Yoon Minjae, Lee Chan Joo, Park Sungha, Lee Sang-Hak
Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2022 Dec;52(12):890-900. doi: 10.4070/kcj.2022.0154.
Some individuals exhibit discrepancies between risk classifications assessed using clinical factors and those obtained by vascular imaging. We aimed to evaluate whether statins provide clinical outcome benefits in patients classified as having low to moderate cardiovascular risk but with carotid plaque.
This was a retrospective propensity score matching study. A total of 12,158 consecutive patients undergoing carotid ultrasound between January 2012 to February 2020 were screened. Individuals with low to moderate cardiovascular risk who were not currently recommended for statin therapy but had carotid plaques were included. Among 1,611 enrolled individuals, 806 (statin group: 403, control group: 403) were analyzed. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs: cardiovascular death, myocardial infarction, coronary revascularization, and ischemic stroke or transient ischemic attack) and all-cause mortality.
During the median follow-up of 6.0 years, the incidence of MACCEs did not differ between the groups (6.1 and 5.7/1,000 person-years in the control and statin groups, respectively; adjusted hazard ratio [HR], 0.95; p=0.90). The incidence of all-cause mortality did not differ (3.9 and 3.9/1,000 person-years, respectively; adjusted HR, 1.02; p=0.97). Kaplan-Meier curves revealed similar rates of MACCEs (log-rank p=0.72) and all-cause mortality (log-rank p=0.99) in the 2 groups. Age and smoking were independent predictors of MACCEs. Subgroups exhibited no differences in clinical outcomes with statin use.
Benefit of statin therapy was likely to be limited in low to moderate risk patients with carotid plaques. These results could guide physicians in clinical decision-making regarding cardiovascular prevention.
一些个体在使用临床因素评估的风险分类与通过血管成像获得的风险分类之间存在差异。我们旨在评估他汀类药物对分类为心血管风险低至中度但有颈动脉斑块的患者的临床结局是否有益。
这是一项回顾性倾向评分匹配研究。对2012年1月至2020年2月期间连续接受颈动脉超声检查的12158例患者进行了筛查。纳入心血管风险低至中度、目前不推荐使用他汀类药物治疗但有颈动脉斑块的个体。在1611名纳入的个体中，对806例（他汀类药物组：403例，对照组：403例）进行了分析。主要结局是主要不良心血管和脑血管事件（MACCEs：心血管死亡、心肌梗死、冠状动脉血运重建以及缺血性中风或短暂性脑缺血发作）和全因死亡率。
在中位随访6.0年期间，两组MACCEs的发生率无差异（对照组和他汀类药物组分别为6.1和5.7/1000人年；调整后的风险比[HR]为0.95；p = 0.90）。全因死亡率的发生率也无差异（分别为3.9和3.9/1000人年；调整后的HR为1.02；p = 0.97）。Kaplan-Meier曲线显示两组MACCEs（对数秩检验p = 0.72）和全因死亡率（对数秩检验p = 0.99）的发生率相似。年龄和吸烟是MACCEs的独立预测因素。亚组在使用他汀类药物后的临床结局方面无差异。
他汀类药物治疗对心血管风险低至中度且有颈动脉斑块的患者的益处可能有限。这些结果可为医生在心血管预防的临床决策中提供指导。
