既往研究已證實他汀可減少冠脈支架置入患者的心血管事件發生率，當前指南也推薦這類人群常規使用他汀類藥物。但約半數患者在第一年內停藥，並在隨訪期間依從性下降。藥物依從性受很多因素影響，包括患者對疾病的感知和理解，其他因素還有社會經濟地位低、藥物話費高和不了解藥物說明書等。
此外，媒體報道也可能對患者藥物依從性和健康相關行為有影響。為驗證這一結論，土耳其學者開展了一項回顧性分析。研究納入908例經皮冠狀動脈介入治療(PCI)患者，分析他汀治療的依從性。使用基於藥物覆蓋天數比例(PDC)方法量化他汀治療依從性，在 Google上以“膽固醇藥物”為關鍵詞檢索相應的新聞頁麵。
結果顯示，檢索到2011年、2012年、2013年和2014年的新聞分別為2320條、6210條、5170條和3070條。隨著2011到2013年關於他汀新聞條數的明顯增加，他汀治療天數百分比呈現顯著減少的趨勢，從2011年的57%到2012年的58%再到2013年的50%(P=0.01)，見下圖。
該研究表明，從2011年至2013年他汀治療依從性明顯下降，患者接觸到的關於他汀負麵新聞可解釋這一結果。研究者在文中寫道，這是首個揭示媒體負麵報道對藥物依從性影響的研究。
相關論文近期發表於《國際心髒病學雜誌》(International Journal of Cardiology)。
參考文獻：CuneytKocas, et al. International Journal of Cardiology .December 15, 2015Volume 201, Page 139. DOI:http://dx.doi.org/10.1016/j.ijcard.2015.07.095
原文
The role of media on statin adherence
Cuneyt Kocas ⁎, Okay Abaci, Betul Balaban Kocas, Gokhan Cetinkal, Sukru Arslan, Ahmet Yildiz, Murat Ersanli
Istanbul University Institute of Cardiology, Department of Cardiology, Turkey
Statins have been reported to reduce the incidence of cardiovascular events after coronary stenting and current guidelines recommend the routine use of statins in this population. But, about half of patients discontinue statin therapy within the first year, and adherence decreases during follow-up period [1,2].Medication adherence is a complex problem that is affected by many factors, including perceptions and understanding of the disease burden. Specific factors identified include low socioeconomic status, high medication costs, lack of transportation and poor understanding of medication instructions [3]. In addition,media coverage of health facts may also have an impact on beliefs,and behaviors related to health. Niederdeppe et al. [4] reported that exposure to statin advertisements increased the diagnosis of hypercholesterolemia
and use of statins. However in recent years, statins were frequently criticized in Turkish media and most of them were also presented in a negative fashion in globalmedia. Our goalwas to analyze the effects of media on statin adherence.
We retrospectively analyzed the statin adherence of 908 percutaneous coronary intervention patients whom were prescribed a statin before 2011 at our institute and had continuous insurance coverage to determine statin adherence. We used the pharmacy-based proportion of days covered (PDC) method to quantify statin adherence. To quantify the effects of media, we made a search on Google. We searched theword “cholesterol drugs” on Turkish pages from “news” section for 2011 to 2014 individually.Search on Google retrieved; 2320 news in 2011, 6210 news in 2012,5170 news in 2013 and 3070 news in 2014. As news about statins increased dramatically from 2011 to 2013, percentage of days covered by statins significantly decreased (57% (IQR: 8–83) in 2011, 58% (IQR :17–83) in 2012 and 50% (IQR: 8–83) in 2013, p = 0.01). (Fig. 1)
Our study demonstrated that statin adherence decreased from2011 to 2013 significantly and this finding can be explained by the exposure of patients to negative news about statins in media. To our knowledge this is the first study which demonstrates the negative role of media on medication adherence.
