sechenovSechenov Medical JournalСеченовский вестник2218-73322658-3348Сеченовский Университет10.47093/2218-7332.2020.11.1.38-48sechenov-129Research ArticleINTERNAL MEDICINEВНУТРЕННИЕ БОЛЕЗНИAdherence to statin therapy in patients with high and very high cardiovascular risk in real clinical practiceПриверженность к терапии статинами у пациентов с высоким и очень высоким сердечно-сосудистым риском в условиях реальной клинической практикиhttps://orcid.org/0000-0002-0758-5609ПодзолковВ. И.PodzolkovV. I.

Подзолков Валерий Иванович — д-p. мед. наук, профессор, зав. кафедрой факультетской терапии № 2, директор клиники факультетской терапии № 2

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Valery I. Podzolkov — MD, PhD, DMSc, Professor, Head of of Faculty Therapy Department № 2, Director of the Faculty Therapy Clinic

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0002-2699-1610БрагинаА. Е.BraginaA. E.

Брагина Анна Евгеньевна — д-p. мед. наук, профессор кафедры факультетской терапии № 2

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Anna E. Bragina — MD, PhD, DMSc, Professor, Faculty Therapy Department № 2

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0001-5730-7837ВасильеваЛ. В.Vasil’evaL. V.

Васильева Любовь Викторовна — канд. мед. наук, ассистент кафедры факультетской терапии № 2

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Lubov’ V. Vasil’eva — MD, PhD, Assistant Professor, Faculty Therapy Department № 2

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0001-5048-7820ГринцевичЮ. П.GrintsevichYu. P.

Гринцевич Юлия Павловна — студент

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Yulia P. Grintsevich — student

8/2, Trubetskaya str., Moscow, 119991

https://orcid.org/0000-0003-3461-6703РодионоваЮ. Н.RodionovaYu. N.

Родионова Юлия Нурисламовна — канд. мед. наук, ассистент кафедры факультетской терапии № 2

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991Тел.: + 7 (906) 774-09-04 

Yulia N. Rodionova — MD, PhD, Assistant Professor, Faculty Therapy Department № 2

8/2, Trubetskaya str., Moscow, 119991Tel.: + 7 (906) 774-09-04

juli.n.rodionova@gmail.comФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2020300320201113848Copyright © Podzolkov V.I., Bragina A.E., Vasil’eva L.V., Grintsevich Y.P., Rodionova Y.N., 20202020Подзолков В.И., Брагина А.Е., Васильева Л.В., Гринцевич Ю.П., Родионова Ю.Н.Podzolkov V.I., Bragina A.E., Vasil’eva L.V., Grintsevich Y.P., Rodionova Y.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sechenovmedj.com/jour/article/view/129

Despite the proven efficacy of lipid-lowering therapy, adherence to long-term statin therapy in patients with cardiovascular disease remains low.

Aim

Aim. To study adherence to long-term statin therapy and factors associated with adherence in patients with high and very high cardiovascular risk (CVR) in real clinical practice.

Materials and methods

Materials and methods. The single-center cohort study included 53 patients (mean age 68.1 ± 10.2 years) with high or very high CVR on the SCORE scale and have been taking statins for at least 3 months prior to inclusion in the study. The level of low-density lipoprotein cholesterol (LDL-C), cognitive impairment (MoCA test), anxiety and depression (HADS scale), presence of senile asthenia (FRAIL scale), M. Charlson comorbidity index were assessed. Adherence to statin therapy was assessed using the original questionnaire. The correlation between patient adherence and ordinal variables for the scores of the studied scales was studied.

Results

Results. Completely adherent to statin therapy were only 12 (22%) patients, 14 (26%) were insufficiently adherent, 27 (51%) were non-adherent. The target level of LDL-С was achieved in 13 (25%) patients. 38 (72%) patients showed a decrease in cognitive functions; a positive correlation was found between adherence and the MoCA test (r = 0.44, p = 0.04). Clinical and subclinical depression and anxiety were noted in 12 (23%) and 14 (26%) patients, respectively. A statistically significant negative correlation was found between adherence and depression (r = –0.32; p = 0.04) and a positive correlation between adherence and anxiety (r = 0.44; p = 0.04). There was no statistically significant correlation between adherence and the FRAIL fragility scale, as well as the M. Charlson comorbidity index.

Conclusions

Conclusions. Depression and cognitive decline are associated with decreased adherence to statin therapy.

Несмотря на доказанную эффективность гиполипидемической терапии, приверженность к длительному лечению статинами у пациентов с сердечно-сосудистыми заболеваниями остается на низком уровне.

Цель

Цель. Изучить у пациентов с высоким и очень высоким сердечно-сосудистым риском (ССР) в условиях реальной клинической практики приверженность к длительной терапии статинами и факторы, ассоциированные с приверженностью.

Материалы и методы

Материалы и методы. В одноцентровое когортное исследование включено 53 пациента (средний возраст 68,1 ± 10,2 года) с высоким или очень высоким ССР по шкале SCORE и приемом статинов не менее 3 месяцев до включения в исследование. Оценивали уровень холестерина липопротеидов низкой плотности (ХС ЛПНП), когнитивные нарушения (тест MoCA), тревогу и депрессию (шкала HADS), наличие старческой астении (шкала FRAIL), индекс коморбидности M. Charlson. Приверженность к терапии статинами определяли с помощью оригинального опросника. Изучена корреляция между приверженностью пациентов и порядковыми переменными для баллов изученных шкал.

Результаты исследования

Результаты исследования. Полностью приверженными к терапии статинами были 12 (22%), недостаточно приверженными — 14 (26%), не приверженными — 27 (51%) пациентов. Целевой уровень ХС ЛПНП был достигнут у 13 (25%) пациентов. У 38 (72%) пациентов выявлено снижение когнитивных функций; установлена положительная корреляция между приверженностью и тестом МоСА (r = 0,44, p = 0,04). Клиническая и субклиническая депрессия и тревога отмечены у 12 (23%) и 14 (26%) пациентов соответственно. Установлена статистически значимая отрицательная корреляция между приверженностью и депрессией (r = –0,32; p = 0,04) и положительная корреляция между приверженностью и тревогой (r = 0,44; p = 0,04). Статистически значимой корреляции между приверженностью и шкалой хрупкости FRAIL, а также индексом коморбидности M. Charlson не установлено.

Заключение

Заключение. Депрессии и снижение когнитивных функций ассоциированы с уменьшением приверженности к лечению статинами.

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The authors declare that there are no conflicts of interest present.