Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Arvid Wallgrens backe, Hus 7 Hälsovetarbacken, 413 90 Gothenburg, Sweden.
Regionhälsan R&D Centre, Skaraborg Primary Care, Regionens hus, 541 80 Skövde, Sweden.
Eur J Prev Cardiol. 2023 Nov 30;30(17):1883-1894. doi: 10.1093/eurjpc/zwad212.
Studies in primary healthcare (PHC) assessing the effect of primary prevention with statins on mortality and cardiovascular disease (CVD) are scarce. This study aimed to estimate the effect of statins on all-cause mortality, cardiovascular mortality, myocardial infarction (MI), and stroke in individuals in PHC with hypertension without CVD or diabetes.
Using the Swedish PHC quality assurance register QregPV, the study included 13 193 individuals with hypertension without CVD or diabetes, who had filled a first statin prescription between 2010 and 2016, and 13 193 matched controls without a filled statin prescription at the index date. Controls were matched on sex and propensity score using clinical data and data from national registers on comorbidities, prescriptions, and socioeconomic status. The effect of statins was estimated in Cox regression models. During a median of 4.2 years of follow-up, 395 individuals in the statin group vs. 475 in the control group died, 197 vs. 232 died of cardiovascular disease, 171 vs. 191 had an MI, and 161 vs. 181 had a stroke. The treatment effect of statins was significant for all-cause mortality [hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.74-0.93] and cardiovascular mortality (HR 0.85, 95% CI 0.72-0.998). Overall, no significant treatment effect of statins was seen for MI (HR 0.89, 95% CI 0.74-1.07), but there was a significant interaction with sex (P = 0.008) with decreased risk of MI for women but not for men (HR 0.66, 95% CI 0.49-0.88 vs. HR 1.09, 95% CI 0.86-1.38).
Primary prevention with statins in PHC was associated with reduced risk of all-cause mortality, cardiovascular mortality, and in women, lower risk of MI.
初级保健（PHC）中评估他汀类药物一级预防对死亡率和心血管疾病（CVD）影响的研究较为匮乏。本研究旨在评估他汀类药物对 PHC 中无 CVD 或糖尿病的高血压患者全因死亡率、心血管死亡率、心肌梗死（MI）和卒中的影响。
利用瑞典 PHC 质量保证登记 QregPV，本研究纳入了 13193 名无 CVD 或糖尿病的高血压患者，他们在 2010 年至 2016 年间首次开具了他汀类药物处方，且在索引日期无他汀类药物处方的 13193 名匹配对照。对照通过临床数据和国家合并症、处方和社会经济状况登记数据进行性别和倾向评分匹配。使用 Cox 回归模型评估他汀类药物的效果。在中位数为 4.2 年的随访期间，他汀组有 395 人死亡，对照组有 475 人死亡；他汀组有 197 人死于心血管疾病，对照组有 232 人死于心血管疾病；他汀组有 171 人发生 MI，对照组有 191 人发生 MI；他汀组有 161 人发生卒中，对照组有 181 人发生卒中。他汀类药物治疗对全因死亡率（危险比 [HR]0.83，95%置信区间 [CI]0.74-0.93）和心血管死亡率（HR0.85，95%CI0.72-0.998）均有显著影响。总体而言，他汀类药物治疗对 MI 无显著影响（HR0.89，95%CI0.74-1.07），但存在性别交互作用（P=0.008），女性发生 MI 的风险降低，而男性则不然（HR0.66，95%CI0.49-0.88 与 HR1.09，95%CI0.86-1.38）。
PHC 中他汀类药物一级预防与全因死亡率、心血管死亡率降低相关，且女性发生 MI 的风险降低。
