Departments of Endocrinology, Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422, USA.
J Clin Endocrinol Metab. 2013 Aug;98(8):3394-401. doi: 10.1210/jc.2013-1431. Epub 2013 Jun 19.
Statins are commonly prescribed to avert cardiovascular disease in diabetics. Little information, however, exists about the interrelationship of obesity, fitness, and statin treatment on mortality.
Our objective was to evaluate the influence of statin therapy on body mass index (BMI), cardiorespiratory fitness, and all-cause mortality risk in diabetics.
We gathered prospective observational data from Veterans Affairs Medical Centers in Washington, DC, and Palo Alto, California, on type 2 diabetic male veterans (n = 3775; mean age = 58.9 ± 9.9 years) who underwent an exercise tolerance test during the period of 1986 to 2011.
There were 930 deaths during a mean follow-up period of 10.5 years (37 826 person-years), with an average annual mortality of 24.6 events per 1000 person-years of observation. Adjusted Cox proportional hazard analysis revealed that mortality risk was 34% lower (hazard ratio [HR] = 0.66; confidence interval [CI] = 0.57-0.77) for individuals treated with statins compared with those not on statins. There was a paradoxical BMI-mortality association, with the highest mortality in those with a BMI of 18.5 to 24.9 kg/m(2) (HR = 1.54; CI = 1.26-1.87, P < .0001) compared with obese subjects (BMI of 30-34.9 kg/m(2)). However, this paradoxical association was evident only in those not treated with statins (HR = 1.79; CI = 1.39-2.29; P < .001) vs those on statins (HR = 1.06; CI = 0.75-1.54; P = .70). When statin therapy and fitness status were combined, mortality risk was 44% higher (HR = 1.44; CI = 1.16-1.78) in the least-fit not treated with statins compared with the least-fit treated with statins. Mortality risk declined progressively with increased fitness to 60% lower (HR = 0.40; CI = 0.24-0.66) and 49% lower (HR = 0.51; CI = 0.38-0.68) for the most highly fit individuals (>9 metabolic equivalents) treated and not treated with statins, respectively.
Statin therapy was associated with increased survival in diabetic veterans, which was further enhanced when fitness and statin therapy were combined. In addition, statin therapy eliminated the increased mortality risk associated with BMI <25 kg/m(2). The presence of a paradoxical BMI-mortality risk association, which is modulated by statin therapy has novel clinically relevant implications.
他汀类药物常用于预防糖尿病患者的心血管疾病。然而，关于肥胖、健康状况和他汀类药物治疗对死亡率的相互关系的信息很少。
我们的目的是评估他汀类药物治疗对糖尿病男性退伍军人的体重指数（BMI）、心肺健康和全因死亡率风险的影响。
我们从华盛顿特区和加利福尼亚州帕洛阿尔托的退伍军人事务医疗中心收集了前瞻性观察数据，纳入了在 1986 年至 2011 年期间接受运动耐量测试的 2 型糖尿病男性退伍军人（n=3775；平均年龄=58.9±9.9 岁）。
在平均 10.5 年的随访期间，有 930 人死亡（37826 人年），平均每年死亡率为每 1000 人年观察 24.6 例。校正后的 Cox 比例风险分析显示，与未使用他汀类药物的患者相比，使用他汀类药物的患者死亡风险降低 34%（风险比[HR] = 0.66；95%置信区间[CI] = 0.57-0.77）。BMI 与死亡率之间存在矛盾的关联，BMI 为 18.5 至 24.9 kg/m2 的患者（HR = 1.54；95%CI = 1.26-1.87，P<0.0001）与肥胖患者（BMI 为 30-34.9 kg/m2）相比，死亡率最高。然而，这种矛盾的关联仅在未使用他汀类药物的患者中明显（HR = 1.79；95%CI = 1.39-2.29；P<0.001），而在使用他汀类药物的患者中则不明显（HR = 1.06；95%CI = 0.75-1.54；P=0.70）。当他汀类药物治疗和健康状况结合时，与使用他汀类药物的最不适合的患者相比，未使用他汀类药物的最不适合的患者死亡率风险高出 44%（HR = 1.44；95%CI = 1.16-1.78）。随着健康状况的改善，死亡率风险逐渐降低，分别降低至 60%（HR = 0.40；95%CI = 0.24-0.66）和 49%（HR = 0.51；95%CI = 0.38-0.68），对于使用和未使用他汀类药物的最高健康状况（>9 个代谢当量）的患者。
他汀类药物治疗与糖尿病退伍军人的生存增加有关，当将健康状况和他汀类药物治疗相结合时，这种效果进一步增强。此外，他汀类药物治疗消除了 BMI<25 kg/m2 与死亡率增加相关的风险。他汀类药物治疗调节 BMI 与死亡率之间存在矛盾的风险关联，具有新的临床相关意义。
