BACKGROUND:There is conflicting evidence as to whether achievement of cholesterol targets at the population level is dependent on the choice and cost of statin. AIM:To investigate the practice-level relationship between cholesterol quality indicators in patients with heart disease, stroke, and diabetes and prescribing of low-cost statins. DESIGN AND SETTING:Correlations and linear regression modelling of retrospective cross-sectional practice-level data with potential explanatory variables in 7909 (96.4%) general practices in England in 2008-2009. METHOD:Quality indicator data were obtained from the Information Centre and prescribing data from the NHS Business Authority. A 'cholesterol quality indicator' score was constructed by dividing the numbers of patients achieving the target for cholesterol control of ≤5 mmol/l in stroke, diabetes, and heart disease by the numbers on each register. A 'low-cost statin' ratio score was constructed by dividing the numbers of defined daily doses of simvastatin and pravastatin by the total numbers of defined daily doses of statins. RESULTS:Simvastatin accounted for 83.3% (standard deviation [SD] = 15.7%) of low-cost statins prescribed and atorvastatin accounted for 85.7% (SD = 14.8%) of high-cost statins prescribed. The mean cholesterol score was 73.7% (SD = 6.0%). Practices using a higher proportion of the low-cost statins were less successful in achieving cholesterol targets. An increase of 10% in the prescribing of low-cost statins was associated with a decrease of 0.46% in the cholesterol quality indicator score (95% confidence interval = -0.54% to -0.38%, P<0.001). CONCLUSION:Greater use of low-cost statins was associated with a small reduction in cholesterol control.

译文

背景:关于在人群水平上实现胆固醇目标是否取决于他汀类药物的选择和成本,有相互矛盾的证据。
目的:探讨心脏病,中风和糖尿病患者的胆固醇质量指标与廉价他汀类药物处方之间的实践水平关系。
设计与设置:回顾性横截面实践水平数据的相关性和线性回归模型,该数据具有2008年至2009年英格兰7909例(96.4%)常规实践中的潜在解释变量。
方法:质量指标数据是从信息中心获得的,处方数据是从NHS商业管理局获得的。通过将中风,糖尿病和心脏病中达到胆固醇控制目标≤5mmol / l的患者人数除以每个登记册上的人数,来构建“胆固醇质量指标”评分。通过将辛伐他汀和普伐他汀的每日定义剂量数除以他汀类药物的每日定义总数,可以构建“低成本他汀类药物”比率评分。
结果:辛伐他汀占处方中低成本他汀类药物的83.3%(标准偏差[SD] = 15.7%),阿托伐他汀占处方中低成本他汀类药物的85.7%(SD = 14.8%)。平均胆固醇得分为73.7%(SD = 6.0%)。使用较高比例的低成本他汀类药物的做法在实现胆固醇目标方面不太成功。低成本他汀类药物处方的增加10%与胆固醇质量指标得分的0.46%的降低相关(95%置信区间= -0.54%至-0.38%,P <0.001)。
结论:大量使用低成本他汀类药物与降低胆固醇控制量有关。

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