Introduction

The impact of additional risk factors on major cardiovascular event (MACE) rates in patients with a history of myocardial infarction (MI) or ischaemic stroke (IS) treated with statins is not well defined.

Methods

In this retrospective population-based cohort study, patients with a history of MI or IS treated with moderate- or high-intensity statins were identified using Swedish national register data. Patients were incident (index event between July 2006 and December 2014 and followed from diagnosis) or prevalent (MI or IS before July 2006 and followed thereafter). Four subgroups were defined on the basis of additional risk factors associated with increased cardiovascular risk: diabetes mellitus with target organ damage; chronic kidney disease stages 3–4; index event within 2 years after prior MI or IS; and polyvascular disease. First and total MACE rates (i.e. MI, IS, or cardiovascular death) were calculated, and first MACE 10-year risks (prevalent cohort only) were predicted.

Results

Numerically, MACE rates in subgroups were 1.5–3 times higher than in overall populations, and were highest in the 2 years after the index event. First MACE rates in the additional risk factor subgroups were 17.2–33.5 per 100 person-years for the incident cohorts and 9.9–13.2 per 100 person-years for the prevalent cohorts. Total MACE rates per 100 person-years were 20.1–39.8 per 100 person-years and 12.4–17.6 per 100 person-years, respectively.

Conclusion

Despite previous use of moderate- or high-intensity statins, patients with a history of MI or IS, and additional risk factors remain at very high cardiovascular risk.

中文翻译：

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有其他危险因素的患者心肌梗死或缺血性卒中后的心血管事件发生率：一项基于人群的回顾性队列研究

介绍

在接受他汀类药物治疗的有心肌梗死 (MI) 或缺血性卒中 (IS) 病史的患者中，其他危险因素对主要心血管事件 (MACE) 发生率的影响尚不明确。

方法

在这项基于人群的回顾性队列研究中，使用瑞典国家登记数据确定了接受过中等或高强度他汀类药物治疗的有 MI 或 IS 病史的患者。患者发生事件（2006 年 7 月至 2014 年 12 月之间的索引事件，并从诊断开始）或普遍（2006 年 7 月之前的 MI 或 IS，之后进行）。根据与心血管风险增加相关的其他风险因素定义了四个亚组：糖尿病合并靶器官损害；慢性肾病 3-4 期；先前 MI 或 IS 后 2 年内的指数事件；和多血管疾病。计算了首次和总 MACE 发生率（即 MI、IS 或心血管死亡），并预测了首次 MACE 10 年风险（仅限流行队列）。

结果

从数值上看，亚组的 MACE 发生率是总体人群的 1.5-3 倍，并且在指数事件发生后的 2 年内最高。额外风险因素亚组中的首次 MACE 发生率为 17.2-33.5/100 人年的事件队列和 9.9-13.2/100 人年的流行队列。每 100 人年的总 MACE 率分别为 20.1-39.8/100 人年和 12.4-17.6/100 人年。

结论

尽管以前使用过中强度或高强度他汀类药物，但有 MI 或 IS 病史以及其他危险因素的患者仍处于非常高的心血管风险中。