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他汀类药物在降低南亚、中国和白人糖尿病患者死亡率方面的效果。

Effectiveness of statin prescribing on reducing mortality in South Asian, Chinese, and White patients with diabetes.

机构信息

Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

Can J Cardiol. 2013 Aug;29(8):920-6. doi: 10.1016/j.cjca.2012.10.012. Epub 2013 Feb 5.

Abstract

BACKGROUND

Clinical trials have shown that 3-hydroxy-3-methylgutaryl coenzyme A reductase inhibitors (statins) reduce mortality in patients with diabetes. However, as these trials were conducted in largely white populations, it is unknown whether the benefits of statins can be extended to other ethnic populations in which the incidence of diabetes is rising sharply. We investigated associations between statin prescription and outcomes in a multiethnic population with diabetes.

METHODS

We identified all patients with newly diagnosed diabetes in British Columbia, Canada (1993-2006), using administrative data. Validated surname analysis was used to identify South Asian and Chinese patients. Statin prescribing was defined as any prescription filled within 1 year of diabetes diagnosis according to a provincial pharmacy database. Median length of follow-up was 4 years. Cox proportional hazards models were constructed for each ethnic group to determine the association of statin prescribing with time to death, adjusting for covariates including age, sex, socioeconomic status, and comorbid conditions.

RESULTS

There were 143,630 white, 9529 South Asian, and 14,084 Chinese persons with newly diagnosed diabetes. White patients were older and had more comorbidity than the other groups. Statin prescribing was associated with lower mortality compared with no prescribing within each ethnic group: South Asian (Hazard Ratio [HR], 0.69; 95% confidence interval [CI], 0.55-0.86; P = 0.001), Chinese (HR, 0.60; 95% CI, 0.49-0.72; P < 0.0001), and white (HR, 0.65; 95% CI, 0.63-0.67; P < 0.0001).

CONCLUSIONS

Statin prescribing is associated with lower mortality in white, Chinese, and South Asian patients with newly diagnosed diabetes, confirming the benefits of statins across these ethnic groups.

摘要

背景

临床试验表明,3-羟基-3-甲基戊二酰辅酶 A 还原酶抑制剂(他汀类药物)可降低糖尿病患者的死亡率。然而,由于这些试验主要在白人人群中进行,因此尚不清楚他汀类药物的益处是否可以扩展到其他糖尿病发病率急剧上升的种族人群。我们研究了他汀类药物处方与多民族糖尿病患者结局之间的关系。

方法

我们使用行政数据在加拿大不列颠哥伦比亚省确定了所有新诊断为糖尿病的患者(1993-2006 年)。采用经过验证的姓氏分析来确定南亚裔和华裔患者。根据省级药房数据库,将他汀类药物处方定义为在糖尿病诊断后 1 年内开具的任何处方。中位随访时间为 4 年。为每个种族群体构建 Cox 比例风险模型,以确定他汀类药物处方与死亡时间的关联,调整年龄、性别、社会经济地位和合并症等协变量。

结果

共有 143630 名白人、9529 名南亚裔和 14084 名华裔新诊断为糖尿病的患者。白人患者比其他群体年龄更大,合并症更多。与未处方他汀类药物相比,每个种族群体的处方与死亡率降低相关:南亚裔(HR,0.69;95%置信区间 [CI],0.55-0.86;P = 0.001)、华裔(HR,0.60;95% CI,0.49-0.72;P < 0.0001)和白人(HR,0.65;95% CI,0.63-0.67;P < 0.0001)。

结论

在新诊断为糖尿病的白人、华裔和南亚裔患者中,开具他汀类药物与死亡率降低相关,证实了他汀类药物在这些种族群体中的益处。

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