Mizuno Kyoichi, Nakaya Noriaki, Ohashi Yasuo, Tajima Naoko, Kushiro Toshio, Teramoto Tamio, Uchiyama Shinichiro, Nakamura Haruo
Department of Internal Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Circulation. 2008 Jan 29;117(4):494-502. doi: 10.1161/CIRCULATIONAHA.106.671826. Epub 2008 Jan 2.
It is well known that statins reduce the risk of cardiovascular disease. However, the effect of statins in women for the primary prevention of cardiovascular disease has not been determined. We conducted an exploratory analysis of the effect of diet plus pravastatin therapy on the primary prevention of cardiovascular events in women with data from a large-scale primary prevention trial with pravastatin.
Patients with hypercholesterolemia (5.7 to 7.0 mmol/L) and no history of coronary heart disease or stroke were randomized to diet or diet plus pravastatin 10 to 20 mg/d and followed up for > or = 5 years. We investigated the effect of diet plus pravastatin treatment on cardiovascular events in 5356 women during the 5-year follow-up. The incidence of cardiovascular events in the women was 2 to 3 times lower than that in men. The occurrence of cardiovascular events was 26% to 37% lower in the diet plus pravastatin treatment group than in the diet alone group. Although these differences did not reach statistical significance, the overall risk reductions were similar to those in men. Notably, women > or = 60 years of age treated with diet plus pravastatin had markedly higher risk reductions for coronary heart disease (45%), coronary heart disease plus cerebral infarction (50%), and stroke (64%) than did women treated with diet alone.
Treatment with pravastatin in women with elevated cholesterol but no history of cardiovascular disease provides a benefit similar to that seen in men, and this benefit is more marked in older women. This treatment should be considered routinely for primary cardiovascular protection in women with elevated cholesterol levels.
众所周知，他汀类药物可降低心血管疾病风险。然而，他汀类药物在女性心血管疾病一级预防中的作用尚未确定。我们利用一项关于普伐他汀的大规模一级预防试验的数据，对饮食加普伐他汀治疗在女性心血管事件一级预防中的效果进行了探索性分析。
将高胆固醇血症（5.7至7.0 mmol/L）且无冠心病或中风病史的患者随机分为饮食组或饮食加10至20 mg/d普伐他汀组，并随访≥5年。我们在5年随访期间调查了饮食加普伐他汀治疗对5356名女性心血管事件的影响。女性心血管事件的发生率比男性低2至3倍。饮食加普伐他汀治疗组的心血管事件发生率比单纯饮食组低26%至37%。尽管这些差异未达到统计学意义，但总体风险降低与男性相似。值得注意的是，接受饮食加普伐他汀治疗的60岁及以上女性，其冠心病（45%）、冠心病加脑梗死（50%）和中风（64%）的风险降低明显高于单纯接受饮食治疗的女性。
在胆固醇水平升高但无心血管疾病病史的女性中，使用普伐他汀治疗带来的益处与男性相似，且在老年女性中更为显著。对于胆固醇水平升高的女性，应常规考虑这种治疗以进行心血管一级保护。
