JAMA Netw Open:他汀不是你想停就能停!老年人停用可将心衰风险提高24%

2021-06-16 MedSci原创 MedSci原创

他汀类药物是西方世界最广泛的处方药物,在心血管(CV)疾病一级和二级预防中占有重要地位。

他汀类药物是西方世界最广泛的处方药物,在心血管(CV)疾病一级和二级预防中占有重要地位。然而,由于各种原因,随机临床试验通常将临床状况不佳的患者排除在外,这意味着他汀类药物在多药联用的患者中发挥CV疾病预防作用仍不清楚。

近日,发表在JAMA Netw Open杂志的一项研究评估了65岁及以上接受多种药物治疗的老年患者,停用他汀类药物的临床意义。结果显示,在维持其他药物治疗的同时,停用他汀类药物可能会给致命和非致命性CV结局带来长期风险。

在这项回顾性队列研究中,研究人员收纳了来自意大利2904765岁及以上的老年患者,这些患者从2013101日至2015131日不间断的接受他汀类药物、降血压药物、抗糖尿病药物和抗血小板药物治疗,并随访至 2018 6 30 日。该数据来自意大利伦巴第地区的医疗保健数据库。数据分析于 2020 3 月至 11 月进行。

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研究结果显示,整个队列包括29047名暴露于多种药物治疗的患者,平均年龄为76.5岁,62.9%为男性。其中,5819名患者(20.0%)停用了他汀类药物,同时保留了其他药物,4010名患者(68.9%)继续服用多种药物治疗。

停止他汀类药物治疗与心血管风险、住院风险、全因死亡率和急诊科住院风险的关联.

在停药组中,平均年龄为76.5岁,60.0%为男性,12.6%的患者多源性房性心动过速评分为45。在维持组中,平均年龄为76.1岁,61.7%为男性,12.0%的患者多源性房性心动过速评分为45。与维持组相比,停药组患者因心力衰竭(HR1.2495%CI1.07-1.43)和心血管疾病发生率(HR1.1495%CI1.03-1.26)、全因死亡率(HR1.1595%CI1.02-1.30)和紧急入院率(HR1.1295%CI1.05-1.19)的风险均有所增加。

综上,那些停止使用他汀类药物而保持其他药物治疗的患者,与那些保持所有药物治疗(包括他汀类药物)的患者相比,有更高的CV入院、全因紧急入院和全因死亡的长期风险。增加的风险并非微不足道,因为与维持所有药物相比,仅停用他汀类药物与12%(全因急诊入院)至24%(心衰)的超额风险有关。未来,需要更多的研究进一步对结果阐释。

原始出处

Federico Rea, PhD1,2Annalisa Biffi, PhD1,2Raffaella Ronco, MsC1,2et al.Cardiovascular Outcomes and Mortality Associated With Discontinuing Statins in Older Patients Receiving Polypharmacy.JAMA Netw Open. 2021;4(6):e2113186. doi:10.1001/jamanetworkopen.2021.13186

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    2022-05-17 feather89
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    2021-06-18 Linxuezhang

