Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Am J Cardiol. 2012 Dec 1;110(11):1568-77. doi: 10.1016/j.amjcard.2012.07.021. Epub 2012 Aug 28.
Although statin therapy is essential for secondary cardiovascular prevention, the therapeutic effect of statins on cardiovascular outcomes in patients with advanced chronic kidney disease (CKD) after coronary revascularization has not been fully elucidated. In the CREDO-Kyoto Registry Cohort-2, 14,706 patients who underwent first coronary revascularization were divided into 4 strata based on estimated glomerular filtration rate (eGFR) or status of hemodialysis (HD). Patients in each stratum were further divided into 2 groups based on statin therapy at discharge: non-CKD stratum (eGFR ≥60 ml/min/1.73 m(2)), 8,959 patients (statin, n = 4,747; no statin, n = 4,212); mild CKD stratum (eGFR ≥30 to <60 ml/min/1.73 m(2)), 4,567 patients (statin, n = 2,135; no statin, n = 2,432); severe CKD stratum (eGFR <30 ml/min/1.73 m(2)), 608 patients (statin, n = 229; no statin, n = 379); and HD stratum, 572 patients (statin, n = 117; no statin, n = 455). Median follow-up duration was 956 days (interquartile range 699 to 1,245). Adjusted risk for major adverse cardiovascular events (MACEs; composite of cardiovascular death, myocardial infarction, or stoke) was significantly lower in the statin group than in the no-statin group in the non-CKD (hazard ratio 0.8, 95% confidence interval 0.68 to 0.95, p = 0.01) and mild CKD (hazard ratio 0.69, 95% confidence interval 0.56 to 0.84, p = 0.0002) strata. However, a significant association of statin therapy and lower risk for MACEs was not seen in the severe CKD (hazard ratio 0.91, 95% confidence interval 0.6 to 1.38, p = 0.65) and HD (hazard ratio 1.04, 95% confidence interval 0.64 to 1.69, p = 0.87) strata. In conclusion, statin therapy was associated with significantly lower risk for MACEs in patients with non-CKD and mild CKD undergoing coronary revascularization. However, therapeutic benefits of statins were not apparent in patients with severe CKD and HD.
虽然他汀类药物治疗对于二级心血管预防至关重要，但在接受冠状动脉血运重建后的晚期慢性肾脏病（CKD）患者中，他汀类药物对心血管结局的治疗效果尚未完全阐明。在 CREDO-Kyoto 登记队列-2 中，14706 例首次接受冠状动脉血运重建的患者根据估计肾小球滤过率（eGFR）或血液透析（HD）状态分为 4 个亚组。每个亚组的患者根据出院时的他汀类药物治疗进一步分为 2 组：非 CKD 亚组（eGFR≥60ml/min/1.73m2），8959 例（他汀类药物，n=4747；无他汀类药物，n=4212）；轻度 CKD 亚组（eGFR≥30 至<60ml/min/1.73m2），4567 例（他汀类药物，n=2135；无他汀类药物，n=2432）；重度 CKD 亚组（eGFR<30ml/min/1.73m2），608 例（他汀类药物，n=229；无他汀类药物，n=379）；和 HD 亚组，572 例（他汀类药物，n=117；无他汀类药物，n=455）。中位随访时间为 956 天（四分位间距 699 至 1245）。调整后的主要不良心血管事件（MACE；心血管死亡、心肌梗死或中风的复合终点）风险在他汀类药物组明显低于无他汀类药物组，在非 CKD 亚组（风险比 0.8，95%置信区间 0.68 至 0.95，p=0.01）和轻度 CKD 亚组（风险比 0.69，95%置信区间 0.56 至 0.84，p=0.0002）。然而，在重度 CKD（风险比 0.91，95%置信区间 0.6 至 1.38，p=0.65）和 HD（风险比 1.04，95%置信区间 0.64 至 1.69，p=0.87）亚组中，他汀类药物治疗与较低的 MACE 风险之间并未观察到显著关联。总之，在接受冠状动脉血运重建的非 CKD 和轻度 CKD 患者中，他汀类药物治疗与显著降低 MACE 风险相关。然而，在重度 CKD 和 HD 患者中，他汀类药物的治疗益处并不明显。
