Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.
Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, China.
BMC Pharmacol Toxicol. 2019 Jul 26;20(1):44. doi: 10.1186/s40360-019-0320-z.
This analysis was designed to investigate the relationship between drug application and mortality rate in Chinese older coronary artery disease (CAD)/chronic heart failure (CHF) patients with and without low glomerular filtration rate (GFR).
All 1050 Chinese hospitalized patients with diagnosed CAD were included in this analysis, and Cox Regression was used to analyze the relationship between drug application and mortality rate after multivariate adjustment. Low GFR was defined as GFR < 60 ml/min/1.73m.
There were 372 patients (35.4%) with low GFR in patients with CAD (1050 patients), and 168 patients (51.4%) in patients with CHF (327 patients). In CAD patients without low GFR, clopidogrel [P = 0.028, odds ratio (OR): 0.620, 95% confidence interval (CI): 0.404-0.951] rather than aspirin (P = 0.173) was significantly associated with lower mortality rate. Statins (P < 0.001, OR: 0.287, 95% CI: 0.180-0.456) were significantly associated with lower mortality rate. In CAD patients with low GFR, aspirin, clopidogrel and statins had no significant relationship with mortality rate (P > 0.05 for all). In CHF patients without low GFR, statins were significantly associated with lower mortality rate (P < 0.001, OR: 0.220, 95% CI: 0.098-0.490). In CHF patients with low GFR, statins had no significant relationship with mortality rate (P > 0.05 for all).
Clopidogrel but not aspirin was beneficial in Chinese older CAD patients without low GFR rather than those with low GFR, and statins benefited for Chinese older CAD/CHF patients without low GFR rather than those with low GFR. These discoveries might offer some help for the therapy of Chinese older patients with cardiovascular/renal diseases.
本分析旨在研究中国老年冠心病（CAD）/慢性心力衰竭（CHF）患者中合并和不合并低肾小球滤过率（GFR）患者的药物应用与死亡率之间的关系。
本分析纳入了所有 1050 例诊断为 CAD 的中国住院患者，采用 Cox 回归分析了多变量调整后药物应用与死亡率之间的关系。低 GFR 定义为 GFR<60ml/min/1.73m。
在 CAD 患者（1050 例）中，有 372 例（35.4%）存在低 GFR，在 CHF 患者（327 例）中，有 168 例（51.4%）存在低 GFR。在 CAD 患者中不合并低 GFR 时，氯吡格雷[P=0.028，比值比（OR）：0.620，95%置信区间（CI）：0.404-0.951]而非阿司匹林（P=0.173）与较低的死亡率显著相关。他汀类药物（P<0.001，OR：0.287，95%CI：0.180-0.456）与较低的死亡率显著相关。在 CAD 患者中合并低 GFR 时，阿司匹林、氯吡格雷和他汀类药物与死亡率无显著关系（P>0.05）。在 CHF 患者中不合并低 GFR 时，他汀类药物与较低的死亡率显著相关（P<0.001，OR：0.220，95%CI：0.098-0.490）。在 CHF 患者中合并低 GFR 时，他汀类药物与死亡率无显著关系（P>0.05）。
在中国老年 CAD 患者中，氯吡格雷而非阿司匹林有益于不合并低 GFR 的患者，而他汀类药物有益于不合并低 GFR 的患者，而不是合并低 GFR 的患者。这些发现可能为中国老年心血管/肾脏疾病患者的治疗提供一些帮助。
