Lemaitre R N, Furberg C D, Newman A B, Hulley S B, Gordon D J, Gottdiener J S, McDonald R H, Psaty B M
Department of Medicine, University of Washington, Seattle, USA.
Arch Intern Med. 1998 Sep 14;158(16):1761-8. doi: 10.1001/archinte.158.16.1761.
To describe recent temporal patterns of cholesterol-lowering medication use and the characteristics that may have influenced the initiation of cholesterol-lowering therapy among those aged 65 years or older.
A cohort of 5201 adults 65 years or older were examined annually between June 1989 and May 1996. We added 687 African American adults to the cohort in 1992-1993. We measured blood lipid levels at baseline and for the original cohort in the third year of follow-up. We assessed the use of cholesterol-lowering drugs at each visit.
The prevalence of cholesterol-lowering drug use in 1989-1990 was 4.5% among the men and 5.9% among the women; these figures increased over the next 6 years to 8.1% and 10.0%, respectively, in 1995-1996. There was a 4-fold increase in the use of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors during the 6 years of follow-up, from 1.9% of all participants in 1989-1990 to 7.5% in 1995-1996. The use of bile acid sequestrants, nicotinic acid, and probucol declined from initial levels of less than 1% each. Among the participants who were untreated in 1989-1990, but eligible for cholesterol-lowering therapy after a trial of dietary therapy according to the 1993 guidelines of the National Cholesterol Education Panel, less than 20% initiated drug therapy in the 6 years of follow-up, even among subjects with a history of coronary heart disease. Among participants untreated at baseline but eligible for either cholesterol-lowering therapy or dietary therapy, initiation of cholesterol-lowering drug therapy was directly associated with total cholesterol levels, hypertension, and a history of coronary heart disease, and was inversely related to age, high-density lipoprotein cholesterol levels, and difficulties with activities of daily living. Other characteristics that form the basis of the 1993 National Cholesterol Education Panel guidelines-diabetes, smoking, family history of premature coronary heart disease, and total number of risk factors-were not associated with the initiation of cholesterol-lowering drug therapy.
Given the clinical trial evidence for benefit, those aged 65 to 75 years and with prior coronary heart disease appeared undertreated with cholesterol-lowering drug therapy.
描述近期65岁及以上老年人使用降胆固醇药物的时间模式，以及可能影响降胆固醇治疗起始的特征。
1989年6月至1996年5月期间，每年对5201名65岁及以上的成年人进行检查。1992 - 1993年，我们将687名非裔美国成年人纳入该队列。我们在基线时以及对原队列随访的第三年测量血脂水平。每次就诊时评估降胆固醇药物的使用情况。
1989 - 1990年，男性使用降胆固醇药物的患病率为4.5%，女性为5.9%；在接下来的6年中，这些数字分别增至1995 - 1996年的8.1%和10.0%。在6年的随访期间，3 - 羟基 - 3 - 甲基戊二酰辅酶A（HMG - CoA）还原酶抑制剂的使用增加了4倍，从1989 - 1990年所有参与者的1.9%增至1995 - 1996年的7.5%。胆汁酸螯合剂、烟酸和普罗布考的使用从各自初始低于1%的水平下降。在1989 - 1990年未接受治疗但根据1993年美国国家胆固醇教育计划指南经饮食治疗试验后符合降胆固醇治疗条件的参与者中，在6年的随访期间，不到20%的人开始药物治疗，即使在有冠心病病史的受试者中也是如此。在基线时未接受治疗但符合降胆固醇治疗或饮食治疗条件的参与者中，开始降胆固醇药物治疗与总胆固醇水平、高血压和冠心病病史直接相关，与年龄、高密度脂蛋白胆固醇水平及日常生活活动困难程度呈负相关。构成1993年美国国家胆固醇教育计划指南基础的其他特征——糖尿病、吸烟、早发冠心病家族史及危险因素总数——与降胆固醇药物治疗的起始无关。
鉴于临床试验显示出获益证据，65至75岁且既往有冠心病的人群似乎未充分接受降胆固醇药物治疗。
