Effect of atorvastatin in elderly patients with a recent stroke or transient ischemic attack
Effect of atorvastatin in elderly patients with a recent stroke or transient ischemic attack
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DOI：
10.1212/01.wnl.0000327339.55844.1a
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发表时间：
2009-02-24
期刊：
影响因子：
9.9
通讯作者：
Welch, M. A.
中科院分区：
文献类型：
--
作者：
Chaturvedi, S.;Zivin, J.;Welch, M. A.
背景：尚不清楚 65 岁及以上近期发生过中风或 TIA 的患者是否能像年轻患者一样从他汀类药物治疗中获益。方法：SPARCL 研究中的 4,731 名患者队列被分为老年组（65 岁及以上）和年轻组。分析主要终点（致死性或非致死性卒中）和次要终点，并计算风险比 (HR) 和 Cox 回归模型的 p 值。 结果：老年组有 2,249 名患者，年轻组有 2,482 名患者。两组的基线 LDL (133 mg/dL) 和总胆固醇相当。试验期间，老年人和年轻人的平均 LDL 分别降低了 61.4 mg/dL 和 58.7 mg/dL。年轻患者的主要终点降低了 26%（HR 0.74, 0.57-0.96，p = 0.02），老年受试者降低了 10%（HR 0.90, 0.73-1.11，p = 0.33）。治疗-年龄相互作用的异质性检验不显着（p = 0.52）。老年组中风或TIA（HR 0.79，p = 0.01）、主要冠状动脉事件（HR 0.68，p = 0.035）、任何冠心病事件（HR 0.61，p = 0.0006）和血运重建手术（HR 0.55，p = 0.0005）的风险降低。 结论：阿托伐他汀在老年人和年轻群体中的应用。在接受阿托伐他汀治疗的老年和年轻亚组中，心脏事件和血运重建手术的发生率也较低。这些结果支持阿托伐他汀在近期发生中风或 TIA 的老年患者中的使用。神经病学（R）2009； 72：688-694
Background: It is unclear whether patients age 65 years and over with a recent stroke or TIA benefit from statin treatment to a similar degree as younger patients.Methods: The 4,731 patient cohort in the SPARCL study was divided into an elderly group (65 and over) and a younger group. The primary endpoint (fatal or nonfatal stroke) and secondary endpoints were analyzed, with calculation of the hazard ratio (HR) and p values from a Cox regression model.Results: There were 2,249 patients in the elderly group and 2,482 in the younger group. The baseline LDL (133 mg/dL) and total cholesterol were comparable in the two groups. The elderly and younger groups had a 61.4 mg/dL and 58.7 mg/dL decrease in mean LDL during the trial. The primary endpoint was reduced by 26% in younger patients (HR 0.74, 0.57-0.96, p = 0.02) and by 10% in elderly subjects (HR 0.90, 0.73-1.11, p = 0.33). A test of heterogeneity for a treatment-age interaction was not significant (p = 0.52). The risk of stroke or TIA (HR 0.79, p = 0.01), major coronary events (HR 0.68, p = 0.035), any coronary heart disease event (HR 0.61, p = 0.0006), and revascularization procedures (HR 0.55, p = 0.0005) was reduced in the elderly group.Conclusions: There was no heterogeneity in the stroke reduction seen with atorvastatin in the elderly and younger groups. Cardiac events and revascularization procedures were also lower in both the elderly and younger subgroups treated with atorvastatin. These results support the use of atorvastatin in elderly patients with recent stroke or TIA. Neurology (R) 2009; 72: 688-694