Institute of Clinical Medicine, National Yang-Ming University, Taipei 112, Taiwan.
Cardiovascular Research Center, National Yang-Ming University, Taipei 112, Taiwan.
J Clin Endocrinol Metab. 2017 Jul 1;102(7):2373-2381. doi: 10.1210/jc.2016-3717.
Although there is evidence to support the beneficial effects of statins on major cardiovascular events, few studies address the protective effect of statins on limb outcome.
To investigate whether the use of statin is associated with a risk reduction in lower-extremity amputation in type 2 diabetes mellitus (DM) patients with peripheral arterial disease (PAD).
Observational cohort study.
A nationwide DM database in Taiwan from 2000 to 2011.
A total of 69,332 patients aged ≥20 years with DM and PAD were identified.
Patients were divided into three groups: 11,409 patients were statin users, 4430 patients used nonstatin lipid-lowering agents, and 53,493 patients were nonusers.
The primary outcome was lower-extremity amputation. Secondary outcomes were in-hospital cardiovascular death and all-cause mortality.
Compared with nonusers, statin users were associated with lower risks of lower-extremity amputation [adjusted hazard ration (aHR), 0.75; 95% confidence interval (CI), 0.62 to 0.90], in-hospital cardiovascular death (aHR, 0.78; 95% CI, 0.69 to 0.87), and all-cause mortality (aHR, 0.73; 95% CI, 0.69 to 0.77). In the propensity score matching analysis, the effect of statin on the risk of lower-extremity amputation was consistent. Only statin users were associated with the risk reduction of lower-extremities amputation (HR, 0.77; 95% CI, 0.61 to 0.97) and cardiovascular death (HR, 0.78; 95% CI, 0.68 to 0.89) when taking competing risk of death into consideration.
Compared with statin nonusers who were never treated with lipid-lowering drugs, this study found that statin users had a lower risk of lower-extremity amputation and cardiovascular death in patients with DM and PAD.
虽然有证据表明他汀类药物对主要心血管事件有益，但很少有研究探讨他汀类药物对肢体结局的保护作用。
研究 2 型糖尿病（DM）合并外周动脉疾病（PAD）患者使用他汀类药物是否与降低下肢截肢风险相关。
观察性队列研究。
台湾 2000 年至 2011 年的全国性 DM 数据库。
共纳入 69332 名年龄≥20 岁的 DM 合并 PAD 患者。
患者分为三组：11409 名患者为他汀类药物使用者，4430 名患者使用非他汀类降脂药物，53493 名患者为非使用者。
主要结局为下肢截肢。次要结局指标为住院期间心血管死亡和全因死亡率。
与非使用者相比，他汀类药物使用者下肢截肢风险较低[校正后的危险比（aHR），0.75；95%置信区间（CI），0.62 至 0.90]、住院期间心血管死亡（aHR，0.78；95%CI，0.69 至 0.87）和全因死亡率（aHR，0.73；95%CI，0.69 至 0.77）。在倾向评分匹配分析中，他汀类药物对下肢截肢风险的影响一致。只有他汀类药物使用者与下肢截肢（HR，0.77；95%CI，0.61 至 0.97）和心血管死亡（HR，0.78；95%CI，0.68 至 0.89）风险降低相关，同时考虑了死亡的竞争风险。
与从未接受过降脂药物治疗的他汀类药物非使用者相比，本研究发现 DM 合并 PAD 患者使用他汀类药物可降低下肢截肢和心血管死亡风险。
