他汀类药物的亲脂性与心力衰竭事件风险。

Statin Lipophilicity and the Risk of Incident Heart Failure.

机构信息

Cardiology Section, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.

Division of Aging, Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Cardiology. 2020;145(6):375-383. doi: 10.1159/000506003. Epub 2020 Apr 14.

DOI:10.1159/000506003

PMID:32289796

Abstract

BACKGROUND

To compare the risk of incident heart failure (HF) between initiators of hydrophilic and lipophilic statins.

METHODS

Using claims data for commercial health insurance program enrollees in the USA (2005-2014), we identified new initiators of hydrophilic or lipophilic statins. Follow-up for the primary outcome of incident HF began after a lag period of 1 year after statin initiation. The outcome was defined as 1 inpatient or 2 outpatient diagnosis codes for HF and the use of loop diuretics. Propensity scores (PS) were used to account for confounding. Hazard ratios (HR) for incident HF were computed separately for low and high-intensity statin users, and then pooled to provide dose-adjusted effect estimates.

RESULTS

A total of 7,820,204 patients met all our inclusion criteria for statin initiation (hydrophilic and lipophilic statins). Mean age was 58 years, 40% had hypertension, and 23% had diabetes mellitus. After PS matching, there were 691,584 patients in the low-intensity statin group and 807,370 patients in the high-intensity statin group. After a median follow-up of 725 days (IQR 500-1,153),there were 8,389 cases of incident HF (incidence rate 4.5/1,000 person years, 95% confidence interval [CI] 4.4-4.6). The unadjusted HR for the risk of HF was 0.77 (95% CI 0.76-0.79) and the pooled adjusted HR for incident HF after PS matching was 0.94 (95% CI 0.90-0.98) for hydrophilic versus lipophilic statins. The HR for incident HF was 1.06 (95% CI 1.00-1.12) for hydrophilic versus lipophilic statins for the low-intensity statin group and 0.82 (95% CI 0.78-0.87) for the high-intensity statin group. In subgroup analyses, a similar trend persisted for those younger and older than 65 years and when comparing rosuvastatin with atorvastatin.

CONCLUSION

In this observational cohort study, hydrophilic statins were associated with a modest risk reduction in incident HF as compared to lipophilic statins. Future research replicating these findings in different populations is recommended.

摘要

背景

比较亲水性和疏水性他汀类药物起始者发生心力衰竭（HF）的风险。

方法

使用美国商业健康保险计划参保者的索赔数据（2005-2014 年），我们确定了新的亲水性或疏水性他汀类药物起始者。在他汀类药物起始后 1 年的潜伏期后，开始对主要结局事件（HF）进行随访。该结局定义为 HF 的 1 次住院或 2 次门诊诊断代码和使用袢利尿剂。采用倾向评分（PS）来控制混杂因素。计算低强度和高强度他汀类药物使用者的 HF 发生率的风险比（HR），然后进行合并以提供剂量调整的效果估计。

结果

共有 7820204 名患者符合我们对他汀类药物起始的所有纳入标准（亲水性和疏水性他汀类药物）。平均年龄为 58 岁，40%有高血压，23%有糖尿病。在 PS 匹配后，低强度他汀类药物组有 691584 名患者，高强度他汀类药物组有 807370 名患者。中位随访 725 天（IQR 500-1153）后，有 8389 例 HF 事件（发生率为 4.5/1000 人年，95%置信区间 [CI] 4.4-4.6）。HF 风险的未调整 HR 为 0.77（95%CI 0.76-0.79），PS 匹配后亲水性与疏水性他汀类药物相比，HF 发生率的合并调整 HR 为 0.94（95%CI 0.90-0.98）。对于低强度他汀类药物组，亲水性与疏水性他汀类药物相比 HF 发生率的 HR 为 1.06（95%CI 1.00-1.12），对于高强度他汀类药物组为 0.82（95%CI 0.78-0.87）。在亚组分析中，对于年龄小于 65 岁和大于 65 岁的患者以及比较罗苏伐他汀和阿托伐他汀时，这种趋势仍然存在。