Ou Huang-Tz, Chang Kai-Cheng, Li Chung-Yi, Yang Chen-Yi, Ko Nai-Ying
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Pharmacy, Chang Gung Memorial Hospital Linkou, Taoyuan, Taiwan.
Int J Cardiol. 2017 Mar 1;230:592-598. doi: 10.1016/j.ijcard.2016.12.050. Epub 2016 Dec 21.
This study evaluated the risk of cardiovascular diseases (CVD) in a statin-treated HIV-infected population and the effects of intensive statin regimens (i.e., high-dose or potency) on CVD risks.
945 HIV-infected patients newly on statin treatment (144, 15.7% with CVD history) were identified from Taiwan's national HIV cohort. Using the median of the first year cumulative statin dosage as a cut-off point, patients were classified into either a high-dose or low-dose group. Patients were also classified as high-potency (i.e., atorvastatin) or low-potency (i.e., pravastatin) statin users. CVD, including ischemic stroke, coronary artery diseases, and heart failure, were identified after statin use to the end of 2011. Cox hazards regression was applied to assess the time-to-event hazards of CVD in association with intensive statin regimens.
In the HIV-infected population with CVD history, the high-dose group had a lower CVD risk compared to that of the low-dose group (hazard ratio [HR]: 0.88, 95% confidence interval [CI]: 0.39-1.99). The high-potency group showed a lower CVD risk compared to that of the low-potency group (HR: 0.42, 95% CI: 0.06-3.13). For those without CVD history, the corresponding figures were HR: 0.64 (95% CI: 0.30-1.35) and HR: 0.67 (95% CI: 0.16-2.87). The event rate of new-onset diabetes in high-dose statin group was higher than that in low-dose statin group (15.28% vs. 8.33%), while no muscle complications (i.e., myalgia, myositis, rhabdomyolysis) and dementia were observed in statin users.
There appears a trend showing a lower CVD risk in HIV patients receiving intensive statin therapy.
本研究评估了接受他汀类药物治疗的HIV感染人群患心血管疾病（CVD）的风险，以及强化他汀类药物治疗方案（即高剂量或高效能）对CVD风险的影响。
从台湾全国HIV队列中识别出945名新接受他汀类药物治疗的HIV感染患者（144名，15.7%有CVD病史）。以第一年累积他汀类药物剂量的中位数作为分界点，将患者分为高剂量组或低剂量组。患者还被分为高效能（即阿托伐他汀）或低效能（即普伐他汀）他汀类药物使用者。在他汀类药物使用至2011年底后，识别出包括缺血性中风、冠状动脉疾病和心力衰竭在内的CVD。应用Cox风险回归评估强化他汀类药物治疗方案与CVD发生时间风险的相关性。
在有CVD病史的HIV感染人群中，高剂量组的CVD风险低于低剂量组（风险比[HR]：0.88，95%置信区间[CI]：0.39 - 1.99）。高效能组的CVD风险低于低效能组（HR：0.42，95% CI：0.06 - 3.13）。对于那些没有CVD病史的患者，相应数字为HR：0.64（95% CI：0.30 - 1.35）和HR：0.67（95% CI：0.16 - 2.87）。高剂量他汀类药物组新发糖尿病的发生率高于低剂量他汀类药物组（15.28%对8.33%），而在他汀类药物使用者中未观察到肌肉并发症（即肌痛、肌炎、横纹肌溶解）和痴呆。
接受强化他汀类药物治疗的HIV患者似乎有CVD风险较低的趋势。
