他汀类药物对接受血液透析患者的有益作用。

The beneficial effects of statins in patients undergoing hemodialysis.

作者信息

Huang Chin-Chou, Chan Wan-Leong, Chen Yu-Chun, Chen Tzeng-Ji, Chung Chia-Min, Huang Po-Hsun, Lin Shing-Jong, Chen Jaw-Wen, Leu Hsin-Bang

机构信息

Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.; Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C.; Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan, R.O.C.

出版信息

Int J Cardiol. 2013 Oct 9;168(4):4155-9. doi: 10.1016/j.ijcard.2013.07.115. Epub 2013 Aug 5.

DOI:10.1016/j.ijcard.2013.07.115

PMID:23928338

Abstract

BACKGROUND

The beneficial effects of statins in patients undergoing hemodialysis are controversial. Our study aimed to investigate the use of statins and the subsequent risk of cardiovascular morbidity and mortality in patients undergoing hemodialysis.

METHODS

We conducted a cohort study using data from the Taiwan National Health Insurance Research Database. Cox regressions were performed to determine the hazard ratio (HR) of cardiovascular morbidity and mortality in the HD patients taking statins (statin cohort) compared with a propensity-matched comparison cohort.

RESULTS

The statin cohort included a total of 4074 patients who received statin treatment while also undergoing hemodialysis (mean age 53.3 ± 13.5 years, male 34.9%). The comparison cohort included 8148 propensity-matched hemodialysis patients who were not using statins. During the three years of follow-up, the statin cohort had lower incidence of ischemic stroke (p < 0.001), hospitalizations due to unstable angina (p < 0.001), deep vein thrombosis (p < 0.001), cardiovascular mortality (p < 0.001), and all-cause mortality (p < 0.001). After Cox regression analysis, statin use was independently associated with lower risk of future ischemic stroke (HR, 0.49; 95% confidence interval [CI], 0.39-0.63), hospitalization for unstable angina (HR, 0.57; 95% CI, 0.47-0.70), deep vein thrombosis (HR, 0.11; 95% CI, 0.05-0.27), cardiovascular mortality (HR, 0.29; 95% CI, 0.18-0.46), and all-cause mortality (HR, 0.49; 95% CI, 0.41-0.58).

CONCLUSION

Statin use was associated with a lower incidence of cardiovascular morbidity and mortality in patients undergoing hemodialysis.

摘要

背景

他汀类药物对接受血液透析患者的有益作用存在争议。我们的研究旨在调查接受血液透析患者使用他汀类药物的情况以及随后发生心血管疾病发病率和死亡率的风险。

方法

我们使用台湾国民健康保险研究数据库的数据进行了一项队列研究。进行Cox回归分析以确定接受他汀类药物治疗的血液透析患者（他汀类药物队列）与倾向匹配的对照队列相比，心血管疾病发病率和死亡率的风险比（HR）。

结果

他汀类药物队列共有4074例接受他汀类药物治疗且同时进行血液透析的患者（平均年龄53.3±13.5岁，男性占34.9%）。对照队列包括8148例倾向匹配的未使用他汀类药物的血液透析患者。在三年的随访期间，他汀类药物队列发生缺血性卒中的发生率较低（p<0.001）、因不稳定型心绞痛住院率较低（p<0.001）、深静脉血栓形成发生率较低（p<0.001）、心血管死亡率较低（p<0.001）以及全因死亡率较低（p<0.001）。经过Cox回归分析，使用他汀类药物与未来发生缺血性卒中的风险较低独立相关（HR，0.49；95%置信区间[CI]，0.39 - 0.63）、因不稳定型心绞痛住院（HR，0.57；95%CI，0.47 - 0.70）、深静脉血栓形成（HR，0.11；95%CI，0.05 - 0.27）、心血管死亡率（HR，0.29；95%CI，0.18 - 0.46）以及全因死亡率（HR，0.49；95%CI，0.41 - 0.58）。