Shah Nisarg, Lan Zhou, Brown C Justin, Martin Seth S, Turchin Alexander
Yale School of Medicine New Haven CT USA.
Brigham and Women's Hospital Boston MA USA.
J Am Heart Assoc. 2025 Jun 3;14(11):e040464. doi: 10.1161/JAHA.124.040464. Epub 2025 May 13.
Many patients with diabetes do not accept statin therapy despite being at increased risk for cardiovascular events compared with the general population. The effects of delaying statin therapy are not well-understood.
This is a retrospective cohort study that followed adults with diabetes and no preexisting atherosclerotic cardiovascular disease at the Mass General Brigham integrated health system between 2000 and 2018. The exposure was immediate versus delayed statin acceptance by patients who were recommended statin therapy. The primary outcome was the composite incidence of myocardial infarction and ischemic stroke.
Among the 7239 study patients, the median age was 55.0 years, and 52.0% were women. Within this cohort, 1280 (17.7%) delayed statin therapy by a mean±SD of 2.7±3.1 years. Patients who delayed statin therapy had higher mean low-density lipoprotein cholesterol levels while they were not prescribed a statin (126.4 versus 99.2 mg/dL, <0.001). The cumulative 10-year rate of myocardial infarctions and ischemic strokes was 6.4% for patients who initiated statins immediately versus 8.5% for patients who delayed statin therapy (=0.001). In a multivariable analysis adjusted for demographic characteristics and comorbidities, statin nonacceptance was an independent risk factor for myocardial infarction and ischemic stroke (hazard ratio [HR], 1.49 [95% CI, 1.16-1.90]; =0.002). Mediation analysis showed that greater low-density lipoprotein cholesterol exposure induced a higher incidence of adverse cardiovascular events (HR, 1.62 [95% CI, 1.46-1.80]; <0.001).
Among patients with diabetes, patients who delayed statin therapy had a significantly higher cardiovascular risk; this relationship was mediated by higher low-density lipoprotein cholesterol levels. These findings underscore the importance of timely lipid-lowering for this high-risk patient population and can help guide decision-making by patients and clinicians.
许多糖尿病患者尽管与普通人群相比心血管事件风险增加，但仍不接受他汀类药物治疗。延迟他汀类药物治疗的影响尚未得到充分了解。
这是一项回顾性队列研究，对2000年至2018年期间在麻省总医院布莱根综合医疗系统中患有糖尿病且无既往动脉粥样硬化性心血管疾病的成年人进行随访。暴露因素为被推荐接受他汀类药物治疗的患者立即接受与延迟接受他汀类药物治疗。主要结局是心肌梗死和缺血性卒中的复合发病率。
在7239名研究患者中，中位年龄为55.0岁，52.0%为女性。在该队列中，1280名（17.7%）患者延迟他汀类药物治疗，平均延迟时间±标准差为2.7±3.1年。延迟他汀类药物治疗的患者在未服用他汀类药物时平均低密度脂蛋白胆固醇水平较高（126.4对99.2mg/dL，<0.001）。立即开始使用他汀类药物的患者10年累积心肌梗死和缺血性卒中发生率为6.4%，而延迟他汀类药物治疗的患者为8.5%（P=0.001）。在对人口统计学特征和合并症进行调整的多变量分析中，不接受他汀类药物治疗是心肌梗死和缺血性卒中的独立危险因素（风险比[HR]，1.49[95%CI，1.16-1.90]；P=0.002）。中介分析表明，更高的低密度脂蛋白胆固醇暴露导致不良心血管事件发生率更高（HR，1.62[95%CI，1.46-1.80]；P<0.001）。
在糖尿病患者中，延迟他汀类药物治疗的患者心血管风险显著更高；这种关系由更高的低密度脂蛋白胆固醇水平介导。这些发现强调了对这一高危患者群体及时进行降脂治疗的重要性，并有助于指导患者和临床医生的决策。
