Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. The Care Investigators.
Cardiovascular events and their reduction with pravastatin in diabetic and glucose-intolerant myocardial infarction survivors with average cholesterol levels: subgroup analyses in the cholesterol and recurrent events (CARE) trial. The Care Investigators.
复制标题
具有平均胆固醇水平的糖尿病和葡萄糖不耐症心肌梗塞幸存者的心血管事件及其通过普伐他汀的减少：胆固醇和复发事件（CARE）试验中的亚组分析。
作者：
R. Goldberg;M. Mellies;F. Sacks;L. Moye;B. Howard;W. Howard;B. Davis;T. Cole;M. Pfeffer;E. Braunwald
背景
虽然糖尿病是冠心病（CHD）的主要危险因素，但关于糖尿病患者降脂效果的信息很少。我们确定了普伐他汀降脂治疗是否可以预防伴有CHD和平均胆固醇水平的糖尿病患者的心血管事件复发。
方法和结果
胆固醇和复发事件（CARE）试验是一项为期5年的试验，比较了普伐他汀和安慰剂的效果，包括586例（14.1%）临床诊断为糖尿病的患者。患有糖尿病的参与者年龄更大，更肥胖，更高血压。糖尿病组的平均基线脂质浓度--LDL胆固醇136 mg/dL，HDL胆固醇38 mg/dL，甘油三酯164 mg/dL--与非糖尿病组相似。在糖尿病组和非糖尿病组中，普伐他汀降低LDL胆固醇的效果相似（分别为27%和28%）。在安慰剂组中，糖尿病患者比非糖尿病患者发生更多的复发性冠状动脉事件（CHD死亡、非致命性心肌梗死[MI]、CABG和PTCA）（37%对25%）。普伐他汀治疗使糖尿病和非糖尿病患者的冠状动脉事件绝对危险度分别降低8.1%和5.2%，相对危险度分别降低25%（P=0.05）和23%（P<0.001）。在糖尿病患者中，普伐他汀使血运重建手术的相对风险降低了32%（P=0.04）。在3553例未被诊断为糖尿病的患者中，342例在入组时空腹血糖受损，美国糖尿病协会定义为110至125 mg/dL。这些空腹血糖受损的非糖尿病患者的冠状动脉事件复发率高于空腹血糖正常的患者（例如，13%对10%的非致死性MI）。与安慰剂组相比，普伐他汀组的复发率倾向于较低（例如，非致死性MI为-50%，P =0.05）。
结论
空腹血糖受损的糖尿病患者和非糖尿病患者冠状动脉事件复发的风险高，普伐他汀治疗可显著降低。
BACKGROUND
Although diabetes is a major risk factor for coronary heart disease (CHD), little information is available on the effects of lipid lowering in diabetic patients. We determined whether lipid-lowering treatment with pravastatin prevents recurrent cardiovascular events in diabetic patients with CHD and average cholesterol levels.
METHODS AND RESULTS
The Cholesterol And Recurrent Events (CARE) trial, a 5-year trial that compared the effect of pravastatin and placebo, included 586 patients (14.1%) with clinical diagnoses of diabetes. The participants with diabetes were older, more obese, and more hypertensive. The mean baseline lipid concentrations in the group with diabetes--136 mg/dL LDL cholesterol, 38 mg/dL HDL cholesterol, and 164 mg/dL triglycerides--were similar to those in the nondiabetic group. LDL cholesterol reduction by pravastatin was similar (27% and 28%) in the diabetic and nondiabetic groups, respectively. In the placebo group, the diabetic patients suffered more recurrent coronary events (CHD death, nonfatal myocardial infarction [MI], CABG, and PTCA) than did the nondiabetic patients (37% versus 25%). Pravastatin treatment reduced the absolute risk of coronary events for the diabetic and nondiabetic patients by 8.1% and 5.2% and the relative risk by 25% (P=0.05) and 23% (P<0.001), respectively. Pravastatin reduced the relative risk for revascularization procedures by 32% (P=0.04) in the diabetic patients. In the 3553 patients who were not diagnosed as diabetic, 342 had impaired fasting glucose at entry defined by the American Diabetes Association as 110 to 125 mg/dL. These nondiabetic patients with impaired fasting glucose had a higher rate of recurrent coronary events than those with normal fasting glucose (eg, 13% versus 10% for nonfatal MI). Recurrence rates tended to be lower in the pravastatin compared with placebo group (eg, -50%, P=0.05 for nonfatal MI).
CONCLUSIONS
Diabetic patients and nondiabetic patients with impaired fasting glucose are at high risk of recurrent coronary events that can be substantially reduced by pravastatin treatment.