Ntu 2: Atorvastatin Muaj Ib Qhov Kev Pab Cuam Tshuam Ntawm Lub raum Kev Ua Haujlwm thiab Kev Sib Raug Zoo Ntawm Cov Kabmob Ntshav Qab Zib: Post Hoc Kev Ntsuam Xyuas Ntawm 6 Ob Qhov Muag Tsis Pom Kev Ntsuas Kev Ntsuas

Hu rau:joanna.jia@wecistanche.com/ WhatsApp: 008618081934791

Kev sib tham

Qhov loj-scale post hoc tsom xam nrog rau ib tug neeg cov ntaub ntawv los ntawm 6 mus sij hawm ntev kev mob plawv cov txiaj ntsig kev sim qhia tau hais tias nyob rau hauv cov neeg mob uas muaj kev pheej hmoo los yog nrog CVD, atorvastatin txo qis kev txhim kho.raumua hauj lwm dhau sij hawm nyob rau hauv ib koob tshuaj-nyob ntawm tus yam ntxwv. Tsis tas li ntawd, qhov kev tshuaj ntsuam no qhia tau tiasraumKev txhim kho kev ua haujlwm tau zoo cuam tshuam nrog kev pheej hmoo ntawm cov hlab plawv qis tsis muaj kev kho mob, qhov txo qis hauv lub raum ua haujlwm cuam tshuam nrog cov txiaj ntsig ntawm cov hlab plawv. Rau txhua qhov SD nce ntawm txoj kab nqes ntawm lub raum ua haujlwm, peb tau pom qhov txo qis ntawm 13 feem pua ​​​​rau 14 feem pua ​​​​ntawm cov kab mob plawv loj thiab cov hlab plawv tuag thaum kho nrog atorvastatin (xws li 10 lossis 80 mg txhua hnub).

Peb cov ntaub ntawv, yog li ntawd, qhia tau hais tias kev ua tau zoo ntawm kev tiv thaiv kab mob plawv hauv lub sijhawm ntev tau txais nrog atorvastatin yog cuam tshuam los ntawm kev cuam tshuam ntawm kev mob plawv.raumua haujlwm dhau sijhawm. Tsis tas li ntawd, peb cov txiaj ntsig tau hais txog kev sib txuas bidirectional ntawm cov hlab plawv thiab covlub raum(piv txwv li, cardiorenal axis) hauv kev kho mob plawv. Qhov no txhais tau hais tias ob qho tib si CVD txo thiab renoprotection tau ua tiav los ntawm kev kho cov neeg mob uas muaj kev pheej hmoo lossis nrog CVD nrog atorvastatin. Vice versa, lub tswv yim renoprotective, raws li sawv cev los ntawm kev kho mob atorvastatin raws li peb cov ntaub ntawv, txhais ua kev tswj hwm kev pheej hmoo ntawm lub plawv zoo dua. Hauv kev xyaum kho mob txhua hnub, ib tus tuaj yeem xav txog kev sib koom ua ke ntawm lub raum kev ua haujlwm raws li kev nyeem ntawv rau kev ua tiav ntawm kev tswj hwm kev pheej hmoo ntawm cov hlab plawv, ntxiv rau kev tswj hwm ntawm cov kab mob plawv xws li BP thiab cov hom phiaj lipid. Txog tam sim no, tsis muaj lub zog txaus RCTs tau sim qhov kev xav tias tsom mus rauraumKev hloov pauv ua haujlwm dhau sijhawm tuaj yeem sawv cev rau kev pheej hmoo ntawm cov hlab plawv yuav raug kho.

Peb cov txiaj ntsig tau lees paub qhov kev soj ntsuam hauv lwm pawg, qhov twgraummuaj nuj nqi kuj tau pom los qhia txog kev sib raug zoo nyob rau lub sijhawm. Ib qho ntxiv, cov kab nqes hauv tag nrho 3 pawg muaj kev coj zoo. Nws paub los ntawm lwm cov tshuaj tiv thaiv cardioprotective xws li RAAS inhibitors uas cov tshuaj tiv thaivraumkev ua haujlwm poob qis, tab sis cov neeg ua haujlwm no feem ntau tsis txhim khoraumfunction.6 Previous post

Daim duab 3. Cov nyhuv ntawmraumkev ua haujlwm nqes hav ntawm cov hlab plawv (CV) cov txiaj ntsig thiab tag nrho-ua rau kev tuag (kho kev tsom xam). BMI qhia lub cev qhov hnyav; DBP, diastolic ntshav siab; HR, txaus ntshai piv; LDL, lipoprotein tsawg ntom; RAAS, renin-angiotensin-aldosterone system; SBP, systolic ntshav siab.

