JACC：阿托伐他汀与新发糖尿病相关性受基线危险因素影响

　　美国学者的一项研究表明，在新发糖尿病（NOD）低风险（无或1项NOD危险因素）患者中，大剂量阿托伐他汀（80 mg/天）未升高NOD发病率，但在高风险（2—4项NOD危险因素）患者中则增加24%的NOD风险；研究进一步表明，80 mg阿托伐他汀可明显减少以上两种风险人群的心血管疾病事件（CV）。论文发表于《美国心脏病学会杂志》[J Am Coll Cardiol 2013, 61(2):148]。

　　此项研究共纳入15,056例基线无糖尿病的冠脉疾病患者，并在风险水平不同的患者中对比了NOD发病率和心血管事件减少情况。心血管事件包括冠心病死亡、心肌梗死、卒中和心搏骤停复苏。空腹血糖>100 mg/dl、空腹甘油三酯>150 mg/dl、体重指数>30 kg/m²以及高血压病史为NOD的4项独立危险因素。

　　结果显示，在基线伴有0～1项NOD危险因素的8825例患者中，阿托伐他汀80 mg组以及阿托伐他汀10 mg和20～40 mg组的NOD发病率分别为3.22%和3.35%[危险比（HR ）0.97；95%置信区间（CI）0.77 —1.22]。在其余伴有2～4项NOD危险因素的6231例患者中，阿托伐他汀80 mg组和小剂量阿托伐他汀组的NOD发病率分别为14.3%和11.9%（HR 1.24；95% CI: 1.08 —1.42 ；P=0.0027）。在各风险组患者中阿托伐他汀80 mg均可显著减少心血管疾病事件。

Cardiovascular Event Reduction Versus New-Onset Diabetes During Atorvastatin Therapy : Effect of Baseline Risk Factors for Diabetes

Objectives

The purpose of this study was to compare the incidence of new-onset diabetes (NOD) with cardiovascular (CV) event reduction at different levels of NOD risk.

Background

Statins reduce the number of CV events but increase the incidence of NOD. We previously reported that 4 factors independently predicted NOD: fasting blood glucose >100 mg/dl, fasting triglycerides >150 mg/dl, body mass index >30 kg/m², and history of hypertension.

Methods

We compared NOD incidence with CV event reduction among 15,056 patients with coronary disease but without diabetes at baseline in the TNT (Treating to New Targets) (n = 7,595) and IDEAL (Incremental Decrease in Endpoints Through Aggressive Lipid Lowering) (n = 7,461) trials. CV events included coronary heart disease death, myocardial infarction, stroke, and resuscitated cardiac arrest.

Results

Among 8,825 patients with 0 to 1 of the aforementioned NOD risk factors at baseline, NOD developed in 142 of 4,407 patients in the atorvastatin 80 mg group and in 148 of 4,418 in the atorvastatin 10 mg and simvastatin 20 to 40 mg groups (3.22% vs. 3.35%; hazard ratio [HR]: 0.97; 95% confidence intervals [CI]: 0.77 to 1.22). Among the remaining 6,231 patients with 2 to 4 NOD risk factors, NOD developed in 448 of 3,128 in the atorvastatin 80 mg group and in 368 of 3,103 in the lower-dose groups (14.3% vs. 11.9%; HR: 1.24; 95% CI: 1.08 to 1.42; p = 0.0027). The number of CV events was significantly reduced with atorvastatin 80 mg in both NOD risk groups.

Conclusions

Compared with lower-dose statin therapy, atorvastatin 80 mg/day did not increase the incidence of NOD in patients with 0 to 1 NOD risk factors but did, by 24%, among patients with 2 to 4 NOD risk factors. The number of CV events was significantly reduced with atorvastatin 80 mg in both NOD risk groups.