Effects of statins on all-cause mortality at different low-density-lipoprotein cholesterol levels in Asian patients with type 2 diabetes

Objective: To investigate the effects of statins on all-cause mortality risk at different low-density lipoprotein cholesterol (LDL-C) levels, and to compare the mortality risk between statin users and non-users with identical LDL-C levels in a type 2 diabetes cohort. Methods: In total, 10,582 outpatients aged ≥18 years with type 2 diabetes mellitus (T2DM) between 2009 and 2012 were enrolled in this retrospective cohort study in central Taiwan. All-cause mortality events were followed up until the end of 2014. According to the medical records during the follow-up period, the patients were classified into statin (+) and statin (−) groups. Patients were categorized into different LDL-C segments based on their mean LDL-C levels during the 2.8-year follow-up. Results: Non-cardiovascular mortality accounted for more than half the deaths. Overall, statin therapy significantly reduced the all-cause mortality risk in both univariable and multivariable models (hazard ratios = 0.39 and 0.38, respectively). Sub-group analyses showed that the lowest mortality risk occurred in the 80–89 mg/dL segment in the statin (−) group and in the 90–99 mg/dL segment in the statin (+) group. Statin therapy significantly reduced the mortality risk at all LDL-C levels except for low LDL-C ( Conclusions: In addition to reducing LDL-C levels, statin therapy reduced all-cause mortality risk in Taiwanese patients with T2DM. Statins further reduced the mortality risk at most LDL levels. However, at low LDL-C levels, the positive effects of statins may have been nullified.研究目的：探讨他汀类药物在不同低密度脂蛋白胆固醇（low-density lipoprotein cholesterol, LDL-C）水平下对全因死亡风险的影响，并在2型糖尿病队列中比较他汀使用者与相同LDL-C水平非使用者的死亡风险。 研究方法：本研究为中国台湾中部地区的回顾性队列研究，于2009年至2012年间纳入10582名年龄≥18岁的2型糖尿病（type 2 diabetes mellitus, T2DM）门诊患者，随访至2014年末以收集全因死亡事件。根据随访期间的病历记录，将患者分为他汀用药组（statin (+)）与非用药组（statin (−)）。基于2.8年随访期间的平均LDL-C水平，将患者划分为不同LDL-C亚组。 研究结果：非心血管死亡占总死亡人数的一半以上。总体而言，无论单变量模型还是多变量模型中，他汀治疗均显著降低全因死亡风险（风险比分别为0.39与0.38）。亚组分析显示，非他汀用药组死亡风险最低的LDL-C区间为80–89 mg/dL，他汀用药组则为90–99 mg/dL。除低LDL-C水平外，他汀治疗在所有LDL-C水平下均显著降低死亡风险（ 研究结论：除降低LDL-C水平外，他汀治疗可显著降低中国台湾地区2型糖尿病患者的全因死亡风险。他汀类药物在多数LDL水平下可进一步降低死亡风险，但在低LDL-C水平时，他汀的正向获益可能被抵消。