Tsai Ming-Hsien, Chen Mingchih, Huang Yen-Chun, Liou Hung-Hsiang, Fang Yu-Wei
Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.
Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
Front Pharmacol. 2022 Jan 28;12:804000. doi: 10.3389/fphar.2021.804000. eCollection 2021.
Lipid-lowering agents display limited benefits on cardiovascular diseases and mortality in patients undergoing dialysis. Therefore, they are not routinely recommended for dialysis patients. The aim of this study was to assess the effects of lipid-lowering agents on clinical outcomes in dialysis patients on the basis of real-world evidence. This research used Taiwan's National Health Insurance Research Database to identify dialysis patients from January 2009 to December 2015; patients were then categorized into a case group treated with lipid-lowering agents ( = 3,933) and a control group without lipid-lowering agents ( = 24,267). Patients were matched by age, sex, and comorbidities in a 1:1 ratio. This study used the Cox regression model to estimate the hazard ratios (HRs) for mortality and major adverse cardiovascular events (MACEs) for events recorded until December 2017. During a mean follow-up period of approximately 3.1 years, 1726 [43.9%, incidence 0.123/person-year (PY)] deaths and 598 (15.2%, incidence 0.047/PY) MACEs occurred in the case group and 2031 (51.6%, incidence 0.153/PY) deaths and 649 (16.5% incidence 0.055/PY) MACEs occurred in the control group. In the multivariable analysis of the Cox regression model, lipid-lowering agent users showed a significantly lower risk of death [HR: 0.75; 95% confidence interval (CI): 0.70-0.80] and MACEs (HR: 0.88; 95% CI: 0.78-0.98) than lipid-lowering agent non-users. Moreover, the survival benefit of lipid-lowering agents was significant across most subgroups. Dialysis patients treated with lipid-lowering agents display a 25 and 12% reduction in their risk of mortality and MACEs, respectively. Therefore, lipid-lowering agents might be considered when treating dialysis patients with hyperlipidemia.
降血脂药物对接受透析的患者的心血管疾病和死亡率的益处有限。因此，不常规推荐给透析患者使用。本研究的目的是基于真实世界证据评估降血脂药物对透析患者临床结局的影响。本研究使用台湾国民健康保险研究数据库，识别出2009年1月至2015年12月期间的透析患者；然后将患者分为接受降血脂药物治疗的病例组（n = 3933）和未接受降血脂药物治疗的对照组（n = 24267）。患者按年龄、性别和合并症以1:1的比例进行匹配。本研究使用Cox回归模型估计截至2017年12月记录的事件的死亡率和主要不良心血管事件（MACE）的风险比（HR）。在平均约3.1年的随访期内，病例组发生1726例死亡（43.9%，发生率0.123/人年（PY））和598例MACE（15.2%，发生率0.047/PY），对照组发生2031例死亡（51.6%，发生率0.153/PY）和649例MACE（16.5%，发生率0.055/PY）。在Cox回归模型的多变量分析中，使用降血脂药物的患者比未使用降血脂药物的患者死亡风险显著更低[HR：0.75；95%置信区间（CI）：0.70 - 0.80]，MACE风险也更低（HR：0.88；95%CI：0.78 - 0.98）。此外，降血脂药物的生存益处在大多数亚组中都很显著。接受降血脂药物治疗的透析患者的死亡风险和MACE风险分别降低了25%和12%。因此，在治疗患有高脂血症的透析患者时，可考虑使用降血脂药物。
