中国老年急性心肌梗死患者调脂药物应用现状

Current use of lipid-lowering drugs in elderly acute myocardial infarction patients in China

目的了解中国老年急性心肌梗死(AMI)患者住院期间及出院后2年调脂药物的应用现状及依从性。方法纳入中国急性心肌梗死注册研究中2013年1月1日~2014年9月30日108家医院入选的AMI患者共26625例,年龄缺失30例,按年龄分为老年组(年龄>65岁)11574例和中青年组(年龄≤65岁)15021例,患者出院后1、6、12、18和24个月时进行随访,比较2组住院期间、出院时及出院后2年内调脂药物的应用和依从性。结果与中青年组比较,老年组女性比例明显升高、体质量指数更低、高血压、糖尿病、既往心肌梗死、既往脑卒中史、外周血管疾病史、慢性肾功能不全比例更高(P=0.000)。老年组高脂血症比例明显低于中青年组、但一直治疗和应用他汀类药物比例高于中青年组(6.3%vs 9.4%,23.4%vs 15.1%,29.7%vs 21.6%,P<0.01)。老年组急诊再灌注治疗比例明显低于中青年组(37.7%vs 51.1%,P<0.01)。住院期间,老年组他汀类药物使用率(88.4%vs 90.5%)、他汀类负荷率(28.0%vs 30.8%)和非他汀类调脂药物使用率(1.5%vs 2.0%)均低于中青年组(P<0.01)。出院后,老年组他汀带药率低于中青年组(87.5%vs 90.4%,P<0.01)。1、6、12、18和24个月随访时,老年组规律服药比例均低于中青年组(P<0.05,P<0.01);2组均以患者自停为主(比例>80%);2组非他汀类调脂药物使用率低(比例≤0.6%)。结论老年AMI患者应用他汀类调脂药物为主,但用药比例低于中青年患者,且用药依从性随病程时间延长逐渐降低,应加强老年AMI患者的一二级预防。

Objective To investigate the current use and compliance of lipid-lowering drugs in elderly AMI patients in China.Methods A total of 26625 AMI patients registered in China AMI Registry from 2013-01-01 to 2014-09-30 were divided into>65 years old group(n=11574)and≤65 years old group(n=15021),without age deficiency in 30 cases.The patients were followed up from months 1,6,12,18 and 24 respectively after discharge.The use and compliance of lipid-lowering drugs were compared between the two groups of patients during their hospital stay time,2-year follow-up period and at discharge.Results The ratio of female patients and the incidence of chronic renal insufficiency were significantly higher,the BMI was significantly lower,the history of hypertension,diabetes,myocardial infarction,cerebral stroke,peripheral vascular disease was significantly longer in>65 years old group than in≤65 years old group(P=0.000).The incidence of hyperlipidemia was significantly lower while the ratio of statins therapy was significantly higher in>65 years old group than in≤65 years old group(6.3%vs 9.4%,23.4%vs 15.1%,29.7%vs 21.6%,P<0.01).The ratio of emergency reperfusion therapy was significantly lower in>65 years old group than in≤65 years old group(37.7%vs 51.1%,P<0.01).The ratio of using statins,load of statins and ratio of using non-statin lipid-lowering drugs were lower in>65 years old group than in≤65 years old group(88.4%vs 90.5%,28.0%vs 30.8%,1.5%vs 2.0%,P<0.01).The ratio of using statins at home was lower in>65 years old group than in≤65 years old group after discharge(87.5%vs 90.4%,P<0.01).The ratio of regular taking lipid-lowering drugs was lower in>65 years old group than in≤65 years old group from months 1,6,12,18,and 24 after discharge(P<0.05,P<0.01).The self-withdrawal ratio of lipid-lowering drugs was>80%in two groups and that of using non-statin lipid-lowering drugs was≤0.6%in two groups.Conclusion Statins are the mainly used lipid lowering drug in elderly AMI patients.However,the ratio of uing statins is lower in>65 years old patients than in≤65 years old patients and the compliance of statins decreases gradually with the course of AMI,first and secondary prevention of AMI should thus be strengthened in the elderly.