Department of Medical Sciences, Uppsala University, University Hospital, 75185, Uppsala, Sweden.
Atherosclerosis. 2020 Aug;306:6-10. doi: 10.1016/j.atherosclerosis.2020.06.012. Epub 2020 Jul 5.
Randomized clinical trials (RCT) have shown statin treatment to slow down the increase in carotid artery intima-media thickness (IMT) seen with ageing. However, those RCTs usually have a limited follow-up (1-3 years). Here an observational study was used to investigate the real-life effect of new statin treatment over a 10-year follow-up.
In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, 954 individuals all aged 70 years at baseline were investigated regarding carotid artery IMT three times during 10 years (n = 771 at age 75, and n = 591 at age 80).
At age 70, 503 subjects were statin-naïve and did not receive statin during the 10-year follow-up period (the never-statin group), while 197 subjects were statin-naïve but received statins during the follow-up period (the received-statin group). Low-density lipoprotein (LDL)-cholesterol increased over time in the never-statin group (+0.1 mmol/l, p = 0.0012), but decreased in the group receiving statin treatment (-1.1 mmol/l, p < 0.0001). The never-statin group increased significantly in IMT over the 10 years (+0.07 mm, p < 0.0001), while the numerical increase seen in the received-statin group was not significant (+0.02 mm, p = 0.22) A significant difference in the change in IMT over time was seen between the received-statin group and the never-statin group (p < 0.0001 for interaction between time and group, adjusted for a propensity score).
This real-life observational study showed that new statin treatment reduced the increase in IMT seen over 10 years compared to subjects not treated with statins.
随机临床试验(RCT)表明,他汀类药物治疗可减缓随年龄增长而出现的颈动脉内膜-中层厚度(IMT)的增加。然而,这些 RCT 通常随访时间有限(1-3 年)。本研究采用观察性研究,旨在调查新的他汀类药物治疗在 10 年随访期间的真实效果。
在 Prospective Investigation of the Vasculature in Uppsala Seniors(PIVUS)研究中,954 名基线时均为 70 岁的个体在 10 年内三次接受颈动脉 IMT 检查(75 岁时 n=771,80 岁时 n=591)。
70 岁时,503 名受试者为他汀类药物初治者,且在 10 年随访期间未接受他汀类药物治疗(未使用他汀类药物组),197 名受试者为他汀类药物初治者,但在随访期间接受了他汀类药物治疗(使用他汀类药物组)。未使用他汀类药物组的低密度脂蛋白胆固醇(LDL-C)随时间逐渐升高(+0.1mmol/L,p=0.0012),而使用他汀类药物治疗组的 LDL-C 逐渐降低(-1.1mmol/L,p<0.0001)。未使用他汀类药物组的 IMT 在 10 年内显著增加(+0.07mm,p<0.0001),而使用他汀类药物治疗组的 IMT 增加则不显著(+0.02mm,p=0.22)。使用他汀类药物治疗组和未使用他汀类药物组的 IMT 随时间的变化差异有统计学意义(时间与组之间的交互作用 p<0.0001,经倾向评分调整)。
本真实世界观察性研究表明,与未接受他汀类药物治疗的受试者相比,新的他汀类药物治疗可减少 10 年内 IMT 的增加。