Wakabayashi Kohei, Suzuki Hiroshi, Fukumoto Yoshihiro, Obara Hitoshi, Kakuma Tatsuyuki, Sakuma Ichiro, Kimura Takeshi, Iimuro Satoshi, Daida Hiroyuki, Shimokawa Hiroaki, Nagai Ryozo
Cardiovascular Center, Showa University Koto-Toyosu Hospital Tokyo Japan.
Division of Cardiology, Showa University Fujigaoka Hospital Yokohama Japan.
Circ Rep. 2022 Aug 24;4(9):422-428. doi: 10.1253/circrep.CR-22-0070. eCollection 2022 Sep 9.
Even with high-dose statin therapy, residual cardiovascular event risks remain in patients with chronic coronary syndrome (CCS). Thus, future treatment targets need to be elucidated. This study determined the factors associated with residual cardiovascular risk in patients with CCS treated with high-dose statins. This study was a subanalysis of the REAL-CAD study. This study enrolled 5,540 patients with CCS receiving 4 mg/day pitavastatin and assessed the impacts of 3 representative risk factors (i.e., blood pressure, glucose level, and renal function), alone or in combination, on clinical outcomes. Each risk factor was classified according to its severity. The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal ischemic stroke, and unstable angina requiring emergency hospitalization. After adjusting for the effects of confounders, a significantly worse prognosis was observed in the group with an estimated glomerular filtration rate (eGFR) ≤60 mL/min/1.73 m (hazard ratio [HR] 1.36; 95% confidence interval 1.03-1.80; P=0.028). No other factors or combinations were associated with the primary endpoint. An eGFR ≤60 mL/min/1.73 m was also associated with cardiac (HR 2.38; P=0.004) and all-cause (HR 1.51; P=0.032) death. Insufficient renal function was associated with a worse prognosis in patients with CCS undergoing high-dose statin therapy, suggesting that renal function is the next target for reducing the risk of residual cardiovascular events.
即使采用大剂量他汀类药物治疗，慢性冠状动脉综合征（CCS）患者仍存在残余心血管事件风险。因此，需要阐明未来的治疗靶点。本研究确定了接受大剂量他汀类药物治疗的CCS患者中与残余心血管风险相关的因素。 本研究是REAL-CAD研究的一项亚分析。本研究纳入了5540例接受每日4毫克匹伐他汀治疗的CCS患者，并评估了3种代表性风险因素（即血压、血糖水平和肾功能）单独或联合对临床结局的影响。每个风险因素根据其严重程度进行分类。主要终点是心血管死亡、非致命性心肌梗死、非致命性缺血性中风和需要紧急住院治疗的不稳定型心绞痛的复合终点。在调整混杂因素的影响后，估计肾小球滤过率（eGFR）≤60 mL/min/1.73 m²的组中观察到预后明显更差（风险比[HR] 1.36；95%置信区间1.03-1.80；P=0.028）。没有其他因素或因素组合与主要终点相关。eGFR≤60 mL/min/1.73 m²也与心脏性死亡（HR 2.38；P=0.004）和全因死亡（HR 1.51；P=0.032）相关。肾功能不全与接受大剂量他汀类药物治疗的CCS患者预后较差相关，这表明肾功能是降低残余心血管事件风险的下一个靶点。
