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世界核心医学期刊文摘（心脏病学分册） 2005年第5期1卷 20-21页

作者： Wassertheil-Smoller S. psaty b. Greenland P. 王亭忠 Dept. of Epidemiol. and Pop. Health Albert Einstein College of Medicine Belfer Building Morris Park Ave Bronx NY 10461 United States Dr.

Context: Diuretic-b.sed therapy is at least as effective as newer classes of agents for hypertension. However, many patients with hypertension require treatment with more than 1 drug class to achieve b.ood pressure control. The relative b.nefits or risks of 2-drug-class comb.nations are not well known. Ob.ective: To prospectively evaluate if there are differences in cardiovascular mortality among postmenopausal women with hypertension b.t no history of cardiovascular disease(CVD)treated with different classes of antihypertensive agents, singly or in comb.nation. Design, Setting, and Participants: Women with hypertension enrolled in the Womens Health Initiative Ob.ervational Study, a longitudinal multicenter cohort study of 93 676 women aged 50 to 79 years at b.seline(1994-1998), assessed for a mean of 5.9 years. Main Outcome Measures: Relationship b.tween b.seline use of ACE inhib.tors, β-b.ockers, calcium channel b.ockers, or diuretics, or a comb.nation of these, and incidence of coronary heart disease, stroke, and CVD mortality. Results: Among 30219 women with hypertension b.t no history of CVD, 11 294(57%)were receiving monotherapy with an ACE inhib.tor, β-b.ocker, calcium channel b.ocker, or diuretic, and 4493(23%)were treated at b.seline with a comb.nation of diuretic plus either ACE inhib.tor, β-b.ocker, or calcium channel b.ocker or ACE inhib.tor plus calcium channel b.ocker. Monotherapy with calcium channel b.ockers vs diuretics was associated with greater risk of CVD death(hazard ratio, 1.55; 95%confidence interval, 1.02-2.35), controlling for multiple covariates. Women treated with a diuretic plus a calcium channel b.ocker had an 85%greater risk of CVD death vs those treated with a diuretic plus a β-b.ocker, after adjustment for age, race, smoking, high cholesterol levels requiring medication, b.dy mass index, physical activity, use of hormone therapy, and diab.tes. After exclusion of women with diab.tes the hazard ratio was 2.16(95%confidence interval, 1

关键词：降压药治疗绝经后高血压钙离子拮抗剂 β受体阻断剂药物联合治疗降压药物利尿剂治疗药物联合应用队列研究脑卒中发病率

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他汀类药物应用和痴呆发病风险的心血管健康研究

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世界核心医学期刊文摘（神经病学分册） 2005年第12期1卷 6-6页

作者： Rea T.D. b.eitner J.C. psaty b.M. 郭俊 Dr.Department of Medicine University of Washington Metropolitan Park 1730 Minor Ave Seattle WA 98101 United States

b.ckground: Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhib.tors) reduce cardiovascular risk through mechanisms that might affect the development of dementia. Ab.tract:Ob.ective: To evaluate whether statin use is associated with a lower risk of dementia compared with never use of lipid-lowering agents (LLAs). Design: Cohort study of community-dwelling adults 65 years and older. The analysis included 2798 participants free of dementia at b.seline. Main Outcome Measures: Using Cox proportional hazards regression analysis, we estimated the risk of incident all-cause and type-specific dementia associated with time-dependent statin therapy compared with never use of LLAs. The primary analyses incorporated a 1-year lag b.tween exposure and outcome. Secondary analyses included the final year of exposure and modeled statin use as current use vs nonuse to simulate a case-control approach. Results: Compared with never use of LLAs, ever use of statins was not associated with the risk of all-cause dementia (multivariab.e-adjusted hazard ratio [HR], 1.08; 95%confidence interval [CI], 0.77-1.52), Alzheimer disease alone (HR, 1.21; 95%CI, 0.76-1.91), mixed Alzheimer disease and vascular dementia (HR, 0.87; 95%CI, 0.44-1.72), or vascular dementia alone (HR, 1.36; 95%CI, 0.61-3.06). In contrast, in secondary analyses, current use of statins compared with nonuse of LLAs was associated with HRs of 0.69 (95%CI, 0.46-1.02) for all-cause dementia and 0.56 (95%CI, 0.35-0.92) for any Alzheimer disease. Conclusions: In this cohort study, statin therapy was not associated with a decreased risk of dementia. Methodological differences may explain why results of this cohort investigation differ from those of prior case-control studies. Additional investigation is needed to determine whether and for whom statin use may affect dementia risk.

关键词：心血管健康他汀类药物发病风险阿尔茨海默病心血管病降脂药物病例对照方法队列研究血管性痴呆无痴

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