Statin Therapy in Patients With Low Serum Levels of Low-Density Lipoprotein Cholesterol

被引:3
作者
Tsujimoto, Tetsuro [1 ]
Kajio, Hiroshi [1 ]
Sugiyama, Takehiro [2 ,3 ]
机构
[1] Natl Ctr Global Hlth & Med, Ctr Hosp, Dept Diabet Endocrinol & Metab, Tokyo, Japan
[2] Natl Ctr Global Hlth & Med, Diabet & Metab Informat Ctr, Tokyo, Japan
[3] Univ Tokyo, Dept Publ Hlth Hlth Policy, Tokyo, Japan
基金
日本学术振兴会;
关键词
CARDIOVASCULAR-DISEASE; PRIMARY PREVENTION; 000; PARTICIPANTS; VASCULAR EVENTS; LDL CHOLESTEROL; INDIVIDUAL DATA; RISK; ROSUVASTATIN; METAANALYSIS; PRAVASTATIN;
D O I
10.1016/j.amjcard.2017.08.011
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Recommendations for the management of low-density lipoprotein cholesterol (LDL-C) and the strategy of statin therapy differ between current guidelines. We performed a prospective cohort study using data from the National Health and Nutrition Examination Survey from 1999 to 2010. For all-cause, cardiovascular, and noncardiovascular mortalities, we used Cox proportional hazards models to analyze unadjusted and multivariable-adjusted hazard ratios (HRs). We included age, gender, race and ethnicity, educational attainment, smoking status, body mass index, previous history of cardiovascular disease and cancer, diabetes, hypertension, LDL-C levels, high-density lipoprotein cholesterol levels, log-transferred triglyceride levels, estimated glomerular filtration rate levels, and the presence or absence of macroalbuminuria for the adjustment. The present study included 1,500 patients with LDL-C levels of <120 mg/dl (mean LDL-C level 88.7 mg/dl) who were at high risk of cardiovascular disease. A total of 99% patients completed the follow-up. Using multivariable Cox proportional hazards models, all-cause mortality was significantly lower in patients receiving statins than in those not on statins (HR 0.62, 95% confidence interval 0.45 to 0.85, p = 0.004). Analyses limited to propensity score-matched patients and patients with LDL-C levels of <100 mg/dl (mean LDL-C level 78.6 mg/dl) showed similar results. All-cause mortality in patients receiving statins was not significantly lower in those with LDL-C levels of <70 mg/dl than in those with LDL-C levels of 70 to 120 mg/dl (HR 1.27, 95% confidence interval 0.76 to 2.10, p = 0.35). In conclusion, statin therapy was effective in reducing all-cause death in high-risk patients, even with low levels of LDL-C. All-cause mortality did not differ between patients receiving statins with lower levels of LDL-C. (C) 2017 Elsevier Inc. All rights reserved.
引用
收藏
页码:1947 / 1954
页数:8
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