Initiation of lipid-lowering therapy as primary prevention of cardiovascular disease in the elderly.

Autor: Vinuesa-Hernando JM; Pharmacy Service, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain., Aguilar-Palacio I; Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain.; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain., Rabanaque MJ; Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain.; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain., García-Cárdenas V; Pharmacy and Pharmaceutical Technology Department, University of Granada, Granada, Spain., Lallana MJ; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.; Primary Care Pharmacy Service, Sector Zaragoza III, Servicio Aragonés de Salud (SALUD), Zaragoza, Spain., Gamba A; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain., Malo S; Department of Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain.; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Fundación Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.; Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), ISCIII, Madrid, Spain.
Jazyk: angličtina
Zdroj: British journal of clinical pharmacology [Br J Clin Pharmacol] 2024 Oct; Vol. 90 (10), pp. 2663-2672. Date of Electronic Publication: 2024 Jul 03.
DOI: 10.1111/bcp.16157
Abstrakt: Aims: This study aimed to analyse the initiation adherence phase to lipid-lowering therapy for primary prevention of cardiovascular disease in a Spanish population aged 70 years or older. The secondary objective was to identify the determinants of initiation and early discontinuation.
Methods: This was an observational study conducted in the CArdiovascular Risk factors for HEalth Service research (CARhES) cohort. People aged 70 and older with a first prescription of a lipid-lowering drug and without a previous major adverse cardiovascular event (MACE) were selected (2018-2021). Data on sociodemographics, clinical conditions, drugs and use of health services were collected from clinical and administrative electronic databases. The study population was classified into: non-initiation, early discontinuation (i.e., discontinuation after the first dispensing) and initiation with more than one dispensing. Their characteristics were compared. Determinants of initiation and early discontinuation were explored.
Results: Among the 15 019 people studied, 80.2% initiated the medication, 11.2% showed an early discontinuation and 8.6% were non-initiators. An older age or conditions such as dementia, diabetes or depression reduced the likelihood of initiation, while obesity and a high pharmacological burden increased it. People over 90 years of age or those prescribed a statin in combination were more likely to have an early discontinuation.
Conclusions: Non-initiation and early discontinuation are common among older people prescribed lipid-lowering drugs as primary prevention of cardiovascular disease for the first time. The presence of chronic pathologies other than cardiovascular ones should be considered when assessing whether or not to prescribe these drugs in the elderly.
(© 2024 The Author(s). British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.)
Databáze: MEDLINE
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