Atorvastatin and Low-Density Lipoprotein Cholesterol in Type 2 Diabetes Mellitus Patients on Hemodialysis
Winfried Ma¨rz,* †‡ Bernd Genser, ‡§ Christiane Drechsler,Vera Krane,
Tanja B. Grammer, ‡ Eberhard Ritz, ¶ Tatjana Stojakovic, † Hubert Scharnagl, † Karl Winkler,** Ingar Holme, †† Hallvard Holdaas, ‡‡ and Christoph Wanner,
Background and objectives Patients undergoing maintenance hemodialysis are at high cardiovascular risk.
Lowering LDL-cholesterol with statins reduces the incidence rate of cardiovascular events in patients with chronic kidney disease. In contrast, two randomized, prospective, placebo-controlled trials have been com-pleted in hemodialysis patients that showed no significant effects of statins on cardiovascular outcomes. Design, setting, participants, & measurements A post hoc analysis was conducted of the 4D (Die Deutsche Diabetes Dialyze) study to investigate whether LDL-cholesterol at baseline is predictive of cardiovascular events and whether the effect of atorvastatin on clinical outcomes depends on LDL-cholesterol at baseline. Results High concentrations of LDL-cholesterol by tendency increased the risks of cardiac endpoints and
all-cause mortality. Concordantly, atorvastatin significantly reduced the rates of adverse outcomes in the highest quartile of LDL-cholesterol ( 145 mg/dl, 3.76 mmol/L). The hazard ratios and 95% confidence in-tervals were 0.69 (0.48 to 1.00) for the composite primary endpoint, 0.58 (0.34 to 0.99) for cardiac death, 0.48 (0.25 to 0.94) for sudden cardiac death, 0.62 (0.33 to 1.17) for nonfatal myocardial infarction,0.68 (0.47 to 0.98) for all cardiac events combined, and 0.72 (0.52 to 0.99) for death from all causes, respec-tively. No such decrease was seen in any of the other quartiles of LDL-cholesterol at baseline.
Conclusions In patients with type 2 diabetes mellitus undergoing hemodialysis, atorvastatin significantly reduces the risk of fatal and nonfatal cardiac events and death from any cause if pretreatment LDL-choles-terol is 145 mg/dl (3.76 mmol/L).
Clin J Am Soc Nephrol 6: 1316–1325, 2011. doi: 10.2215/CJN.09121010
這篇文章最後的結論告訴我們在糖尿病透析病患 LDL 145mg/dl 的狀況下，使用Atorvastatin 可以有效減少病人的死亡率！這個結論與我們現行觀念應該是相符合的。