Determinants of residual risk in secondary prevention patients treated with high- versus low-dose statin therapy: the Treating to New Targets (TNT) study.
Determinants of residual risk in secondary prevention patients treated with high- versus low-dose statin therapy: the Treating to New Targets (TNT) study.
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DOI：
10.1161/circulationaha.111.088591
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发表时间：
2012-04-24
期刊：
影响因子：
37.8
通讯作者：
Waters DD
中科院分区：
文献类型：
--
作者：
Mora S;Wenger NK;Demicco DA;Breazna A;Boekholdt SM;Arsenault BJ;Deedwania P;Kastelein JJ;Waters DD
心血管事件发生在他汀类药物治疗的患者中，尽管发生率较低。尚未全面研究这种“剩余风险”的风险因素。我们的目的是确定这种风险的决定因素，而不是与脂质相关的风险因素。9,251名LDL胆固醇<130 mg/dL的冠心病患者在治疗新目标（TNT）研究中随机接受双盲阿托伐他汀10或80 mg/天治疗，有完整的治疗1年血脂数据。中位随访时间为4.9年。主要终点为主要心血管事件（n=729）：冠状动脉死亡、非致死性心肌梗死、心脏骤停后复苏或致死性或非致死性卒中。增加风险的多变量决定因素是年龄较大（校正风险比1.13/1-SD [8.8年]，95% CI 1.04-1.23），体重指数（BMI）增加（1.09，1.02-1.17/4.5 kg/m2），男性（1.33，1.07-1.65），高血压（1.38，1.17-1.63），糖尿病（1.33，1.11-1.60），基线载脂蛋白B（1.19，1.11-1.28/19 mg/dL）和血尿素氮（1.10，1.03-1.17/4.9 mg/dL），加上目前吸烟、既往心血管疾病和钙通道阻滞剂使用。风险降低的决定因素是高剂量他汀类药物（0.82，0.70-0.94）、阿司匹林使用（0.67，0.56-0.81）和基线载脂蛋白A-I（0.91，0.84-0.99/25 mg/dL）。在多变量模型中，治疗1年的血脂或载脂蛋白与风险无关。已知的基线变量在区分未来病例和非病例方面表现良好（Harrell的c指数=0.679）。他汀类药物治疗的二级预防患者的剩余风险的决定因素包括脂质相关和非脂质因素，如基线载脂蛋白、BMI增加、吸烟、高血压和糖尿病。应强调采取多方面的预防办法来应对这一风险。http://clinicaltrials.gov唯一标识符：NCT 00327691
Cardiovascular events occur among statin-treated patients, albeit at lower rates. Risk factors for this “residual risk” have not been studied comprehensively. We aimed to identify determinants of this risk above and beyond lipid-related risk factors. 9,251 coronary patients with LDL cholesterol<130 mg/dL randomized to double-blind atorvastatin 10 or 80 mg/day in the Treating to New Targets (TNT) study had complete on-treatment 1-year lipid data. Median follow-up was 4.9 years. The primary endpoint was major cardiovascular events (n=729): coronary death, non-fatal myocardial infarction, resuscitation after cardiac arrest, or fatal or non-fatal stroke. Multivariable determinants of increased risk were older age (adjusted hazard ratio 1.13 per 1-SD [8.8 years], 95% CI 1.04–1.23), increased body-mass index (BMI) (1.09, 1.02–1.17 per 4.5 kg/m2), male gender (1.33, 1.07–1.65), hypertension (1.38, 1.17–1.63), diabetes (1.33, 1.11–1.60), baseline apolipoprotein B (1.19, 1.11–1.28 per 19 mg/dL) and blood urea nitrogen (1.10, 1.03–1.17 per 4.9 mg/dL), in addition to current smoking, prior cardiovascular disease, and calcium channel blocker use. Determinants of decreased risk were high-dose statin (0.82, 0.70–0.94), aspirin use (0.67, 0.56–0.81), and baseline apolipoprotein A-I (0.91, 0.84–0.99 per 25 mg/dL). On-treatment 1-year lipids or apolipoproteins were not additionally associated with risk in multivariable models. Known baseline variables performed moderately well in discriminating future cases from non-cases (Harrell’s c-index=0.679). Determinants of residual risk in statin-treated secondary prevention patients included lipid-related and non-lipid factors such as baseline apolipoproteins, increased BMI, smoking, hypertension, and diabetes. A multi-faceted prevention approach should be underscored to address this risk. http://clinicaltrials.gov; Unique identifier: NCT00327691