Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
J Allergy Clin Immunol. 2012 Mar;129(3):702-707.e2. doi: 10.1016/j.jaci.2011.11.052. Epub 2012 Jan 12.
The leukotriene pathway has been associated with an increased cardiovascular risk. However, the effects of the antileukotriene treatment used in asthmatic patients on cardiovascular outcomes have remained largely unexplored.
We sought to examine a potential protective role of the leukotriene receptor antagonist montelukast on future risk of incident and recurrent myocardial infarction and ischemic stroke.
A nationwide population-based cohort of approximately 7 million persons integrating data from the Prescribed Drug, Patient, Cause of Death, Income, Educational, and Emigration Registers was followed from July 1, 2005, to December 31, 2008. Analyses were performed in the whole population after exclusion of subjects with a prior cardiovascular diagnosis (incident events; sample size, n = 6,910,923 for myocardial infarction and n = 6,932,578 for stroke) and in subjects with a prior diagnosis (recurrent events; n = 153,937 and n = 132,291 for stroke and myocardial infarction, respectively).
Cox proportional hazard ratios (HRs) did not reveal an association of montelukast use with incident events. In contrast to these findings, montelukast use was associated with a lower risk for recurrent stroke (HR, 0.62; 95% CI, 0.38-0.99) accounting for age, sex, education level, and yearly income. Adjusting the latter finding also for respiratory and cardiovascular medications and diagnoses revealed similar point estimates (HR, 0.62; 95% CI, 0.39-1.0). Post hoc analyses revealed a significant association of montelukast use with a lower risk for recurrent myocardial infarction in male subjects (HR, 0.65; 95% CI, 0.43-0.99).
These data provide a first indication for a potential role of the antiasthma drug montelukast for secondary prevention of cardiovascular disease.
白三烯途径与心血管风险增加有关。然而，用于哮喘患者的抗白三烯治疗对心血管结局的影响在很大程度上仍未得到探索。
我们试图研究白三烯受体拮抗剂孟鲁司特对未来新发和复发性心肌梗死和缺血性卒中风险的潜在保护作用。
一项基于人群的全国性队列研究，约有 700 万人的数据整合自处方药物、患者、死因、收入、教育和移民登记处，随访时间从 2005 年 7 月 1 日至 2008 年 12 月 31 日。在排除有既往心血管诊断的患者（新发事件；样本量，心肌梗死 n=6910923，卒中 n=6932578）和有既往诊断的患者（复发性事件；卒中 n=153937，心肌梗死 n=132291）后，对全人群进行了分析。
Cox 比例风险比（HRs）并未显示孟鲁司特的使用与新发事件有关。与这些发现相反，孟鲁司特的使用与复发性卒中的风险降低相关（HR，0.62；95%CI，0.38-0.99），并考虑了年龄、性别、教育程度和年收入。调整上述发现，还考虑了呼吸系统和心血管药物及诊断，也得到了类似的点估计（HR，0.62；95%CI，0.39-1.0）。事后分析显示，孟鲁司特的使用与男性患者复发性心肌梗死风险的降低显著相关（HR，0.65；95%CI，0.43-0.99）。
这些数据首次提供了抗哮喘药物孟鲁司特在心血管疾病二级预防中的潜在作用的证据。
