Secondary prevention of cardiovascular events with long-term pravastatin in patients with diabetes or impaired fasting glucose - Results from the LIPID trial
Secondary prevention of cardiovascular events with long-term pravastatin in patients with diabetes or impaired fasting glucose - Results from the LIPID trial
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DOI：
10.2337/diacare.26.10.2713
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发表时间：
2003-10-01
期刊：
影响因子：
16.2
通讯作者：
Tonkin, A
中科院分区：
文献类型：
--
作者：
Keech, A;Colquhoun, D;Tonkin, A
目的-糖尿病是世界范围内的一个主要健康问题，它增加了心血管疾病及其相关死亡率的风险。需要证据证明脂质修饰在该领域的总体益处。研究设计和方法 - 普伐他汀长期干预缺血性疾病 (LIPID) 试验表明，普伐他汀降胆固醇治疗可降低 9,014 名年龄 31-75 岁、总胆固醇水平为 4.0-7.0 mmol/l 的冠心病 (CHD) 患者的死亡率和冠心病 (CHD) 事件。我们在 6.0 年内测量了普伐他汀治疗（每天 40 毫克）对 1,077 名 LIPID 糖尿病患者和 940 名空腹血糖受损 (IFG) 患者的 CHD 死亡或非致命性心肌梗塞和其他心血管结局的风险的影响。结果——在分配给安慰剂的患者中，与糖尿病患者相比，糖尿病患者发生主要 CHD 事件的风险高出 61%，IFG 组高出 23%。空腹血糖正常，糖尿病组发生任何心血管事件的风险高出 37%，IFG 组高出 19%。普伐他汀治疗将主要 CHD 事件的总体风险从 15.9% 降低至 12.3%（相对风险降低 [RRR] 24%，P < 0.001），将糖尿病组的风险从 23.4% 降低至 19.6%（19%，P = 0.11）；在糖尿病组中，这种减少与其他组的减少没有显着差异。普伐他汀将糖尿病患者的任何心血管事件风险从 52.7% 降低至 45.2%（21%，P < 0.008），将 IFG 组的心血管事件风险从 45.7% 降低至 37.1%（26%，P = 0.003）。普伐他汀将糖尿病组中风的风险从 9.9% 降低至 6.3%（RRR 39%，Cl 7-61%，P = 0.02），将 IFG 组中风风险从 5.4% 降低至 3.4%（RRR 42%，Cl -9 至 69%，P = 0.09）。普伐他汀并没有降低糖尿病的发病率。 6 年多来，普伐他汀治疗预防了 23 名 IFG 患者和 18 名糖尿病患者的一项重大 CHD 事件（CHD 死亡或非致命性心肌梗塞）。其他主要试验的荟萃分析证实了这些患者患糖尿病和 IFG 的绝对风险较高，以及他汀类药物治疗的绝对益处。 结论：普伐他汀降胆固醇治疗可预防糖尿病或 IFG 合并先心病患者的心血管事件，包括中风。
OBJECTIVE- Diabetes, a major health problem worldwide, increases the risk of cardiovascular disease and its associated mortality. Evidence of the overall benefits of lipid modification in this area is needed. RESEARCHDESIGN AND METHODS- The Long-Term Intervention with Pravastatin in Ischemic Disease (LIPID) trial showed that cholesterol-lowering treatment with pravastatin reduced mortality and coronary heart disease (CHD) events in 9,014 patients aged 31-75 years with CHD and total cholesterol 4.0-7.0 mmol/l. We measured the effects of pravastatin therapy, 40 mg/day over 6.0 years, on the risk of CHD death or nonfatal myocardial infarction and other cardiovascular outcomes in 1,077 LIPID patients with diabetes and 940 patients with impaired fasting glucose (IFG).RESULTS- in patients allocated to placebo, the risk of a major CHD event was 61% higher in patients with diabetes and 23% higher in the IFG group than in patients with normal fasting glucose, and the risk of any cardiovascular event was 37% higher in the diabetic group and 19% higher in the IFG group. Pravastatin therapy reduced the risk of a major CHD event overall from 15.9 to 12.3% (relative risk reduction [RRR] 24%, P < 0.001) and from 23.4 to 19.6% in the diabetic group (19%, P = 0.11); in the diabetic group, the reduction was not significantly different from the reductions in the other groups. Pravastatin reduced the risk of any cardiovascular event from 52.7 to 45.2% (21%, P < 0.008) in patients With diabetes and from 45.7 to 37.1% (26%, P = 0.003) in the IFG group. Pravastatin reduced the risk of stroke from 9.9 to 6.3% in the diabetic group (RRR 39%, Cl 7-61%, P = 0.02) and from 5.4 to 3.4% in the IFG group (RRR 42%, Cl -9 to 69%, P = 0.09). Pravastatin did not reduce the incidence of diabetes. Over 6 years, pravastatin therapy prevented one major,CHD event (CHD death or nonfatal myocardial infarction) in 23 patients with IFG and 18 patients with diabetes. A meta-analysis of other major trials confirmed the high absolute risks of diabetes and IFG and the absolute benefits of statin therapy in these patients.CONCLUSIONS- Cholesterol-lowering treatment with pravastatin therapy prevents cardiovascular events, including stroke, in patients with diabetes or IFG and established CHD.