他汀类药物治疗的延续与慢性肾脏病患者和非慢性肾脏病患者心房颤动/扑动风险降低的关系。

Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease.

机构信息

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.

Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Family Medicine, Cathay General Hospital, Taipei, Taiwan.

出版信息

Atherosclerosis. 2014 Jan;232(1):224-30. doi: 10.1016/j.atherosclerosis.2013.11.036. Epub 2013 Nov 19.

DOI:10.1016/j.atherosclerosis.2013.11.036

PMID:24401243

Abstract

BACKGROUND

To contain cost, Taiwan's previous National Health Insurance Reimbursement Policy requested that physicians discontinue their patients' statin therapy once the serum cholesterol had reached appropriate levels. This allowed us to evaluate the association between statin continuation and the occurrence of atrial fibrillation/flutter and whether it was modified by chronic kidney disease (CKD) status.

METHODS

Patients who initiated statin therapy between January 1, 2001 and December 31, 2009 were identified from a random sample of one million subjects in the Taiwan National Health Insurance Research Database. The outcome was atrial fibrillation/flutter. A proportional hazard regression model with time-varying statin use was applied to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) for atrial fibrillation/flutter according to current statin use versus treatment discontinuation, adjusted for baseline disease risk scores and time-varying covariates.

RESULTS

A total of 6767 CKD and 63,678 non-CKD patients initiating statin therapy were included and followed for an average of 4.0 years. A total of 1118 participants experienced new-onset atrial fibrillation/flutter. The incidence of atrial fibrillation/flutter was approximately 2 fold higher in the CKD patients. Continuation of statin therapy was associated with a 22% (adjusted hazard ratio 0.78; 95% CI: 0.65-0.93) and 57% (adjusted HR 0.43; 95% CI: 0.27-0.68) decrease in atrial fibrillation/flutter hazard as compared with discontinuation in non-CKD and CKD patients, respectively.

CONCLUSIONS

Continuation of statin therapy was associated with a decreased risk of atrial fibrillation/flutter among CKD and non-CKD patients. However, further randomized studies are still needed to assess the association.

摘要

背景

为了控制成本，台湾之前的全民健康保险偿付政策要求医生一旦患者的血清胆固醇达到适当水平，就停止其他汀类药物治疗。这使我们能够评估他汀类药物的持续使用与心房颤动/扑动的发生之间的关联，以及这种关联是否受慢性肾脏病（CKD）状况的影响。

方法

从台湾全民健康保险研究数据库的一个 100 万受试者的随机样本中确定了 2001 年 1 月 1 日至 2009 年 12 月 31 日期间开始使用他汀类药物治疗的患者。结局为心房颤动/扑动。应用时变他汀类药物使用的比例风险回归模型，根据当前他汀类药物使用与治疗中断的情况，估计了心房颤动/扑动的风险比（HR）和 95%置信区间（CI），调整了基线疾病风险评分和时变协变量。

结果

共纳入 6767 例 CKD 和 63678 例非 CKD 开始他汀类药物治疗的患者，并进行了平均 4.0 年的随访。共有 1118 名患者出现新发心房颤动/扑动。CKD 患者的心房颤动/扑动发生率约为非 CKD 患者的 2 倍。与非 CKD 患者相比，继续他汀类药物治疗与心房颤动/扑动的风险降低 22%（调整后的 HR 0.78；95%CI：0.65-0.93）和 57%（调整后的 HR 0.43；95%CI：0.27-0.68）；与 CKD 患者相比，分别降低 22%和 57%。