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Lancet Diabetes Endocrinol:使用他汀降低LDL-C,有益于慢性肾病

2016-08-09 Seven L 译 MedSci原创

背景:对轻、中度慢性肾脏病患者,使用他汀类药物可有效预防冠心病和卒中风险;但是对于更严重的慢性肾脏病患者,比如透析患者,他汀类药物的效果又怎样?方法:对28项试验(n = 183 419)进行荟萃分析,研究他汀类药物为基础的治疗对大血管事件(冠状动脉事件[非致死性心肌梗死或冠心病死亡],卒中或冠状动脉血运重建)和病因特异性死亡率的影响。在基线时评估参与者的肾小球滤过率(eGFR)。结果:总的来说,

背景:对轻、中度慢性肾脏病患者,使用他汀类药物可有效预防冠心病和卒中风险;但是对于更严重的慢性肾脏病患者,比如透析患者,他汀类药物的效果又怎样?

方法:对28项试验(n = 183 419)进行荟萃分析,研究他汀类药物为基础的治疗对大血管事件(冠状动脉事件[非致死性心肌梗死或冠心病死亡],卒中或冠状动脉血运重建)和病因特异性死亡率的影响。在基线时评估参与者的肾小球滤过率(eGFR)。

结果:总的来说,他汀类药物治疗后LDL胆固醇每降低1 mmol/L,首次主要血管事件的风险降低21%(RR 0.79, 95% CI 0.77-0.81; p<0.0001)。eGFR下降对主要血管事件的相对影响更小(eGFR ≥60 mL/min /1.73 m2:P-趋势=0.008,RR 0.78, 99% CI 0.75-0.82;eGFR 45~<60:0.76, 0.70-0.81;eGFR 30~<45:0.85, 0.75-0.96;eGFR <30但没有透析:0.85, 0.71-1.02;透析患者:0.94, 0.79-1.11)。基线肾功能对主要冠心病事件(P-趋势=0.01)和血管死亡率(P-趋势=0.03)有类似的趋势;但对冠状动脉血运重建的影响不明显(P=0.90)。无论eGFR,他汀类药物治疗所致LDL胆固醇的下降,对非血管性死亡率没有影响。

结论:对于慢性肾脏疾病患者,应选择基于他汀类药物的治疗方案,最大化LDL胆固醇的绝对减少,达到最大的治疗效果。

原始出处:


Cholesterol Treatment Trialists' (CTT) Collaboration.Impact of renal function on the effects of LDL cholesterol lowering with statin-based regimens: a meta-analysis of individual participant data from 28 randomised trials.Lancet Diabetes Endocrinol. 2016 Jul 28. pii: S2213-8587(16)30156-5. doi: 10.1016/S2213-8587(16)30156-5.


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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97832, encodeId=e0df9e832a7, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97642, encodeId=b6209e64240, content=汀类药物作用很多啊!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7gGJY7ibia1wDTTwTL7vXbqvekMBTHAsd3KZ7btXM9tnHuicI2LdxJtIiccXeDCiaTvzkwMuribZ9oHVA/0, createdBy=c7b81713099, createdName=木水晶, createdTime=Thu Aug 11 22:30:00 CST 2016, time=2016-08-11, status=1, ipAttribution=)]
    2017-04-22 howi
  5. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97832, encodeId=e0df9e832a7, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97642, encodeId=b6209e64240, content=汀类药物作用很多啊!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7gGJY7ibia1wDTTwTL7vXbqvekMBTHAsd3KZ7btXM9tnHuicI2LdxJtIiccXeDCiaTvzkwMuribZ9oHVA/0, createdBy=c7b81713099, createdName=木水晶, createdTime=Thu Aug 11 22:30:00 CST 2016, time=2016-08-11, status=1, ipAttribution=)]
    2016-09-06 李东泽

    很好,不错,以后会多学习

    0

  6. 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objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7gGJY7ibia1wDTTwTL7vXbqvekMBTHAsd3KZ7btXM9tnHuicI2LdxJtIiccXeDCiaTvzkwMuribZ9oHVA/0, createdBy=c7b81713099, createdName=木水晶, createdTime=Thu Aug 11 22:30:00 CST 2016, time=2016-08-11, status=1, ipAttribution=)]
    2016-08-19 136****0753赵

    值得学习

    0

  7. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97832, encodeId=e0df9e832a7, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97642, encodeId=b6209e64240, content=汀类药物作用很多啊!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7gGJY7ibia1wDTTwTL7vXbqvekMBTHAsd3KZ7btXM9tnHuicI2LdxJtIiccXeDCiaTvzkwMuribZ9oHVA/0, createdBy=c7b81713099, createdName=木水晶, createdTime=Thu Aug 11 22:30:00 CST 2016, time=2016-08-11, status=1, ipAttribution=)]
    2016-08-16 lalalallalalaalla

    继续学习

    0

  8. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLMzGpMQ8w4I7FpiblCXNcmI6O7TDINutbaicEUpoYFR1rWqn3kTbulfMhT0iaPFurLz2ddEcWe3BiciaQ/0, createdBy=5f6e1724878, createdName=136****0753赵, createdTime=Fri Aug 19 15:53:00 CST 2016, time=2016-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=99099, encodeId=74b5990999b, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=81, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=941f1739368, createdName=lalalallalalaalla, createdTime=Tue Aug 16 11:32:00 CST 2016, time=2016-08-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97831, encodeId=70a99e83127, content=继续关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97832, encodeId=e0df9e832a7, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97642, encodeId=b6209e64240, content=汀类药物作用很多啊!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7gGJY7ibia1wDTTwTL7vXbqvekMBTHAsd3KZ7btXM9tnHuicI2LdxJtIiccXeDCiaTvzkwMuribZ9oHVA/0, createdBy=c7b81713099, createdName=木水晶, createdTime=Thu Aug 11 22:30:00 CST 2016, time=2016-08-11, status=1, ipAttribution=)]
    2016-08-12 doctorJiangchao

