Jujo Kentaro, Ueshima Daisuke, Abe Takuro, Shimazaki Kensuke, Fujimoto Yo, Tanaka Tomofumi, Murata Teppei, Miyazaki Toru, Matsumoto Michiaki, Tokuyama Hideo, Shimura Tsukasa, Funada Ryuichi, Murata Naotaka, Higashitani Michiaki
Department of Cardiology, Nishiarai Heart Center Hospital, Tokyo, Japan.
Department of Cardiology, Kameda Medical Center, Chiba, Japan.
Am Heart J Plus. 2024 Oct 30;47:100481. doi: 10.1016/j.ahjo.2024.100481. eCollection 2024 Nov.
Statins bring favourable effects on the clinical prognosis of patients with atherosclerotic disease partly through their anti-inflammatory properties. However, this effect has not been fully verified in patients with peripheral arterial disease (PAD). We aimed to test whether statins exert different prognostic effects depending on the degrees of inflammation in patients with PAD.
This study was a sub-analysis of a multicenter prospective cohort of 2321 consecutive patients with PAD who received endovascular therapy (EVT). After excluding patients without information on C-reactive protein (CRP) levels at the time of index EVT, 1974 patients (1021 statin users and 953 non-users) were classified into four groups depending on CRP levels: low CRP (<0.1 mg/dL), intermediate-low CRP (0.1-0.3 mg/dL), intermediate-high CRP (0.3-1.0 mg/dL), and high CRP (>1.0 mg/dL). A composite of death, stroke, myocardial infarction, and major amputation as the primary endpoint was compared between statin users and non-users in each CRP category.
During the median observation period of 316 days, the primary composite endpoint occurred in 112 (11.0 %) statin users and 178 (18.7 %) non-users (log-rank test, < 0.001). However, statin therapy was associated with significantly lower event rates only in the intermediate-high- and high-CRP categories ( = 0.02 and = 0.008, respectively). Multivariable Cox regression analysis revealed that statin use was independently associated with the primary endpoint only in the high-CRP category (adjusted hazard ratio: 0.64 [95 % confidence interval: 0.41-0.98]).
Statins may exert favourable prognostic effects in patients with PAD and highly elevated CRP levels.
他汀类药物部分通过其抗炎特性对动脉粥样硬化疾病患者的临床预后产生有益影响。然而，这种作用在周围动脉疾病（PAD）患者中尚未得到充分验证。我们旨在测试他汀类药物是否会根据PAD患者的炎症程度产生不同的预后效果。
本研究是对2321例接受血管内治疗（EVT）的连续性PAD患者的多中心前瞻性队列研究的亚分析。在排除索引EVT时无C反应蛋白（CRP）水平信息的患者后，1974例患者（1021例他汀类药物使用者和953例非使用者）根据CRP水平分为四组：低CRP（<0.1mg/dL）、中低CRP（0.1 - 0.3mg/dL）、中高CRP（0.3 - 1.0mg/dL）和高CRP（>1.0mg/dL）。比较了各CRP类别中他汀类药物使用者和非使用者之间以死亡、中风、心肌梗死和大截肢组成的复合终点。
在316天的中位观察期内，112例（11.0%）他汀类药物使用者和178例（18.7%）非使用者发生了主要复合终点（对数秩检验，<0.001）。然而，他汀类药物治疗仅在中高CRP和高CRP类别中与显著较低的事件发生率相关（分别为 = 0.02和 = 0.008）。多变量Cox回归分析显示，仅在高CRP类别中，使用他汀类药物与主要终点独立相关（调整后的风险比：0.64 [95%置信区间：0.41 - 0.98]）。
他汀类药物可能对CRP水平高度升高的PAD患者产生有益的预后效果。