Kev ntsuas kub ntawm 2 RCTs (TNT thiab SPARCL, uas tau suav nrog hauv kev tshuaj ntsuam tam sim no) tau pom tias qhov nruab nrab ntawm eGFR tau nce ntxiv thaum rov qab los ntawm kev kho mob atorvastatin ob qho tib si hauv cov neeg mob CKD thiab tsis yog CKD.14,15 Ib qho kev txwv ntawm cov no. 2 kev tshuaj ntsuam xyuas yog tias thaum rov qab los ntawm cov neeg kawm tau poob qis, tshwj xeeb tshaj yog nyob rau hauv SPARCL.14 Yog li ntawd, cov teebmeem uas tsis yog-random tej zaum yuav piav qhia txog tag nrho eGFR nce, txhais tau hais tias tsuas yog cov neeg mob uas muaj kev tawm zoo dua-cov randomized mus rau qhov zoo tshaj plaws. kev kho mob caj npab - tseem nyob hauv qhov kev sim, thiab cov neeg mob uas muaj eGFR phem dua tau tso tseg. Ua raws li qhov no, saib ze dua ntawm cov ntaub ntawv los ntawm post hoc tsom xam ntawm SPARCL qhia tias qhov hloov pauv eGFR los ntawm cov hauv paus ntsiab lus tsawg dua thaum qhov "kev soj ntsuam zaum kawg ua ntej" tsom xam, suav nrog tag nrho cov ntsiab lus (xws li, tag nrho ntawm 4393 es tsis txhob ua rau qhov no. 2169 cov ntsiab lus nrog cov ntaub ntawv eGFR ua tiav tom qab 60- hli tom qab), tau ua tiav.14 Raws li kev tshuaj xyuas no, eGFR tseem nyob ruaj khov hauv cov koob tshuaj atorvastatin caj npab thaum eGFR tsis kam nyob hauv pawg placebo. 14 Peb txoj kev tshawb fawb tau tuaj yeem kuaj qhov muaj zog ntawm lub raum cov txiaj ntsig los ntawm 2 yav dhau los kev soj ntsuam tom qab hoc los ntawm kev sib txuas tag nrho 6 qhov txiaj ntsig RCTs uas cov neeg mob tau randomized rau atorvastatin lossis tswj kev kho mob thiab los ntawm kev txheeb xyuas qhov chaw siab tshaj.raumkev ua haujlwm (siv ob qho tib si hauv cov ntshav creatinine thiab eGFR qhov tseem ceeb) tsis yog txhais tau tias eGFR qhov tseem ceeb ntawm kev mus ntsib.

Vim tias qhov presumed linearity ntawm txoj kab nqes thaum siv tus naj npawb txaus ntawm creatinine qhov tseem ceeb, cov nyhuv ntawm atorvastatin rau.raumKev ua haujlwm poob qis yog qhov sib txawv ntawm kev ua raws sijhawm thiab tso tawm ntawm cov neeg mob mus rau qhov tsawg dua. Txawm li cas los xij, hauv peb qhov kev tshuaj xyuas, cov teebmeem tsis sib xws uas cuam tshuam txog kev tiv thaiv ntawm atorvastatin tuaj yeem suav txog kev txhim kho eGFR. Yog li ntawd, peb tau ua qhov kev soj ntsuam rhiab heev los ntawm kev suav nrog cov ntaub ntawv creatinine nkaus xwb thaum cov neeg mob tseem tau txais cov tshuaj tshawb fawb, uas tau muab cov txiaj ntsig zoo sib xws rau cov kev tshuaj ntsuam tseem ceeb. Qhov ua tau tias cov teebmeem tsis sib xws yuav muaj feem cuam tshuam rau peb cov txiaj ntsig zoo li tsis zoo li, tshwj xeeb yog hais txog kev sib piv ntawm 3 pawg. Txawm li cas los xij, tsis muaj qhov cuam tshuam tsis zoo tuaj yeem yog lub luag haujlwm rau qhov zoo ntawm qhov chaw pom hauv pawg neeg mob randomized rau cov placebo.

Lwm qhov kev piav qhia rau kev txhim kho ntawmraumKev ua haujlwm dhau sijhawm tuaj yeem cuam tshuam txog kev hloov pauv ntawm cov leeg nqaij vim cov ntshav creatinine thiab eGFR (xws li siv cov ntshav creatinine) nyob ntawm cov leeg nqaij. Kev txo qis ntawm cov leeg nqaij, cuam tshuam cov protein nkim, yuav ua rau muaj txiaj ntsig ntau dua creatinine thiab ntau dua eGFR. Txawm li cas los xij, kev poob ntawm cov leeg nqaij feem ntau cuam tshuam nrog qhov tshwm sim tsis zoo, uas yog qhov sib txawv ntawm peb qhov kev soj ntsuam tias qhov chaw siab zoo tau cuam tshuam nrog cov txiaj ntsig zoo ntawm cov txiaj ntsig ntawm cov hlab plawv.

