Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease
Continuation of statin therapy and a decreased risk of atrial fibrillation/flutter in patients with and without chronic kidney disease
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DOI：
10.1016/j.atherosclerosis.2013.11.036
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发表时间：
2014-01-01
期刊：
影响因子：
5.3
通讯作者：
Lai, Mei-Shu
中科院分区：
文献类型：
--
作者：
Chang, Chia-Hsuin;Lee, Yen-Chieh;Lai, Mei-Shu
背景：为了控制成本，台湾先前的国民健康保险报销政策要求医生一旦患者的血清胆固醇达到适当的水平就停止他汀类药物治疗。这使我们能够评估他汀类药物继续使用与房颤/扑动发生之间的关系，以及慢性肾脏疾病（CKD）状态是否会改变这种关系。结果是心房颤动/扑动。根据基线疾病风险评分和时变协变量，应用他汀类药物使用时变的比例风险回归模型估计心房颤动/扑动的风险比（HR）和95%置信区间（CIs）。结果：共有6767名CKD和63,678名非CKD患者开始他汀类药物治疗，平均随访4.0年。共有1118名参与者经历了新发心房颤动/扑动。CKD患者的心房颤动/扑动发生率大约高出2倍。与非CKD和CKD患者相比，继续他汀类药物治疗与房颤/扑动风险分别降低22%（校正风险比0.78;95% CI: 0.65-0.93）和57%（校正风险比0.43;95% CI: 0.27-0.68）相关。结论：在CKD和非CKD患者中，继续他汀类药物治疗与房颤/扑动风险降低相关。然而，仍需要进一步的随机研究来评估这种关联。2013爱思唯尔爱尔兰有限公司版权所有。
Background: To contain cost, Taiwan's previous National Health Insurance Reimbursement Policy requested that physicians discontinue their patients' statin therapy once the serum cholesterol had reached appropriate levels. This allowed us to evaluate the association between statin continuation and the occurrence of atrial fibrillation/flutter and whether it was modified by chronic kidney disease (CKD) status.Methods: Patients who initiated statin therapy between January 1, 2001 and December 31, 2009 were identified from a random sample of one million subjects in the Taiwan National Health Insurance Research Database. The outcome was atrial fibrillation/flutter. A proportional hazard regression model with time-varying statin use was applied to estimate the hazard ratios (HR) and 95% confidence intervals (CIs) for atrial fibrillation/flutter according to current statin use versus treatment discontinuation, adjusted for baseline disease risk scores and time-varying covariates.Results: A total of 6767 CKD and 63,678 non-CKD patients initiating statin therapy were included and followed for an average of 4.0 years. A total of 1118 participants experienced new-onset atrial fibrillation/flutter. The incidence of atrial fibrillation/flutter was approximately 2 fold higher in the CKD patients. Continuation of statin therapy was associated with a 22% (adjusted hazard ratio 0.78; 95% CI: 0.65-0.93) and 57% (adjusted HR 0.43; 95% CI: 0.27-0.68) decrease in atrial fibrillation/flutter hazard as compared with discontinuation in non-CKD and CKD patients, respectively.Conclusions: Continuation of statin therapy was associated with a decreased risk of atrial fibrillation/flutter among CKD and non-CKD patients. However, further randomized studies are still needed to assess the association. (C) 2013 Elsevier Ireland Ltd. All rights reserved.