Statin use and outcome risks according to predicted CVD risk in Korea: A retrospective cohort study.
Statin use and outcome risks according to predicted CVD risk in Korea: A retrospective cohort study.
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DOI：
10.1371/journal.pone.0245609
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Jung HH
中科院分区：
文献类型：
--
作者：
Jung HH
心血管疾病（CVD）风险计算器在他汀类药物治疗决策中的有效性尚未在人群水平上得到充分评价。本研究旨在根据预测的CVD风险检查他汀类药物的净获益。一组40至79岁的韩国成年人，没有CVD，来自2006-2017年国家健康信息数据库。将2007-2010年期间开始使用他汀类药物的58，265名使用者的主要CVD事件发生率和全因死亡率与2012年1月1日至2017年12月31日期间58，265名非使用者的倾向评分进行比较。此外，对659，759名成年人的基于人群的队列进行了模拟。使用2018年修订的汇总队列方程预测CVD风险。在倾向评分匹配队列中，偶尔、间歇和定期使用他汀类药物的CVD风险比（95% CI）分别为1.06（0.93-1.20）、0.82（0.70-0.97）和0.57（0.50-0.64）。相应的死亡风险比分别为1.01（0.92-1.10）、0.87（0.78-0.98）和0.71（0.66-0.77）。在分层分析中，无论年龄、性别或预测的CVD风险如何，相对风险降低程度相似。因此，在风险较高的类别中，绝对风险降低幅度较大。在6年随访模拟队列中，定期使用他汀类药物可减少10年风险≥10.0%的1000例成人中的17例心血管疾病和28例死亡，而≥2个主要风险因素的1000例成人中的10例心血管疾病和14例死亡。然而，在风险≥ 10%的实际成人中，他汀类药物的使用不足，估计每1000例患者中可减少3例心血管疾病和4例死亡。本研究的局限性包括基于处方数据的药物使用评估，缺乏他汀类药物强度的信息，以及对高龄或其他种族个体的普遍性有限。CVD风险计算器在一级预防他汀类药物治疗决策中有效。在高预测风险患者中进行适当的风险评估和定期使用他汀类药物将比亚洲人群更能降低结局风险。
The validity of cardiovascular disease (CVD) risk calculators in decision for statin therapy has not been fully evaluated at a population level. This study aimed to examine the net benefits of statins according to predicted CVD risk. A cohort of 40 to 79-year-old Korean adults without CVD was generated from the National Health Information Database 2006–2017. Major CVD event rates and all-cause mortality in 58,265 users who initiated statins during 2007–2010 were compared with those in 58,265 nonusers matched on propensity scores, from January 1, 2012 through December 31, 2017. Additionally, simulation was performed for the population-based cohort of 659,759 adults. CVD risk was predicted using the 2018 revised Pooled Cohort Equations. In propensity score-matched cohort, the CVD hazard ratios (95% CIs) in occasional, intermittent, and regular statin users were 1.06 (0.93–1.20), 0.82 (0.70–0.97), and 0.57 (0.50–0.64), respectively. The corresponding mortality hazard ratios were 1.01 (0.92–1.10), 0.87 (0.78–0.98), and 0.71 (0.66–0.77), respectively. In stratified analyses, the relative risk reductions were similar, irrespective of age, sex, or predicted CVD risk. Accordingly, absolute risk reductions were greater in higher risk categories. In 6-year follow-up simulation cohorts, regular statin use could reduce 17 CVDs and 28 deaths in 1000 adults with a 10-year risk of ≥10.0% vs 10 CVDs and 14 deaths in 1000 with ≥2 major risk factors. However, in actual adults with a risk of ≥10%, statin use was insufficient and estimated to reduce 3 CVDs and 4 deaths in 1000. Limitations of this study include assessment of medication use based on the prescription data, lack of information on the intensity of statins, and limited generalizability to individuals with very old age or other ethnicity. CVD risk calculators were valid in decision-making for primary prevention statin therapy. Proper risk assessment and regular statin use in patients at high predicted risk would reduce outcome risks much more than present in Asian populations.
