Dong Yuanli, Liu Xukui, Zhao Yingxin, Chai Qiang, Zhang Hua, Gao Yumei, Liu Zhendong
Department of Community, Lanshan District People Hospital, Linyi, China.
Basic Medical College, Shandong First Medical University, Jinan, China.
Front Cardiovasc Med. 2021 Jun 17;8:692773. doi: 10.3389/fcvm.2021.692773. eCollection 2021.
To investigate the beneficial of attenuating the variability of lipids to the hypertension management in older adults. Between April 2008 and November 2010, 1,244 hypertensive patients aged ≥60 years were recruited and randomized into placebo and rosuvastatin groups. Outcomes and inter-visit plasma lipids variability were assessed. Over an average follow-up of 83.5 months, the coefficients of variation (CVs) in total cholesterol (TCHO), triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were significantly lower in the rosuvastatin group than the placebo group ( < 0.05). The risks of composite cardiovascular event, myocardial infarction, coronary revascularization, heart failure, total stroke, ischemic stroke, cardiovascular death, and all-cause death were significantly lower in the rosuvastatin group than the placebo group (all p < 0.05). The differences in the risks were significantly diminished after the CVs for TCHO, triglycerides, HDL-c, and LDL-c were separately included as confounders. One-SD of CVs for TCHO, triglycerides, HDL-c, and LDL-c increment were significantly associated with the risks of composite cardiovascular event, myocardial infarction, heart failure, total stroke, ischemic stroke, cardiovascular death, and all-cause death, respectively (all < 0.05). Rosuvastatin significantly attenuated the intra-visit variability in lipids and decreased the risk of cardiovascular mortality and morbidity. Controlling the variability of lipids is as important as antihypertensive treatment to reduce the cardiovascular morbidity and mortality in the management of older hypertensive patients. ChiCTR.org.cn, ChiCTR-IOR-17013557.
为研究降低老年人血脂变异性对高血压管理的益处。2008年4月至2010年11月,招募了1244名年龄≥60岁的高血压患者,并随机分为安慰剂组和瑞舒伐他汀组。评估了结局指标和访间血脂变异性。在平均83.5个月的随访中,瑞舒伐他汀组总胆固醇(TCHO)、甘油三酯、高密度脂蛋白胆固醇(HDL-c)和低密度脂蛋白胆固醇(LDL-c)的变异系数(CVs)显著低于安慰剂组(<0.05)。瑞舒伐他汀组复合心血管事件、心肌梗死、冠状动脉血运重建、心力衰竭、总卒中、缺血性卒中、心血管死亡和全因死亡的风险显著低于安慰剂组(均p<0.05)。将TCHO、甘油三酯、HDL-c和LDL-c的CVs分别作为混杂因素纳入后,风险差异显著减小。TCHO、甘油三酯、HDL-c和LDL-c增量的CVs每增加1个标准差,分别与复合心血管事件、心肌梗死、心力衰竭、总卒中、缺血性卒中、心血管死亡和全因死亡的风险显著相关(均<0.05)。瑞舒伐他汀显著降低了访间血脂变异性,并降低了心血管死亡率和发病率。在老年高血压患者的管理中,控制血脂变异性与抗高血压治疗对于降低心血管发病率和死亡率同样重要。中国临床试验注册中心,ChiCTR-IOR-17013557。