Investigation and analysis of statins compliance differential effects on cardiovascular
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摘要:
目的探讨调查分析他汀类药物依从性差对心血管不良事件的影响。 方法选取我院2015年1月~2016年1月就诊的冠状动脉粥样硬化性心脏病、缺血性脑卒中、糖尿病、高血压等心脑血管疾病的患者1248例，根据诊疗规范原则，在坚持原发病治疗用药基础上，需要长期服用他汀类药物的1020例患者作为研究对象，对患者进行随访6个月。根据患者的依从性分为依从性好组（n=502）和依从性差组（n=518），对两组患者的心血管不良事件进行分析，并对心血管不良事件的发生率、发生时间、发病与停药（或间断用药）的时间、发病人群年龄段关系进行亚组分析。 结果依从性差组发生心血管不良事件发生率明显高于依从性好组（P < 0.05）；大于60岁的患者发生心血管不良事件比例明显高于小于60岁患者（P < 0.05）；发生时间大于1年的患者发生心血管不良事件比例明显高于小于1年的患者（P < 0.05）；病程大于5年的患者发生心血管不良事件比例明显高于小于5年的患者（P < 0.05）；间断用药大于1年的患者发生心血管不良事件比例明显高于小于1年的患者（P < 0.05）；Logistic多元回归分析年龄大于60岁，停药大于1年、发病大于5年及发生时间超过1年是发生他汀类药物依从性差的心血管不良事件的危险因素。 结论他汀类药物依从性差的患者更容易发生心血管不良事件，而且年龄大于60岁，停药大于1年、发病大于5年及发生时间超过1年是发生他汀类药物依从性差的心血管不良事件的危险因素。 Abstract:ObjectiveTo study the investigation and analysis of statins poor adherence to cardiovascular adverse events. MethodsFrom January 2015 to January 2016, We selected 1248 cases of patients of coronary atherosclerotic heart disease, ischemic stroke, cardiovascular disease such as diabetes, high blood pressure, blood in our hospital, according to the requirements of the diagnosis and treatment principle of long-term use of statins was 1020 patients as the research object, which adhered to the treatment of primary disease, and follow-up the patients, according to the patients compliance was good or bad into good compliance group (n=502) and poor compliance group (n=518), analyzed the relationship between with cardiovascular adverse events, incidence rate of cardiovascular adverse events occurring time, pathogenesis, drug (or continuous) discontinuation of time previously and ages. ResultsThe incidence of cardiovascular adverse events of poor compliance group was significantly higher than good compliance group, with statistical significance (P < 0.05); Proportion of adverse cardiovascular events in patients of more than 60 years old was significantly higher than with less than 60 patients, with statistical significance (P < 0.05); The proportion of adverse cardiovascular events in patients of time greater than 1 year was significantly higher than patients with less than 1 year, with statistical significance (P < 0.05); The proportion of adverse cardiovascular events in patients of duration more than 5 years was significantly higher than patients with less than 5 years, statistically significant (P < 0.05); The proportion of adverse cardiovascular events in patients of intermittent medication of patients more than 1 year was significantly higher than patients with less than 1 year, with statistical significance (P < 0.05); Logistic multivariate regression analysis was older than 60, withdrawal more than 1 year, more than 5 years and more than 1 year were occurring statins with poor compliance risk factors of cardiovascular adverse events. ConclusionStatins poor compliance of patients are more likely to happen in cardiovascular adverse events, and older than 60, withdrawal more than 1 year, more than 5 years and more than 1 year is occurring statins with poor compliance risk factors of cardiovascular adverse events. -
Key words:
- cardiovascular disease /
- statins /
- poor adherence /
- cardiovascular adverse events
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表 1 两组患者发生一级终点的心血管不良事件情况（n）
分组 一级终点事件 死亡 致命性心肌梗死 恶性心律失常 大面积脑梗塞 大量脑出血 发生率(%) 依从性好组（n=502） 8 5 6 8 5 6.4* 依从性差组（n=518） 35 37 38 35 33 34.4 *P < 0.05 vs依从性差组 
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表 2 两组患者发生二级终点的心血管不良事件情况（n）
分组 二级终点事件 非致命性心肌
梗死不稳定型
心绞痛非致死性
心力衰竭新发非致命性
心律脑血栓形成失
常支架内血栓发生率
(%)依从性好组（n=502） 5 6 8 6 8 6.6* 依从性差组（n=518） 35 35 36 38 36 34.7 *P < 0.05 vs依从性差组
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表 3 影响他汀类药物依从性差发生心血管不良事件的因素(n=358)
因素 发生率n（%） χ2值 P 年龄（岁） ≥60 259（72.3） 36.248 < 0.05 < 60 99（27.7） 发生时间（年） ≥1 218（60.9） 35.646 < 0.05 < 1 140（39.1） 病程（年） ≥5 245（68.4） 35.646 < 0.05 < 5 113（31.6） 间断用药（年） ≥1 215（60.1） 34.967 < 0.05 < 1 143（39.9）
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表 4 影响他汀类药物依从性差发生心血管不良事件Logistic多元分析
因素 回归系数 标准误 R Walds χ2 年龄≥60岁 6.102 3.982 3.579 12.201 发生时间≥1年 5.144 3.788 3.501 10.215 病程≥5年 4.087 3.691 3.996 7.199 间断用药≥1年 4.958 3.798 3.424 7.001
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