Effectiveness of statin intensive therapy in type 2 diabetes mellitus with high visit-to-visit blood pressure variability
Effectiveness of statin intensive therapy in type 2 diabetes mellitus with high visit-to-visit blood pressure variability
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DOI：
10.1097/hjh.0000000000002823
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发表时间：
2021-07-01
影响因子：
4.9
通讯作者：
Tsutsui，Hiroyuki
中科院分区：
文献类型：
--
作者：
Ikeda，Shota;Shinohara，Keisuke;Tsutsui，Hiroyuki
背景：强化降脂治疗被推荐给伴有靶器官损害的2型糖尿病（T2DM）患者。然而，证据还不足以对其中哪些患者将受益于强化治疗进行分层。收缩压（SBP）的高访间变异性与心血管事件风险增加有关。我们研究了强化与标准他汀类药物治疗对T2DM视网膜病变患者心血管事件一级预防的有效性，并按每次就诊的收缩压变异性分层。方法：高胆固醇血症合并糖尿病视网膜病变患者的标准与强化他汀类药物治疗研究是第一个比较他汀类药物强化治疗低密度脂蛋白胆固醇(LDL-C)< 70 mg/dl和标准治疗LDL-C≥100至< 120 mg/dl的T2DM视网膜病变患者无已知心血管疾病的研究。使用该数据集，我们根据最初6个月内临床收缩压的标准差（SD）和平均真实变异性（ARV）将患者分为两个亚群。结果：4899例患者中，在37.3个月的中位随访期间，共观察到240例复合心血管事件。在比较强化治疗与标准治疗的多变量调整模型中，在SD定义的高收缩压变异性和低收缩压变异性患者中，复合心血管事件的危险比分别为0.64 （95% CI 0.45-0.90）和1.21 （95% CI 0.82-1.80）。收缩压变异性与他汀类药物治疗之间的相互作用显著（P= 0.018）。收缩压的ARV分析也显示了类似的结果。结论：与标准治疗相比，针对LDL-C< 70 mg/dl的他汀类药物强化治疗在T2DM视网膜病变患者的心血管事件一级预防方面有好处，这些患者就诊时收缩压变异性高，但不低。
Background:Intensive lipid-lowering therapy is recommended in type 2 diabetes mellitus (T2DM) patients with target organ damage. However, the evidence is insufficient to stratify the patients who will benefit from the intensive therapy among them. High visit-to-visit variability in systolic blood pressure (SBP) is associated with increased risk of cardiovascular events. We investigated the effectiveness of intensive versus standard statin therapy in the primary prevention of cardiovascular events among T2DM patients with retinopathy stratified by visit-to-visit SBP variability.Methods:The standard versus intensive statin therapy for hypercholesterolemic patients with diabetic retinopathy study was the first trial comparing statin intensive therapy targeting low-density lipoprotein cholesterol (LDL-C)< 70 mg/dl and standard therapy targeting LDL-C≥ 100 to< 120 mg/dl in T2DM patients with retinopathy without known cardiovascular disease. Using this dataset, we divided the patients into two subpopulations based on standard deviation (SD) and average real variability (ARV) of clinic SBP within the initial 6 months.Results:In a total of 4899 patients, 240 composite cardiovascular events were observed during a median follow-up of 37.3 months. In multivariable-adjusted model comparing intensive versus standard therapy, the hazard ratios for composite cardiovascular events were 0.64 (95% CI 0.45–0.90) and 1.21 (95% CI 0.82–1.80) in patients with high and low SBP variability as defined by SD, respectively. Interaction between SBP variability and statin therapy was significant (P= 0.018). The analysis using ARV of SBP showed similar results.Conclusion:Statin intensive therapy targeting LDL-C< 70 mg/dl had benefits in primary prevention of cardiovascular events compared with standard therapy among T2DM patients with retinopathy having high, but not low, visit-to-visit SBP variability.