Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment: The Action to Control Cardiovascular Risk in Diabetes Study
Effects of High Density Lipoprotein Raising Therapies on Cardiovascular Outcomes in Patients with Type 2 Diabetes Mellitus, with or without Renal Impairment: The Action to Control Cardiovascular Risk in Diabetes Study
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DOI：
10.1159/000453626
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发表时间：
2017-01-01
影响因子：
4.2
通讯作者：
Doumas, Michael
中科院分区：
文献类型：
--
作者：
Papademetriou, Vasilios;Lovato, Laura;Doumas, Michael
背景：除了他汀类药物治疗外，高密度脂蛋白升高干预在糖尿病患者中的作用仍然存在争议。慢性肾脏疾病（CKD）是心血管（CV）结局的一个强有力的修饰因子。因此，在控制糖尿病心血管风险行动（ACCORD）脂质试验中，我们研究了基线时CKD状态对随机接受标准他汀类药物或他汀类药物加非诺贝特治疗的糖尿病患者结局的影响。方法：在ACCORD脂质试验的5464名参与者中，3554名（65%）在基线时无CKD，而1910名（35%）患有轻度至中度CKD。研究了CKD和非CKD亚组随访期间CV结果的差异。此外，非诺贝特与安慰剂对两个亚组的CV结果的影响进行了比较。结果：CKD患者的所有CV结果比非CKD患者高1.4-3倍。在CKD患者中，非诺贝特的加入对任何主要或次要结局都没有影响。然而，在没有CKD的患者中，非诺贝特的加入与CV死亡率显著降低36%相关（风险比[HR] 0.64; 95% CI 0.42-0.97；治疗相互作用的p值）
Background: The role of high density lipoprotein-raising interventions in addition to statin therapy in patients with diabetes remains controversial. Chronic kidney disease (CKD) is a strong modifier of cardiovascular (CV) outcomes. We therefore investigated the impact of CKD status at baseline on outcomes in patients with diabetes randomized to standard statin or statin plus fenofibrate treatment in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) lipid trial. Methods: Among 5,464 participants in the ACCORD lipid trial, 3,554 (65%) were free of CKD at baseline, while 1,910 (35%) had mild to moderate CKD. Differences in CV outcomes during follow-up between CKD and non-CKD subgroups were examined. In addition, the effect of fenofibrate as compared to placebo on CV outcomes was examined for both subgroups. Results: All CV outcomes were 1.4-3 times higher among patients with CKD as compared to non-CKD patients. In patients with CKD, the addition of fenofibrate had no effect on any of the primary or secondary outcomes. In patients without CKD, however, the addition of fenofibrate was associated with a significant 36% reduction of CV mortality (hazards ratio [HR] 0.64; 95% CI 0.42-0.97; p value for treatment interaction