Kertai Miklos D, Boersma Eric, Westerhout Cynthia M, van Domburg Ron, Klein Jan, Bax Jeroen J, van Urk Hero, Poldermans Don
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Med. 2004 Jan 15;116(2):96-103. doi: 10.1016/j.amjmed.2003.08.029.
To assess the potential long-term beneficial effects of statin use after successful abdominal aortic surgery.
Between 1991 and 2001, 570 patients underwent abdominal aortic aneurysm repair at the Erasmus Medical Center. Of the 519 patients (91%) who survived surgery beyond 30 days, 510 (98%) were followed for a median of 4.7 years (interquartile range, 2.7 to 7.3 years). These patients were evaluated for use of statins and beta-blockers, and for clinical risk factors (e.g., advanced age; prior myocardial infarction; diabetes mellitus; renal dysfunction; chronic pulmonary disease; history of heart failure, stroke, or angina), and their association with all-cause and cardiovascular mortality.
A total of 205 patients (40%) died during follow-up; 140 due to cardiovascular causes. The incidence of all-cause (18% [27/154] vs. 50% [178/356], P <0.001) and cardiovascular (11% [17/154] vs. 34% [122/356], P <0.001) mortality was significantly lower in statin users than in nonstatin users. After adjusting for clinical risk factors and beta-blocker use, the association between statin use and reduced all-cause (hazard ratio [HR] = 0.4; 95% confidence interval [CI]: 0.3 to 0.6; P <0.001) and cardiovascular (HR = 0.3; 95% CI: 0.2 to 0.6; P <0.001) mortality persisted. Beta-blocker use was also associated with a significant reduction in all-cause (HR = 0.6; 95% CI: 0.5 to 0.9; P = 0.003) and cardiovascular (HR = 0.7; 95% CI: 0.4 to 0.9; P = 0.03) mortality. There was no evidence of an association between statin use and all-cause and cardiovascular mortality according to beta-blocker use or clinical risk factors.
Long-term statin use is associated with reduced all-cause and cardiovascular mortality irrespective of clinical risk factors and beta-blocker use.
评估腹主动脉手术成功后使用他汀类药物的潜在长期有益效果。
1991年至2001年间，570例患者在伊拉斯谟医疗中心接受了腹主动脉瘤修复手术。在术后存活超过30天的519例患者（91%）中，510例（98%）接受了中位时间为4.7年（四分位间距为2.7至7.3年）的随访。对这些患者进行了他汀类药物和β受体阻滞剂使用情况、临床危险因素（如高龄、既往心肌梗死、糖尿病、肾功能不全、慢性肺病、心力衰竭、中风或心绞痛病史）的评估，以及它们与全因死亡率和心血管死亡率的关联。
共有205例患者（40%）在随访期间死亡；140例死于心血管原因。他汀类药物使用者的全因死亡率（18%[27/154]对50%[178/356]，P<0.001）和心血管死亡率（11%[17/154]对34%[122/356]，P<0.001）显著低于非他汀类药物使用者。在对临床危险因素和β受体阻滞剂使用情况进行校正后，他汀类药物使用与全因死亡率降低（风险比[HR]=0.4；95%置信区间[CI]：0.3至0.6；P<0.001）和心血管死亡率降低（HR=0.3；95%CI：0.2至0.6；P<0.001）之间的关联仍然存在。β受体阻滞剂的使用也与全因死亡率（HR=0.6；95%CI：0.5至0.9；P=0.003）和心血管死亡率（HR=0.7；95%CI：0.4至0.9；P=0.03）的显著降低相关。没有证据表明根据β受体阻滞剂使用情况或临床危险因素，他汀类药物使用与全因死亡率和心血管死亡率之间存在关联。
无论临床危险因素和β受体阻滞剂使用情况如何，长期使用他汀类药物都与全因死亡率和心血管死亡率降低相关。
