Spatz Erica S, Canavan Maureen E, Desai Mayur M
Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT 06520-8088, USA.
Circ Cardiovasc Qual Outcomes. 2009 Jan;2(1):41-8. doi: 10.1161/CIRCOUTCOMES.108.832592. Epub 2009 Jan 13.
Guidelines for statin use currently focus on patients with elevated low-density lipoprotein levels. Recent findings from the Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER), however, indicate that statin therapy to reduce cardiovascular risk is also effective among older persons with at-goal low-density lipoprotein but elevated high-sensitivity C-reactive protein levels. We estimate the size of and describe this new population for whom statin therapy may now be indicated based on JUPITER's findings.
Using data from the 1999 to 2004 National Health and Nutrition Examination Survey, we estimate that 57.9% of older adults (men >or=50 years and women >or=60 years), or 33,547 000 (95% CI, 32,217,000 to 34,877,000) Americans, are currently taking a statin (24.4%) or indicated for statin therapy (33.5%). In addition, we estimate that 19.2%, or 11 144 000 (95% CI, 10 053 000 to 12 235 000), may become newly eligible for statin therapy. This includes 8 071 000 (13.9%; 95% CI, 7 173 000 to 8 969 000) with high-sensitivity C-reactive protein >or=2 mg/L and low-density lipoprotein <130 mg/dL (ie, those meeting "strict" JUPITER criteria) and an additional 3,073,000 (5.3%; 95% CI, 2,404,000 to 3,743,000) with high-sensitivity C-reactive protein >or=2 mg/L and low-density lipoprotein of 130 to 160 mg/dL for whom JUPITER's findings might reasonably be extended. Thus, approximately 80% of older persons may now have an indication for statin therapy. Compared with those who would continue to have no indication for statin therapy, the JUPITER group was more likely to be female, to be older, and to have obesity, hypertension, and the metabolic syndrome.
JUPITER's findings have the potential to impact treatment recommendations for approximately 20% of middle-aged to elderly adults, thus increasing the proportion of this segment of the population with an indication for statin therapy to nearly 80%.
目前他汀类药物使用指南主要关注低密度脂蛋白水平升高的患者。然而，来自“他汀类药物在一级预防中的应用合理性：评估瑞舒伐他汀的干预试验（JUPITER）”的最新研究结果表明，对于低密度脂蛋白水平达标的老年人，但高敏C反应蛋白水平升高的患者，使用他汀类药物治疗以降低心血管风险同样有效。我们根据JUPITER的研究结果估计了这一可能适合使用他汀类药物治疗的新人群的规模并对其进行描述。
利用1999年至2004年美国国家健康和营养检查调查的数据，我们估计57.9%的老年人（男性≥50岁，女性≥60岁），即3354.7万（95%可信区间，3221.7万至3487.7万）美国人，目前正在服用他汀类药物（24.4%）或适合接受他汀类药物治疗（33.5%）。此外，我们估计19.2%，即1114.4万（95%可信区间，1005.3万至1223.5万）可能新符合他汀类药物治疗条件。这包括807.1万（13.9%；95%可信区间，717.3万至896.9万）高敏C反应蛋白≥2mg/L且低密度脂蛋白<130mg/dL（即符合“严格”JUPITER标准的患者），以及另外307.3万（5.3%；95%可信区间，240.4万至374.3万）高敏C反应蛋白≥2mg/L且低密度脂蛋白为130至160mg/dL的患者，JUPITER的研究结果可能合理地适用于他们。因此，大约80%的老年人现在可能有使用他汀类药物治疗的指征。与那些仍无他汀类药物治疗指征的人相比，JUPITER组更可能为女性、年龄更大，且有肥胖、高血压和代谢综合征。
JUPITER的研究结果有可能影响约20%的中年至老年成年人的治疗建议，从而使这部分有他汀类药物治疗指征的人群比例增加到近80%。
