论文部分内容阅读
Statins improve survival in patients with coronary artery disease, especially those with elevated C-reactive protein (CRP). Although some randomized studies have shown a delay in statin-related survival advantage of up to 2 years, recent studies demonstrated early(< 2 months) survival benefit in certain patient groups. We hypothesized that this early benefit relates to baseline CRP concentration. Patients(n=2,924) with significant, angiographically defined coronary artery disease(≥70%stenosis in ≥1 coronary artery) were followed for an average of 2.4 years after discharged on a statin prescription. CRP was divided into tertiles(< 1.2, 1.2 to 1.7, >1.7mg/dl), and Kaplan-Meier methods were used to determine timing of statin benefit in both the overall population and a propensity score-matched subgroup. Cox regressions(multivariable and propensity score approaches) were used to predict mortality. Statins were prescribed for 28.4%of patients. In the first CRP tertile, no early statin benefit was observed (adjusted hazard ratio 0.69, 95%confidence interval 0.30 to 1.6, p=0.39), and survival curves separated after >2 years. However, in the second and the third tertiles, statin survival curves separated much earlier (～3 months and 1 week, respectively) and statins predicted improved survival(second tertile: hazard ratio 0.63, 95%CI 0.32 to 1.2, p=0.17; third tertile: hazard ratio 0.35, 95%CI 0.18 to 0.67, p=0.002). Propensity score analysis confirmed both statin benefit and early timing. Thus, statin use in patients with high CRP provides not only a larger but also a significantly earlier absolute survival benefit than statin use in patients with lower CRP. This provides further evidence of an anti-inflammatory effect of statins.
Statins improve survival in patients with coronary artery disease, especially those with elevated coronary artery disease (CRP). Although some randomized studies have shown a delay in statin-related survival advantage of up to 2 years, recent studies demonstrated early (<2 months We hypothesized that this early benefit was related to baseline CRP concentration. Patients (n = 2,924) with significant, angiographically defined coronary artery disease (≥70% stenosis in ≥1 coronary artery) were followed for an average of 2.4 years afterwards on a statin prescription. CRP was divided into tertiles (<1.2, 1.2 to 1.7,> 1.7 mg / dl), and Kaplan-Meier methods were used to determine timing of statin benefit in both the overall population and a Propensity score-matched subgroups. Cox regressions (multivariable and propensity score approaches) were used to predict mortality. Statins were prescribed for 28.4% of patients. In the first CRP tertile, no early statin b However, in the second and the third tertiles, statin survival curves separated much earlier (~ 3, 95% confidence interval 0.30 to 1.6, p = 0.39) months and 1 week, respectively) and statins predicted improved survival (second tertile: hazard ratio 0.63, 95% CI 0.32 to 1.2, p = 0.17; third tertile: hazard ratio 0.35, 95% CI 0.18 to 0.67, p = 0.002). Thus, statin use in patients with high CRP provides not only a larger but also a significantly earlier absolute survival benefit than statin use in patients with lower CRP. This provides further evidence of an anti- inflammatory effect of statins.