Statins for Primary Prevention of Cardiovascular Events and Mortality in Older Men
Statins for Primary Prevention of Cardiovascular Events and Mortality in Older Men
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DOI：
10.1111/jgs.14993
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发表时间：
2017-11-01
影响因子：
6.3
通讯作者：
Driver, Jane A.
中科院分区：
文献类型：
--
作者：
Orkaby, Ariela R.;Gaziano, J. Michael;Driver, Jane A.
背景/目的：我们试图确定他汀类药物用于一级预防是否与老年男性较低的心血管事件风险或死亡率相关。设计：前瞻性队列研究。设置：医师健康研究参与者。参与者：7，213名年龄≥ 70岁无心血管疾病（CVD）史的男性医师。测量：他汀类药物使用的多变量倾向评分与贪婪匹配（1：结果：中位基线年龄为77岁（70-102岁），中位随访时间为7年。非使用者与1，130名他汀类药物使用者相匹配。使用他汀类药物与全因死亡风险降低18%相关，HR 0.82（95% CI 0.69-0.98），CVD事件风险降低0.86（95% CI 0.70-1.06），卒中风险降低0.70（95% CI 0.45-1.09），但无显著性差异。在亚组分析中，结果没有根据基线年龄组（70-76岁或>76岁）或功能状态而改变。有证据表明，基线时>76岁的患者在死亡率方面没有从他汀类药物中获益，HR 1.14（95% CI 0.89-1.47），而基线时70-76岁的患者HR 0.83（95% CI 0.61-1.11）;然而，两组之间的CI重叠，表明没有差异。总胆固醇升高的他汀类药物使用者的主要心血管事件比非使用者少，HR分别为0.68（95%CI 0.50-0.94）和1.43（95%CI 0.99-2.07））。在基线时或根据功能状态>76岁的患者中，结果没有变化。有一种说法认为，总胆固醇升高的人可能会受益。需要进一步的工作来确定哪些老年人将受益于他汀类药物作为一级预防。
BACKGROUND/OBJECTIVES: We sought to determine whether statin use for primary prevention is associated with a lower risk of cardiovascular events or mortality in older men.DESIGN: Prospective cohort study.SETTING: Physicians' Health Study participants.PARTICIPANTS: 7,213 male physicians >= 70 years without a history of cardiovascular disease (CVD).MEASUREMENTS: Multivariable propensity score for statin use with greedy matching (1: 1) to minimize confounding by indication.RESULTS: Median baseline age was 77 (70-102), median follow-up was 7 years. Non-users were matched to 1,130 statin users. Statin use was associated with an 18% lower risk of all-cause mortality, HR 0.82 (95% CI 0.69-0.98) and non-significant lower risk of CVD events, HR 0.86 (95% CI 0.70-1.06) and stroke, HR 0.70 (95% CI 0.45-1.09). In subgroup analyses, results did not change according to age group at baseline (70-76 or >76 years) or functional status. There was a suggestion that those >76 at baseline did not benefit from statins for mortality, HR 1.14 (95% CI 0.89-1.47), compared to those 70-76 at baseline, HR 0.83 (95% CI 0.61-1.11); however the CIs overlap between the two groups, suggesting no difference. Statin users with elevated total cholesterol had fewer major CVD events than non-users, HR 0.68 (95% CI 0.50-0.94) and HR 1.43 (95% CI 0.99-2.07)), respectively.CONCLUSIONS: Statin use was associated with a significant lower risk of mortality in older male physicians >= 70 and a nonsignificant lower risk of CVD events. Results did not change in those who were >76 years at baseline or according to functional status. There was a suggestion that those with elevated total cholesterol may benefit. Further work is needed to determine which older individuals will benefit from statins as primary prevention.