Ko Dennis T, Wijeysundera Harindra C, Jackevicius Cynthia A, Yousef Altayyeb, Wang Julie, Tu Jack V
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Circ Cardiovasc Qual Outcomes. 2013 May 1;6(3):315-22. doi: 10.1161/CIRCOUTCOMES.111.000015. Epub 2013 May 14.
Practice guidelines recommend intensive-dose statins for patients with acute coronary syndrome, but recent data about the risk of new-onset diabetes mellitus have raised concerns about its use. Our main objective was to evaluate the association between intensive statin therapy and new-onset diabetes mellitus in patients with myocardial infarction and to evaluate the association of intensive statin therapy with long-term adverse clinical outcomes.
A propensity score-matched cohort was created consisting of 17 080 patients with myocardial infarction aged >65 years old, hospitalized in Ontario, Canada, from 2004 to 2010. Clinical outcomes were compared in patients prescribed intensive-dose versus moderate-dose statins at hospital discharge. At 5 years, 13.6% of patients receiving intensive-dose statins and 13.0% of patients receiving moderate-dose statins had new-onset diabetes, which was not significantly different (P=0.19). By contrast, the 5-year rate of death or acute coronary syndrome was significantly lower at 44.8% in the intensive-dose statin group compared with 46.5% in the moderate-dose group (P=0.044). The reduction in combined clinical outcome was driven mainly by a significantly lower rate of acute coronary syndrome (P=0.039) associated with intensive-dose statins. No significant difference in mortality rates (34.8% in both groups) was observed between the treatment groups during the study period (P=0.89).
In older patients with myocardial infarction, we found intensive-dose statin therapy to be effective in reducing repeat hospitalization for acute coronary syndrome. The rate of new-onset diabetes mellitus at long term was not significantly different between intensive-dose and moderate-dose statins.
实践指南推荐对急性冠脉综合征患者使用强化剂量他汀类药物，但近期有关新发糖尿病风险的数据引发了对其使用的担忧。我们的主要目标是评估强化他汀治疗与心肌梗死患者新发糖尿病之间的关联，并评估强化他汀治疗与长期不良临床结局的关联。
通过倾向评分匹配创建了一个队列，该队列由2004年至2010年在加拿大安大略省住院的17080名年龄大于65岁的心肌梗死患者组成。比较出院时接受强化剂量他汀与中等剂量他汀治疗患者的临床结局。5年后，接受强化剂量他汀治疗的患者中有13.6%发生新发糖尿病，接受中等剂量他汀治疗的患者中有13.0%发生新发糖尿病，二者无显著差异（P = 0.19）。相比之下，强化剂量他汀组5年死亡或急性冠脉综合征发生率显著低于中等剂量组，分别为44.8%和46.5%（P = 0.044）。联合临床结局的降低主要是由于强化剂量他汀相关的急性冠脉综合征发生率显著降低（P = 0.039）。研究期间，治疗组之间的死亡率无显著差异（两组均为34.8%）（P = 0.89）。
在老年心肌梗死患者中，我们发现强化剂量他汀治疗可有效减少急性冠脉综合征的再次住院。强化剂量他汀与中等剂量他汀长期新发糖尿病发生率无显著差异。
