Endo Akihiro, Okada Taiji, Pak Misun, Kagawa Yuzo, Ito Shimpei, Sato Hirotomo, Kageshima Kenji, Yoshida Yasuyuki, Tanabe Kazuaki
Division of Cardiology, Shimane University Faculty of Medicine, Izumo, Japan.
Division of Cardiology, Tottori Prefectural Central Hospital, Tottori, Japan.
J Geriatr Cardiol. 2017 Jun;14(6):383-391. doi: 10.11909/j.issn.1671-5411.2017.06.004.
To assess whether the low-density lipoprotein cholesterol (LDL-C) target value and preventive effect of statins are different between elderly and younger patients.
We investigated 304 patients with previous percutaneous coronary intervention who underwent coronary angiography from January 2007 to December 2016 for examination of recurrent ischemia beyond the early restenosis. Patients were classified into two groups: age ≥ 75 years (elderly group: = 140) and < 75 years (younger group: = 164). Relationships between the achieved LDL-C level, incidence of late coronary events, and the effectiveness of statins were evaluated.
During follow-up, 179 patients underwent late coronary revascularization. Recurrent ischemia presenting as acute coronary syndrome (ACS) occurred in 83 cases. Kaplan-Meier curve analysis revealed that in the younger group, recurrent ACS was significantly lower in patients with LDL-C < 70 mg/dL than in those with LDL-C ranging from 70 to < 100 mg/dL ( = 0.035); however, there was no difference between these in the elderly group ( = 0.863). Instead, recurrent ACS was less frequent in patients with LDL-C ranging from 70 mg/dL to < 100 mg/dL than in those with LDL-C ≥ 100 mg/dL in the elderly group ( = 0.033). Statin use was associated with decreased recurrent ACS ( = 0.005); moreover, only using statins was an independent predictor in the elderly group (HR: 0.375; = 0.007).
Strict control of LDL-C to < 70 mg/dL was effective for reducing the incidence of recurrent ACS in younger patients. However, LDL-C < 100 mg/dL might be sufficient as the target value of LDL-C-lowering therapy for secondary prevention of ischemic events in Japanese elderly patients.
评估老年患者与年轻患者的低密度脂蛋白胆固醇（LDL-C）目标值及他汀类药物的预防效果是否存在差异。
我们调查了2007年1月至2016年12月期间因早期再狭窄后复发性缺血接受冠状动脉造影的304例曾行冠状动脉介入治疗的患者。患者分为两组：年龄≥75岁（老年组：n = 140）和<75岁（年轻组：n = 164）。评估达到的LDL-C水平、晚期冠状动脉事件发生率与他汀类药物有效性之间的关系。
随访期间，179例患者接受了晚期冠状动脉血运重建。83例出现表现为急性冠状动脉综合征（ACS）的复发性缺血。Kaplan-Meier曲线分析显示，在年轻组中，LDL-C < 70 mg/dL的患者复发性ACS显著低于LDL-C在70至<100 mg/dL之间的患者（P = 0.035）；然而，老年组中这两者之间无差异（P = 0.863）。相反，在老年组中，LDL-C在70 mg/dL至<100 mg/dL之间的患者复发性ACS比LDL-C≥100 mg/dL的患者更少（P = 0.033）。使用他汀类药物与复发性ACS减少相关（P = 0.005）；此外，仅使用他汀类药物是老年组的独立预测因素（HR：0.375；P = 0.007）。
将LDL-C严格控制在<70 mg/dL对降低年轻患者复发性ACS的发生率有效。然而，LDL-C < 100 mg/dL可能足以作为日本老年患者缺血事件二级预防中降低LDL-C治疗的目标值。
