Jacobson Terry A, Wertz Debra A, Hoy Tracey, Kuznik Andreas, Grochulski Daniel, Cziraky Mark
Office of Health Promotion and Disease Prevention, Emory University, Atlanta, GA 30303, USA.
Mayo Clin Proc. 2008 Dec;83(12):1316-25. doi: 10.1016/S0025-6196(11)60779-9.
To compare cardiovascular (CV) event rates and risk in patients without previous CV disease in whom atorvastatin or simvastatin was newly initiated in a managed care setting.
Patients aged 18 to 64 years in whom atorvastatin or simvastatin was newly initiated between January 1, 2003, and December 31, 2006, and who had no history of CV disease and at least 12 months of preindex and 3 months of postindex continuous eligibility in a managed care health plan, were identified using administrative claims from the HealthCore Integrated Research Database. Descriptive statistics were reported for sample characteristics. Unadjusted CV event rates were compared between treatment groups. A multivariate Cox proportional hazards model was developed to evaluate adjusted CV risk in all patients, as well as in a subset of patients with diabetes mellitus.
A total of 168,096 patients in the atorvastatin group and 51,333 patients in the simvastatin group were analyzed. Mean+/-SD age was 50.2+/-9.0 years for patients using atorvastatin and 50.6+/-9.0 years for patients using simvastatin. Mean+/-SD follow-up time was 664.2+/-386.2 days for the atorvastatin group and 511.4+/-359.8 days for the simvastatin group. Mean+/-SD dose and mean+/-SD therapy duration for patients taking simvastatin were 29.1+/-15.1 mg and 188.6+/-236.3 days, respectively, compared with 16.8+/-11.1 mg and 241.8+/-292.0 days, respectively, for patients taking atorvastatin. Unadjusted CV event rates were lower with use of atorvastatin than with simvastatin (hazard ratio, 0.80; 95% confidence interval, 0.75-0.84; P<.001). Adjusting for demographic/clinical characteristics, patients taking atorvastatin experienced a 13% risk reduction in total CV events during the entire follow-up period compared with those who were taking simvastatin (hazard ratio, 0.87; 95% confidence interval, 0.82-0.92; P<.001). No significant differences in CV events were found between patients taking atorvastatin or simvastatin in the diabetes mellitus subset (n=36,969).
In a managed care population with no history of CV disease, risk of CV events was lower among patients taking atorvastatin compared with patients taking simvastatin, after adjusting for known baseline differences.
比较在管理式医疗环境中初治阿托伐他汀或辛伐他汀的无既往心血管疾病患者的心血管（CV）事件发生率及风险。
利用HealthCore综合研究数据库中的管理式医疗索赔数据，确定2003年1月1日至2006年12月31日期间初治阿托伐他汀或辛伐他汀、无心血管疾病史、在管理式医疗健康计划中有至少12个月的索引前和3个月的索引后连续参保资格的18至64岁患者。报告样本特征的描述性统计数据。比较治疗组间未经调整的CV事件发生率。建立多变量Cox比例风险模型，评估所有患者以及糖尿病患者亚组中经调整的CV风险。
共分析了阿托伐他汀组的168,096例患者和辛伐他汀组的51,333例患者。使用阿托伐他汀患者的平均±标准差年龄为50.2±9.0岁，使用辛伐他汀患者的平均±标准差年龄为50.6±9.0岁。阿托伐他汀组的平均±标准差随访时间为664.2±386.2天，辛伐他汀组为511.4±359.8天。服用辛伐他汀患者的平均±标准差剂量和平均±标准差治疗持续时间分别为29.1±15.1mg和188.6±236.3天，而服用阿托伐他汀患者分别为16.8±11.1mg和241.8±292.0天。使用阿托伐他汀时未经调整的CV事件发生率低于辛伐他汀（风险比，0.80；95%置信区间，0.75 - 0.84；P<0.001）。在调整人口统计学/临床特征后，与服用辛伐他汀的患者相比，服用阿托伐他汀的患者在整个随访期间总CV事件风险降低了13%（风险比，0.87；95%置信区间，0.82 - 0.92；P<0.001）。在糖尿病亚组（n = 36,969）中，服用阿托伐他汀或辛伐他汀的患者之间未发现CV事件有显著差异。
在无心血管疾病史的管理式医疗人群中，在调整已知基线差异后，服用阿托伐他汀的患者发生CV事件的风险低于服用辛伐他汀的患者。
