Martín-Fernández Marta, González-González M Asunción, Pedrosa-Naudín M Aránzazu, Fernández-Lázaro Diego, Álvarez F Javier, Gutiérrez-Abejón Eduardo
Pharmacological Big Data Laboratory, Department of Cell Biology, Genetics, Histology and Pharmacology, Faculty of Medicine, University of Valladolid, 47003 Valladolid, Spain.
BioCritic, Group for Biomedical Research in Critical Care Medicine, 47003 Valladolid, Spain.
Pharmaceuticals (Basel). 2025 Apr 27;18(5):634. doi: 10.3390/ph18050634.
Cardiovascular disease (CVD) remains the leading cause of death worldwide, and the effectiveness of statin therapy is critically dependent on patient adherence and persistence. The aim of this study was to evaluate adherence and persistence in newly started and previously treated statin patients, with reference to cardiovascular prevention. A retrospective cohort study was conducted to assess adherence and persistence in newly started and previously treated statin patients. Patients aged 18 years or older with a statin claim from 1 January 2021 to 31 December 2023 were included. Adherence was defined as a Medication Possession Rate (MPR) of 80% or greater. Persistence was defined as the time between the index date and treatment discontinuation. Binary logistic regression and Cox proportional hazard regression were used to analyze factors influencing adherence and persistence, respectively. Kaplan-Meier survival analysis was used to compare persistence between both cohorts. Of the 411,956 patients on statins, 81.21% were adherent, with higher rates in the previously treated statin patients (83.05% vs. 73.73%; = 0.001). Statin persistence decreased from 92.65% at 3 months to 78.28% at 12 months, with higher persistence rates in previously treated statin patients. Previously treated statin patients were more likely to be adherent (AOR: 1.29) and persistent (AHR: 2.08) than those newly started on statins. In secondary prevention patients, adherence was higher in the previously treated cohort (88.09% vs. 79.77%; = 0.001) than in the newly started cohort (80.52% vs. 71.38%; = 0.001). Similar results were observed for persistence; 82.97% vs. 81.65% ( = 0.001) and 65.08% vs. 61.57% ( = 0.001), respectively. : Adherence and persistence to statins were higher in previously treated patients than in newly started patients, especially for secondary cardiovascular prevention. New strategies are needed to improve medication adherence and persistence in patients with poor cardiovascular prognosis.
心血管疾病（CVD）仍然是全球主要的死亡原因，他汀类药物治疗的有效性严重依赖于患者的依从性和持续性。本研究的目的是评估新开始使用他汀类药物的患者和既往接受过治疗的他汀类药物患者在心血管预防方面的依从性和持续性。进行了一项回顾性队列研究，以评估新开始使用他汀类药物的患者和既往接受过治疗的他汀类药物患者的依从性和持续性。纳入了2021年1月1日至2023年12月31日有他汀类药物报销记录的18岁及以上患者。依从性定义为药物持有率（MPR）达到80%或更高。持续性定义为索引日期与治疗中断之间的时间。分别使用二元逻辑回归和Cox比例风险回归分析影响依从性和持续性的因素。使用Kaplan-Meier生存分析比较两组之间的持续性。在411956名服用他汀类药物的患者中，81.21%的患者依从性良好，既往接受过治疗的他汀类药物患者的依从率更高（83.05%对73.73%；P = 0.001）。他汀类药物的持续性从3个月时的92.65%下降到12个月时的78.28%，既往接受过治疗的他汀类药物患者的持续性更高。既往接受过治疗的他汀类药物患者比新开始使用他汀类药物的患者更有可能依从（调整后比值比：1.29）和持续（调整后风险比：2.08）。在二级预防患者中，既往接受过治疗的队列的依从性高于新开始使用他汀类药物的队列（88.09%对79.77%；P = 0.001）（80.52%对71.38%；P = 0.001）。持续性也观察到类似结果；分别为82.97%对81.65%（P = 0.001）和65.08%对61.57%（P = 0.001）。结论：既往接受过治疗的患者对他汀类药物的依从性和持续性高于新开始使用他汀类药物的患者，尤其是在二级心血管预防方面。需要新的策略来提高心血管预后较差患者的药物依从性和持续性。
