Patterns of statin use and long‐term adherence and persistence among older adults with diabetes

• Published in: Journal of diabetes 2018-09, Vol.10 (9), p.699-707
• Main Authors: Ofori‐Asenso, Richard, Ilomäki, Jenni, Tacey, Mark, Zomer, Ella, Curtis, Andrea J., Bell, J. Simon, Zoungas, Sophia, Liew, Danny
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Australia; Cardiovascular Diseases - prevention & control; Diabetes; Diabetes Mellitus - drug therapy; discontinuation; Drug Utilization - statistics & numerical data; Drug Utilization - trends; Female; Follow-Up Studies; Gender differences; geriatrics; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Medication Adherence - statistics & numerical data; non‐adherence; Older people; Retrospective Studies; Statins; Time Factors; 不依从; 他汀类药物; 停药; 糖尿病; 老年病
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12769

Background Statins reduce the risk of cardiovascular disease in patients with diabetes. This study examined the prevalence of statin use and assessed long‐term adherence and persistence among people aged ≥65 years with diabetes. Methods Pharmaceutical Benefits Scheme data covering a 10% random sample of the Australian population were analyzed. Among older adults with diabetes, the yearly prevalence of statin use was compared via Poisson regression modeling using 2006 as the reference year. A cohort of 7400 new statin users (mean age 72.9 years; 46.2% female) was followed longitudinally. Adherence was assessed via the proportion of days covered (PDC). Statin discontinuation was defined as the first ≥90 days without statin coverage. Results The prevalence of statin use increased from 52.0% in 2006 to 71.2% in 2016 (age and sex‐adjusted rate ratio 1.37; 95% confidence interval 1.33–1.41). No gender differences in statin use were observed, but the likelihood of being dispensed statin decreased with increasing age. Among the longitudinal cohort, the proportion adherent (PDC ≥0.80) decreased from 54.0% at 6 months to 37.0% at 9 years. Over a mean follow‐up of 4.9 years, 66.8% discontinued, and the likelihood of stopping statin medication within the first year was 42.7%. No age or gender differences in statin discontinuation were evident. Conclusions Statin use has increased among older adults with diabetes. However, adherence is low and discontinuation is high. Further investigations into the factors associated with non‐adherence or discontinuation of statins are important so as to optimize statin use towards achieving the intended cardiovascular benefits among older people with diabetes. 摘要 背景 他汀类药物可以降低糖尿病患者的心血管疾病风险。本研究在年龄≥ 65岁的糖尿病人群中调查了他汀类药物的使用率,  并且评估了长期依从性与持久性。 方法 对药物补贴计划数据进行分析,  涵盖了按照10%比例随机抽样的澳大利亚人口。在老年糖尿病患者中,  使用泊松回归模型,  将2006年作为参考年比较他汀类药物的年使用率。对7400名新使用他汀类药物的患者(平均年龄为72.9岁;46.2%为女性)队列进行了纵向随访。使用覆盖天数比例(proportion of days covered,  PDC)来评估依从性。停用他汀类药物的定义为首次≥ 90天内都没有使用他汀类药物。 结果 他汀类药物的使用率从2006年的52.0%增加到了2016年的71.2%(校正年龄与性别后的比例为1.37;95%置信区间为1.33‐1.41)。没有观察到他汀类药物的使用有性别差异,  但是随着年龄的增加患者使用他汀类药物治疗的可能性在不断地降低。在纵向队列中,  坚持治疗的患者比例(PDC ≥ 0.80)从第6个月时的54.0%下降到第9年时的37.0%。在平均4.9年的随访期间,  有66.8%的患者停药,  并且在第一年内停用他汀类药物治疗的可能性为42.7%。在停用他汀类药物治疗的患者中没有明显的年龄或性别之间的差异。 结论 在老年糖尿病患者中他汀类药物的使用率在不断地上升。然而,  依从性却很低,  并且停药率也很高。在老年糖尿病患者中为了优化他汀类药物的使用以达到预期的心血管获益,  需要针对他汀类药物使用过程中的不依从或停药相关的因素进行进一步研究。 Highlights Over the past 10 years, there has been increased use of statins among Australians aged ≥65