Sung Fung-Chang, Jong Ying-Chin, Muo Chih-Hsin, Hsu Chih-Cheng, Tsai Wen-Chen, Hsu Yueh-Han
Department of Health Services Administration, China Medical University, Taichung, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Front Pharmacol. 2022 Mar 4;13:815882. doi: 10.3389/fphar.2022.815882. eCollection 2022.
For non-dialysis patients with hyperlipidemia, statins may provide clinical benefits in reducing mortality risk; however, the optimal treatment for dialysis patients with hyperlipidemia remains debatable. We evaluated the mortality risks for hyperlipidemic patients with renal disorders associated with statin therapy (ST), using the insurance claims data of Taiwan. From hyperlipidemic patients diagnosed in 2000-2011, we identified 555,153 patients receiving statin treatment for at least 90 days continuously and 1,141,901 non-statin users, and then randomly selected, from both groups, the propensity score-matched subcohorts of statin users and nonusers in a 1:1 pair by renal function: 415,453 pairs with normal renal function , 43,632 pairs with chronic kidney disease (CKD), and 3,624 pairs with end-stage renal disease (ESRD). We compared the mortalities, by the end of 2016, from all causes, cancer, heart disease, and septicemia between statin users and non-users and between hydrophilic-statin users and lipophilic-statin users. The Cox method estimated ST users to non-user hazard ratios. The time-dependent model was also conducted as sensitivity analysis. The mean ages were 58.7 ± 10.7, 64.2 ± 10.7, and 62.2 ± 10.8 years in normal renal function, CKD, and ESRD groups, respectively. Compared with non-users, statin users had reduced mortality risks from all causes for 32%-38%, from cancer for 37%-46%, from heart disease for 6%-24%, and from septicemia for 17%-21% in all three renal groups. The hydrophilic statin therapy was superior than the lipophilic statin therapy, particularly for reducing deaths from all-causes and cancer. The results under the time-dependent model were similar. Statin therapy is associated with reduced all-causes and non-cardiovascular mortality in ESRD patients.
对于非透析的高脂血症患者，他汀类药物可能在降低死亡风险方面具有临床益处；然而，对于透析的高脂血症患者的最佳治疗方法仍存在争议。我们利用台湾的保险理赔数据评估了接受他汀类药物治疗（ST）的高脂血症肾病患者的死亡风险。从2000年至2011年诊断出的高脂血症患者中，我们确定了555153名连续接受他汀类药物治疗至少90天的患者和1141901名未使用他汀类药物的患者，然后从两组中按肾功能以1:1配对的方式随机选择他汀类药物使用者和非使用者的倾向评分匹配亚队列：415453对肾功能正常者、43632对慢性肾脏病（CKD）患者和3624对终末期肾病（ESRD）患者。我们比较了截至2016年底，他汀类药物使用者和非使用者之间以及亲水性他汀类药物使用者和亲脂性他汀类药物使用者之间因各种原因、癌症、心脏病和败血症导致的死亡率。采用Cox方法估计他汀类药物使用者与非使用者的风险比。还进行了时间依赖性模型作为敏感性分析。正常肾功能组、CKD组和ESRD组的平均年龄分别为58.7±10.7岁、64.2±10.7岁和62.2±10.8岁。在所有三个肾脏组中，与非使用者相比，他汀类药物使用者因各种原因导致的死亡风险降低了32%-38%，因癌症导致的死亡风险降低了37%-46%，因心脏病导致的死亡风险降低了6%-24%，因败血症导致的死亡风险降低了17%-21%。亲水性他汀类药物治疗优于亲脂性他汀类药物治疗，尤其是在降低各种原因和癌症导致的死亡方面。时间依赖性模型下的结果相似。他汀类药物治疗与ESRD患者全因死亡率和非心血管死亡率降低有关。
