【学术2015-100】随访间的LDL-C变化可预测CVD患者的心血管事件

2015-04-22 长城国际心脏病学会议 长城国际心脏病学会议

长城国际心脏病学会议

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（英文原文） Visit-to-Visit Low-Density Lipoprotein Cholesterol Variability andRisk of Cardiovascular Outcomes

Background Studies demonstrate that lowering low-densitylipoprotein cholesterol (LDL-C) using a statin is associated with significantreduction in cardiovascular events. Whether visit-to-visit variability in LDL-Clevels affects cardiovascular outcomes is unknown.

Objectives This study sought to evaluate the role of visit-to-visitvariability in LDL-C levels on cardiovascular outcomes.

Methods We evaluated patients with coronary artery disease andLDL-C <130 mg/dl enrolled in the TNT (Treating to New Targets) trial,randomly assigned to receive atorvastatin 80mg/day versus 10mg/day and with at least one post-baseline measurement of LDL-C. Visit-to-visitLDL-C variability was evaluated from 3 months into random assignment throughthe use of various measurements of LDL-C variability: SD, average successivevariability (ASV), coefficient of variation, and variation independent of mean,with the first 2 measurements used as the primary measurements. Primary outcomewas any coronary event, and secondary outcomes were any cardiovascular event,death, myocardial infarction, or stroke.

Results Among 9,572 patients, SD and ASV were significantly lower withatorvastatin 80 mg/day versus 10 mg/day (SD: 12.03 ± 9.70 vs. 12.52 ± 7.43;p = 0.005; ASV: 12.84 ± 10.48 vs. 13.76 ± 8.69; p < 0.0001). Inthe adjusted model, each 1-SD increase in LDL-C variability (by ASV) increasedthe risk of any coronary event by 16% (hazard ratio [HR]: 1.16; 95% confidenceinterval [CI]: 1.10 to 1.23; p < 0.0001), any cardiovascular event by11% (HR: 1.11; 95% CI: 1.07 to 1.15; p < 0.0001), death by 23%(HR: 1.23; 95% CI: 1.14 to 1.34; p < 0.0001), myocardial infarction by10% (HR: 1.10; 95% CI: 1.02 to 1.19; p = 0.02), and stroke by 17% (HR:1.17; 95% CI: 1.04 to 1.31; p = 0.01), independent of treatment effect andachieved LDL-C levels. Results were largely consistent when adjusted formedication adherence.

Conclusions In subjects with coronary artery disease, visit-to-visitLDL-C variability is an independent predictor of cardiovascular events.

来源： CardioSource Journal scans （ April 13 ， 2015 ）

随访间的 LDL-C 变化可预测 CVD 患者的心血管事件（中文摘要）

近日一项研究研究表明，随葛糟访间的 LDL-C 水平变化是冠状动脉疾病（ CVD ）患者心血管事件的独立预测因子。

研究已证实用他汀降低 LDL-C 可显著减少心血管事件。但随访间的 LDL-C 变化是否可影响心血管转归还不得而知。为此本研究对 TNT 试验中 LDL-C <130 mg/dl 的 CAD 患者进行评估，并随机将他们分为阿托伐他汀 80 mg/d 组和 10 mg/d 组，这些患者在分组后至少测定过 1 次 LDL-C 。从随机分组 3 个月开始通过采用 LDL-C 变化的不同测定指标 [SD 、平均连续变化（ ASV ）、变异系数和独立于平均值的变化 ] 来评估随访间 LDL-C 的变化，其中前两个被用作主要测定指标。主要转归是任何冠脉事件，次要转归是任何心血管事件、死亡、心肌梗死或卒中。

结果显示，在 9572 例患者中，阿托伐他汀 80 mg/d 组的 SD 和 ASV 显著小于 10 mg/d 组 [SD: （ 12.03 ± 9.70 ）对比（ 12.52 ±7.43 ）， P =0.005 ； ASV: （ 12.84 ± 10.48 ）对比（ 13.76 ±8.69 ）， P <0.0001] 。校正后的模型显示， LDL-C 变化每增加 1 个 SD ，任何冠脉事件（ HR ： 1.16 ， P <0.0001 ）、任何心血管事件（ HR ： 1.11 ， P <0.0001 ）、死亡（ HR ： 1.23 ， P <0.0001 ）、心肌梗死（ HR ： 1.10 ， P = 0.02 ）和卒中（ HR ： 1.17 ， P = 0.01 ）的发生危险就会随之增加：分别为 16% 、 11% 、 23% 、 10% 和 17% ，其独立于疗效和用药治疗后所实现的 LDL-C 水平。在校正了用药依从性后上述结果基本保持一致。