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他汀类药物使用对 COPD 患者全因死亡率的影响:一项基于人群的队列研究。

The Impact of Statin Drug Use on All-Cause Mortality in Patients With COPD: A Population-Based Cohort Study.

机构信息

Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada.

Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada; Division of Respiratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

出版信息

Chest. 2017 Sep;152(3):486-493. doi: 10.1016/j.chest.2017.02.002. Epub 2017 Feb 12.

Abstract

BACKGROUND

Patients with COPD are often prescribed statin drugs due to the increased prevalence of cardiovascular disease. There is considerable debate about the benefits conferred by statin drugs in patients with COPD. This study evaluates the association of statin drug use with all-cause and lung-related mortality in patients with COPD.

METHODS

This study uses population-based administrative data for the province of British Columbia, Canada. A cohort of patients with COPD was identified based on individual patient prescription records. Statin drug exposure was ascertained in the 1-year period after the COPD diagnosis. The primary and secondary outcomes, all-cause and lung-related mortality, respectively, were evaluated in the 1-year period thereafter using multivariate Cox proportional hazards models and several definitions of medication exposure.

RESULTS

There were 39,678 patients with COPD that met the study inclusion criteria. Of them, 7,775 (19.6%) had received at least one statin drug dispensed in the exposure ascertainment window. There were 1,446 all-cause deaths recorded in the cohort in the 1-year period after exposure ascertainment. In multivariate analysis, the estimated hazard ratio (HR) for statin drug exposure was 0.79 (95% CI, 0.68-0.92; P = .0016), suggesting a 21% reduction in the risk from statin drug use on all-cause mortality. For lung-related mortality, there was also a considerable reduction in the risk for all-cause mortality from statin drug use (HR, 0.55; 95% CI, 0.32-0.93; P = .0254). These results were robust to different specifications of the exposure ascertainment window.

CONCLUSIONS

This study shows that statin drug use in a population-based cohort of patients with COPD may confer benefits regarding reduced lung-related and all-cause mortality.

摘要

背景

由于心血管疾病的患病率增加,COPD 患者常被开他汀类药物。关于 COPD 患者使用他汀类药物的益处存在相当大的争议。本研究评估了他汀类药物使用与 COPD 患者全因和肺部相关死亡率的相关性。

方法

本研究使用加拿大不列颠哥伦比亚省的基于人群的行政数据。根据患者的个人处方记录确定了 COPD 患者队列。在 COPD 诊断后的 1 年内确定他汀类药物的暴露情况。使用多变量 Cox 比例风险模型和几种药物暴露定义评估了 1 年后的主要和次要结局(全因和肺部相关死亡率)。

结果

共有 39678 名符合研究纳入标准的 COPD 患者。其中,7775 名(19.6%)在暴露确定窗口中至少开具了一种他汀类药物。在暴露确定后的 1 年内,该队列中记录了 1446 例全因死亡。多变量分析中,他汀类药物暴露的估计风险比(HR)为 0.79(95%CI,0.68-0.92;P=.0016),表明他汀类药物使用可降低 21%的全因死亡率风险。对于肺部相关死亡率,他汀类药物使用也可显著降低全因死亡率风险(HR,0.55;95%CI,0.32-0.93;P=.0254)。这些结果在不同的暴露确定窗口规范下均具有稳健性。

结论

本研究表明,在基于人群的 COPD 患者队列中使用他汀类药物可能会带来降低肺部相关和全因死亡率的益处。

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