当前位置: X-MOL 学术Circ. Cardiovasc. Qual. Outcomes › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Predictors of PCSK9 (Proprotein Convertase Subtilisin/Kexin Type 9) Inhibitor Prescriptions for Secondary Prevention of Clinical Atherosclerotic Cardiovascular Disease
Circulation: Cardiovascular Quality and Outcomes ( IF 6.2 ) Pub Date : 2021-08-18 , DOI: 10.1161/circoutcomes.120.007237
Daniel M. Blumenthal 1, 2 , Thomas M. Maddox 3, 4 , Krishna Aragam 1, 2, 5 , Chana A. Sacks 2, 6 , Salim S. Virani 7 , Jason H. Wasfy 1, 2
Affiliation  

Background:Little is known about patterns of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor) use among patients with established clinical atherosclerotic cardiovascular disease. This study’s objective was to describe PCSK9i prescribing patterns among patients with atherosclerotic cardiovascular disease.Methods:We used a national outpatient clinic registry linked to zip-code level on household income from the US Census to assess characteristics of patients with atherosclerotic cardiovascular disease and LDL-C (low-density lipoprotein cholesterol) <190 mg/dL between September 1, 2015, and September 30, 2019, who did and did not receive PCSK9i prescriptions and practice-level and temporal variation in PCSK9i prescriptions. We assessed predictors of PCSK9i prescription with a multivariable mixed effects regression model which included patient covariates as fixed effects and the cardiology practice as a random effect. Adjusted practice-level variation in PCSK9i prescribing was evaluated with median odds ratio (OR).Results:Of 2 148 100 patients meeting study inclusion criteria, 27 249 (1.3%) received PCSK9i prescriptions. Receiving a PCSK9i prescription was associated with White race (versus non-White: OR, 1.78 [95% CI, 1.55–1.83]); high estimated household income (versus low income: OR, 1.18 [95% CI, 1.08–1.29]), and urban or suburban (versus rural) practice location (urban: OR, 1.47 [95% CI, 1.32–1.64]; suburban: OR, 1.25 [95% CI, 1.13–1.39]). Hispanics had lower odds of receiving PCSK9i prescriptions (OR, 0.66 [95% CI, 0.57–0.76]). The adjusted median odds ratio was 2.68 (95% CI, 2.46–2.94), consistent with clinically significant practice-level variation in PCSK9i prescriptions. No differences in quarterly PCSK9i prescription rates were observed before and after price reductions for evolocumab and alirocumab initiated during the fourth quarter of 2018 and first quarter of 2019, respectively.Conclusions:This study highlights racial, socioeconomic, geographic, and practice-level variations in early PCSK9i prescriptions which persist despite adjustment for clinical and demographic factors. After adjustment, 2 randomly selected practices would differ in likelihood of PCSK9i prescription by a factor of >2.

中文翻译:

PCSK9(Proprotein Convertase Subtilisin/Kexin Type 9)的预测因子用于临床动脉粥样硬化心血管疾病二级预防的抑制剂处方

背景:对于已确诊的临床动脉粥样硬化心血管疾病患者使用 PCSK9i(前蛋白转化酶枯草杆菌蛋白酶/可欣 9 型抑制剂)的模式知之甚少。本研究的目的是描述动脉粥样硬化性心血管疾病患者的 PCSK9i 处方模式。 C(低密度脂蛋白胆固醇)在 2015 年 9 月 1 日至 2019 年 9 月 30 日之间<190 mg/dL,接受和未接受 PCSK9i 处方以及 PCSK9i 处方的实践水平和时间变化。我们使用多变量混合效应回归模型评估了 PCSK9i 处方的预测因素,该模型包括作为固定效应的患者协变量和作为随机效应的心脏病学实践。使用中位优势比 (OR) 评估 PCSK9i 处方调整后的实践水平变化。结果:在 2 148 100 名符合研究纳入标准的患者中,27 249 名 (1.3%) 接受了 PCSK9i 处方。接受 PCSK9i 处方与白人种族相关(与非白人相比:OR,1.78 [95% CI,1.55–1.83]);高估计家庭收入(相对于低收入:OR,1.18 [95% CI,1.08-1.29]),以及城市或郊区(相对于农村)实践地点(城市:OR,1.47 [95% CI,1.32-1.64];郊区:OR,1.25 [95% CI,1.13–1.39])。西班牙裔接受 PCSK9i 处方的几率较低(OR,0.66 [95% CI,0.57–0.76])。调整后的中位优势比为 2.68(95% CI,2.46–2.94),与 PCSK9i 处方的临床显着实践水平变化一致。分别于 2018 年第四季度和 2019 年第一季度开始降低 evolocumab 和 alirocumab 的价格之前和之后,未观察到每季度 PCSK9i 处方率的差异。结论:本研究强调了种族、社会经济、地理和实践水平的差异尽管针对临床和人口统计学因素进行了调整,但早期的 PCSK9i 处方仍然存在。调整后,2 个随机选择的实践在 PCSK9i 处方的可能性方面将相差 >2 倍。分别于 2018 年第四季度和 2019 年第一季度开始降低 evolocumab 和 alirocumab 的价格之前和之后,未观察到每季度 PCSK9i 处方率的差异。结论:本研究强调了种族、社会经济、地理和实践水平的差异尽管针对临床和人口统计学因素进行了调整,但早期的 PCSK9i 处方仍然存在。调整后,2 个随机选择的实践在 PCSK9i 处方的可能性方面将相差 >2 倍。分别于 2018 年第四季度和 2019 年第一季度开始降低 evolocumab 和 alirocumab 的价格之前和之后,未观察到每季度 PCSK9i 处方率的差异。结论:本研究强调了种族、社会经济、地理和实践水平的差异尽管针对临床和人口统计学因素进行了调整,但早期的 PCSK9i 处方仍然存在。调整后,2 个随机选择的实践在 PCSK9i 处方的可能性方面将相差 >2 倍。尽管针对临床和人口统计学因素进行了调整,但早期 PCSK9i 处方的实践水平差异仍然存在。调整后,2 个随机选择的实践在 PCSK9i 处方的可能性方面将相差 >2 倍。尽管针对临床和人口统计学因素进行了调整,但早期 PCSK9i 处方的实践水平差异仍然存在。调整后,2 个随机选择的实践在 PCSK9i 处方的可能性方面将相差 >2 倍。
更新日期:2021-09-22
down
wechat
bug