Klungel Olaf H, Heckbert Susan R, de Boer Anthonius, Leufkens Hubert G M, Sullivan Sean D, Fishman Paul A, Veenstra David L, Psaty Bruce M
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Sorbonnelaan 16, 3584 CA Utrecht, the Netherlands.
Ann Pharmacother. 2002 May;36(5):751-7. doi: 10.1345/aph.1A308.
The benefits of lipid-lowering drug treatment for the secondary prevention of coronary heart disease have been well established by randomized, controlled trials. Nonetheless, the risk of events has not been compared directly for inhibitors of hydroxymethylglutaryl coenzyme A reductase (statins) and non-statin lipid-lowering drugs. Further, it remains uncertain whether patients in usual practice who are treated with lipid-lowering drugs after myocardial infarction (MI) gain a similar benefit with regard to the risk of cardiovascular events compared with patients in randomized, controlled trials.
To assess the association between lipid-lowering drug therapies in usual clinical practice and the risk of cardiovascular events in patients with a first MI who were discharged alive from the hospital.
An inception-cohort study was performed among 1956 enrollees of Group Health Cooperative who sustained an incident MI between July 1986 and December 1996 and survived for at least 6 months after hospitalization. Subjects with untreated low-density-lipoprotein cholesterol concentrations > 130 mg/dL or untreated total cholesterol concentrations >200 mg/dL were included. The median duration of follow-up after the first MI was 3.3 years. Medical record review was used to collect information on cardiovascular risk factors. Computerized pharmacy records were used to assess antihyperlipidemic drug use during the first 6 months after hospitalization.
Compared with 1263 subjects who did not receive lipid-lowering drug treatment, 373 subjects who received statins had a lower risk of recurrent coronary events (relative risk [RR] 0.59; 95% CI 0.39 to 0.89), stroke (RR 0.82; 95% CI 0.35 to 1.95), atherosclerotic cardiovascular mortality (RR 0.49; 95% CI 0.21 to 1.13), and any atherosclerotic cardiovascular event (RR 0.63; 95% CI 0.40 to 0.98). Among 320 subjects who used non-statin drug therapies, the RRs were 0.66 (95% CI 0.45 to 0.97) for recurrent coronary events, 0.95 (95% CI 0.46 to 1.95) for stroke, 0.68 (95% CI 0.35 to 1.32) for cardiovascular mortality, and 0.77 (95% CI 0.53 to 1.11) for any atherosclerotic cardiovascular event, compared with untreated hyperlipidemic patients.
In this study of MI survivors, the use of lipid-lowering drug therapies after hospitalization was associated with a reduced risk of cardiovascular events. These results emphasize the importance of lipid-lowering drug treatment in patients with hyperlipidemia who survive a first MI.
降脂药物治疗对冠心病二级预防的益处已通过随机对照试验得到充分证实。尽管如此，羟甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）和非他汀类降脂药物的事件风险尚未直接比较。此外，与随机对照试验中的患者相比，心肌梗死（MI）后接受降脂药物治疗的普通临床实践患者在心血管事件风险方面是否获得类似益处仍不确定。
评估普通临床实践中降脂药物治疗与首次心肌梗死且出院存活患者心血管事件风险之间的关联。
对1956名健康合作组织成员进行了一项队列研究，这些成员在1986年7月至1996年12月期间发生了首次心肌梗死，并在住院后存活至少6个月。纳入未治疗时低密度脂蛋白胆固醇浓度>130mg/dL或总胆固醇浓度>200mg/dL的受试者。首次心肌梗死后的中位随访时间为3.3年。通过病历审查收集心血管危险因素信息。利用计算机化药房记录评估住院后前6个月的降血脂药物使用情况。
与1263名未接受降脂药物治疗的受试者相比，373名接受他汀类药物治疗的受试者复发性冠状动脉事件风险较低（相对风险[RR]0.59；95%CI0.39至0.89）、中风风险较低（RR0.82；95%CI0.35至1.95）、动脉粥样硬化性心血管病死亡率较低（RR0.49；95%CI0.21至1.13）以及任何动脉粥样硬化性心血管事件风险较低（RR0.63；95%CI0.40至0.98）。在320名使用非他汀类药物治疗的受试者中，与未治疗的高脂血症患者相比，复发性冠状动脉事件的RR为0.66（95%CI0.45至0.97），中风的RR为0.95（95%CI0.46至1.95），心血管病死亡率的RR为0.68（95%CI0.35至1.32），任何动脉粥样硬化性心血管事件的RR为0.77（95%CI0.53至1.11）。
在这项对心肌梗死幸存者的研究中，住院后使用降脂药物治疗与心血管事件风险降低相关。这些结果强调了降脂药物治疗在首次心肌梗死存活的高脂血症患者中的重要性。
