摘要
目的:应用他汀类药物的强化降脂治疗对合并糖尿病(DM)的急性冠状动脉综合征(ACS)患者的影响尚不明确。方法和结果:利用PROVEIT(普伐他汀或阿托伐他汀评估和抗感染治疗)TIMI 22试验中对比ACS后早期标准(普伐他汀40mg)和强化他汀类药物治疗(阿托伐他汀80mg)的资料探讨上述问题。
Aims: The impact of intensive lipid lowering therapy with statins in acute coronary syndrome (ACS) patients with diabetes mellitus (DM) is not well characterized. Methods and results: We explored this question in data from the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT) TIMI 22 trial, which tested standard (pravastatin 40 mg) vs. intensive (atorvastatin 80 mg) statin therapy among patients treated early in the post-ACS period. We compared outcomes between patients with DM (identified by history, fasting plasma glucose ≥126 mg/dL or haemoglobin A1C < 7%; n=978) against those without DM (n=3184). The rate of acute cardiac events (death, myocardial infarction, and unstable angina requiring rehospitalization) was much higher in patients with DM, but was reduced with intensive vs. standard therapy similarly in diabetic (21.1 vs. 26.6%, HR=0.75, P=0.03) and non-diabetic patients (14.0 vs. 18.0%, HR=0.76, P=0.002); P-interaction=0.97. Despite intensive therapy, the majority of diabetics (62%) did not reach the dual goal of LDL-C < 70 mg/dL and high-sensitivity C-reactive protein < 2 mg/L. Conclusion: In ACS patients with DM, intensive statin therapy reduces acute cardiac events as it does in those without DM, with 55 vs. 40 events prevented per 1000 patients treated. However, our data highlight the need for additional strategies in this high-risk group.
