Feringa Harm H H, Karagiannis Stefanos E, van Waning Virginie H, Boersma Eric, Schouten Olaf, Bax Jeroen J, Poldermans Don
Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
J Vasc Surg. 2007 May;45(5):936-43. doi: 10.1016/j.jvs.2007.01.024. Epub 2007 Mar 13.
The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are associated with improved outcome in patients with peripheral arterial disease. Statins may also have beneficial properties beyond their lipid-lowering effect.
A prospective, observational cohort study was conducted at a university hospital from 1990 to 2005 to examine whether higher doses of statins and lower low-density lipoprotein (LDL) cholesterol levels are both independently associated with improved outcome in peripheral arterial disease. Enrolled were 1374 consecutive patients (age, 61 +/- 10 years, 73% male) with peripheral arterial disease (ankle-brachial index <or=0.90). They were screened for clinical risk factors, statin therapy, and LDL cholesterol levels. Serial LDL cholesterol levels were measured at 6 months and yearly after enrollment. The mean follow-up time was 6.4 +/- 3.6 years, and no patients were lost to follow-up. The primary end points were all-cause and cardiac mortality. The secondary end point was the progression to kidney failure.
Overall mortality, cardiac death, and progression to kidney failure occurred in 29%, 20%, and 5% of patients, respectively. Multivariate analysis revealed that higher doses of statins (per 10% increase) and lower 6-month LDL cholesterol levels (per 10 mg/dL decrease) were both independently associated with lower all-cause mortality (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.62 to 0.80; and HR, 0.96; 95% CI, 0.93 to 0.98, respectively) and cardiac death (HR, 0.76; 95% CI, 0.67 to 0.86; and HR, 0.95; 95% CI, 0.92 to 0.98, respectively). Higher high-density lipoprotein cholesterol levels also correlated significantly with lower all-cause and cardiac mortality. Higher doses of statins (per 10% increase) were associated with less progression to kidney failure (HR, 0.69; 95% CI, 0.54 to 0.89).
Higher doses of statins and lower LDL cholesterol levels are both independently associated with improved outcome in patients with peripheral arterial disease. These results support the view that statins have beneficial effects beyond their lipid-lowering properties and should be considered in all patients with PAD, irrespective of LDL cholesterol levels.
3-羟基-3-甲基戊二酰辅酶A还原酶抑制剂（他汀类药物）与外周动脉疾病患者预后改善相关。他汀类药物可能还具有降脂作用之外的有益特性。
1990年至2005年在一所大学医院进行了一项前瞻性观察队列研究，以检验更高剂量的他汀类药物和更低的低密度脂蛋白（LDL）胆固醇水平是否均与外周动脉疾病患者预后改善独立相关。纳入1374例连续的外周动脉疾病患者（年龄61±10岁，73%为男性）（踝臂指数≤0.90）。对他们进行临床危险因素、他汀类药物治疗及LDL胆固醇水平筛查。入组后6个月及每年测量LDL胆固醇水平。平均随访时间为6.4±3.6年，无患者失访。主要终点为全因死亡率和心脏死亡率。次要终点为进展至肾衰竭。
分别有29%、20%和5%的患者发生全因死亡、心脏死亡和进展至肾衰竭。多因素分析显示，更高剂量的他汀类药物（每增加10%）和更低的6个月时LDL胆固醇水平（每降低10mg/dL）均与更低的全因死亡率（风险比[HR]，0.7
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