Risk of cardiovascular disease in elderly subjects with obesity and liver fibrosis and the potential benefit of statin treatment.

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-12-05 DOI:10.1111/eci.14368

Willy B Theel, Vivian D de Jong, Manuel Castro Cabezas, Diederick E Grobbee, Johan W Jukema, Stella Trompet

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引用次数: 0

Abstract

Background: Liver fibrosis progression is influenced by older age and cardiometabolic risk factors such as obesity and is associated with an increased risk of cardiovascular events. While statins may protect against cardiovascular complications, their effects in elderly individuals with obesity and liver fibrosis are unclear.

Method: The PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) database was used to evaluate the effect of pravastatin on major adverse cardiovascular events in an elderly population (>70 years). Subjects were categorized by BMI: lean (<25 kg/m²), overweight (25-29.9 kg/m²) and obese (≥30 kg/m²). Liver fibrosis was assessed using the FIB-4 index: low risk (<2.0), intermediate risk (2.0-2.66) and high risk (≥2.67). Time-to-event data were analysed using the Cox proportional hazards model, adjusted for confounders and compared the placebo and pravastatin groups.

Results: A total of 5.804 subjects were included. In the placebo group, the highest risk group (high FIB-4 and obesity) had a significantly higher hazard ratio for (non-)fatal stroke (HR 2.74; 95% CI 1.19-6.29) compared to the low FIB-4, lean BMI group. This risk disappeared in the same pravastatin group. Pravastatin did not affect other cardiovascular endpoints. All-cause mortality was significantly higher in subjects with lean weight and high FIB-4 on placebo (HR 1.88; 95% CI 1.14-3.11), but not on pravastatin (HR .58; 95% CI .28-1.20).

Conclusion: Elderly individuals with obesity and liver fibrosis are at higher risk for (non-)fatal stroke, which is reduced with pravastatin. Pravastatin also potentially lowers all-cause mortality in subjects with lean weight and liver fibrosis.

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老年肥胖和肝纤维化患者心血管疾病的风险及他汀类药物治疗的潜在益处

背景：肝纤维化的进展受年龄和心脏代谢危险因素（如肥胖）的影响，并与心血管事件风险增加相关。虽然他汀类药物可以预防心血管并发症，但其对肥胖和肝纤维化老年人的影响尚不清楚。方法：应用PROSPER数据库评估普伐他汀对老年人群（70岁~ 60岁）主要心血管不良事件的影响。受试者按BMI分为：瘦(2)、超重（25-29.9 kg/m2）和肥胖（≥30 kg/m2）。采用FIB-4指数评估肝纤维化：低危（结果：共纳入5.804例受试者）。在安慰剂组中，最高风险组（高FIB-4和肥胖）的（非）致死性卒中的风险比显著更高(HR 2.74；95% CI 1.19-6.29)，与低FIB-4、瘦BMI组相比。在同一个普伐他汀组，这种风险消失了。普伐他汀对其他心血管终点无影响。瘦体重和高FIB-4受试者的全因死亡率显著高于安慰剂组(HR 1.88；95% CI 1.14-3.11)，但普伐他汀组没有(HR .58；95% ci 0.28 -1.20)。结论：肥胖和肝纤维化的老年人发生（非）致死性卒中的风险较高，普伐他汀可降低这一风险。普伐他汀还可能降低瘦体重和肝纤维化患者的全因死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.