Department of Cardiovascular Surgery, Taichung Tzu Chi Hospital, Taichung, Taiwan.
Department of Surgery, School of Medicine, Tzu Chi University, Hualien, Taiwan.
Curr Atheroscler Rep. 2023 Sep;25(9):619-628. doi: 10.1007/s11883-023-01135-w. Epub 2023 Jul 29.
The aim of this study is to investigate the protective effects of different statin classes, intensity, and cumulative dose-dependent against primary ischemic stroke in patients with T2DM.
The Cox hazards model was used to evaluate statin use on primary ischemic stroke. Case group: T2DM patients who received statins; control group: T2DM patients who received no statins during the follow-up. Adjusted hazard ratio (aHR) for primary ischemic stroke was 0.45 (95% CI: 0.44 to 0.46). Cox regression analysis showed significant reductions in primary ischemic stroke incidence in users of different statin classes. Corresponding aHRs (95% CI) were 0.09 to 0.79 for pitavastatin, rosuvastatin, atorvastatin, pravastatin, simvastatin, fluvastatin, and lovastatin. Multivariate analyses indicated significant reductions in primary ischemic stroke incidence for patients who received different cumulative defined daily doses (cDDDs) per year (cDDD-year). Corresponding aHRs (95% CI) were 0.17 to 0.77 for quartiles 4 to 1 of cDDD-years, respectively (P for trend < .0001). Optimal intensity daily dose of statin use was 0.89 DDD with the lowest aHR of primary ischemic stroke compared with other DDDs. Persistent statin use reduces the risk of primary ischemic stroke in T2DM patients. Higher cDDD-year values are associated with higher reductions in primary ischemic stroke risk in T2DM patients.
本研究旨在探讨不同他汀类药物、强度和累积剂量依赖性对 T2DM 患者首发缺血性卒中的保护作用。
采用 Cox 风险模型评估他汀类药物对首发缺血性卒中的影响。病例组:接受他汀类药物治疗的 T2DM 患者;对照组:在随访期间未接受他汀类药物治疗的 T2DM 患者。调整后的首发缺血性卒中风险比(aHR)为 0.45(95%CI:0.44 至 0.46)。Cox 回归分析显示,不同他汀类药物的使用显著降低了首发缺血性卒中的发生率。相应的 aHR(95%CI)分别为 0.09 至 0.79(培伐他汀、瑞舒伐他汀、阿托伐他汀、普伐他汀、辛伐他汀、氟伐他汀和洛伐他汀)。多变量分析表明,接受不同累积定义日剂量(cDDD)/年(cDDD-year)的患者首发缺血性卒中的发生率显著降低。相应的 aHR(95%CI)分别为 cDDD-year 四分位数 4 至 1 的 0.17 至 0.77(P 趋势<.0001)。他汀类药物最佳日剂量强度为 0.89 DDD,与其他 DDD 相比,首发缺血性卒中的 aHR 最低。持续使用他汀类药物可降低 T2DM 患者首发缺血性卒中的风险。较高的 cDDD-year 值与 T2DM 患者首发缺血性卒中风险的降低呈正相关。