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luosier铁杆木虫 (正式写手)
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他汀类药物和糖尿病反向关联的研究发表
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近年来，医学界已经越来越意识到服用他汀类药物可能导致血糖水平有所升高，这会使少数人被诊断出，人数虽少但有统计显著性。但迄今不清楚服用他汀类药物被诊断出糖尿病的患者是否也有与糖尿病有关的微血管并发症风险。 最近，发表在《柳叶刀·糖尿病与内分泌学》（Lancet Diabetes & Endocrinology ——Statin use before diabetes diagnosis and risk of microvascular disease: a nationwide nested matched study。 2014/9/10）的一篇观察研究发现，人新诊断出的糖尿病患者中，使用他汀类药物者比不用他汀类者较少发生这类并发症。（他汀类药物对减少这类事件高危人群的糖尿病及其它大血管病变——心血管疾病——的有益作用被充分证实。） 丹麦的研究人员在1.5万名他汀类药物服用者和4.7万名非他汀类药物服用者中调查了微血管结果。中位随访2.7年，他汀类类服用者视网膜病变风险降低了40％（HR = 0.60，CI 0.54-0.66，P <0.0001），糖尿病神经病变风险降低了34％（HR = 0.66，0.57-0.75，P <0.0001），而足坏疽减少了12％（HR 0.88，0.80-0.97，P = 0.010）。而糖尿病肾病无显著差异（HR 0.97，0.85-1.10，P = 0.62）。两组间差异经调整后总的结果相似。与先前的研究大致相符，这些丹麦研究人员发现，服用他汀类药物者患糖尿病的风险增加了17％。 研究报告的作者Author(s)为：Sune F Nielsen PhD, Prof Børge G Nordestgaard MD Summary Background The role of statins in the development of microvascular disease in patients with diabetes is unknown. We tested the hypothesis that statin use increases the risk of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, and gangrene of the foot in individuals with diabetes. Methods We identified all patients living in Denmark who were aged 40 years or older and were diagnosed with incident diabetes between Jan 1, 1996, and Dec 31, 2009. We obtained patients' data from the Danish Patient Registry and information on drug use from the Danish Registry of Medicinal Product Statistics. We randomly selected 15 679 individuals from the database who had used statins regularly until their diagnosis of diabetes (statin users) and matched them in a 1:3 ratio with 47 037 individuals who had never used statins before diagnosis (non-statin users). Our primary outcome was to compare the cumulative incidence of diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, or gangrene of the foot in statin users versus non-statin users. We analysed data with Cox regression models, adjusted for covariates including sex, age at diabetes diagnosis, and method of diabetes diagnosis. To address potential biases between statin users and non-statin users, we made adjustments to our analysis with a propensity score and with other factors. Median follow-up was 2·7 years (range 0—13). Findings During 215 725 person-years of follow-up, 2866 patients developed diabetic retinopathy, 1406 developed diabetic neuropathy, 1248 developed diabetic nephropathy, and 2392 developed gangrene of the foot. Compared with non-statin users, statin users had a lower cumulative incidence of diabetic retinopathy (hazard ratio 0·60, 95% CI 0·54—0·66; p<0·0001), diabetic neuropathy (0·66, 0·57—0·75; p<0·0001), and gangrene of the foot (0·88, 0·80—0·97; p=0·010), but not diabetic nephropathy (0·97, 0·85—1·10; p=0·62). These results were similar after adjusting for the competing risk of death, after matching for a propensity score, after adjusting for visits to a family doctor, and by stratification on covariates. The corresponding multivariable adjusted hazard ratio for risk of diabetes in the total population was 1·17 (95% CI 1·14—1·21; p<0·0001). Interpretation Use of statins before diagnosis of incident diabetes was not associated with an increased risk of microvascular disease. Whether statins are protective against some forms of microvascular disease—a possibility raised by these data—will need to be addressed in other studies similar to ours, in mendelian randomisation studies, and preferably in randomised controlled trials. Funding Herlev Hospital, Copenhagen University Hospital. 全文链接：http://www.thelancet.com/search/ ... earchStarted=landia |
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