Thaum kawg, qhov nce ntawm koob tshuaj ntawm qhov chaw thaum lub sijhawm kho atorvastatin tuaj yeem cuam tshuam nrog kev nce ntxiv ntawm creatine kinase kev ua ub no cuam tshuam nrog kev siv statin. Kev ua haujlwm siab creatine kinase tuaj yeem ua rau qis qis hauv cov ntshav creatinine, eGFR siab dua, thiab ntau dua cov zis creatinine excretion - cov ntsuas uas feem ntau cuam tshuam cov leeg nqaij nkoos. Txawm li cas los xij, kev tshawb fawb tsis ntev los no hauv 1801 CKD cov neeg mob tau pom tias cov ntshav siab creatine kinase tsis cuam tshuam nrog kev nce nrawm dua rau ESRD.27 Hauv qhov kev tshawb fawb no cov ntshav siab creatine kinase tau cuam tshuam nrog kev siv ntau zaus ntawm statins, thiab kev kho rau qhov muaj peev xwm confounder tau ua. cuam ​​tshuam cov txiaj ntsig. Yog li ntawd, ob qho tib si txoj kev tshawb no thiab peb pom tias txoj kab nqes zoo kuj tseem muaj nyob rau hauv pawg placebo qhia tau hais tias cov leeg nqaij tsis zoo li tsis muaj lub luag haujlwm rau cov kev hloov pauv tsis tau xav txog hauv cov ntshav creatinine slopes.

Yog tias kev hloov pauv hauv creatinine metabolism tsis piav qhia peb qhov kev tshawb pom, cov lus nug tshwm sim li cas qhov kev nce qib nce ntxiv? CKD yog txuam nrog ventricular thiab vascular remodeling. Cov teebmeem ntawm kev hloov pauv tuaj yeem thim rov qab los ntawm kev siv statin, thiab qhov ntawd yuav, dhau los, txhais ua zoo dua.raummuaj nuj nqi. Kev vam meejraumKev ua haujlwm poob qis tau cuam tshuam nrog subclinical atherosclerosis nrog rau cov hlab ntsha ntxiv.28 Atorvastatin tau pom tias yuav thim rov qab cov kev hloov pauv ntawm cov hlab ntsha uas ua rau muaj kev pheej hmoo siab plawv.29 Vim li ntawd, kev poob qis ntxiv ntawmraumkev ua haujlwm yuav raug tiv thaiv. Lwm cov neeg tuaj yeem kho tau yog oxidative kev nyuaj siab thiab lub raum microvascular hloov pauv, uas ua rau lub raum tsis zoo tab sis tau txais txiaj ntsig zoo los ntawm kev kho statin.30 Nco ntsoov, cov kev cuam tshuam ncaj qha, tshaj li qhov txo qis hauv lipid, ntawm vasculature thiab lub raum, tej zaum yuav tsis tshwm sim tom qab. kev kho mob nrog tag nrho cov statins. Cov kev tshawb fawb PLANET tau pom qhov txawv txav ntawm atorvastatin piv rau kev kho rosuvastatin. Thaum atorvastatin 80 mg induced txo qis ntawm albuminuria thiab stabilization ntawm eGFR, rosuvastatin ua rau ntau dua albuminuria thiab decrement ntawm eGFR.

