目的:我们估计治疗方案中所有抗高血压[AHT]和/或降脂药物的总体补充依从性及其与1型糖尿病成人心血管疾病(CVD)的关系,考虑到肾脏疾病。
方法:这项芬兰糖尿病肾病研究涉及1,558名1型糖尿病成年人,他们在基线±0.5年内购买了AHT和/或降脂药,并一直随访到他们的第一次CVD事件,死亡,或2015年底。使用覆盖天数(PDC)方法计算依从性。依从性分类为良好(≥80%),中等(≥50且<80%)或较差(<50%)。
结果:中位依从率为74%(IQR63-84%)。两者均良好(OR0.55[95%CI0.33,0.92],P=0.02)和中间(0.47[0.29,0.77],P=0.003)依从性与较低的CVD几率相关,与较差的坚持相比。此外,中度白蛋白尿患者的依从性百分比越高,心血管疾病的几率较低(0.81[0.67,0.98],P=0.03,每增加10个单位的依从性)。
结论:在1型糖尿病的成年人中,对心脏保护药物的再治疗依从性达到50%或更高与心血管事件发生率较低相关.我们的发现强调了超越处方保护性CVD药物的相关性,确保,和提高药物依从性很重要。
OBJECTIVE: We estimated overall refill adherence to all antihypertensive [AHT] and/or lipid-lowering drugs in the treatment regimen and its association with cardiovascular disease (CVD) in adults with type 1 diabetes, taking kidney disease into account.
METHODS: This Finnish Diabetic Nephropathy Study involved 1,558 adults with type 1 diabetes who had purchased AHT and/or lipid-lowering drugs within ± 0.5 year from baseline and were followed until their first CVD event, death, or end of 2015. Proportion of days covered (PDC) method was used to calculate adherence. The adherence was classified as good (≥80 %), intermediate (≥50 and <80%) or poor (<50%).
RESULTS: Median adherence rate was 74% (IQR 63-84 %). Both good (OR 0.55 [95% CI 0.33, 0.92], P=0.02) and intermediate (0.47 [0.29, 0.77], P=0.003) adherence were associated with lower odds of CVD, compared to poor adherence. Moreover, the higher the adherence percentage point in those with moderate albuminuria, the lower was the odds for CVD (0.81 [0.67, 0.98], P=0.03, per 10 unit increase in adherence).
CONCLUSIONS: In adults with type 1 diabetes, refill adherence of 50% or more to cardio-protective medications is associated with lower odds of incident CVD. Our findings highlight the relevance of going beyond prescribing protective CVD drugs, ensuring, and improving medication adherence matters.