Data_Sheet_1_Attenuating the Variability of Lipids Is Beneficial for the Hypertension Management to Reduce the Cardiovascular Morbidity and Mortality in Older Adults.pdf

Objective: To investigate the beneficial of attenuating the variability of lipids to the hypertension management in older adults.
Methods: Between April 2008 and November 2010, 1,244 hypertensive patients aged ≥60 years were recruited and randomized into placebo and rosuvastatin groups. Outcomes and inter-visit plasma lipids variability were assessed.
Results: Over an average follow-up of 83.5 months, the coefficients of variation (CVs) in total cholesterol (TCHO), triglycerides, high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) were significantly lower in the rosuvastatin group than the placebo group (p < 0.05). The risks of composite cardiovascular event, myocardial infarction, coronary revascularization, heart failure, total stroke, ischemic stroke, cardiovascular death, and all-cause death were significantly lower in the rosuvastatin group than the placebo group (all p < 0.05). The differences in the risks were significantly diminished after the CVs for TCHO, triglycerides, HDL-c, and LDL-c were separately included as confounders. One-SD of CVs for TCHO, triglycerides, HDL-c, and LDL-c increment were significantly associated with the risks of composite cardiovascular event, myocardial infarction, heart failure, total stroke, ischemic stroke, cardiovascular death, and all-cause death, respectively (all p < 0.05).
Conclusions: Rosuvastatin significantly attenuated the intra-visit variability in lipids and decreased the risk of cardiovascular mortality and morbidity. Controlling the variability of lipids is as important as antihypertensive treatment to reduce the cardiovascular morbidity and mortality in the management of older hypertensive patients.
Clinical Trial Registration:ChiCTR.org.cn, ChiCTR-IOR-17013557.

研究目的：探讨降低血脂变异性对老年高血压患者高血压管理的获益效应。
研究方法：2008年4月至2010年11月期间，共纳入1244名年龄≥60岁的高血压患者，将其随机分配至安慰剂（placebo）组与瑞舒伐他汀（rosuvastatin）组。对研究结局及就诊间期血浆血脂变异性进行评估。
研究结果：平均随访83.5个月期间，瑞舒伐他汀组患者的总胆固醇（total cholesterol, TCHO）、甘油三酯、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol, HDL-c）及低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-c）的变异系数（coefficients of variation, CVs）均显著低于安慰剂组（p < 0.05）。瑞舒伐他汀组患者的复合心血管事件、心肌梗死、冠状动脉血运重建、心力衰竭、全卒中、缺血性卒中、心血管死亡及全因死亡风险均显著低于安慰剂组（所有p < 0.05）。在将总胆固醇、甘油三酯、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇的变异系数分别作为混杂因素（confounders）纳入校正后，上述风险差异显著缩小。总胆固醇、甘油三酯、高密度脂蛋白胆固醇及低密度脂蛋白胆固醇的变异系数每增加1个标准差，分别与复合心血管事件、心肌梗死、心力衰竭、全卒中、缺血性卒中、心血管死亡及全因死亡风险升高显著相关（所有p < 0.05）。
研究结论：瑞舒伐他汀可显著降低血脂的就诊内变异性，并降低心血管死亡与不良心血管事件发生风险。在老年高血压患者的管理中，控制血脂变异性与降压治疗对于降低心血管不良事件发生率及死亡率同等重要。
临床试验注册：ChiCTR.org.cn，ChiCTR-IOR-17013557。