强化降脂治疗对于急性冠状动脉综合征伴糖尿病患者是否有益?PROVE IT-TIMI 22试验的结果  

Acute coronary syndromes and diabetes: Is intensive lipid lowering beneficial? Results of the PROVE IT-TIMI 22 trial

作　　者：Ahmed S. Cannon C.P. Murphy S.A. Braunwald E. C.P. Cannon 刘少伟 

机构地区：[1]Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 350 Longwood Avenue, Boston, MA 02115, United States

出　　处：《世界核心医学期刊文摘（心脏病学分册）》2007年第3期49-49,共1页

摘　　要：目的:应用他汀类药物的强化降脂治疗对合并糖尿病(DM)的急性冠状动脉综合征(ACS)患者的影响尚不明确。方法和结果:利用PROVEIT(普伐他汀或阿托伐他汀评估和抗感染治疗)TIMI 22试验中对比ACS后早期标准(普伐他汀40mg)和强化他汀类药物治疗(阿托伐他汀80mg)的资料探讨上述问题。Aims: The impact of intensive lipid lowering therapy with statins in acute coronary syndrome (ACS) patients with diabetes mellitus (DM) is not well characterized. Methods and results: We explored this question in data from the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE IT) TIMI 22 trial, which tested standard (pravastatin 40 mg) vs. intensive (atorvastatin 80 mg) statin therapy among patients treated early in the post-ACS period. We compared outcomes between patients with DM (identified by history, fasting plasma glucose ≥126 mg/dL or haemoglobin A1C < 7%; n=978) against those without DM (n=3184). The rate of acute cardiac events (death, myocardial infarction, and unstable angina requiring rehospitalization) was much higher in patients with DM, but was reduced with intensive vs. standard therapy similarly in diabetic (21.1 vs. 26.6%, HR=0.75, P=0.03) and non-diabetic patients (14.0 vs. 18.0%, HR=0.76, P=0.002); P-interaction=0.97. Despite intensive therapy, the majority of diabetics (62%) did not reach the dual goal of LDL-C < 70 mg/dL and high-sensitivity C-reactive protein < 2 mg/L. Conclusion: In ACS patients with DM, intensive statin therapy reduces acute cardiac events as it does in those without DM, with 55 vs. 40 events prevented per 1000 patients treated. However, our data highlight the need for additional strategies in this high-risk group.

关 键 词：降脂治疗 普伐他汀 强化降脂 他汀类药物 中对比 稳定心绞痛 急性心脏事件 空腹血糖 再入院 交互作 

分 类 号：R541.4[医药卫生—心血管疾病] R587.1[医药卫生—内科学]