Li Yan-Rong, Tsai Sung-Sheng, Lin Yu-Sheng, Chung Chang-Min, Chen Szu-Tah, Sun Jui-Hung, Liou Miaw-Jene, Chen Tien-Hsing
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.
Division of Cardiology, Chang Gung Memorial Hospital, Chiayi, Taiwan.
Diabetol Metab Syndr. 2017 Sep 19;9:71. doi: 10.1186/s13098-017-0272-7. eCollection 2017.
Evidences support the benefits of moderate- to high-intensity statins for patients with acute myocardial infarction (AMI) except for those with type 2 diabetes mellitus (T2DM) on dialysis after AMI. This study was aimed to investigate the safety and efficacy of secondary prevention of cardiovascular diseases using moderate- to high-intensity statins in T2DM patients on dialysis after AMI.
A simulated prospective cohort study was conducted between January 1st, 2001 and December 31st, 2013 utilizing data from the Taiwan National Health Insurance Research Database. A total of 882 patients with T2DM on dialysis after AMI were selected as the study cohort. Cardiovascular efficacy and safety of moderate- to high-intensity statins were evaluated by comparing outcomes of 441 subjects receiving statins after AMI to 441 matched subjects not receiving statins after AMI. The primary composite outcome included cardiovascular death, non-fatal myocardial infarction and non-fatal ischemic stroke.
The Kaplan-Meier event rate for the primary composite outcomes at 8 years was 30.2% (133 patients) in the statin group compared with 25.2% (111 patients) in the non-statin group (hazard ratio [HR], .98; 95% confidence interval [CI] .76-1.27). Significantly lower risks of non-fatal ischemic stroke (HR, .58; 95% CI .35-.98) and all-cause mortality (HR, .70; 95% CI .59-.84) were found in the statin group.
In T2DM patients on dialysis after AMI, the use of moderate- to high-intensity statins has neutral effects on composite cardiovascular events but may reduce risks of non-fatal ischemic stroke and all-cause mortality.
有证据支持中高强度他汀类药物对急性心肌梗死（AMI）患者有益，但AMI后接受透析的2型糖尿病（T2DM）患者除外。本研究旨在探讨中高强度他汀类药物对AMI后接受透析的T2DM患者进行心血管疾病二级预防的安全性和有效性。
利用台湾国民健康保险研究数据库的数据，于2001年1月1日至2013年12月31日进行了一项模拟前瞻性队列研究。共选择882例AMI后接受透析的T2DM患者作为研究队列。通过比较441例AMI后接受他汀类药物治疗的受试者与441例匹配的AMI后未接受他汀类药物治疗的受试者的结局，评估中高强度他汀类药物的心血管疗效和安全性。主要复合结局包括心血管死亡、非致命性心肌梗死和非致命性缺血性中风。
他汀类药物组8年时主要复合结局的Kaplan-Meier事件发生率为30.2%（133例患者），而非他汀类药物组为25.2%（111例患者）（风险比[HR]，0.98；95%置信区间[CI]0.76-1.27）。他汀类药物组非致命性缺血性中风（HR，0.58；95%CI 0.35-0.98）和全因死亡率（HR，0.70；95%CI 0.59-0.84）的风险显著降低。
在AMI后接受透析的T2DM患者中，使用中高强度他汀类药物对复合心血管事件有中性影响，但可能降低非致命性缺血性中风和全因死亡率的风险。
