Statin treatment and the risk of recurrent pulmonary embolism
Statin treatment and the risk of recurrent pulmonary embolism
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DOI：
10.1093/eurheartj/eht046
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发表时间：
2013-06-01
影响因子：
39.3
通讯作者：
Kamphuisen, Pieter W.
中科院分区：
文献类型：
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作者：
Biere-Rafi, Sara;Hutten, Barbara A.;Kamphuisen, Pieter W.
特发性静脉血栓栓塞症（VTE）患者在抗凝治疗期间和停止抗凝治疗后复发风险较高。几项研究表明，他汀类药物治疗可降低VTE首次发作的发生率，但缺乏既往发作患者的疗效数据。我们研究了他汀类药物治疗对复发性肺栓塞（PE）风险的影响。方法和结果使用PHARMO记录链接系统，一个荷兰人口为基础的登记处的药房记录与医院出院记录相联系，患者住院治疗急性发作的PE被确定在1998年和2008年之间。从出院时和随访期间开始，确定他汀类药物和维生素K拮抗剂（VKA）的处方使用。使用考克斯回归分析评估他汀类药物使用（随时间变化）与复发、心血管事件和死亡发生率之间的关系。平均（标准差）年龄为61（17）岁。急性PE后VKA治疗的中位（范围）持续时间为199（45-3793）天。24%的患者（n = 737）在随访期间至少接受过一次他汀类药物处方，他汀类药物治疗的中位持续时间为1557（5-4055）天。在1529（1-4155）天的中位随访期间，285例（9.2%）患者发生复发。在VKA治疗期间和停止VKA治疗后，他汀类药物治疗与PE复发风险降低相关[校正风险比（HR）0.50，95% CI：0.36-0.70]。效力显示出剂量-反应关系，最有效的他汀类药物降低幅度最大。最后，他汀类药物治疗也降低了心血管事件和全因mortals.Conclusion的风险，他汀类药物治疗降低PE复发的风险，无论VKA治疗。他汀类药物治疗可能是PE长期治疗中抗凝治疗的一种有吸引力的替代方案。
Aims Patients with idiopathic venous thromboembolism (VTE) have a high recurrence risk during and after stopping anticoagulant treatment. Several studies suggest that treatment with statins reduces the incidence of a first episode of VTE, but data on the effects in patients with a previous episode are lacking. We examined the effect of statin therapy on the risk of recurrent pulmonary embolism (PE).Methods and results Using the PHARMO Record Linkage System, a Dutch population-based registry of pharmacy records linked with hospital discharge records, patients hospitalized with an acute episode of PE were identified between 1998 and 2008. Prescription-based use of statins and vitamin K antagonist (VKA) were identified starting at hospital discharge and during follow-up. The association between statin use (time-varying) and the incidence of recurrences, cardiovascular events, and death was assessed using Cox regression analysis. The mean (standard deviation) age was 61 (17) years. The median (range) duration of VKA treatment after acute PE was 199 (45-3793) days. Twenty-four per cent of the patients (n = 737) had at least one prescription of statins during the follow-up period and the median duration of statin therapy was 1557 (5-4055) days. During a median follow-up of 1529 (1-4155) days, 285 (9.2%) patients experienced a recurrence. Treatment with statins was associated with a reduced risk of recurrent PE [adjusted hazard ratio (HR) 0.50, 95% CI: 0.36-0.70], both during and after stopping VKA treatment. A dose-response relationship was shown for potency, with the largest reduction in those with the most potent statins. Finally, statin treatment also reduced the risk for cardiovascular events and all-cause mortality.Conclusion Statin treatment decreases the risk of recurrent PE, irrespective of VKA treatment. Treatment with statins may be an attractive alternative for anticoagulant treatment in the long-term treatment of PE.