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【文摘发布】他汀类药物能降低糖尿病死亡率
Volume 371, Issue 9607, 12 January 2008-18 January 2008, Pages 117-125 ...
Efficacy of cholesterol-lowering therapy in 18 686 people with diabetes in 14 randomised trials of statins: a meta-analysis
Cholesterol Treatment Trialists' (CTT) Collaborators‡, , , ,
Available online 11 January 2008.
Refers to: Statins for people with diabetes
The Lancet, Volume 371, Issue 9607, 12 January 2008-18 January 2008, Pages 94-95
Bernard MY Cheung
Abstract | Full Text + Links | PDF (76 K)
Referred to by: Statins for people with diabetes
The Lancet, Volume 371, Issue 9607, 12 January 2008-18 January 2008, Pages 94-95
Bernard MY Cheung
Abstract | Full Text + Links | PDF (76 K)
Summary
Background
Although statin therapy reduces the risk of occlusive vascular events in people with diabetes mellitus, there is uncertainty about the effects on particular outcomes and whether such effects depend on the type of diabetes, lipid profile, or other factors. We undertook a prospective meta-analysis to help resolve these uncertainties.
Methods
We analysed data from 18 686 individuals with diabetes (1466 with type 1 and 17 220 with type 2) in the context of a further 71 370 without diabetes in 14 randomised trials of statin therapy. Weighted estimates were obtained of effects on clinical outcomes per 1·0 mmol/L reduction in LDL cholesterol.
Findings
During a mean follow-up of 4·3 years, there were 3247 major vascular events in people with diabetes. There was a 9% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol in participants with diabetes (rate ratio [RR] 0·91, 99% CI 0·82–1·01; p=0·02), which was similar to the 13% reduction in those without diabetes (0·87, 0·82–0·92; p<0·0001). This finding reflected a significant reduction in vascular mortality (0·87, 0·76–1·00; p=0·008) and no effect on non-vascular mortality (0·97, 0·82–1·16; p=0·7) in participants with diabetes. There was a significant 21% proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol in people with diabetes (0·79, 0·72–0·86; p<0·0001), which was similar to the effect observed in those without diabetes (0·79, 0·76–0·82; p<0·0001). In diabetic participants there were reductions in myocardial infarction or coronary death (0·78, 0·69–0·87; p<0·0001), coronary revascularisation (0·75, 0·64–0·88; p<0·0001), and stroke (0·79, 0·67–0·93; p=0·0002). Among people with diabetes the proportional effects of statin therapy were similar irrespective of whether there was a prior history of vascular disease and irrespective of other baseline characteristics. After 5 years, 42 (95% CI 30–55) fewer people with diabetes had major vascular events per 1000 allocated statin therapy.
Interpretation
Statin therapy should be considered for all diabetic individuals who are at sufficiently high risk of vascular events. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Efficacy of cholesterol-lowering therapy in 18 686 people with diabetes in 14 randomised trials of statins: a meta-analysis
14项他汀类药物随机研究中18686例糖尿病患者降胆固醇治疗的疗效：一项荟萃分析
Background
Although statin therapy reduces the risk of occlusive vascular events in people with diabetes mellitus, there is uncertainty about the effects on particular outcomes and whether such effects depend on the type of diabetes, lipid profile, or other factors. We undertook a prospective meta-analysis to help resolve these uncertainties.
背景：他汀类药物治疗降低糖尿病患者血管闭塞事件，这一作用的具体效果及其是否受糖尿病类型、血脂类型及其它因素影响尚不清楚。我们开展了这项前瞻性的荟萃分析以解决这些疑问。
Methods
We analysed data from 18 686 individuals with diabetes (1466 with type 1 and 17 220 with type 2) in the context of a further 71 370 without diabetes in 14 randomised trials of statin therapy. Weighted estimates were obtained of effects on clinical outcomes per 1·0 mmol/L reduction in LDL cholesterol.
方法：我们分析了14项他汀类药物随机研究中的18686例糖尿病患者（1466例1型糖尿病患者级17220例2型糖尿病患者）以及71370例非糖尿病患者。通过1mmol/L低密度脂蛋白胆固醇下降对临床预后的影响来评估其疗效。
Findings
During a mean follow-up of 4·3 years, there were 3247 major vascular events in people with diabetes. There was a 9% proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol in participants with diabetes (rate ratio [RR] 0·91, 99% CI 0·82–1·01; p=0·02), which was similar to the 13% reduction in those without diabetes (0·87, 0·82–0·92; p<0·0001). This finding reflected a significant reduction in vascular mortality (0·87, 0·76–1·00; p=0·008) and no effect on non-vascular mortality (0·97, 0·82–1·16; p=0·7) in participants with diabetes. There was a significant 21% proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol in people with diabetes (0·79, 0·72–0·86; p<0·0001), which was similar to the effect observed in those without diabetes (0·79, 0·76–0·82; p<0·0001). In diabetic participants there were reductions in myocardial infarction or coronary death (0·78, 0·69–0·87; p<0·0001), coronary revascularisation (0·75, 0·64–0·88; p<0·0001), and stroke (0·79, 0·67–0·93; p=0·0002). Among people with diabetes the proportional effects of statin therapy were similar irrespective of whether there was a prior history of vascular disease and irrespective of other baseline characteristics. After 5 years, 42 (95% CI 30–55) fewer people with diabetes had major vascular events per 1000 allocated statin therapy.
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作者:admin@医学,生命科学 2011-04-09 05:14
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