高齢患者のスタチン治療の長期持続性
Joshua S Benner1, Robert J Glynn, Helen Mogun
1Division of Pharmacoepidemiology & Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Ave, Suite 341, Boston, MA 02115, USA. jbenner@post.harvard.edu
JAMA
|July 23, 2002
まとめ
高齢の患者では,特に最初の6ヶ月以内に,長期スタチン治療の持続性が著しく低下します. 介入は,高リスクグループにとって,コレステロールを低下させる薬の遵守を改善するために非常に重要です.
科学分野:
- ゲリアトリック・メディシン (老年医学)
- 心血管薬理学について
- 医療サービス 研究 医療サービス
背景:
- 3-ヒドロキシ-3-メチルグルタリル共酵素A還元酵素阻害剤 (スタチン) 療法に長期的に従うに関するデータは限られている.
- 以前の研究では,しばしば短い観察期間または非代表的な患者集団が含まれていました.
研究 の 目的:
- スタチン療法による長期的持続パターンを調査する.
- 米国の高齢者集団におけるスタチンの服用習慣の予測要因を特定する.
主な方法:
- ニュージャージー州で34,501人の高齢者 (≥65歳) を対象とした遡及的なコホート研究.
- 薬の補充データ (補充された日の比率 - PDC) を時間とともに分析する.
- サブオプティマルの持続性 (PDC <80%) の予測要因を特定するために使用される一般化された線形モデル.
主要な成果:
- 平均PDCは,時間とともに著しく低下し,120ヶ月で42%に達しました.
- 5年後にPDCを少なくとも80%維持したのは25%の患者だけでした.
- 持続性の低い予測要因には,非白人人種,低所得者,高齢者,併発性疾患,うつ病,認知症,冠動脈疾患などが含まれている.
結論:
- スタチンの持続性は,高齢者において,特に初期治療段階において,著しく低下します.
- 最近の治療開始では,持続性がわずかに改善されたが,全体的に長期使用は低いままである.
- スタチンの服用率を高めるには,早期の介入と高リスク患者の標的型支援が必要である.
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