高龄动脉粥样硬化性心血管疾病患者他汀疗效分析

Effect of statin therapy on elderly patients with atherosclerotic cardiovascular

目的探究他汀类药物对高龄动脉粥样硬化性心血管疾病(atherosclerotic cardiovascular disease,ASCVD)患者的治疗效果。方法采取回顾性队列研究的方法,搜集整理自2008年于解放军总医院第二医学中心住院的高龄ASCVD患者的检查检验资料、患病情况、用药情况等,将患者分为他汀组及非他汀组,记录随访结局事件及相关化验结果,应用生存分析及Cox比例风险模型分析他汀治疗与全因死亡及主要心血管不良事件(MACE)的关系。结果本研究他汀组随访年限为7.92±0.24年,非他汀组随访年限为7.03±0.34年。在随访期内,他汀组全因死亡率(32.0%)明显低于非他汀组(52.8%),差异有统计学意义(HR:0.629,P=0.033)。他汀组MACE发生率(18.3%)明显低于非他汀组(37.7%),差异有统计学意义(HR=0.503,P=0.012);其中非致死性心肌梗死的发生率他汀组(3.5%)明显低于非他汀组(13.0%),差异有统计学意义(HR=0.268,P=0.011);而不稳定性心绞痛、冠脉血运重建、脑卒中、心脏死亡的发生率两组无统计学差异。他汀组LDL-C为(2.11±0.67)mmol/L,明显低于非他汀组(2.50±0.64)mmol/L,差异有统计学意义(P=0.000)。多因素Cox回归分析表明,年龄和服用ARB类药物在全因死亡中有统计学意义(HR分别为3.006、0.570,P均<0.05);他汀治疗对MACE的发生的影响有统计学意义(HR=0.509,P<0.05)。结论他汀类药物能显著降低ASCVD患者LDL-C的水平,并可显著降低高龄老年ASCVD患者全因死亡率、MACE发生率、非致死性心肌梗死发生率。年龄增加是导致全因死亡重要因素,他汀治疗是MACE发生的重要影响因素。

Objective To investigate the effect of statins in the treatment of atherosclerotic cardiovascular(ASCVD)in elderly patients.Methods Clinical data about aged patients with ASCVD admitted to the second medical center of Chinese PLA General Hospital,including physical examination data,medical history,drug use during hospital-stay,were collected in the follow-up study since 2008,and the patients were divided into statin group and non-statin group according to the medication conditions,their follow-up ending events and relevant test results were recorded,and the relationship between statins and all-cause death and MACE events was analyzed by survival analysis and Cox proportional risk model.Results In this study,the follow-up period was 7.92±0.24 years in the statin group and 7.03±0.34 years in the non-statin group.During the follow-up period,all-cause mortality in the statin group was significantly lower than that in the non-statin group(32.0%vs 52.8%),with statistically significant difference(HR=0.629,P=0.033).While the incidence of MACE events in statin group was lower than that in the non-statin group(18.3%vs 37.7%),with statistically significant difference(HR=0.503,P=0.012).The incidence rate of nonfatal myocardial infarction in statin group was significantly lower than that in the non-statin group(3.5%vs 13.0%,HR=0.268,P=0.011).However,there was no significant difference in unstable angina,coronary revascularization,stroke,and the incidence of cardiac death between the two groups.LDL-C in the statin group was significantly lower than that in the non-statin group([2.11±0.67]mmol/L vs[2.50±0.64]mmol/L,P=0.000).Multivariate correlation analysis showed that age had statistically significant influence on all-cause deaths(HR=3.006,P=0.000).After correcting for age,sex,ARB,beta blockers,and antiplatelet agents,statin therapy showed significant influence on the incidence of MACE events(HR=0.509,P=0.016).Conclusion Statins can significantly reduce LDL-C levels,thus reducing the all-cause mortality,the incidence of MACE events,and non-fatal myocardial infarction in elderly ASCVD patients.Aging is the most important factor leading to all-cause death,and statin therapy is an important factor for the occurrence of MACE events.