他汀类药物在 65 岁以上人群中的使用与全因死亡率:对 19518 人的 10 年随访。

Statin Use Over 65 Years of Age and All-Cause Mortality: A 10-Year Follow-Up of 19 518 People.

机构信息

Department of Family Medicine, Clalit Health Services Northern District, Israel.

Department of Family Medicine, Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.

出版信息

J Am Geriatr Soc. 2019 Oct;67(10):2038-2044. doi: 10.1111/jgs.16060. Epub 2019 Jul 9.

Abstract

OBJECTIVES

As life expectancy continues to rise, the burden of cardiovascular disease among older people is expected to increase, making cardiovascular prevention in older people an issue of growing interest and public health importance. We aimed to explore the long-term effects of adherence to statins on mortality and cardiovascular morbidity among older adults.

DESIGN

A historical population-based cohort study using routinely collected data.

SETTING

Clalit Health Services Northern District.

PARTICIPANTS

We followed members of Clalit Health Services aged 65 years or older who were eligible for primary cardiovascular prevention for a period of 10 years.

MEASUREMENTS

We fitted Cox regression models to assess the association between the adherence to statin therapy and all-cause mortality and cardiovascular morbidity, adjusting for cardiovascular risk factors and associated morbidity as time-updated variables.

RESULTS

The analysis included 19 518 older adults followed during 10 years (median = 9.7 y). All-cause mortality rates were 34% lower among those who had adhered to statin treatment, compared with those who had not (hazard ratio [HR] = .66; 95% confidence interval [CI] = .56-.79). Adherence to statins was also associated with fewer atherosclerotic cardiovascular disease events (HR = .80; 95% CI = .71-.81). The benefit of statin use did not diminish among beyond age 75 and was evident for both women and men.

CONCLUSION

Adherence to statins may be associated with reduced mortality and cardiovascular morbidity among older adults, regardless of age and sex. J Am Geriatr Soc 67:2038-2044, 2019.

摘要

目的

随着预期寿命的持续延长,老年人中心血管疾病的负担预计将增加,因此老年人的心血管预防成为一个日益受到关注和具有公共卫生重要性的问题。我们旨在探讨老年人坚持使用他汀类药物对死亡率和心血管发病率的长期影响。

设计

一项基于历史人群的队列研究,使用常规收集的数据。

地点

Clalit 健康服务北部区。

参与者

我们对符合初级心血管预防条件的 Clalit 健康服务 65 岁或以上的成员进行了为期 10 年的随访。

测量

我们拟合了 Cox 回归模型,以评估他汀类药物治疗依从性与全因死亡率和心血管发病率之间的关联,同时调整了心血管危险因素和相关发病率作为时间更新变量。

结果

分析包括 19518 名年龄在 65 岁以上的老年人,随访时间为 10 年(中位数=9.7 年)。与未坚持他汀类药物治疗的患者相比,坚持他汀类药物治疗的患者全因死亡率降低了 34%(风险比[HR] =.66;95%置信区间[CI] =.56-.79)。坚持使用他汀类药物也与较少的动脉粥样硬化性心血管疾病事件相关(HR =.80;95% CI =.71-.81)。他汀类药物的使用获益在 75 岁以上的患者中并未减弱,且在女性和男性中均可见。

结论

坚持使用他汀类药物可能与老年人死亡率和心血管发病率的降低相关,无论年龄和性别如何。

美国老年医学会杂志 67:2038-2044, 2019。

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