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Neurology:没有指征的心源性脑卒中患者他汀类药物疗效分析

2020-04-10 MedSci原创 MedSci原创

在缺血性脑卒中急性期开始服用他汀类药物,可降低没有他汀类药物治疗指征的心源性脑卒中患者发生重大血管事件、血管死亡和全因死亡的风险。

目前还不确定,对于没有基于指南的他汀类药物治疗指征的心源性脑卒中患者是否应该使用他汀类药物来预防随后的血管事件。近日,神经病学领域权威杂志Neurology上发表了一篇研究文章,该研究旨在明确他汀类药物治疗是否有助于预防该人群的主要血管事件。

研究人员采用前瞻性多中心卒中登记数据库,确定了2008年至2015年期间住院的急性心源性卒中患者。根据当前指南有其它明确的他汀类药物治疗适应症的患者被排除在外。主要血管事件被定义为卒中复发、心肌梗死和血管死亡的复合事件。研究人员使用稳健的三明治方差估计量进行了衰弱模型分析,使用稳定的治疗加权逆概率法来估计他汀类药物治疗对患者结局的风险比。

在6124例心脏栓塞性卒中患者中,2,888例(男性为44.6%,平均年龄为75.3岁,95%可信区间为74.8-75.8)患者符合纳入标准,1863例(64.5%)患者住院期间服用他汀类药物。在359天的中位随访后,他汀类药物服用者主要血管事件的累积发生率为9.3%,而非服用者为20.5% (log-rank检验p<0.001)。他汀类药物治疗主要血管事件的调整风险比为0.39 (95%CI为0.31-0.48),卒中复发的调整风险比为0.81 (95%CI为0.57-1.16),血管死亡的调整风险比为0.28 (95%CI为0.21-0.36),全死因死亡的调整风险比为0.53 (95%CI为0.45-0.61)。

由此可见,在缺血性脑卒中急性期开始服用他汀类药物,可降低没有他汀类药物治疗指征的心源性脑卒中患者发生重大血管事件、血管死亡和全因死亡的风险。

原始出处:

Hong-Kyun Park,et al.Statin therapy in acute cardioembolic stroke with no guidance-based indication.Neurology.2020.https://n.neurology.org/content/early/2020/04/09/WNL.0000000000009397

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    2020-06-27 yinhl1978
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  4. 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  8. 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    2020-04-12 mhm295
  9. 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    2020-04-11 1de33e15m69(暂无匿称)

    他汀类有严重副作用,建议壳寡糖替代

    0

  10. 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createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIibticIBly5jCSic5ZElW4He3rO4DMpUHUFaFX57OicNMnzckWaicBNeStwugWHFCuOdicoakApM4HGmtw/132, createdBy=f8672500006, createdName=ms6390871039024434, createdTime=Thu May 28 20:02:17 CST 2020, time=2020-05-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1593517, encodeId=627a159351e33, content=<a href='/topic/show?id=9850510e9a3' target=_blank style='color:#2F92EE;'>#心源性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51079, encryptionId=9850510e9a3, topicName=心源性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=955718147815, createdName=mhm295, createdTime=Sun Apr 12 04:02:17 CST 2020, time=2020-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=381579, encodeId=9eb53815e98b, content=他汀类有严重副作用,建议壳寡糖替代, beContent=null, objectType=article, channel=null, level=null, likeNumber=119, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c2531680715, createdName=1de33e15m69(暂无匿称), createdTime=Sat Apr 11 10:37:00 CST 2020, time=2020-04-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026621, encodeId=a305102662125, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=136, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Fri Apr 10 16:02:17 CST 2020, time=2020-04-10, status=1, ipAttribution=)]
    2020-04-10 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

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Stroke:既往卒中患者服用他汀类药物与脑出血风险

由此可见,这项大型研究结果表明他汀类药物不会增加既往卒中患者脑出血的风险。在既往缺血性卒中患者亚组中,风险可能更低。

Prostate Cancer P D:他汀类药物、预防性护理和前列腺癌死亡率相关性分析

越来越多的证据表明了他汀类药物和前列腺癌特异性死亡率(PCSM)的减少存在相关性。然而,这些研究中可能存在显著的偏差。其中一个特别的评估偏差为健康护理的影响,可通过筛选模式进行量化。最近,有研究人员在一个具有详细纵向信息的数据库中评估了他汀类药物的使用、筛选和PCSM间的相关性。研究群体包括了68432名男性,其中40772名(59.6%)为诊断前他汀类使用者,27660名(40.4%)为非使用者

PNAS:他汀类药物使癌细胞无法吸收蛋白而“饿死”

流行病学迹象表明,长期服用他汀类药物的人,往往很少患有侵袭性癌症。在美国,每天有超过3500万人服用这类药物来降低血液胆固醇水平。美国约翰霍普金斯大学医学院的研究人员在对人体细胞进行的实验中,发现越来

Diabetes Care:美国成年糖尿病患者服用他汀类药物后高甘油三酸酯血症和估计的动脉粥样硬化性心血管疾病风险

由此可见,五分之一(约550万)的美国糖尿病成人会发生HTG,包括接受他汀类药物治疗和LDL-C控制良好的糖尿病患者。超过四分之三的HTG的成年人有中等或较高的10年ASCVD风险。需要做出更大的努力来促进生活方式和药物手段以解决HTG。

Stroke:年轻人缺血性卒中后他汀类药物使用与长期结局的关系

由此可见,年轻的缺血性卒中患者中有不到一半使用他汀类药物,其使用受年龄和危险因素的影响。服用他汀类药物与降低全因死亡率和卒中复发的风险独立相关。

Heart:70岁以上未服用他汀类药物的男性总胆固醇过低与严重不良心血管事件相关

由此可见,在没有IHD且未接受他汀类药物治疗的男性中,低TC与MACE的发生风险增加有关。

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