高龄冠心病患者应用他汀类药物的疗效及安全性

Efficacy and safety of statins in very old coronary heart disease patients

目的探讨高龄冠心病患者应用他汀类药物(阿托伐他汀、普伐他汀和瑞舒伐他汀)的疗效及安全性。方法回顾性分析于中南大学湘雅医院门诊或住院服用他汀类药物年龄≥80岁冠心病患者174例,根据服用他汀类药物种类分为3组:阿托伐他汀组58例,剂量为20mg/d;普伐他汀组55例,剂量为40mg/d;瑞舒伐他汀组61例,剂量为10mg/d。观察治疗前和治疗6个月后的血脂达标率、丙氨酸转氨酶(ALT)、肌酸激酶(CK)、血肌酐水平变化及1年内的心脑血管事件发生等情况。结果与治疗前比较,治疗后阿托伐他汀组、普伐他汀组、瑞舒伐他汀组LDL-C(31.03%vs 15.52%、21.82%vs 7.27%、27.87%vs 9.84%)和非HDL-C(58.62%vs 37.93%、43.64%vs25.45%、65.57%vs 31.15%)达标率均有显著提高,差异有统计学意义(P<0.05,P<0.01)。3组治疗前后ALT、CK和血肌酐无显著差异(P>0.05)。治疗后1年内,阿托伐他汀组、普伐他汀组、瑞舒伐他汀组主要心脑血管事件发生率分别为18.97%、23.64%、16.39%,死亡事件(冠心病死亡和全因死亡)的发生率分别为5.17%、5.45%、4.92%,3组比较差异无统计学意义(P>0.05)。结论高龄冠心病患者应用中等剂量的阿托伐他汀、普伐他汀、瑞舒伐他汀调脂治疗,其临床获益肯定,并且总体上是安全的。

Objective To study the efficacy and safety of statins（atorvastatin,pravastatin,rosuvastatin）in very old coronary heart disease（CHD）patients.Methods One hundred and seventy-four≥80years old CHD patients admitted to our hospital were divided into atorvastatin（20 mg/d）treatment group（n=58）,pravastatin（40 mg/d）treatment group（n=55）,and rosuvastatin（10mg/d）treatment group（n=61）.Their serum levels of lipid,ALT,Scr,CK were measured and the incidence of cardiovascular and cerebrovascular events was recorded before and 6 months after treatment.Results The serum levels of LDL-C and non-HDL-C were significantly higher in 3statin treatment groups before treatment than after treatment（31.03% vs 15.52%,21.82% vs7.27%,27.87% vs 9.84%,P〈0.05;58.62% vs 37.93%,43.64% vs 25.45%,65.57% vs31.15%,P 0.05）.The incidence of major cardiovascular and cerebrovascular events was18.97%,23.64% and 16.39%respectively and the mortality was 5.17%,5.45% and 4.92% respectively in 3statin treatment groups 12 months after treatment（P〉0.05）.Conclusion Moderate dose of atorvastatin,pravastatin and rosuvastatin can effectively and safely reduce the serum lipid level in very old CHD patients.