Cardiology Department, Veterans Affairs Medical Center, Washington DC 20422, USA.
Lancet. 2013 Feb 2;381(9864):394-9. doi: 10.1016/S0140-6736(12)61426-3. Epub 2012 Nov 28.
Statins are commonly prescribed for management of dyslipidaemia and cardiovascular disease. Increased fitness is also associated with low mortality and is recommended as an essential part of promoting health. However, little information exists about the combined effects of fitness and statin treatment on all-cause mortality. We assessed the combined effects of statin treatment and fitness on all-cause mortality risk.
In this prospective cohort study, we included dyslipidaemic veterans from Veterans Affairs Medical Centers in Palo Alto, CA, and Washington DC, USA, who had had an exercise tolerance test between 1986, and 2011. We assigned participants to one of four fitness categories based on peak metabolic equivalents (MET) achieved during exercise test and eight categories based on fitness status and statin treatment. The primary endpoint was all-cause mortality adjusted for age, body-mass index, ethnic origin, sex, history of cardiovascular disease, cardiovascular drugs, and cardiovascular risk factors. We assessed mortality from Veteran's Affairs' records on Dec 31, 2011. We compared groups with Cox proportional hazard model.
We assessed 10,043 participants (mean age 58·8 years, SD 10·9 years). During a median follow-up of 10·0 years (IQR 6·0-14·2), 2318 patients died, with an average yearly mortality rate of 22 deaths per 1000 person-years. Mortality risk was 18·5% (935/5046) in people taking statins versus 27·7% (1386/4997) in those not taking statins (p<0·0001). In patients who took statins, mortality risk decreased as fitness increased; for highly fit individuals (>9 MET; n=694), the hazard ratio (HR) was 0·30 (95% CI 0·21-0·41; p<0·0001) compared with least fit (≤5 METs) patients (HR 1; n=1060). For those not treated with statins, the HR for least fit participants (n=1024) was 1·35 (95% CI 1·17-1·54; p<0·0001) and progressively decreased to 0·53 (95% CI 0·44-0·65; p<0·0001) for those in the highest fitness category (n=1498).
Statin treatment and increased fitness are independently associated with low mortality among dyslipidaemic individuals. The combination of statin treatment and increased fitness resulted in substantially lower mortality risk than either alone, reinforcing the importance of physical activity for individuals with dyslipidaemia.
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他汀类药物通常用于治疗血脂异常和心血管疾病。较高的健康水平也与较低的死亡率相关，被推荐作为促进健康的重要组成部分。然而，关于他汀类药物治疗和健康水平对全因死亡率的综合影响的信息很少。我们评估了他汀类药物治疗和健康水平对全因死亡率风险的综合影响。
在这项前瞻性队列研究中，我们纳入了来自美国加利福尼亚州帕洛阿尔托退伍军人事务医疗中心和华盛顿特区退伍军人事务医疗中心的血脂异常退伍军人，他们在 1986 年至 2011 年间进行了运动耐量测试。我们根据运动试验期间达到的峰值代谢当量（MET）将参与者分为四个健康水平类别，并根据健康水平和他汀类药物治疗情况分为八个类别。主要终点是经年龄、体重指数、种族、性别、心血管疾病史、心血管药物和心血管危险因素调整后的全因死亡率。我们根据 2011 年 12 月 31 日退伍军人事务部的记录评估死亡率。我们使用 Cox 比例风险模型比较了各组。
我们评估了 10043 名参与者（平均年龄 58.8 岁，标准差 10.9 岁）。在中位随访 10.0 年（IQR 6.0-14.2）期间，2318 名患者死亡，平均每年死亡率为 22 例/1000 人年。服用他汀类药物的患者死亡率为 18.5%（935/5046），未服用他汀类药物的患者死亡率为 27.7%（1386/4997）（p<0.0001）。在服用他汀类药物的患者中，随着健康水平的提高，死亡率风险降低；对于高度健康的患者（>9 MET；n=694），风险比（HR）为 0.30（95%CI 0.21-0.41；p<0.0001），而最不健康的患者（≤5 METs；n=1060）的 HR 为 1。对于未接受他汀类药物治疗的患者，最不健康组（n=1024）的 HR 为 1.35（95%CI 1.17-1.54；p<0.0001），而健康水平最高组（n=1498）的 HR 逐渐降至 0.53（95%CI 0.44-0.65；p<0.0001）。
他汀类药物治疗和健康水平的提高与血脂异常患者的低死亡率独立相关。他汀类药物治疗和健康水平的提高相结合，导致的死亡率风险显著低于单独使用任何一种方法，这进一步强调了对于血脂异常患者来说，进行身体活动的重要性。
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