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首页> 外文期刊>Internal medicine journal >Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study
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Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study

机译：药物遵守和链接到心血管疾病风险因素控制的障碍：Framingham心脏研究

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Abstract Background In the elderly, impaired cognition may weaken medication adherence and compromise treatment for cardiovascular disease (CVD). Aim We examined risk factors for medication adherence and the relationship between adherence and levels of CVD risk factors among older participants with hypertension, dyslipidaemia and diabetes in the Framingham Heart Study. Methods The four‐item Morisky Medication Adherence Scale was administered to 1559 participants, median age 70 years, 53% women. We created an adherence score, ranging from 0 to 4, with low adherence defined as a score ≥2. CVD risk factors were assessed using standard protocols. Cognition was measured using the Mini‐Mental State Examination (MMSE) and depressive symptoms were measured using the Center for Epidemiologic Studies of Depression (CES‐D) scale. Results Among participants who self‐reported taking antihypertensive, lipid‐lowering and/or hyperglycaemic medication(s), 12% ( n = 191) had low medication adherence. The risk of low adherence increased by 45% (95% confidence interval (CI): 25–68%, P 0.001) per five‐unit increase in CES‐D score. In participants taking antihypertensive medication ( n = 1017), low adherence was associated with higher mean diastolic blood pressure (73 mmHg, 95% CI: 71–75 vs 71 mmHg, 95% CI: 70–71; P = 0.04) after adjusting for covariates. Among participants taking lipid‐lowering medication ( n = 937), low adherence was associated with higher mean low‐density lipoprotein cholesterol (92 mg/dL, 95% CI: 87–96 vs 86 mg/dL, 95% CI: 84–88; P = 0.03). Low adherence was not associated with fasting plasma glucose ( P = 0.10) or haemoglobin A1c ( P = 0.68) in the subgroup of participants ( n = 192) taking hypoglycaemic medication. Conclusions Depressive symptoms might act as a barrier for medication adherence, which exacerbates CVD risk factors in older‐aged adults.
机译：摘要背景在老年人身上，无法受损的认知可能会削弱心血管疾病（CVD）的药物粘附和妥协处理。目的，我们检查了药物遵守的危险因素，以及在Framingham心脏研究中的高血压，血脂血症和糖尿病患者中持续的参与者依从性和CVD风险因素之间的关系。方法采用四项药物药物申诉规模，向1559名参与者进行，中位数70岁，妇女53％。我们创建了一个依从性得分，范围为0到4，并且低粘附程度定义为分数≥2。使用标准协议评估CVD危险因素。使用迷你精神状态检查（MMSE）测量认知，并使用抑郁症（CES-D）规模的流行病学研究中心测量抑郁症状。结果自报告抗高血压，降脂和/或高血糖药物的参与者之间，12％（n = 191）具有低药物依从性。低粘附的风险增加了45％（95％置信区间（CI）：25-68％，P <0.001）CES-D得分。在参与者服用抗高血压药物（n = 1017）中，低粘附性与平均舒张压（73mmHg，95％CI：71-75 Vs 71mmHg，95％CI：70-71; P = 0.04）相关联适合协变量。在参与者中，采用脂降低药物（n = 937），低粘附性与较高的平均低密度脂蛋白胆固醇有关（92mg / dl，95％CI：87-96 Vs 86mg / dl，95％CI：84- 88; p = 0.03）。在参与者（n = 192）的亚组中，低粘附与空腹血糖葡萄糖（p = 0.10）或血红蛋白A1c（p = 0.68）相关，服用低血糖药物。结论抑郁症状可能是用作药物依从性的障碍，它加剧了老年人成年人的CVD危险因素。

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