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Influence of LDL-Cholesterol Lowering on Cardiovascular Outcomes in Patients With Diabetes Mellitus Undergoing Coronary Revascularization
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2020-11-01 , DOI: 10.1016/j.jacc.2020.09.536
Michael E. Farkouh , Lucas C. Godoy , Maria M. Brooks , G.B. John Mancini , Helen Vlachos , Vera A. Bittner , Bernard R. Chaitman , Flora S. Siami , Pamela M. Hartigan , Robert L. Frye , William E. Boden , Valentin Fuster
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2020-11-01 , DOI: 10.1016/j.jacc.2020.09.536
Michael E. Farkouh , Lucas C. Godoy , Maria M. Brooks , G.B. John Mancini , Helen Vlachos , Vera A. Bittner , Bernard R. Chaitman , Flora S. Siami , Pamela M. Hartigan , Robert L. Frye , William E. Boden , Valentin Fuster
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BACKGROUND
Elevated low-density lipoprotein cholesterol (LDL-C) is associated with increased cardiovascular events, especially in high-risk populations. OBJECTIVES
This study sought to evaluate the influence of LDL-C on the incidence of cardiovascular events either following a coronary revascularization procedure (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) or optimal medical therapy alone in patients with established coronary heart disease and type 2 diabetes (T2DM). METHODS
Patient-level pooled analysis of 3 randomized clinical trials was undertaken. Patients with T2DM were categorized according to the levels of LDL-C at 1 year following randomization. The primary endpoint was major adverse cardiac or cerebrovascular events ([MACCE] the composite of all-cause mortality, nonfatal myocardial infarction, and nonfatal stroke). RESULTS
A total of 4,050 patients were followed for a median of 3.9 years after the index 1-year assessment. Patients whose 1-year LDL-C remained ≥100 mg/dl experienced higher 4-year cumulative risk of MACCE (17.2% vs. 13.3% vs. 13.1% for LDL-C between 70 and <100 mg/dl and LDL-C <70 mg/dl, respectively; p = 0.016). When compared with optimal medical therapy alone, patients with PCI experienced a MACCE reduction only if 1-year LDL-C was <70 mg/dl (hazard ratio: 0.61; 95% confidence interval: 0.40 to 0.91; p = 0.016), whereas CABG was associated with improved outcomes across all 1-year LDL-C strata. In patients with 1-year LDL-C ≥70 mg/dl, patients undergoing CABG had significantly lower MACCE rates as compared with PCI. CONCLUSIONS
In patients with coronary heart disease with T2DM, lower LDL-C at 1 year is associated with improved long-term MACCE outcome in those eligible for either PCI or CABG. When compared with optimal medical therapy alone, PCI was associated with MACCE reductions only in those who achieved an LDL-C <70 mg/dl.
中文翻译:
降低 LDL-C 对接受冠状动脉血运重建的糖尿病患者心血管结局的影响
背景 低密度脂蛋白胆固醇 (LDL-C) 升高与心血管事件增加有关,尤其是在高危人群中。目的 本研究旨在评估 LDL-C 对冠状动脉血运重建手术 (经皮冠状动脉介入治疗 [PCI] 或冠状动脉旁路移植术 [CABG]) 或单独最佳药物治疗后心血管事件发生率的影响确诊冠心病和 2 型糖尿病 (T2DM)。方法 对 3 项随机临床试验进行了患者水平的汇总分析。根据随机分组后 1 年的 LDL-C 水平对 T2DM 患者进行分类。主要终点是主要不良心脑血管事件 ([MACCE] 全因死亡率、非致死性心肌梗死和非致死性卒中的复合)。结果 指数 1 年评估后,共有 4,050 例患者接受了中位随访 3.9 年。1 年 LDL-C 保持在 ≥100 mg/dl 的患者 MACCE 的 4 年累积风险更高(LDL-C 在 70 至 <100 mg/dl 之间和 LDL-C <70 mg/dl 分别为 17.2% 对 13.3% 对 13.1%;p = 0.016)。与单独最佳药物治疗相比,仅当 1 年 LDL-C 为 <70 mg/dl 时,PCI 患者的 MACCE 降低(风险比:0.61;95% 置信区间:0.40 至 0.91;p = 0.016),而 CABG 与所有 1 年 LDL-C 层的结局改善相关。在 1 年 LDL-C ≥70 mg/dl 患者中,与 PCI 相比,接受 CABG 的患者 MACCE 发生率显着降低。结论 在 2DM 型冠心病患者中,1 年时较低的 LDL-C 与符合 PCI 或 CABG 条件的患者的长期 MACCE 结局改善相关。 与单独最佳药物治疗相比,PCI 仅在达到 LDL-C <70 mg/dl 的患者中与 MACCE 降低相关。
更新日期:2020-11-01
中文翻译:
![](https://scdn.x-mol.com/jcss/images/paperTranslation.png)
降低 LDL-C 对接受冠状动脉血运重建的糖尿病患者心血管结局的影响
背景 低密度脂蛋白胆固醇 (LDL-C) 升高与心血管事件增加有关,尤其是在高危人群中。目的 本研究旨在评估 LDL-C 对冠状动脉血运重建手术 (经皮冠状动脉介入治疗 [PCI] 或冠状动脉旁路移植术 [CABG]) 或单独最佳药物治疗后心血管事件发生率的影响确诊冠心病和 2 型糖尿病 (T2DM)。方法 对 3 项随机临床试验进行了患者水平的汇总分析。根据随机分组后 1 年的 LDL-C 水平对 T2DM 患者进行分类。主要终点是主要不良心脑血管事件 ([MACCE] 全因死亡率、非致死性心肌梗死和非致死性卒中的复合)。结果 指数 1 年评估后,共有 4,050 例患者接受了中位随访 3.9 年。1 年 LDL-C 保持在 ≥100 mg/dl 的患者 MACCE 的 4 年累积风险更高(LDL-C 在 70 至 <100 mg/dl 之间和 LDL-C <70 mg/dl 分别为 17.2% 对 13.3% 对 13.1%;p = 0.016)。与单独最佳药物治疗相比,仅当 1 年 LDL-C 为 <70 mg/dl 时,PCI 患者的 MACCE 降低(风险比:0.61;95% 置信区间:0.40 至 0.91;p = 0.016),而 CABG 与所有 1 年 LDL-C 层的结局改善相关。在 1 年 LDL-C ≥70 mg/dl 患者中,与 PCI 相比,接受 CABG 的患者 MACCE 发生率显着降低。结论 在 2DM 型冠心病患者中,1 年时较低的 LDL-C 与符合 PCI 或 CABG 条件的患者的长期 MACCE 结局改善相关。 与单独最佳药物治疗相比,PCI 仅在达到 LDL-C <70 mg/dl 的患者中与 MACCE 降低相关。