| Summary: | 碩士 === 國立成功大學 === 臨床藥學研究所 === 96 === Background:
Until now, cardiovascular disease is still one of the major causes of death. To prevent cardiovascular disease has become an important issue. Many studies have proved that statins can not only effectively control hyperlipidemia but also help to prevent cardiovascular disease. However more and more studies have shown that the adherence of statins and cardiovascular disease prevention is highly related. The mortality of patient with low compliance is higher by 8 % than that of patients with high compliance. There are a lot of factors which may affect compliance, including the knowledge about statins, income, and the interaction between health care provider and patients. In Taiwan, statins has accouted for large part of National Health Insurance expenditure. Therefore, it is important to investagate the association between adherence of statins and cardiovascular disease.
Objective:
To analyze the association between adherence of statins and cardiovascular disease.
Method:
Our study design is a retrospective cohort study. The data source is from National Health Insurance in 2000~2004. Our subjective is patients with first cardiovascular disease in medical center used statins in 90 days after discharge.Use medication possession ratio (MPR) to present adherence, the calculation of MPR: MPR= (statins prescribed days) /365 days (365days as followed duration)x100%, define >80% as high MPR, 79~40% as moderate MPR, and <40% as low MPR. The endpoint is the readmission of cardiovascular disease
Result:
After calculating the one year MPR, in CHD group, there were 1196 persons in high MPR group, 1170 persons in medium MPR group and 1414 persons in low MPR group. And in ischemia stroke group, there were 412 persons in high MPR group, 604 persons in medium MPR group and 908 persons in low MPR group. The event rate of each group were 22.91%，30.26%，29.68% in CHD group and 4.48%，14.22%，54.24% in ischemia group. Used survival analysis to analyse the relationship between adherence of statins and readmission rate of cardiovascular disease, the hazard ratio of MPR in CHD group was 1.038 (P=0.6085), after ajustment the hazard ratio was 1.011 (P=0.8836), and the hazard ratio of MPR in ischemia stroke group was 1.038 (P=0.6085), after ajustment the hazard ratio was 1.011(P=0.8836). Furthermore our study analysed the readmission risk of different MPR by logistic regression. In CHD group, the odds ratio of moderate MPR group, compared to high MPR group, was 1.373 (P=0.0437), after ajustment the hazzar ratio is 1.326(P=0.0755), and the odds ratio group in low MPR group is 1.094(P=0.5677), after ajustment the hazard ratio was 1.05 (P=0.7521). In ischemia stroke group, the odds ratio of moderate MPR group, compared to high MPR group, was 1.562 (P=0.0526), after ajustment the hazard ratio was 1.552 (P=0.0584), and the odds ratio group in low MPR group was 2.130 (P=0.0003), after ajustment the hazard ratio is 2.131 (P=0.0004).
Conclusion:
Statins can effectively prevent readmission of cardiovascular disease. And compliance is the key point of statins’ effect. No matter in CHD group or ischemia group, the worse the compliance, the higher the risk of cardiovascular disease.
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