美国马萨诸塞州退伍军人流行病学研究和信息中心（MAVERIC）Luc Djousse研究组分析了，75岁及以上的美国退伍军人服用他汀类药物与全因和心血管死亡的相关性。该研究于2020年7月7日发表在《美国医学会杂志》上。
目前，关于他汀类药物用于75岁及以上成年人初级预防动脉粥样硬化性心血管疾病（ASCVD）的数据很有限，为了评估他汀类药物在75岁及以上的退伍军人中对ASCVD的死亡率和一级预防的作用，研究组进行了一项回顾性队列研究。他们使用退伍军人卫生管理局（VHA）中75岁及以上、无ASCVD的成年人，于2002-2012年进行了临床随访，随访持续至2016年12月31日。所有数据均与Medicare和Medicaid索赔以及药物数据相关联。
研究组共招募了326981名符合条件的退伍军人，平均年龄为81.1岁，男性占97％，白人占91％，其中57178名（17.5％）新开始服用他汀类药物。平均随访6.8年后，他汀类药物服用者和非服用者中共发生206902例死亡，包括53296例心血管死亡，每1000人年的总死亡数分别为78.7例和98.2例。
他汀类药物服用者和非服用者中每1000人年分别有22.6例和25.7例心血管死亡。包括心肌梗塞、缺血性中风以及通过冠状动脉搭桥术或经皮冠状动脉介入术进行血运重建的综合ASCVD事件共发生123379起，他汀类药物服用者和非服用者中每1000人年分别发生66.3起和70.4起。采用倾向得分重叠加权后，他汀类药物服用者与非服用者相比，全因死亡的风险比为0.75，心血管疾病死亡的风险比为0.80，综合ASCVD事件的风险比为0.92。
总之，在75岁以上的美国退伍军人中，基线时没有ASCVD的情况下，服用他汀类药物可显著降低全因和心血管疾病死亡的风险。
附：英文原文
Title: Association of Statin Use With All-Cause and Cardiovascular Mortality in US Veterans 75 Years and Older
Author: Ariela R. Orkaby, Jane A. Driver, Yuk-Lam Ho, Bing Lu, Lauren Costa, Jacqueline Honerlaw, Ashley Galloway, Jason L. Vassy, Daniel E. Forman, J. Michael Gaziano, David R. Gagnon, Peter W. F. Wilson, Kelly Cho, Luc Djousse
Issue&Volume: 2020/07/07
Abstract: Importance Data are limited regarding statin therapy for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in adults 75 years and older.
Objective To evaluate the role of statin use for mortality and primary prevention of ASCVD in veterans 75 years and older.
Design, Setting, and Participants Retrospective cohort study that used Veterans Health Administration (VHA) data on adults 75 years and older, free of ASCVD, and with a clinical visit in 2002-2012. Follow-up continued through December 31, 2016. All data were linked to Medicare and Medicaid claims and pharmaceutical data. A new-user design was used, excluding those with any prior statin use. Cox proportional hazards models were fit to evaluate the association of statin use with outcomes. Analyses were conducted using propensity score overlap weighting to balance baseline characteristics.
Exposures Any new statin prescription.
Main Outcomes and Measures The primary outcomes were all-cause and cardiovascular mortality. Secondary outcomes included a composite of ASCVD events (myocardial infarction, ischemic stroke, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention).
Results Of 326981 eligible veterans (mean [SD] age, 81.1 [4.1] years; 97% men; 91% white), 57178 (17.5%) newly initiated statins during the study period. During a mean follow-up of 6.8 (SD, 3.9) years, a total 206902 deaths occurred including 53296 cardiovascular deaths, with 78.7 and 98.2 total deaths/1000 person-years among statin users and nonusers, respectively (weighted incidence rate difference [IRD]/1000 person-years, –19.5 [95% CI, –20.4 to –18.5]). There were 22.6 and 25.7 cardiovascular deaths per 1000 person-years among statin users and nonusers, respectively (weighted IRD/1000 person-years, –3.1 [95 CI, –3.6 to –2.6]). For the composite ASCVD outcome there were 123379 events, with 66.3 and 70.4 events/1000 person-years among statin users and nonusers, respectively (weighted IRD/1000 person-years, –4.1 [95% CI, –5.1 to –3.0]). After propensity score overlap weighting was applied, the hazard ratio was 0.75 (95% CI, 0.74-0.76) for all-cause mortality, 0.80 (95% CI, 0.78-0.81) for cardiovascular mortality, and 0.92 (95% CI, 0.91-0.94) for a composite of ASCVD events when comparing statin users with nonusers.
Conclusions and Relevance Among US veterans 75 years and older and free of ASCVD at baseline, new statin use was significantly associated with a lower risk of all-cause and cardiovascular mortality. Further research, including from randomized clinical trials, is needed to more definitively determine the role of statin therapy in older adults for primary prevention of ASCVD.
DOI: 10.1001/jama.2020.7848
Source: https://jamanetwork.com/journals/jama/article-abstract/2767861
JAMA-Journal of The American Medical Association：《美国医学会杂志》，创刊于1883年。隶属于美国医学协会，最新IF：157.335
官方网址：https://jamanetwork.com/
投稿链接：http://manuscripts.jama.com/cgi-bin/main.plex
本期文章：《美国医学会杂志》：Vol 324 No 1