    继续关注

    0

  9. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97832, encodeId=e0df9e832a7, content=继续学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzfPkmqRTH5rHib5mcib8Wb3QdXjhfOK1UubQL2lictjJFdFJ6Lc3cnnCOSWqxXZ4Kk6y5GdzDoy764R/0, createdBy=156e1644785, createdName=doctorJiangchao, createdTime=Fri Aug 12 17:52:00 CST 2016, time=2016-08-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=97642, encodeId=b6209e64240, content=汀类药物作用很多啊!, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7gGJY7ibia1wDTTwTL7vXbqvekMBTHAsd3KZ7btXM9tnHuicI2LdxJtIiccXeDCiaTvzkwMuribZ9oHVA/0, createdBy=c7b81713099, createdName=木水晶, createdTime=Thu Aug 11 22:30:00 CST 2016, time=2016-08-11, status=1, ipAttribution=)]
    2016-08-12 doctorJiangchao

    继续学习

    0

  10. 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objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7gGJY7ibia1wDTTwTL7vXbqvekMBTHAsd3KZ7btXM9tnHuicI2LdxJtIiccXeDCiaTvzkwMuribZ9oHVA/0, createdBy=c7b81713099, createdName=木水晶, createdTime=Thu Aug 11 22:30:00 CST 2016, time=2016-08-11, status=1, ipAttribution=)]
    2016-08-11 木水晶

    汀类药物作用很多啊!

    0

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背景:坚持药物治疗方案的依从性差是常见的,可能有助于相关疾病的发生。目标:研究者旨在评估不坚持他汀类和/或抗高血压治疗与致命性卒中的风险的相关性。方法:研究者使用1995至2007年芬兰国家登记中的电子医疗和处方记录进行一项以人口为基础的研究。58266例高胆固醇血症的患者,年龄30岁以上,无卒中或心血管疾病。在平均随访5.5年中,532例死于脑卒中和57734例无卒中事件(对照组)。研究者获得两

JAMA Intern Med:心脏病患者,低密度脂蛋白水平并不是越低越好

背景:国际指南推荐患有缺血性心脏病的患者进行他汀类药物治疗预防心血管事件的发生,但他汀治疗的目标低密度脂蛋白胆固醇(LDL-C)值不同。这个问题相关的试验数据不确定,缺乏观测数据。目的:评估缺血性心脏病患者应用他汀治疗的LDL-C水平与心血管事件发生的相关性。设计、设置和参与者:这项研究是基于人口的观察性队列研究,从2009年到2013年,应用来自以色列的医疗保健机构数据,这个机构超过430万名成

J Stroke Cerebrovasc Dis:他汀药物可降低缺血性卒中感染发生的风险

目标:他汀类药物独立于其降脂作用具有免疫调节的作用和外周抗炎的特性。在临床研究中,这些性质是否降低卒中后感染风险尚不确定。研究者评估18岁以上住院的缺血性卒中患者,他汀类暴露对卒中后感染发生的风险。材料与方法:对急性护理医院电子病历进行回顾性分析。将患者分配到暴露队列,感染前应用他汀类药物,应用他汀药物治疗但未感染。未暴露队列包括未应用他汀类药物,或感染后应用他汀类药物。校正卒中后感染的危险因素条

BMJ:重视媒体报道的健康事件对民众医疗健康相关行为的影响

本研究旨在评估激烈的他汀药物治疗的利弊争议的媒体报道对他汀药物使用的影响。前瞻性收集初级保健的电子数据以进行中断时间序列分析。纳入2011年1月至2015年3月每个月新服用或目前正在服用他汀类药物治疗原发性和继发性心血管疾病的患者。主要研究结果为媒体报道后开始/停止服用他汀类药物的校正后的比值比。结果发现,尽管有记录风险评分的患者总体比例下降,但是并没有证据表明高密度媒体报道时期与心血管疾病风险得

冠脉搭桥术后他汀和阿司匹林长期服用率需进一步提高

冠脉搭桥(CABG)是缺血性心脏病的有效治疗手段,但由于移植血管狭窄和阻塞发生率高,冠脉搭桥长期获益受到一定程度的限制。大量研究证实冠脉搭桥术后服用他汀类药物和阿司匹林可获益,近期美国心脏协会发布的 CABG 术后二级预防科学声明也将长期服用他汀和阿司匹林作为 Ia 类推荐。但是,针对他汀和阿司匹林长期服用情况的研究数据比较匮乏,为此,来自美国宾夕法尼亚州 Thomas Jefferson 大学附

赵水平解读ADA糖尿病指南:几乎所有糖尿病患者都需加用他汀

糖尿病患者多合并有血脂紊乱,如何更好管理糖尿病患者血脂?近期中南大学湘雅二院赵水平、赵旺等就此对近年来美国糖尿病学会(ADA)和美国内分泌医师协会(AACE)/美国内分泌学会(ACE)对糖尿病患者降脂的态度和推荐进行了对比和分析。   几乎所有糖尿病患者在生活方式干预基础上应加用他汀 ADA指南认为,他汀类药物治疗应基于患者的危险因素而非LDL-C检测结果,推荐几乎所有糖尿

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