Incidence rate of CVD and all-cause of death.

ObjectivesThe impact of concurrent adherence to antihypertensives, antidiabetics, and statins on cardiovascular disease (CVD) outcomes and intermediate clinical outcomes in people with hypertension and diabetes remains unclear. This study aimed to evaluate the association between medication adherence and CVD outcomes in such patients.MethodsThis retrospective cohort study analyzed the electronic medical records of 36,211 adults aged 18 or older diagnosed with hypertension and diabetes between January 2008 and June 2016 in Canada. Patients were prescribed antihypertensives, antidiabetics, and statins, with a minimum 1-year follow-up post-diagnosis. Medication adherence was determined by the proportion of days covered (PDC). For monotherapy, a PDC≥80% and ResultsHigh adherence to antidiabetic and statin monotherapy was associated with a lower all-cause mortality risk (aHR=0.67, P=0.001; aHR=0.68, PConclusionsHigh adherence to antidiabetic and statin monotherapy correlated with lower all-cause mortality risk and improved intermediate clinical outcomes. However, simultaneous adherence to three medications did not significantly affect CVD outcomes, but influenced intermediate outcomes. Therefore, improving adherence to antihypertensives, antidiabetics, and statins among patients with hypertension and diabetes is important in primary care settings.研究目标：联合服用降压药、降糖药与他汀类药物的依从性，对高血压合并糖尿病患者的心血管疾病（cardiovascular disease, CVD）结局及中间临床结局的影响目前尚无明确定论。本研究旨在评估此类患者的药物依从性与心血管疾病结局之间的关联。 研究方法：本项回顾性队列研究分析了加拿大2008年1月至2016年6月期间确诊为高血压合并糖尿病的36211名18岁及以上成年人的电子病历。所有入组患者均接受降压药、降糖药及他汀类药物处方，且确诊后随访时长至少为1年。药物依从性通过药物覆盖天数比例（proportion of days covered, PDC）进行评估。对于单药治疗，以药物覆盖天数比例≥80%且 研究结果：降糖药与他汀类药物单药治疗的高依从性与更低的全因死亡风险相关（校正后风险比adjusted hazard ratio, aHR=0.67，P=0.001；aHR=0.68，P[原文此处存在截断]） 研究结论：降糖药与他汀类药物单药治疗的高依从性与更低的全因死亡风险及更优的中间临床结局显著相关。然而，同时坚持服用三类药物并未对心血管疾病结局产生显著影响，但可对中间临床结局产生调控作用。因此，在基层医疗卫生机构中，提高高血压合并糖尿病患者对降压药、降糖药及他汀类药物的依从性具有重要的临床意义。