Circulation:外周动脉疾病患者应用高剂量他汀类药物治疗,可显著降低其截肢和死亡风险

2018-04-16 MedSci MedSci原创

对于外周动脉疾病(PAD)患者,他汀类药物的指导原则主要是基于冠状动脉疾病和中风的数据。现Shipra Arya等人对他汀类药物剂量对PAD患者的截肢和死亡预后的影响进行研究。研究人员进行一观察性队列研究,从国家退伍军人数据中鉴别有PAD表现的患者(2003-2014)。确诊PAD一年内,通过对比高他汀剂量暴露、中低他汀剂量暴露和无他汀的抗血小板疗法,确定他汀最高暴露剂量。主要结点是下肢截肢和死亡

对于外周动脉疾病(PAD)患者,他汀类药物的指导原则主要是基于冠状动脉疾病和中风的数据。现Shipra Arya等人对他汀类药物剂量对PAD患者的截肢和死亡预后的影响进行研究。

研究人员进行一观察性队列研究,从国家退伍军人数据中鉴别有PAD表现的患者(2003-2014)。确诊PAD一年内,通过对比高他汀剂量暴露、中低他汀剂量暴露和无他汀的抗血小板疗法,确定他汀最高暴露剂量。主要结点是下肢截肢和死亡。通过多种统计学方法评估他汀剂量与意外截肢和死亡的关联。

共155647位患者有PAD表现,其中28%的患者未应用他汀类药物。与合并冠状动脉/颈动脉疾病的患者相比,仅患PAD的患者应用高剂量他汀的比例最低(6.4% vs 18.4%)。与仅进行抗血小板治疗组相比,添加任何剂量他汀治疗的患者意外截肢和死亡风险均明显减小。在校正的Cox模型中,与仅采用抗血小板治疗相比,应用高剂量他汀与截肢风险和死亡率降低均相关(危险比分别是 0.67,95% CI 0.61-0.74;0.74,95% CI 0.70-0.77);此外中低剂量的他汀也可明显降低截肢风险和死亡率(截肢危险比 0.81,95% CI 0.75-0.86;死亡危险比 0.83;95% CI 0.81-0.86),但降低效果明显低于高剂量他汀(p<0.001)。

他汀类药物,特别是高剂量的配方,在PAD患者中尚未得到充分利用。本研究结果提示确诊PAD时应用高剂量他汀可显著降低截肢和死亡风险。

原始出处:

Shipra Arya,et al.Association of Statin Dose With Amputation and Survival in Patients With Peripheral Artery Disease.Circulation.April 03,2018.https://doi.org/10.1161/CIRCULATIONAHA.117.032361

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    2018-10-22 amy0550
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