Lu Chiung-Ray, Lu Shang-Yeh, Lin Shi-Yi, Yip Hei-Tung, Liu Chia-Hao, Hsu Kai-Cheng, Chang Shih-Sheng
Division of Cardiovascular Medicine, China Medical University Hospital.
School of Medicine, College of Medicine.
Acta Cardiol Sin. 2023 Sep;39(5):755-764. doi: 10.6515/ACS.202309_39(5).20230118A.
Previous studies have reported that statins have inconsistent and marginal cardiovascular (CV) benefits in patients with end-stage renal disease (ESRD). However, whether statins play a secondary preventive role in patients with peripheral artery disease (PAD) and ESRD remains unclear.
This study aimed to compare the long-term clinical outcomes between statin users and nonusers with PAD and ESRD.
This retrospective cohort study assessed the long-term protective effects of statins using data from the National Health Insurance Research Database in Taiwan. Propensity score matching was performed according to sex, age, index year, related comorbidities, and medications. The main outcomes were limb events and major adverse CV events (MACEs).
The statin user group (n = 4,460) was compared with the propensity score-matched statin nonuser group (n = 4,460). The mean age of the matched patients was 64 years, and 40% of the patients were men. The baseline characteristics of the groups were well-balanced. The overall limb event and MACE rates were not different between the two groups. However, the statin user group had lower rates of limb amputation [adjusted hazard ratio (aHR): 0.85, 95% confidence interval (CI): 0.73-0.99], stroke (aHR: 0.71, 95% CI: 0.62-0.83), CV death (aHR: 0.46, 95% CI: 0.32-0.66), and all-cause death (aHR: 0.45, 95% CI: 0.42-0.48) despite having a higher rate of percutaneous transluminal angioplasty for PAD.
This population-based retrospective cohort study demonstrated that statin therapy was associated with a lower risk of limb amputation, nonfatal stroke, CV death, and all-cause death in patients with PAD and ESRD.
既往研究报道，他汀类药物对终末期肾病（ESRD）患者的心血管（CV）益处并不一致且作用有限。然而，他汀类药物在周围动脉疾病（PAD）合并ESRD患者中是否发挥二级预防作用仍不明确。
本研究旨在比较PAD合并ESRD患者中他汀类药物使用者和非使用者的长期临床结局。
这项回顾性队列研究利用台湾国民健康保险研究数据库的数据评估他汀类药物的长期保护作用。根据性别、年龄、索引年份、相关合并症和用药情况进行倾向评分匹配。主要结局为肢体事件和主要不良心血管事件（MACE）。
将他汀类药物使用者组（n = 4460）与倾向评分匹配的非使用者组（n = 4460）进行比较。匹配患者的平均年龄为64岁，40%为男性。两组的基线特征均衡。两组的总体肢体事件和MACE发生率无差异。然而，尽管他汀类药物使用者组因PAD接受经皮腔内血管成形术的比例较高，但其肢体截肢率[调整后风险比（aHR）：0.85，95%置信区间（CI）：0.73 - 0.99]、中风（aHR：0.71，95%CI：0.62 - 0.83）、心血管死亡（aHR：0.46，95%CI：0.32 - 0.66）和全因死亡（aHR：0.45，95%CI：0.42 - 0.48）较低。
这项基于人群的回顾性队列研究表明，他汀类药物治疗与PAD合并ESRD患者肢体截肢、非致命性中风、心血管死亡和全因死亡风险较低相关。