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影响因子：
2.9
作者：
Jee SH;Jang Y;Oh DJ;Oh BH;Lee SH;Park SW;Seung KB;Mok Y;Jung KJ;Kimm H;Yun YD;Baek SJ;Lee DC;Choi SH;Kim MJ;Sung J;Cho B;Kim ES;Yu BY;Lee TY;Kim JS;Lee YJ;Oh JK;Kim SH;Park JK;Koh SB;Park SB;Lee SY;Yoo CI;Kim MC;Kim HK;Park JS;Kim HC;Lee GJ;Woodward M
通讯作者：
Woodward M
影响因子：
39.3
作者：
Mach F;Ray KK;Wiklund O;Corsini A;Catapano AL;Bruckert E;De Backer G;Hegele RA;Hovingh GK;Jacobson TA;Krauss RM;Laufs U;Leiter LA;März W;Nordestgaard BG;Raal FJ;Roden M;Santos RD;Stein EA;Stroes ES;Thompson PD;Tokgözoglu L;Vladutiu GD;Gencer B;Stock JK;Ginsberg HN;Chapman MJ;European Atherosclerosis Society Consensus Panel
通讯作者：
European Atherosclerosis Society Consensus Panel
影响因子：
168.9
作者：
Mihaylova, B.;Emberson, J.;Blackwell, L.;Keech, A.;Simes, J.;Barnes, E. H.;Voysey, M.;Gray, A.;Collins, R.;Baigent, C.;de Lemos, J.;Braunwald, E.;Blazing, M.;Murphy, S.;Downs, J. R.;Gotto, A.;Clearfield, M.;Holdaas, H.;Gordon, D.;Davis, B.;Koren, M.;Dahlof, B.;Poulter, N.;Sever, P.;Knopp, R. H.;Fellstrom, B.;Holdaas, H.;Jardine, A.;Schmieder, R.;Zannad, F.;Goldbourt, U.;Kaplinsky, E.;Colhoun, H. M.;Betteridge, D. J.;Durrington, P. N.;Hitman, G. A.;Fuller, J.;Neil, A.;Wanner, C.;Krane, V.;Sacks, F.;Moye, L.;Pfeffer, M.;Hawkins, C. M.;Braunwald, E.;Kjekshus, J.;Wedel, H.;Wikstrand, J.;Barter, P.;Keech, A.;Tavazzi, L.;Maggioni, A.;Marchioli, R.;Tognoni, G.;Franzosi, M. G.;Maggioni, A.;Bloomfield, H.;Robins, S.;Collins, R.;Armitage, J.;Keech, A.;Parish, S.;Peto, R.;Sleight, P.;Pedersen, T. R.;Ridker, P. M.;Holman, R.;Meade, T.;Simes, J.;Keech, A.;MacMahon, S.;Marschner, I.;Tonkin, A.;Shaw, J.;Serruys, P. W.;Nakamura, H.;Knatterud, G.;Furberg, C.;Byington, R.;Macfarlane, P.;Cobbe, S.;Ford, I.;Murphy, M.;Blauw, G. J.;Packard, C.;Shepherd, J.;Kjekshus, J.;Pedersen, T.;Wilhelmsen, L.;Braunwald, E.;Cannon, C.;Murphy, S.;Collins, R.;Armitage, J.;Bowman, L.;Parish, S.;Peto, R.;Sleight, P.;Baigent, C.;Landray, M.;Collins, R.;La Rosa, J.;Rossouw, J.;Probstfield, J.;Shepherd, J.;Cobbe, S.;Macfarlane, P.;Ford, I.
通讯作者：
Ford, I.
影响因子：
168.9
作者：
Sattar, Naveed;Preiss, David;Ford, Ian
通讯作者：
Ford, Ian
影响因子：
168.9
作者：
Sever, PS;Dahlöf, B;Östergren, J
通讯作者：
Östergren, J