类固醇药物治疗以及慢性心力衰竭中死亡和住院的风险
Alan S Go1, Wendy Y Lee, Jingrong Yang
1Division of Research, Kaiser Permanente of Northern California, Oakland 94612, USA. Alan.S.Go@kp.org
JAMA
|November 2, 2006
概括
在心力衰竭患者中,启动他类药物治疗显著降低了死亡和住院的风险. 这种益处在患有或没有冠状动脉心脏病的个体中观察到,强调了他类药物.
科学领域:
- 心血管医学 心血管医学
- 药理学 药理学是指药理学的学科.
- 流行病学 流行病学
背景情况:
- 对于诊断为心力衰竭的患者改善临床结果,他类药物治疗的作用仍然不确定.
- 现有研究尚未确定他类药物是否对心力衰竭患者的治疗有好处.
研究的目的:
- 研究开始他类药物治疗与慢性心力衰竭成年人死亡和住院的风险之间的关联.
- 为了确定开始他类药物治疗是否会影响该患者群体中死亡或心力衰竭相关住院的可能性.
主要方法:
- 进行了一项倾向调整的队列研究,涉及被诊断为心力衰竭的成年人,他们有资格接受降脂疗法,但之前没有使用他类药物.
- 从1996年至2004年期间,从加利福尼亚北部的一个综合医疗保健系统收集了数据,通过门诊处方记录确定了他类药物的使用.
- 这项研究研究了所有原因的死亡率和心力衰竭住院情况,平均随访时间为2.4年,根据潜在的混因素进行调整,并按冠心病状况分层.
主要成果:
- 在24,598名符合条件的患者中,有12,648人开始使用他类药物治疗. 这些患者通常更年轻,男性,并且患有更多的并发症,如心血管疾病,糖尿病和高血压.
- 病例性他类药物使用与死亡 (调整后危险比率[aHR],0.76;95% CI,0.72-0.80) 和心力衰竭住院 (aHR,0.79;95% CI,0.74-0.85) 的风险显著降低.
- 这些关联在调整倾向分数,胆固醇水平,其他心血管药物和潜在混因素后仍然存在,并且在患有和没有冠状动脉心脏病的患者中一致.
结论:
- 在心力衰竭的成年人中,没有先前使用他类药物,开始他类药物治疗独立地与死亡和住院的风险降低有关.
- 开始服用他类药物的有益影响是显而易见的,无论是否存在冠心病,这表明它具有广泛的保护作用.
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