新的研究证实，这种神奇的药物可以降低老年人的死亡风险

诸平

A study has found that statin therapy effectively prevents cardiovascular disease and all-cause mortality in adults aged 60 and older, including those over 85, without increasing the risk of adverse events. 

据美国医师协会（American College Of Physicians）2024年5月31日提供的消息，新的研究证实，他汀（Statin）这种神奇的药物可以降低老年人的死亡风险（New Research Confirms That This “Wonder Drug” Decreases Older Adults’ Risk of Death）。

他汀类药物治疗可以降低60岁以上老年人的心血管疾病和死亡风险，即使超过85岁也证明是安全有效的。他汀类药物通常被誉为一种神奇的药物，它是一类降脂药物，可以显著降低血液中的胆固醇水平。这些药物抑制β-羟-β-甲戊二酸单酰辅酶A(HMG-CoA)还原酶(HMG-CoA reductase)，这种酶在肝脏胆固醇的产生中起着至关重要的作用。通过降低胆固醇，他汀类药物有助于预防心血管疾病(cardiovascular diseases简称CVD)的发展，包括心脏病发作和中风。它们通常用于治疗和预防心血管疾病，使它们成为现代心血管治疗不可或缺的一部分。

一项针对60岁及以上成年人的新研究发现，使用他汀类药物治疗预防原发性心血管疾病(CVD)对预防CVD和全因死亡率有效，即使在85岁及以上的成年人中也是如此。这项研究结果于2024年5月28日已经在《内科医学年鉴》（Annals of Internal Medicine）网站发表——Wanchun Xu, Amanda Lauren Lee, Cindy Lo Kuen Lam, Goodarz Danaei, Eric Yuk Fai Wan. Benefits and Risks Associated With Statin Therapy for Primary Prevention in Old and Very Old Adults: Real-World Evidence From a Target Trial Emulation Study. Annals of Internal Medicine, 28 May 2024, DOI: 10.7326/M24-0004. https://www.acpjournals.org/doi/10.7326/M24-0004

参与此项研究的有来自中国香港大学（The University of Hong Kong, Hong Kong Special Administrative Region, China）、中国香港大学—深圳医院（The University of Hong Kong - Shenzhen Hospital, Shenzhen, China）、美国波士顿的哈佛大学陈曾熙公共卫生学院（Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA）、中国香港大学李嘉诚医学院、沙田香港科技园健康数据发现实验室(D24H)及中国香港特别行政区先进医学数据分析(ADAMS)有限公司{Li Ka Shing Faculty of Medicine, The University of Hong Kong, Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, and Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong Special Administrative Region, China}的研究人员。

香港大学（University of Hong Kong）的研究人员利用香港医院管理局（Hong Kong Hospital Authority）的电子健康记录(electronic health records简称EHRs)，采用目标试验模拟设计来研究他汀类药物治疗与心血管疾病风险之间的关系。该研究纳入了2008年1月至2015年12月期间，符合他汀类药物治疗指征的60岁以上无心血管疾病诊断的成年患者。既往有他汀类药物使用、降脂药物使用、癌症、肌病或肝功能障碍的患者被排除在外。

他汀类药物治疗被定义为特定的他汀类药物，结果包括主要心血管疾病、全因死亡率和不良事件。随访一直持续到结果、死亡、随访失败或研究结束。数据显示，在所有年龄组中，开始他汀类药物治疗与较低的心血管疾病发病率和全因死亡率相关，即使在85岁或以上的老年人群中也是如此。此外，他汀类药物的使用不会增加不良事件的风险，如肌病和肝功能障碍。

本研究得到了中国香港特别行政区政府卫生局卫生及医学研究基金（Health and Medical Research Fund, Health Bureau, the Government of Hong Kong Special Administrative Region, China Project no: 05190107）、中国国家自然科学基金优秀青年科学家基金（香港和澳门）{National Natural Science Foundation of China (NSFC) Excellent Young Scientists Fund (Hong Kong and Macau) (Ref No. 82222902)}的资助。

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Abstract

Background: There is little consensus on using statins for primary prevention of cardiovascular diseases (CVDs) and all-cause mortality in adults aged 75 years or older due to the underrepresentation of this population in randomized controlled trials.

Objective: To investigate the benefits and risks of using statins for primary prevention in old (aged 75 to 84 years) and very old (aged ≥85 years) adults.

Design: Sequential target trial emulation comparing matched cohorts initiating versus not initiating statin therapy.

Setting: Territory-wide public electronic medical records in Hong Kong.

Participants: Persons aged 75 years or older who met indications for statin initiation from January 2008 to December 2015 were included. Participants with preexisting diagnosed CVDs at baseline, such as coronary heart disease (CHD), were excluded from the analysis. Among 69 981 eligible persons aged 75 to 84 years and 14 555 persons aged 85 years or older, 41 884 and 9457 had history of CHD equivalents (for example, diabetes) in the respective age groups.

Intervention: Initiation of statin therapy.

Measurements: Incidence of major CVDs (stroke, myocardial infarction, or heart failure), all-cause mortality, and major adverse events (myopathies and liver dysfunction).

Results: Of 42680 matched person-trials aged 75 to 84 years and 5390 matched person-trials aged 85 years or older (average follow-up, 5.3 years), 9676 and 1600 of them developed CVDs in each age group, respectively. Risk reduction for overall CVD incidence was found for initiating statin therapy in adults aged 75 to 84 years (5-year standardized risk reduction, 1.20% [95% CI, 0.57% to 1.82%] in the intention-to-treat [ITT] analysis; 5.00% [CI, 1.11% to 8.89%] in the per protocol [PP] analysis) and in those aged 85 years or older (ITT: 4.44% [CI, 1.40% to 7.48%]; PP: 12.50% [CI, 4.33% to 20.66%]). No significantly increased risks for myopathies and liver dysfunction were found in both age groups.

Limitation: Unmeasured confounders, such as lifestyle factors of diet and physical activity, may exist.

Conclusion: Reduction for CVDs after statin therapy were seen in patients aged 75 years or older without increasing risks for severe adverse effects. Of note, the benefits and safety of statin therapy were consistently found in adults aged 85 years or older.