Kev txwv

Ntau qhov kev txwv ntawm peb txoj kev tshawb fawb yuav tsum tau daws. Ua ntej, qhov zoo tshaj plaws, lub xub ntiag ntawm tag nrho 3 pawg hauv RCT yuav tau txo qhov loj heterogeneity ntawm cov yam ntxwv hauv paus, uas tau pom nyob rau hauv peb txoj kev tshawb fawb vim yog siv cov kev tshawb fawb sib txawv. Heterogeneous cuam tshuam thoob plaws kev tshawb fawb ntawmraumkev ua haujlwm txoj kab nqes tau pom, tab sis cov nqes hav yog tag nrho nyob rau hauv tib txoj kev, qhia tias cov nyhuv ntawm lub raum ua haujlwm tau zoo. Txawm hais tias kev hloov kho rau cov yam ntxwv hauv paus hauv peb qhov kev tshuaj ntsuam, qhov sib txawv ntawm tus neeg mob tus yam ntxwv ntawm cov kev sim no tseem yuav piav qhia qee qhov vim li cas qhov loj ntawm qhov cuam tshuam ntawm txoj kab nqes sib txawv. Qhov thib ob, cov kev tshawb fawb hauv qhov kev tshuaj ntsuam no suav nrog cov neeg mob uas muaj lub raum tsis ua haujlwm thiab muaj kev pheej hmoo tsawg ntawm kev loj hlob ntawm ESRD. Yog li ntawd, cov kev hloov hauvraumkev ua haujlwm dhau lub sijhawm tsawg heev thiab, yog li, ntawm cov nqi tsawg hauv kev kho mob txhua hnub. Qhov thib peb, albuminuria yog ib qho tseem ceeb ntawm kev pheej hmoo rau lub raum kev ua haujlwm poob qis, tab sis hauv peb qhov kev soj ntsuam, peb tsis tuaj yeem ntsuas cov teebmeem albuminuria thaum lub sijhawm vim tias qhov no tsis raug ntsuas hauv cov kev sim suav nrog. Thaum kawg, rau tib lub laj thawj, peb tsis muaj peev xwm tswj tau lub sijhawm sib txawv ntawm cov kev sib txawv uas cuam tshuam qhov chaw xws li kev txhim kho BP tswj lossis kev taw qhia ntawm RAS inhibitors hauv kev soj ntsuam ntawm 6 RCTs. Hauv kev xaus, peb qhov kev soj ntsuam qhia tau hais tias atorvastatin txhim khoraumua haujlwm dhau sijhawm nyob rau hauv ib koob tshuaj (piv txwv li, 80- mg piv rau 10-mg koob). Hauv txhua pab pawg kho mob, nws tau pom tias kev txhim kho lub raum ua haujlwm tau zoo cuam tshuam nrog kev pheej hmoo ntawm cov hlab plawv. Cov ntaub ntawv no txhawb qhov kev xav tias ob qho tib si cardio- thiab vasculoprotective kev ua tau zoo ntawm tus neeg sawv cev tshuaj tau cuam tshuam los ntawm lub raum ua haujlwm dhau sijhawm. Txawm hais tias qhov kev hloov pauv me me, peb cov ntaub ntawv tseem qhia tias qhov ntsuas ntawm lub raum no, thiab tsis yog xwb

Kev txo qis LDL-cholesterol tuaj yeem sawv cev rau qhov xaus rau qhov tshwm sim ntev hauv cov neeg mob plawv.

Kev lees paub

Tsis muaj kev pab cuam nrog kev txhim kho cov ntsiab lus lossis kev sau ntawv, tab sis kev txhawb nqa hauv kev npaj cov duab yog muab los ntawm Jon Edwards ntawm Engage Scientific Solutions thiab tau txais nyiaj los ntawm Pfizer. Tus kws sau ntawv tau nkag mus rau tag nrho cov ntaub ntawv hauv kev tshawb fawb thiab muaj lub luag haujlwm kawg rau kev txiav txim siab xa mus rau kev tshaj tawm. Tsis muaj ib tus kws sau ntawv kawm tau txais kev them nyiaj rau kev ua haujlwm ntawm kab lus no.

Cov peev txheej nyiaj txiag

Txoj haujlwm no suav nrog 6 qhov kev sim tshuaj (CARDS [ClinicalTrials.gov [NCT00327418]; SPARCL [NCT00147602]; TNT [NCT003 27691]; ASCOT; ASPEN; thiab SAGE) tau txhawb nqa los ntawm Pfizer.

Qhia tawm

Drs Fayyad, Laskey, thiab DeMicco yog cov neeg ua haujlwm ntawm Pfizer Inc (New York, NY). Dr. Waters tau txais kev qhuas qhuas rau kev qhuab qhia thiab kev them nyiaj rau kev koom nrog hauv pawg neeg soj ntsuam kuaj mob los ntawm Merck Schering-Plough (Whitehouse Station, NJ) thiab Pfizer Inc. Cov sau phau ntawv ntxiv tsis muaj kev tshaj tawm los qhia.

Cov ntaub ntawv

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16. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Charlton-Menys V, DeMicco DA, Fuller JH; CARDS Investigators. Cov txiaj ntsig ntawm atorvastatin rauraumCov txiaj ntsig thiab kab mob plawv hauv cov neeg mob ntshav qab zib: kev tsom xam los ntawm Kev Sib Koom Tes Atorvastatin Diabetes Study (CARDS). Am JLub raumDis. 2009; 54:810–819.

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