi: 10.1016/j.jacadv.2024.101231. eCollection 2024 Oct.
BACKGROUND
Data on real-world statin prescription in large, private health care networks and impacts on primary prevention of atherosclerotic cardiovascular disease (ASCVD) outcomes across race are scarce.
OBJECTIVES
The purpose of this study was to investigate the impact of statin prescription on ASCVD outcomes within and across race in a large, nongovernmental health care system.
METHODS
Statin prescription in Black and White patients without ASCVD was evaluated (2013-2019). Guideline-directed statin intensity was defined as at least "moderate" for intermediate and high-risk patients. Statin prescription at index and ASCVD outcomes at follow-up (myocardial infarction/revascularization, stroke, mortality) were assessed via electronic health care records using International Classification of Diseases-9 and 10 codes. Cox regression models, adjusted for CVD risk factors, were used to calculate HRs for association between statin prescription and incident ASCVD events across race.
RESULTS
Among 270,079 patients, 7.6% (n = 20,477) and 92.4% (n = 249,602) identified as Black and White, respectively. Significantly fewer Black patients were prescribed statin therapy than White patients (13.6% vs 19.0%; < 0.001). At a mean follow-up of 6 years, patients with "no statin" prescription vs guideline-directed statin intensity showed increased ASCVD in Black patients (HR: 1.40 [95% CI: 1.05-1.86]), and White patients (HR: 1.32 [95% CI: 1.21-1.45]; < 0.05) and all-cause mortality. Intermediate and high-risk Black patients faced a 17% higher risk of mortality compared to White patients. However, the interaction between race and statin prescription was not a significant predictor of incident ASCVD events.
CONCLUSIONS
Statins remain underprescribed. Although Black patients received proportionally less statin prescription than White patients, this was not associated with higher risk of mortality in Black patients.
背景
关于大型私立医疗保健网络中他汀类药物的实际处方数据，以及其对不同种族动脉粥样硬化性心血管疾病（ASCVD）一级预防结果的影响，目前尚少。
目的
本研究旨在调查在一个大型非政府医疗保健系统中，他汀类药物处方对不同种族及种族内部ASCVD结果的影响。
方法
对无ASCVD的黑人和白人患者的他汀类药物处方情况进行评估（2013 - 2019年）。指南指导的他汀类药物强度定义为中高危患者至少为“中等”强度。通过使用国际疾病分类第9版和第10版编码的电子医疗记录，评估索引时的他汀类药物处方情况以及随访时的ASCVD结果（心肌梗死/血运重建、中风、死亡率）。采用经心血管疾病风险因素调整的Cox回归模型，计算不同种族中他汀类药物处方与新发ASCVD事件之间关联的风险比（HR）。
结果
在270,079名患者中，分别有7.6%（n = 20,477）和92.4%（n = 249,602）被认定为黑人和白人。接受他汀类药物治疗的黑人患者明显少于白人患者（13.6%对19.0%；P < 0.001）。在平均6年的随访中，与指南指导的他汀类药物强度相比，“未服用他汀类药物”处方的患者中，黑人患者的ASCVD增加（HR：1.40 [95% CI：1.05 - 1.86]），白人患者的ASCVD也增加（HR：1.32 [95% CI：1.21 - 1.45]；P < 0.05），且全因死亡率增加。中高危黑人患者的死亡风险比白人患者高17%。然而，种族与他汀类药物处方之间的相互作用并非新发ASCVD事件的显著预测因素。
结论
他汀类药物的处方量仍然不足。尽管黑人患者接受他汀类药物处方的比例低于白人患者，但这与黑人患者较高的死亡风险并无关联。
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