Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea.
Cardiovasc Diabetol. 2022 Feb 22;21(1):28. doi: 10.1186/s12933-022-01466-z.
Current guidelines recommend life-long use of statin for patients with type 2 diabetes (T2D), however, a number of patients discontinue statin therapy in clinical practice. We aimed to estimate the optimal statin therapy including statin therapy duration, statin intensity, and low-density lipoprotein cholesterol (LDL-C) level among patients with T2D in a real-world setting.
From Korean National Health Insurance Service Cohort (2007-2015), 8937 patients with T2D (≥ 40 years of age) who received statin therapy for at least 90 days were included. Risk of major adverse cardiovascular event (MACE) including ischemic heart disease, ischemic stroke, and cardiovascular death was estimated according to statin intensity, achieved serum LDL-C level, and statin therapy duration, respectively. The relative contributions of these factors to MACE risk were quantified by calculating the proportion of log-likelihood explained by each factor.
The hazard ratio (HR) of MACE was lower in patients receiving moderate- or high-intensity statins than in those receiving low-intensity statins (HR, 0.72; p = 0.027). Among patients who received moderate- or high-intensity statins, lower achieved LDL-C level was associated with lower cardiovascular risk. Notably, the longer the patients received statins, the lower was the risk of MACE; the HR of MACE was significantly reduced after at least 18 months (adjusted HR, 0.70; p = 0.009) as a reference to 3-6 months of therapy. The proportion of explainable log-likelihood for MACE was greatest for statin duration (2.55), followed by achieved LDL-C level (2.18), and statin intensity (0.95).
Statin therapy duration is as important as or more crucial than statin intensity or achieved LDL-C level for the reduction of cardiovascular risk in T2D patients. The concept of "longer is better" regarding statin therapy should be considered in clinical practice.
目前的指南建议 2 型糖尿病（T2D）患者终身使用他汀类药物，但在临床实践中，许多患者停止了他汀类药物治疗。我们旨在评估 T2D 患者在真实环境中使用他汀类药物的最佳治疗方案，包括他汀类药物治疗持续时间、他汀类药物强度和低密度脂蛋白胆固醇（LDL-C）水平。
从韩国国家健康保险服务队列（2007-2015 年）中，纳入了 8937 名接受他汀类药物治疗至少 90 天的 T2D（≥40 岁）患者。根据他汀类药物强度、达到的血清 LDL-C 水平和他汀类药物治疗持续时间，分别估计主要不良心血管事件（MACE）的风险，包括缺血性心脏病、缺血性卒中和心血管死亡。通过计算每个因素对 MACE 风险的解释比例来量化这些因素对 MACE 风险的相对贡献。
与接受低强度他汀类药物治疗的患者相比，接受中高强度他汀类药物治疗的患者的 MACE 风险较低（HR，0.72；p=0.027）。在接受中高强度他汀类药物治疗的患者中，较低的 LDL-C 水平与较低的心血管风险相关。值得注意的是，患者接受他汀类药物治疗的时间越长，MACE 的风险越低；与 3-6 个月的治疗相比，至少 18 个月（调整后的 HR，0.70；p=0.009）后，MACE 的风险显著降低。他汀类药物治疗持续时间对 MACE 的可解释对数似然比例最大（2.55），其次是达到的 LDL-C 水平（2.18）和他汀类药物强度（0.95）。
他汀类药物治疗持续时间与他汀类药物强度或达到的 LDL-C 水平一样重要，甚至更重要，可降低 T2D 患者的心血管风险。在临床实践中，应考虑他汀类药物治疗“时间更长更好”的概念。
