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他汀类药物长期使用降低中年高脂血症患者缺血性卒中再住院风险:一项基于人群的研究

Long-Term Use of Statins Lowering the Risk of Rehospitalization Caused by Ischemic Stroke Among Middle-Aged Hyperlipidemic Patients: A Population-Based Study.

作者信息

Yin Jiu-Haw, Peng Giia-Sheun, Chen Kang-Hua, Chu Chi-Ming, Chien Wu-Chien, Kao Li-Ting, Wu Chia-Chao, Yang Chih-Wei, Tsai Wen-Chiuan, Lin Wei-Zhi, Wu Yi-Syuan, Lin Hung-Che, Chang Yu-Tien

机构信息

Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

Division of Neurology, Department of Internal Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu County, Taipei, Taiwan.

出版信息

Front Pharmacol. 2021 Oct 18;12:741094. doi: 10.3389/fphar.2021.741094. eCollection 2021.

Abstract

The long-term effects of statin use on rehospitalization due to ischemic stroke (reHospIS) in hyperlipidemic patients are still unknown. Therefore, we aimed to assess the long-term risks of reHospIS for hyperlipidemic patients who were taking statins and nonstatin lipid-lowering medicines on a regular basis. The National Health Insurance Research Database in Taiwan was used to conduct a 6-year cohort study of patients >45 years old ( = 9,098) who were newly diagnosed with hyperlipidemia and hospitalized for the first or second time due to ischemic stroke (IS). The risk of reHospIS was assessed using Cox proportional hazards regression model. Nonstatin lipid-lowering medicines regular users were associated with a higher risk of reHospIS compared to stains users (hazard ratio, HR = 1.29-1.39, < 0.05). Rosuvastatin was the most preferred lipid-lowering medicine with lower HRs of reHospIS in hyperlipidemic patients whether they developed diabetes or not. Bezafibrate regular users of hyperlipidemic patients developing diabetes (HR = 2.15, < 0.01) had nearly 50% lower reHospIS risks than those without diabetes (HR = 4.27, < 0.05). Age, gender, drug dosage, comorbidities of diabetes and heart failure (HF), and characteristics of the first hospitalization due to IS were all adjusted in models. Moreover, increasing trends of HRs of reHospIS were observed from Rosuvastatin, nonstatin lipid-lowering medicines, Lovastatin, and Gemfibrozil to Bezafibrate users. Statins were associated with long-term secondary prevention of reHospIS for hyperlipidemic patients. Rosuvastatin seemed to have the best protective effects. On the other hand, Bezafibrate appears to be beneficial for hyperlipidemic patients developing diabetes. Further research into the combination treatment of statin and nonstatin lipid-lowering medicines in hyperlipidemic patients developing diabetes is warranted.

摘要

他汀类药物对高脂血症患者因缺血性中风再次住院(reHospIS)的长期影响尚不清楚。因此,我们旨在评估长期规律服用他汀类药物和非他汀类降脂药物的高脂血症患者发生reHospIS的风险。利用台湾地区国民健康保险研究数据库,对年龄>45岁(n = 9098)、新诊断为高脂血症且因缺血性中风(IS)首次或第二次住院的患者进行了为期6年的队列研究。使用Cox比例风险回归模型评估reHospIS的风险。与他汀类药物使用者相比,规律使用非他汀类降脂药物的患者发生reHospIS的风险更高(风险比,HR = 1.29 - 1.39,P < 0.05)。瑞舒伐他汀是最受青睐的降脂药物,无论高脂血症患者是否患有糖尿病,其发生reHospIS的HR均较低。患有糖尿病的高脂血症患者规律使用苯扎贝特(HR = 2.15,P < 0.01),其reHospIS风险比未患糖尿病的患者(HR = 4.27,P < 0.05)低近50%。模型中对年龄、性别、药物剂量、糖尿病和心力衰竭(HF)合并症以及首次因IS住院的特征进行了校正。此外,从瑞舒伐他汀、非他汀类降脂药物、洛伐他汀、吉非贝齐到苯扎贝特使用者,观察到reHospIS的HR呈上升趋势。他汀类药物与高脂血症患者reHospIS的长期二级预防相关。瑞舒伐他汀似乎具有最佳的保护作用。另一方面,苯扎贝特似乎对患有糖尿病的高脂血症患者有益。有必要进一步研究他汀类药物和非他汀类降脂药物联合治疗对患有糖尿病的高脂血症患者的效果。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ac1e/8558418/cd9c354b210a/fphar-12-741094-g001.jpg

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