Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.
Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia.
Metabolism. 2019 Apr;93:93-99. doi: 10.1016/j.metabol.2018.11.006. Epub 2018 Nov 16.
Higher plasma fibroblast growth factor 21 (FGF21) levels predict incident cardiovascular events in type 2 diabetes patients. However, whether FGF21 levels predict cardiovascular events in statin-treated patients in the general population is unknown. We investigated whether FGF21 levels predict major cardiovascular event (MCVE) in the Treating to New Targets (TNT) trial participants.
After 8-week run-in on atorvastatin 10 mg/day, 10,001 patients with stable coronary disease in the TNT trial were randomized to 10 mg or 80 mg/day of atorvastatin for a median of 4.9 years. We analyzed data from 1996 patients with plasma FGF21 levels measured at randomization. Among them, 1835 patients had FGF21 measured one-year post-randomization.
Higher ln-transformed FGF21 levels at randomization were associated with higher risk of incident MCVE (adjusted hazards ratio per SD increase = 1.18, P = 0.019). At 1-year post-randomization, FGF21 levels were lower in patients randomized to receive 80 mg versus 10 mg atorvastatin (186.9 versus 207.5 pg/mL respectively, P = 0.006). Higher ln-transformed FGF21 levels at 1-year post-randomization were also associated with higher subsequent risk of MCVEs (adjusted hazards ratio per SD increase = 1.24, P = 0.009). However, changes in FGF21 levels over 1-year were not related to subsequent MCVE risk. FGF21 levels had significant incremental value in net reclassification improvement in MCVE risk prediction.
Higher plasma FGF21 levels are associated with higher CVD risk in statin-treated high-risk patients. Higher dose atorvastatin is associated with a reduction in FGF21 levels. FGF21 provides incremental value in CVD risk prediction in statin-treated patients.
较高的血浆成纤维细胞生长因子 21（FGF21）水平可预测 2 型糖尿病患者的心血管事件。然而，在一般人群中，他汀类药物治疗的患者的 FGF21 水平是否可预测心血管事件尚不清楚。我们研究了 FGF21 水平是否可预测 Treating to New Targets（TNT）试验参与者的主要心血管事件（MCVE）。
在阿托伐他汀 10mg/天的 8 周导入期后，TNT 试验中 10001 例稳定型冠心病患者被随机分为阿托伐他汀 10mg 或 80mg/天治疗，中位随访时间为 4.9 年。我们分析了随机分组时测量血浆 FGF21 水平的 1996 例患者的数据。其中，1835 例患者在随机分组后一年测量了 FGF21。
随机分组时的 ln 转换 FGF21 水平较高与 MCVE 事件的发生风险增加相关（每 SD 增加的调整后的危险比为 1.18，P=0.019）。在随机分组后 1 年，接受 80mg 阿托伐他汀与 10mg 阿托伐他汀治疗的患者的 FGF21 水平较低（分别为 186.9pg/ml 和 207.5pg/ml，P=0.006）。随机分组后 1 年的 ln 转换 FGF21 水平较高与随后的 MCVE 风险增加相关（每 SD 增加的调整后的危险比为 1.24，P=0.009）。然而，1 年内 FGF21 水平的变化与随后的 MCVE 风险无关。FGF21 水平在 MCVE 风险预测的净重新分类改善方面具有显著的增量价值。
较高的血浆 FGF21 水平与他汀类药物治疗的高危患者的 CVD 风险增加相关。较高剂量的阿托伐他汀与 FGF21 水平降低相关。FGF21 为他汀类药物治疗患者的 CVD 风险预测提供了增量价值。
