Ozieh Mukoso N, Taber David J, Egede Leonard E
From the Division of Nephrology, Medical University of South Carolina, Charleston, SC; Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC (MNO); Division of Transplant Surgery, Medical University of South Carolina, Charleston, SC; Department of Pharmacy, Ralph H Johnson VAMC, Charleston, SC (DJT); Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC; and Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VAMC, Charleston, SC (LEE).
Medicine (Baltimore). 2015 Dec;94(49):e2283. doi: 10.1097/MD.0000000000002283.
There is a lack of studies assessing if race impacts the efficacy of 3-hydroxy-3-methyl-glutaryl-CoA reductase (HMGCR) inhibitor ("statin") therapy on renal transplantation (RTx) outcomes. We examined the association between statin therapy and RTx outcomes, while concurrently quantifying the effect modification African American (AA) race has on statin efficacy.This was a retrospective longitudinal cohort study of solitary adult RTx (n = 1176) between June 2005 and May 2013. The Cox proportional hazard model was used to examine the impact of statin therapy on graft loss, death, and acute rejection and determine if significant interactions exist between statin therapy and race. Models were adjusted for demographics, socioeconomic status, cardiovascular history, medication use, and transplant characteristics.AAs (n = 624) and non-African Americans (n = 552) were equally likely to receive statin therapy (P = 0.922). Mean LDL and TGs in AA were 94 mg/dL and 133 mg/dL compared to 90 mg/dL and 163 mg/dL in non-AA, respectively. After adjusting for confounders, high statin users had 52% lower risk of developing graft loss (HR 0.48, 95% CI 0.29-0.80) and a nonstatistically significant reduction in death (HR 0.50, 95% CI 0.23-1.06) compared to low statin users. Acute rejection was not significantly influenced by statin use (HR 0.77 95% CI 0.46-1.27). There was a significant interaction between race and statin therapy for death (P = 0.007), but not for graft loss (P = 0.121) or rejection (P = 0.605). After stratifying by race, high statin use reduced the risk of death in AAs (HR 0.43, 95% CI 0.20-0.94), but not in non-AAs (HR 1.09, 95% CI 0.49-2.44).High statin use reduces the risk of graft loss in RTx, with a mortality benefit in AAs compared to non-AA, despite similar LDL levels. These results suggest a compelling reason to optimize statin therapy in renal transplant recipients (RTR), especially in AAs.
目前缺乏关于种族是否会影响3-羟基-3-甲基戊二酰辅酶A还原酶（HMGCR）抑制剂（“他汀类药物”）治疗对肾移植（RTx）结果疗效的研究。我们研究了他汀类药物治疗与RTx结果之间的关联，同时量化非裔美国人（AA）种族对他汀类药物疗效的效应修正。
这是一项对2005年6月至2013年5月期间成年单肾RTx患者（n = 1176）的回顾性纵向队列研究。使用Cox比例风险模型来研究他汀类药物治疗对移植物丢失、死亡和急性排斥反应的影响，并确定他汀类药物治疗与种族之间是否存在显著的相互作用。模型对人口统计学、社会经济地位、心血管病史、药物使用和移植特征进行了调整。
非裔美国人（n = 624）和非非裔美国人（n = 552）接受他汀类药物治疗的可能性相同（P = 0.922）。非裔美国人的平均低密度脂蛋白（LDL）和甘油三酯（TG）分别为94mg/dL和133mg/dL，而非非裔美国人分别为90mg/dL和163mg/dL。在对混杂因素进行调整后，与低剂量他汀类药物使用者相比，高剂量他汀类药物使用者发生移植物丢失的风险降低了52%（风险比[HR] 0.48，95%置信区间[CI] 0.29 - 0.80），死亡风险有非统计学意义的降低（HR 0.50，95% CI 0.23 - 1.06）。他汀类药物的使用对急性排斥反应没有显著影响（HR 0.77，95% CI 0.46 - 1.27）。种族与他汀类药物治疗在死亡方面存在显著的相互作用（P = 0.007），但在移植物丢失方面不存在（P = 0.121），在排斥反应方面也不存在（P = 0.605）。按种族分层后，高剂量他汀类药物的使用降低了非裔美国人的死亡风险（HR 0.43，95% CI 0.20 - 0.94），但未降低非非裔美国人的死亡风险（HR 1.09，95% CI 0.49 - 2.44）。
尽管低密度脂蛋白水平相似，但高剂量他汀类药物的使用降低了肾移植患者移植物丢失的风险，与非非裔美国人相比，非裔美国人有死亡获益。这些结果表明，有令人信服的理由在肾移植受者（RTR）中优化他汀类药物治疗，尤其是在非裔美国人中。
