| Objective:To explore the predictors which could affect the adherence of statins therapy and the relationship between statin adherence and long-term clinical consequences in patients with cardiovascular disease with the method of systematic review and meta-analysis. And to explore the factors that have an affect on post-discharge statin withdraw and the impact of post-discharge statin withdraw on long-term prognosis in patients after acute myocardial infarction (AMI) by a retrospective follow-up method.Part one:Predictors of adherence to statins therapy:a systematic review and meta-analysisMethod:A computer-based online search of PubMed, EMBASE, Wanfang, CNKI and Chinese Biological Medicine Database was performed using the search terms "adherence", "non-adherence", "persistence", "non-persistence", "discontinuation", "predictor", "indicator" and "statins". The Stata12.0 software was used for meta-analysis. The outcome measures were relative ratios (RR) with 95% CI (Confidence Interval) assessing the affection to adherence to statins therapy of possible factors.Results:A total of 52 studies were included in this meta-analysis. According to the included studies, there were 13 possible factors which could affect the adherence to statins therapy. The RR and 95% CI of these factors were:female 1.10(1.07,1.13), new statin user 1.59(1.44,1.74), under 2 lipid tests per year 1.38(1.16,1.65), high education level 1.03(1.02,1.05), live alone 1.08(1.03,1.13), high-income 0.84(0.78,0.90), obese 0.91(0.84,0.99), high cardiovascular disease risk 0.45 (0.32,0.64), heart disease history 0.72 (0.62,0.84), hypertension history0.86 (0.83,0.89), diabetes history 0.88 (0.86,0.91), acute coronary syndrome history 0.67 (0.61,0.73), stroke history 0.85 (0.74,0.97). Age factor was not pooled to analysis because the grouping criteria is not consistent among studies.Conclusion:Female, new statin user, under 2 lipid tests per year, high education level, live alone were factors which could decrease the statins adherence; High-income, obese, high cardiovascular disease risk, heart disease history, hypertension history, diabetes history, acute coronary syndrome history, stroke history were factors which could increase the statins adherence; relationship between age and adherence was complicated, people younger than 50 or older than 70 had worse adherence while those between 50 and 70 had relatively better adherence.Part two:Relationship between statin adherence and long-term clinical consequences in patients with cardiovascular disease:a systematic review and meta-analysisMethod:A computer-based online search of PubMed, EMBASE, Cochrane Library database, Wanfang, CNKI and Chinese Biological Medicine Database was performed using the search terms "adherence", "discontinuation", "persistence" and "statins". The Statal2.0 software was used for meta-analysis. The outcome measures were relative ratios (RR) with 95% CI (Confidence Interval) assessing the relationship between statin adherence and clinical consequences in CVD patients. Proportion of days covered (PDC) was used to measure the adherence of statins. PDC?80% was defined as good adherence and PDC<80% was defined as bad adherence. The primary endpoints was all-cause mortality, the secondary endpoints were hospitalization for recurrence of CVD and revascularization.Results:A total of six studies including 38301 patients were included in this meta-analysis. The results of meta-analyses showed that patients with good statin adherence reduced the risk of all-cause mortality by 36%(RR,0.64; 95%CI,0.51-0.80) and the risk of hospitalization for recurrence of CVD by 21% (RR,0.79; 95%CI, 0.65-0.97) and had no impact on risk of revascularization (RR,1.00; 95%CI,0.72-1.39).Conclusion:CVD patients with better statin adherence had better long-term prognosis.Part three:Impact of post-discharge statin withdrawal on long-term mortality in patients with acute myocardial infarctionMethod:A retrospective follow up study was carried out for AMI patients receiving percutaneous coronary intervention treatment in department of cardiology PLA general hospital from Jan.2009 to Dec.2010. A total of 739 patients were recruited in this study and were divided into 2 groups according to withdrawal of statin [statin withdrawal (+), n=178; statin withdrawal (-), n=561].The incidences of long-term all-cause mortality and cardiac mortality were compared between the 2 groups.Results:After 4 years follow-up, statin withdrawal was associated with higher all-cause mortality and cardiac mortality (hazard ratio 1.62,95% confidence interval 1.04 to 2.85, P=0.008 and hazard ratio 1.98,95% confidence interval 1.26 to 3.64, P=0.002).Conclusion:Statin withdrawal of patients with acute myocardial infarction after discharge would increase the long-term mortality. Effective education and strict supervision about statin treatment are needed for these patients to improve their long-term survival situation. |
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