    了解

    0

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    2021-06-18 蕾蕾

    学习了

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1728981, encodeId=ab071e2898138, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue May 17 04:05:03 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974661, encodeId=20c69e4661a5, content=了解, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210618/6f6883dbb0e24f0087875ef21cc0f282/62f7bae59f3e41cbacff5bc8d8f4ba1a.jpg, createdBy=cde45526117, createdName=Linxuezhang, createdTime=Fri Jun 18 14:41:45 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974652, encodeId=aeee9e4652ea, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5a832571815, createdName=蕾蕾, createdTime=Fri Jun 18 14:22:39 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1389479, encodeId=ea6e13894e94d, content=<a href='/topic/show?id=8425519625e' target=_blank style='color:#2F92EE;'>#心衰风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51962, encryptionId=8425519625e, topicName=心衰风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Fri Jun 18 13:05:03 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734380, encodeId=23031e34380ec, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Sun Jan 09 16:05:03 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974364, encodeId=11fb9e4364b9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=c7ad5218670, createdName=14775a26m11暂无昵称, createdTime=Thu Jun 17 12:58:43 CST 2021, time=2021-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036683, encodeId=56011036683e3, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jun 17 01:05:03 CST 2021, time=2021-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974228, encodeId=95a29e42287b, content=以前不知道, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201109/6ea5abada2334aabb2737efec80d0f14/16a8a75d63a842369f74b14d4c0fcf86.jpg, createdBy=a8555433340, createdName=春江水暖, createdTime=Wed Jun 16 23:26:46 CST 2021, time=2021-06-16, status=1, ipAttribution=)]
    2022-01-09 canlab
  6. [GetPortalCommentsPageByObjectIdResponse(id=1728981, encodeId=ab071e2898138, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue May 17 04:05:03 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974661, encodeId=20c69e4661a5, content=了解, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210618/6f6883dbb0e24f0087875ef21cc0f282/62f7bae59f3e41cbacff5bc8d8f4ba1a.jpg, createdBy=cde45526117, createdName=Linxuezhang, createdTime=Fri Jun 18 14:41:45 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974652, encodeId=aeee9e4652ea, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5a832571815, createdName=蕾蕾, createdTime=Fri Jun 18 14:22:39 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1389479, encodeId=ea6e13894e94d, content=<a href='/topic/show?id=8425519625e' target=_blank style='color:#2F92EE;'>#心衰风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51962, encryptionId=8425519625e, topicName=心衰风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Fri Jun 18 13:05:03 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734380, encodeId=23031e34380ec, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Sun Jan 09 16:05:03 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974364, encodeId=11fb9e4364b9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=c7ad5218670, createdName=14775a26m11暂无昵称, createdTime=Thu Jun 17 12:58:43 CST 2021, time=2021-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036683, encodeId=56011036683e3, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jun 17 01:05:03 CST 2021, time=2021-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974228, encodeId=95a29e42287b, content=以前不知道, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201109/6ea5abada2334aabb2737efec80d0f14/16a8a75d63a842369f74b14d4c0fcf86.jpg, createdBy=a8555433340, createdName=春江水暖, createdTime=Wed Jun 16 23:26:46 CST 2021, time=2021-06-16, status=1, ipAttribution=)]
    2021-06-17 14775a26m11暂无昵称

    学习

    0

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    2021-06-17 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1728981, encodeId=ab071e2898138, content=<a href='/topic/show?id=986913980dd' target=_blank style='color:#2F92EE;'>#PE#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13980, encryptionId=986913980dd, topicName=PE)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f06c33759375, createdName=feather89, createdTime=Tue May 17 04:05:03 CST 2022, time=2022-05-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974661, encodeId=20c69e4661a5, content=了解, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210618/6f6883dbb0e24f0087875ef21cc0f282/62f7bae59f3e41cbacff5bc8d8f4ba1a.jpg, createdBy=cde45526117, createdName=Linxuezhang, createdTime=Fri Jun 18 14:41:45 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974652, encodeId=aeee9e4652ea, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5a832571815, createdName=蕾蕾, createdTime=Fri Jun 18 14:22:39 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1389479, encodeId=ea6e13894e94d, content=<a href='/topic/show?id=8425519625e' target=_blank style='color:#2F92EE;'>#心衰风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51962, encryptionId=8425519625e, topicName=心衰风险)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/101296147/4E6244DB7C1860858424437821E08291/100, createdBy=a6a52500039, createdName=ms3994565386320060, createdTime=Fri Jun 18 13:05:03 CST 2021, time=2021-06-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1734380, encodeId=23031e34380ec, content=<a href='/topic/show?id=d4f412668a4' target=_blank style='color:#2F92EE;'>#NET#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=12668, encryptionId=d4f412668a4, topicName=NET)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7ea033781210, createdName=canlab, createdTime=Sun Jan 09 16:05:03 CST 2022, time=2022-01-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974364, encodeId=11fb9e4364b9, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=c7ad5218670, createdName=14775a26m11暂无昵称, createdTime=Thu Jun 17 12:58:43 CST 2021, time=2021-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1036683, encodeId=56011036683e3, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Jun 17 01:05:03 CST 2021, time=2021-06-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=974228, encodeId=95a29e42287b, content=以前不知道, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201109/6ea5abada2334aabb2737efec80d0f14/16a8a75d63a842369f74b14d4c0fcf86.jpg, createdBy=a8555433340, createdName=春江水暖, createdTime=Wed Jun 16 23:26:46 CST 2021, time=2021-06-16, status=1, ipAttribution=)]
    2021-06-16 春江水暖

    以前不知道

    0

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