Effects of statin medication on mortality risk associated with type 2 diabetes in older persons: the population-based AGES-Reykjavik Study.
Effects of statin medication on mortality risk associated with type 2 diabetes in older persons: the population-based AGES-Reykjavik Study.
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DOI：
10.1136/bmjopen-2011-000132
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发表时间：
2011-06-29
期刊：
影响因子：
2.9
通讯作者：
Gudnason V
中科院分区：
文献类型：
--
作者：
Olafsdottir E;Aspelund T;Sigurdsson G;Thorsson B;Eiriksdottir G;Harris TB;Launer LJ;Benediktsson R;Gudnason V
研究2型糖尿病随机临床试验中他汀类药物对死亡率的有益影响是否同样适用于老年人一般人群的观察性研究。一项前瞻性、基于人群的队列研究。冰岛，雷克雅未克。来自年龄、基因/环境易感性-雷克雅未克研究的5152名男性和女性，平均年龄77岁，范围66-96岁。 心血管和全因死亡率和死亡的RR根据他汀类药物的使用和冠心病（CHD）的2型糖尿病患者和非糖尿病患者的中位随访时间为5.3年，直到2009年底。 2型糖尿病的患病率为12.4%，其中35%使用他汀类药物。他汀类药物的使用与糖尿病患者心血管死亡率降低50%（95%CI 8%-72%）和全因死亡率降低53%（29%-68%）相关。对于那些没有糖尿病的人，他汀类药物的使用与16%（-24%至43%）的心血管疾病和30%（11%至46%）的全因死亡率降低相关。使用他汀类药物的糖尿病患者的心血管和全因死亡风险与非糖尿病的一般人群相当。该效应与血糖控制水平无关。这项观察性研究为随机临床试验的现有数据提供了重要支持。这些数据表明，在老年糖尿病患者的一般人群中，他汀类药物显著降低了过度的心血管和全因死亡风险，无论是否存在冠心病或降糖药物。临床试验表明，他汀类药物对糖尿病患者的心血管发病率和死亡率有益。除了严格的随机临床研究之外，这一点还没有得到很好的确立。这项基于人群的老年人观察性研究表明，他汀类药物治疗糖尿病患者可将心血管死亡率降低至与非糖尿病患者相当的水平。观察到的效果与随机临床试验中报告的效果相当。这项研究的一个主要优点是，在这一以人口为基础的队列中，国家代表性很大，参与率很高，关于发病率和死亡率的信息也很全面。观察到的效应与随机临床试验中报告的效应相当。一个局限性是研究中体弱个体未参加，这可能导致本研究基线时对更健康个体的偏倚。然而，研究中的非参与者在早期的访问中显示出具有相当水平的传统心血管风险因素。一个局限性是无法获得用于此分析的饮食信息。我们研究的一个弱点是5年随访期间的事件数量相对较低。一个局限性是缺乏用于诊断糖尿病的葡萄糖耐量试验。
To examine if the beneficial effect of statin medication on mortality seen in randomised clinical trials of type 2 diabetes applies equally to observational studies in the general population of older people. A prospective, population-based cohort study. Reykjavik, Iceland. 5152 men and women from the Age, Gene/Environment Susceptibility-Reykjavik Study, mean age 77 years, range of 66–96 years. Cardiovascular and all-cause mortalities and the RR of dying according to statin use and history of coronary heart disease (CHD) in persons with type 2 diabetes and those without diabetes with a median follow-up time of 5.3 years, until end of 2009. The prevalence of type 2 diabetes was 12.4% of which 35% used statins. Statin use was associated with a 50% (95% CI 8% to 72%) lower cardiovascular mortality and 53% (29% to 68%) lower all-cause mortalities in persons with diabetes. For those without diabetes, statin use was associated with a 16% (−24% to 43%) lower cardiovascular and 30% (11% to 46%) lower all-cause mortalities. Persons with diabetes using statins had a comparable risk of cardiovascular and all-cause mortality to that of the general population without diabetes. The effect was independent of the level of glycaemic control. This observational study lends important support to existing data from randomised clinical trials. These data suggest that in the general population of older people with diabetes, statin medication markedly reduces the excess cardiovascular and all-cause mortality risk, irrespective of the presence or absence of coronary heart disease or glucose-lowering medication. Clinical trials have shown that statin medication is beneficial for persons with diabetes as regards cardiovascular morbidity and mortality. This is not well established, except within the rigours of randomised clinical studies. This population-based observational study of older individuals demonstrates that treatment with statins in persons with diabetes reduces cardiovascular mortality to a level comparable with that observed in those without diabetes. The effect observed is of a magnitude comparable with that reported in randomised clinical trials. A major strength of the study is the proportionally large national representation in this population-based cohort, the high participation rate and the comprehensive information on morbidity and mortality. The effect observed is of comparable magnitude to the effect reported in randomised clinical trials. A limitation is the non-attendance of frail individuals in the study that may cause a possible bias towards more healthy individuals at baseline of this study. Non-attendees in the study have been shown, however, at earlier visits to have comparable levels of conventional cardiovascular risk factors. A limitation is the unavailability of dietary information for this analysis. A weakness in our study is the relatively low number of events during the 5-year follow-up. A limitation is the lack of glucose tolerance test for diagnosis of diabetes.