Statin类药物可降低血清阴性脊椎关节病变之死亡率


  【24drs.com】根据一篇人口基础研究之结果,对于僵直性脊椎炎或乾癣性关节炎的患者,statin类药物或许可以降低死亡率风险达32%。
  
  第一研究者、波士顿麻州综合医院Amar Oza医师表示,研究结果认为,对于这类患者,医师们应考虑比以往更早开立statin类药物。他表示,因为有可降低死亡率这方面的好处,如果有其它原因要开始使用statin类药物,我当然(希望有)一个比较低的阈值。
  
  研究结果发表于美国风湿病学院2016年年会。
  
  研究者从「健康改善网络(The Health Improvement Network,THIN)」资料库辨识患有僵直性脊椎炎与乾癣性关节炎的患者,这个资料库共有1,110万名于英国一般开业机构就诊之患者的资料。
  
  他们使用时间分层倾向得分匹配探讨2,904名开始使用statin类药物之患者、以及2,904名没有使用这类药物者的所有原因死亡率。
  
  一项包括3,389名开始使用statin类药物以及3,389未使用者的未匹配分析,则是为了证明倾向得分匹配分析之效度。在未匹配分析中,使用statin类药物者与未使用者,在年龄、共病症、胆固醇值等方面,开始时之差异即是显著的,分析结果是使用statin类药物者的死亡率风险高出44%。
  
  Oza医师解释,这确认了我们的了解,也就是statin类药物一般是开立给比较严重的患者,这些严重患者的累积死亡率高于不需要statin类药物治疗者。
  
  不过,进行倾向得分匹配以平衡干扰因素之后,在平均5.3年追踪期间,statin类药物使用者的死亡人数少于未使用者(271 vs 376)。
  
  Oza医师报告指出,这表示,statin类药物使用者的发生率低于未使用者(17.6 vs 25.1/1000人-年),使用statin类药物的所有原因死亡率风险比为0.68 。
  
  同时考量僵直性脊椎炎与乾癣性关节炎患者时,statin类药物的保护效果达到统计上的显著意义,分别考量时则否。
  
  会议主持人、费城宾夕法尼亚大学Joan Von Feldt医师表示,许多研究显示,对于我们的风湿病患者,我们或许在心血管风险方面治疗不足,而这篇研究显示,我们可以考虑将statin类药物做为治疗选项。
  
  她表示,如果这激励了医师们将心血管疾病视为风湿性疾病的关节外表现,我们将可以有一个更适当的风险管理方法提供给这些患者。
  
  Von Feldt医师解释,虽然类风湿关节炎和全身性红斑狼疮已被证明是心血管死亡率的独立风险因素,迄今,僵直性脊椎炎与乾癣性关节炎都还未被纳入。
  
  Oza医师表示,僵直性脊椎炎与乾癣性关节炎的心血管风险评估,还没有足够的实证指引。他解释,迄今为止,一般人口风险评估指引纳入类风湿关节炎,但是,并未发表僵直性脊椎炎与乾癣性关节炎的实际资料。他认为,这是帮助这些患者的第一步。
  
  资料来源:http://www.24drs.com/
  
  Native link:Statins Cut Mortality in Seronegative Spondyloarthropathies

Statins Cut Mortality in Seronegative Spondyloarthropathies

By Kate Johnson
Medscape Medical News

WASHINGTON, DC — For patients with ankylosing spondylitis or psoriatic arthritis, statins might lower the risk for mortality by up to 32%, according to the results from a population-based study.

The findings suggest that clinicians can consider prescribing statins earlier than they previously have in this patient population, said lead investigator Amar Oza, MD, from the Massachusetts General Hospital in Boston.

"With this amount of mortality benefit, if there are other reasons to start a statin, I certainly would have a lower threshold," he told Medscape Medical News.

The results of the study were presented here at the American College of Rheumatology 2016 Annual Meeting.

The investigators identified people with ankylosing spondylitis and psoriatic arthritis from The Health Improvement Network (THIN) database, which contains data on 11.1 million patients seen in general practice in the United Kingdom.

They used time-stratified propensity score matching to look at all-cause mortality in 2904 patients who initiated statin use and 2904 who did not.

An unmatched analysis, involving 3389 patients who initiated statin use and 3389 who did not, was conducted to demonstrate the validity of propensity score matching.

In the unmatched analysis, baseline differences in age, comorbidities, and cholesterol levels between statin initiators and noninitiators were significant. This translated to a mortality risk that was 44% higher in initiators.

"This confirms our understanding that statins are generally prescribed in sicker patients, who will go on to have a higher cumulative mortality than patients not requiring statin treatment," Dr Oza explained.

However, after propensity score matching, which was aimed at balancing confounders, there were fewer deaths in the statin initiators than in noninitiators during the mean follow-up of 5.3 years (271 vs 376).

This translated to lower incidence rates for statin initiators than for noninitiators (17.6 vs 25.1 per 1000 person-years), and a hazard ratio of 0.68 for all-cause mortality with statin use, Dr Oza reported.

The protective effect of statins only reached statistical significance when patients with ankylosing spondylitis and psoriatic arthritis were combined, not when they were considered separately.

"Numerous studies have shown that we probably undertreat cardiovascular risk in our rheumatic disease patients. This study demonstrates that we can consider statins as a treatment option," said session moderator Joan VonFeldt, MD, from the University of Pennsylvania in Philadelphia.

"If this motivates clinicians to think about cardiovascular disease as an extra-articular manifestation of rheumatic disease, we could have a more appropriate risk management for these patients," she told Medscape Medical News.

Although both rheumatoid arthritis and systemic lupus erythematosus have been shown to be independent risk factors for cardiovascular mortality, to date, neither ankylosing spondylitis nor psoriatic arthritis have been, Dr VonFeldt explained.

"There aren't too many evidence-based guidelines for evaluation of cardiovascular risk in ankylosing spondylitis and psoriatic arthritis," added Dr Oza.

So far, the guidelines have included rheumatoid arthritis in general-population risk calculators, but the actual data for doing that with ankylosing spondylitis and psoriatic arthritis have not been published, he explained.

"I think this is one of the first steps in going down that road and helping these patients," he added.

Dr Oza and Dr VonFeldt have disclosed no relevant financial relationships. Senior study author Hyon Choi, MD, from Massachusetts General Hospital, reports receiving research grants from AstraZeneca for unrelated projects, and acting as a consultant for Takeda Pharmaceuticals and Selecta Biosciences.

American College of Rheumatology (ACR) 2016 Annual Meeting: Abstract910. Presented November13, 2016.

    
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