Medicines Monitoring Unit, Division of Medical Sciences, Ninewells Hospital and Medical School, University of Dundee, Dundee, DD1 9SY, UK.
QJM. 2012 Jul;105(7):641-8. doi: 10.1093/qjmed/hcs031. Epub 2012 Feb 29.
Previous studies show that statins reduce total cholesterol (TC) concentration by both 21% in primary prevention (PP) and secondary prevention (SP) in clinical trials and by ∼24% in the general population. There are few data about the efficacy of statins on TC concentration and cardiovascular (CV) outcome in patients with chronic kidney disease (CKD). We evaluated the reduction of TC concentration and subsequent risk of CV morbidity and mortality with statins in CKD patients.
A population-based cohort study using a record-linkage database in Tayside, Scotland. A total of 2369 patients who had a primary diagnosis of CKD from Scottish Morbidity Record data or biochemistry database (serum creatinine of 220 μmol/l or higher) and who had at least two separate TC measurements between 1993 and 2007 were studied. Patients were categorized into statin-exposed and statin-unexposed groups according to statin use status during the follow-up. They were also classified into PP (n = 1325) and SP (n = 1044) cohorts at the entry date. The main outcomes were TC concentration change from baseline, CV events [Antiplatelet Trialist's Collaboration (APTC)] and all-cause mortality during the follow-up. Cox regression models, in which statin use was a time-dependent variable, were employed to assess the risk of outcome and adjusted for other known confounders.
Statin-associated TC concentrations decreased by 0.59 mmol/l (12%) in PP cohort and 0.56 mmol/l (13%) in SP cohort from 4.77 and 4.48 mmol/l at baselines, respectively. Statin use was associated with a reduced risk of APTC events, CV mortality or all-cause mortality in PP {adjusted hazard ratio (HR), 0.65 [95% confidence interval (CI) 0.48-0.88]; 0.73 (95% CI 0.52-0.98); 0.59 (95% CI 0.48-0.73)} and SP [adjusted HR, 0.66 (95% CI 0.52-0.84); 0.60 (95% CI 0.47-0.77); 0.56 (95% CI 0.47-0.68)], respectively.
Statin use reduced TC concentrations by ∼13% in patients with CKD. Statins were protective of APTC events, CV mortality and all-cause mortality in patients with or without established CV disease.
先前的研究表明，在临床试验中，他汀类药物在一级预防（PP）和二级预防（SP）中可将总胆固醇（TC）浓度降低 21%，在普通人群中降低约 24%。关于他汀类药物在慢性肾脏病（CKD）患者中对 TC 浓度和心血管（CV）结局的疗效的数据较少。我们评估了 CKD 患者使用他汀类药物降低 TC 浓度和随后发生 CV 发病率和死亡率的情况。
这是一项基于人群的队列研究，使用苏格兰泰赛德的记录链接数据库。共有 2369 名患者在苏格兰发病率记录数据或生化数据库（血清肌酐≥220μmol/l）中首次诊断为 CKD，并且在 1993 年至 2007 年间至少有两次单独的 TC 测量值，研究了这些患者。根据随访期间他汀类药物的使用情况，将患者分为他汀类药物暴露组和他汀类药物未暴露组。根据进入日期，他们还分为 PP（n=1325）和 SP（n=1044）队列。主要结局是从基线开始的 TC 浓度变化、CV 事件[抗血小板试验者协作（APTC）]和随访期间的全因死亡率。使用 Cox 回归模型，其中他汀类药物的使用是一个时间依赖性变量，以评估结局的风险，并调整了其他已知的混杂因素。
在 PP 队列中，他汀类药物相关的 TC 浓度从基线时的 4.77mmol/L 下降了 0.59mmol/L（12%），在 SP 队列中从 4.48mmol/L 下降了 0.56mmol/L（13%）。在 PP 队列中，使用他汀类药物与 APTC 事件、CV 死亡率或全因死亡率降低相关[校正后的危险比（HR），0.65（95%置信区间[CI]：0.48-0.88）；0.73（95% CI：0.52-0.98）；0.59（95% CI：0.48-0.73）]，在 SP 队列中，也与 APTC 事件、CV 死亡率或全因死亡率降低相关[校正后的 HR，0.66（95% CI：0.52-0.84）；0.60（95% CI：0.47-0.77）；0.56（95% CI：0.47-0.68）]。
他汀类药物的使用使 CKD 患者的 TC 浓度降低了约 13%。他汀类药物可预防有或无已确立的 CV 疾病患者的 APTC 事件、CV 死亡率和全因死亡率。
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