背景:与常规临床治疗中接受治疗的年轻个体相比,老年个体从初始低密度脂蛋白胆固醇(LDL-C)降低并进行二级预防的降脂治疗的临床获益和主要血管事件风险的数据有限。我们在全国范围内进行了调查。
方法:年龄≥50岁首次因心血管事件住院的个体(指数事件,包括急性冠脉综合征,非出血性中风,短暂性脑缺血发作和冠状动脉血运重建),2008年1月1日至2018年10月31日,随后使用降脂治疗,并且在事件发生前后进行了LDL-C测量。使用Cox回归估计21,751名老年人和22,681名年轻人(≥/<70岁)的LDL-C每降低1mmol/L主要血管事件的危险比(HR)。
结果:LDL-C降低与老年个体的主要血管事件风险降低12%相关(HR0.88,95%置信区间[CI]0.84-0.93),与年轻个体之间的风险降低相比没有显着差异(HR0.88,95%CI0.83-0.93;年龄组之间差异的P值:0.86)。事后限制时,风险降低更加明显,作为合规性的代理,对于年龄较大(0.81,95%CI0.73-0.90)和年龄较小(0.81,95%CI0.72-0.91)的LDL-C降低高于最低分位数的新用户。
结论:本研究强烈支持在年龄≥70岁和<70岁的个体中,降低LDL-C与降脂治疗对主要血管事件的二级预防具有相似的相对临床益处。
Data about the clinical benefit from initial low-density lipoprotein cholesterol (LDL-C) reduction with lipid lowering treatment for secondary prevention and risk of major vascular events amongst older as compared with younger individuals treated during routine clinical care are limited. We investigated this in a nationwide cohort.
Individuals aged ≥ 50 years with a first-time hospitalisation for a cardiovascular event (index event, including acute coronary syndrome, non-haemorrhagic stroke, transient ischaemic attack and coronary revascularisation), 1 January 2008 to 31 October 2018, who subsequently used lipid lowering treatment, and had an LDL-C measurement before and after the event were included. Hazard ratios (HRs) for major vascular events per 1 mmol/L reduction in LDL-C were estimated for the included 21,751 older and 22,681 younger individuals (≥/<70 years old) using Cox regression.
LDL-C lowering was associated with a 12% lower risk of major vascular events in older individuals per 1 mmol/L reduction in LDL-C (HR 0.88, 95% confidence interval [CI] 0.84-0.93), with no significant difference compared with the risk reduction amongst younger individuals (HR 0.88, 95% CI 0.83-0.93; P-value for difference between age groups: 0.86). The risk reduction was more pronounced when post hoc restricting, as a proxy for compliance, to new users with an LDL-C reduction above the lowest decile for both older (0.81, 95% CI 0.73-0.90) and younger (0.81, 95% CI 0.72-0.91) individuals.
This study strongly supports a similar relative clinical benefit of LDL-C reduction with lipid lowering treatment for secondary prevention of major vascular events amongst individuals aged ≥70 and <70 years.