چکیده (انگلیسی):

Background:Cholesterol-lowering therapy with statins is recommended in established cardiovascular disease (CVD)
and should be considered for patients at high cardiovascular risk. We surveyed statin treatment before first-time
myocardial infarction in clinical practice compared to current guidelines, in patients with and without known CVD
in primary care clinics with general practitioners (GPs) on short-term contracts vs. permanent staff GPs.
Methods:A total of 931 patients (345 women) in northern Sweden were enrolled in the study between November
2009 and December 2014 and stratified by prior CVD, comprising angina pectoris, revascularisation, ischaemic
stroke or transitory ischaemic attack, or peripheral artery disease. Primary care clinics were classified by the
proportion of GP salaries that were paid to GPs working on short-term contracts: low (0–9 %), medium (10–39 %),
or high (≥40 %). We used logistic regression to identify determinants of statin treatment.
Results:Among patients with prior CVD, only 34.5 % received statin treatment before myocardial infarction. The
probability of statin treatment decreased with age (≥70 years OR 0.30; 95 % CI 0.13–0.66) and female gender
(OR 0.39; 95 % CI 0.20–0.78) but increased in patients with diabetes (OR 3.52; 95 % CI 1.75–7.08). Among patients
with prior CVD, the type of primary care clinic was not predictive of statin treatment. In the entire study cohort,
17.3 % of patients were treated with statins; women < 70 years old were more likely to receive statin treatment
than women≥70 years old (OR 3.24; 95 % CI 1.64–6.38), and men≥70 years old were twice as likely to be treated
with statins than women of the same age (OR 2.22; 95 % CI 1.31–3.76) after adjusting for diabetes and CVD. Overall,
patients from clinics with predominantly permanent staff GPs received statin therapy less frequently than those
with GPs on short-term contracts.
Conclusions:In patients with prior CVD we found considerable under-treatment with statins, especially among
women and the elderly. Methodologies for case findings, recall, and follow-up need to be improved and
implemented to reach the goals for CVD prevention in clinical practice.