ICES (Campitelli, Maxwell, Maclagan, Ko, Bell, Daneman, Bronskill); Sunnybrook Research Institute (Ko, Daneman, Bronskill), Department of Cardiology (Ko) and Division of Infectious Diseases (Daneman), Sunnybrook Health Sciences Centre; Department of Medicine (Ko, Bell, Morris, Daneman) and Institute of Health Policy, Management and Evaluation (Ko, Jeffs, Daneman, Bronskill), University of Toronto; Lawrence S. Bloomberg Faculty of Nursing (Jeffs), University of Toronto; Division of General Internal Medicine (Bell), Mount Sinai Health System; Women's College Research Institute (Bronskill), Women's College Hospital; Keenan Research Centre at the Li Ka Shing Knowledge Institute (Jeffs), St. Michael's Hospital, Toronto, Ont.; Schools of Pharmacy (Maxwell) and Public Health and Health Systems (Maxwell), University of Waterloo, Waterloo, Ont.; Department of Quantitative Health Sciences (Lapane), University of Massachusetts Medical School, Worchester, Mass.
CMAJ. 2019 Jan 14;191(2):E32-E39. doi: 10.1503/cmaj.180853.
Guidance from randomized clinical trials about the ongoing benefits of statin therapies in residents of long-term care facilities is lacking. We sought to examine the effect of statin dose on 1-year survival and admission to hospital for cardiovascular events in this setting.
We conducted a retrospective cohort study using population-based administrative data from Ontario, Canada. We identified 21 808 residents in long-term care facilities who were 76 years of age and older and were prevalent statin users on the date of a full clinical assessment between April 2013 and March 2014, and categorized residents as intensive- or moderate-dose users. Treatment groups were matched on age, sex, admission to hospital for atherosclerotic cardiovascular disease, resident frailty and propensity score. Differences in 1-year survival and admission to hospital for cardiovascular events were measured using Cox proportional and subdistribution hazard models, respectively.
Using propensity-score matching, we included 4577 well-balanced pairs of residents who were taking intensive- and moderate-dose statins. After 1 year, there were 1210 (26.4%) deaths and 524 (11.5%) admissions to hospital for cardiovascular events among residents using moderate-dose statins compared with 1173 (25.6%) deaths and 522 (11.4%) admissions to hospital for cardiovascular events among those taking intensive-dose statins. We found no significant association between prevalent use of intensive-dose statins and 1-year survival (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.90 to 1.05) or 1-year admission to hospital for cardiovascular events (HR 0.99, 95% CI 0.88 to 1.12) compared with use of moderate-dose statins.
The rates of mortality and admission to hospital for cardiovascular events at 1 year were similar between residents in long-term care taking intensive-dose statins compared with those taking moderate-dose statins. This lack of benefit should be considered when prescribing statins to vulnerable residents of long-term care facilities who are at potentially increased risk of statin-related adverse events.
缺乏关于他汀类药物治疗在长期护理机构居民中持续获益的随机临床试验指导。我们试图研究这种情况下他汀类药物剂量对 1 年生存率和心血管事件住院的影响。
我们使用来自加拿大安大略省的基于人群的行政数据进行了回顾性队列研究。我们确定了 21808 名 76 岁及以上、2013 年 4 月至 2014 年 3 月期间在全面临床评估时为常规他汀类药物使用者的长期护理机构居民，并将居民分为强化剂量或中等剂量使用者。治疗组在年龄、性别、因动脉粥样硬化性心血管疾病住院、居民脆弱性和倾向评分方面进行匹配。使用 Cox 比例风险和亚分布风险模型分别测量 1 年生存率和心血管事件住院的差异。
通过倾向评分匹配，我们纳入了 4577 对服用中等剂量和强化剂量他汀类药物的情况良好平衡的居民。1 年后，服用中等剂量他汀类药物的居民中有 1210 例（26.4%）死亡和 524 例（11.5%）心血管事件住院，而服用强化剂量他汀类药物的居民中有 1173 例（25.6%）死亡和 522 例（11.4%）心血管事件住院。我们发现，与使用中等剂量他汀类药物相比，使用强化剂量他汀类药物与 1 年生存率（风险比[HR]0.97，95%置信区间[CI]0.90 至 1.05）或 1 年心血管事件住院（HR 0.99，95%CI 0.88 至 1.12）无显著关联。
与服用中等剂量他汀类药物的长期护理机构居民相比，服用强化剂量他汀类药物的居民在 1 年内的死亡率和心血管事件住院率相似。在为长期护理机构中处于他汀类药物相关不良反应风险增加的脆弱居民开处方时，应考虑到这种缺乏获益。
