与其他他汀类药物相比，瑞舒伐他汀降低糖尿病患者低密度脂蛋白胆固醇的有效性及达到美国国家胆固醇教育计划成人治疗小组第三次指南低密度脂蛋白胆固醇目标的情况：一项使用美国电子病历数据集的回顾性研究

Effectiveness of rosuvastatin in low-density lipoprotein cholesterol lowering and National Cholesterol Education Program Adult Treatment Panel guideline III LDL-C goal attainment compared to other statins among diabetes mellitus patients: a retrospective study using an electronic medical records dataset in the United States.

作者信息

Fox Kathleen M, Gandhi Sanjay K, Ohsfeldt Robert L, Blasetto James W, Bays Harold E

机构信息

University of Maryland School of Medicine, Department of Epidemiology & Preventive Medicine, Baltimore, MD, USA.

出版信息

Curr Med Res Opin. 2007 Sep;23(9):2125-33. doi: 10.1185/030079907X219580.

DOI:10.1185/030079907X219580

PMID:17655813

Abstract

OBJECTIVE

To compare effectiveness of rosuvastatin (RSV) with other statins on lowering low-density lipoprotein cholesterol (LDL-C) and LDL-C goal attainment among patients with type 1 or type 2 diabetes mellitus.

METHODS

A retrospective study using US General Electric Medical Systems (GEMS) database of patients with diabetes mellitus (ICD9 code = 250, prescription for anti-diabetic medication or fasting blood glucose level > or = 126 mg/dL in the 12 months preceding statin therapy) treated across clinical practices in the US, who were newly prescribed statin therapy during August 2003-March 2006, was conducted. Multivariate linear and logistic regression models were used for analyzing prescription data with baseline LDL-C, age, gender, smoking, very high CHD risk, systolic blood pressure, and statin duration as covariates.

RESULTS

Of 4754 diabetes mellitus patients, 5% were prescribed RSV, 59% atorvastatin (ATV), 21% simvastatin (SMV), 5% pravastatin (PRV), 2% fluvastatin (FLV), and 7% lovastatin (LOV). RSV patients had significantly higher (p < 0.05) baseline mean LDL-C levels (138 vs. 117-131 mg/dL), lower average starting dose (11.7 vs. 17.0-63.7 mg) and were younger (p < 0.005) than patients on other statins (mean age 61 vs. 63-69 years). Percent LDL-C reduction was significantly greater (p < 0.0001) with RSV (28.4%) compared to ATV (22.5%), SMV (20.1%), PRV (13.7%), FLV (15.8%), and LOV (17.3%). A greater (p < 0.05) proportion of RSV diabetes patients attained LDL-C goal < 100 mg/dL (72.8%) vs. diabetes mellitus patients on other statins (36.8-67.4%).

CONCLUSIONS

Rosuvastatin was more effective in lowering LDL-C and achieving LDL-C treatment goals in the diabetes mellitus population as compared to other statins in real-world clinical practice setting. Validating study results in a different diabetes population with dispensed statin prescriptions will help increase generalizability of study findings.

摘要

目的

比较瑞舒伐他汀（RSV）与其他他汀类药物在降低1型或2型糖尿病患者低密度脂蛋白胆固醇（LDL-C）水平及实现LDL-C治疗目标方面的有效性。

方法

采用美国通用电气医疗系统（GEMS）数据库进行一项回顾性研究，纳入美国临床实践中接受治疗的糖尿病患者（国际疾病分类第九版代码=250，在他汀类药物治疗前12个月内有抗糖尿病药物处方或空腹血糖水平≥126mg/dL），这些患者于2003年8月至2006年3月开始新的他汀类药物治疗。使用多变量线性和逻辑回归模型分析处方数据，将基线LDL-C、年龄、性别、吸烟、极高冠心病风险、收缩压和他汀类药物使用时长作为协变量。

结果

在4754例糖尿病患者中，5%的患者使用RSV，59%使用阿托伐他汀（ATV），21%使用辛伐他汀（SMV），5%使用普伐他汀（PRV），2%使用氟伐他汀（FLV），7%使用洛伐他汀（LOV）。与使用其他他汀类药物的患者相比，使用RSV的患者基线平均LDL-C水平显著更高（p<0.05）（138 vs. 117 - 131mg/dL），平均起始剂量更低（11.7 vs. 17.0 - 63.7mg）且年龄更小（p<0.005）（平均年龄61岁 vs. 63 - 69岁）。与ATV（22.5%）、SMV（20.1%）、PRV（13.7%）、FLV（15.8%）和LOV（17.3%）相比，RSV使LDL-C降低的百分比显著更大（p<0.0001）（28.4%）。达到LDL-C目标<100mg/dL的RSV糖尿病患者比例更高（p<0.05）（72.8%），而使用其他他汀类药物的糖尿病患者这一比例为36.8% - 67.4%。