使用23价肺炎球菌多糖疫苗预防不良心血管事件:一项随机临床试验

IF 14.1 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Alexis Hure,Roseanne Peel,Catherine D'Este,Walter P Abhayaratna,Andrew Tonkin,Ingrid Hopper,Amanda G Thrift,Christopher Levi,Jonathan Sturm,David Durrheim,Joseph Hung,Tom Briffa,Derek P Chew,Shu Ren,Mark McEvoy,Philip Hansbro,David Newby,Stuart Szwec,Simon Chiu,John Attia
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Participants were community-dwelling adults 55 to 60 years of age at baseline in 2016 to 2017, with at least 2 risk factors (obesity, hypertension, or hypercholesterolemia) for cardiovascular disease (CVD) but no prior CVD event or indication for early pneumococcal vaccination. Data were analyzed from February 2023 to December 2024 using competing risk proportional hazards regression models, stratified by sex and center.\r\n\r\nInterventions\r\nParticipants received either 23-valent PPV (PPV23) or placebo (saline).\r\n\r\nMain Outcomes and Measures\r\nThe primary outcome was a composite of fatal and nonfatal myocardial infarction or ischemic stroke, ascertained via electronic medical records from emergency department, admitted patient, and mortality data collections using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes.\r\n\r\nResults\r\nA total of 4725 participants (mean [SD] age, 58.0 [1.7] years; 2433 male [52%]) were included in this study. There was no significant difference in the primary outcome (58 of 2366 events in the active PPV23 group compared with 64 of 2357 events in the control group, hazard ratio, 0.90; 95% CI, 0.63-1.28; P = .57). 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引用次数: 0

摘要

动物研究和人类观察数据的荟萃分析表明,肺炎球菌多糖疫苗(PPV)可能对动脉粥样硬化具有保护作用;然而,据作者所知,尚未进行随机临床试验。目的确定肺炎球菌疫苗(Pneumovax [Merck Sharp & Dohme Corp .])是否会降低高危人群致死性和非致死性急性冠状动脉综合征和缺血性卒中的综合主要结局,接种后平均随访7年。设计、环境和参与者这是一项在澳大利亚6个中心进行的双盲、安慰剂对照、平行组随机临床试验。参与者是2016年至2017年基线时55至60岁的社区居住成年人,至少有2种心血管疾病(CVD)危险因素(肥胖、高血压或高胆固醇血症),但既往无CVD事件或早期肺炎球菌疫苗接种指征。使用竞争风险比例风险回归模型对2023年2月至2024年12月的数据进行分析,按性别和中心分层。干预措施:参与者接受23价PPV (PPV23)或安慰剂(生理盐水)。主要结局和测量主要结局是致死性和非致死性心肌梗死或缺血性卒中的综合结果,通过急诊科、住院患者的电子病历和使用《国际疾病统计分类第十版澳大利亚修订版》(ICD-10-AM)代码收集的死亡率数据确定。结果共纳入4725例受试者(平均[SD]年龄58.0[1.7]岁,男性2433例[52%])。主要结局无显著差异(活性PPV23组2366例事件中有58例,对照组2357例事件中有64例,风险比为0.90;95% CI为0.63-1.28;P = 0.57)。同样,在全因死亡率、全因住院表现和cvd相关医院程序的探索性结果中也没有显著差异。这些结果由于低于预期的事件率导致低功耗而受到影响。结论和相关性这项随机临床试验的结果发现,PPV23并没有降低致死性和非致死性急性冠状动脉综合征和缺血性中风的发生率,尽管这项研究的研究能力不足。试验注册anzctr标识符:ACTRN12615000536561。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prevention of Adverse Cardiovascular Events Using the 23-Valent Pneumococcal Polysaccharide Vaccine: A Randomized Clinical Trial.
Importance Animal studies and meta-analysis of human observational data suggest that pneumococcal polysaccharide vaccination (PPV) could be protective against atherosclerosis; however, to the authors' knowledge, no randomized clinical trial has been conducted. Objective To determine whether pneumococcal vaccination (Pneumovax [Merck Sharp & Dohme Corp]) decreases the composite primary outcome of fatal and nonfatal acute coronary syndrome and ischemic stroke in people at increased risk, with an average follow-up of 7 years after immunization. Design, Setting, and Participants This was a double-blind, placebo-controlled, parallel-arm randomized clinical trial conducted at 6 centers across Australia. Participants were community-dwelling adults 55 to 60 years of age at baseline in 2016 to 2017, with at least 2 risk factors (obesity, hypertension, or hypercholesterolemia) for cardiovascular disease (CVD) but no prior CVD event or indication for early pneumococcal vaccination. Data were analyzed from February 2023 to December 2024 using competing risk proportional hazards regression models, stratified by sex and center. Interventions Participants received either 23-valent PPV (PPV23) or placebo (saline). Main Outcomes and Measures The primary outcome was a composite of fatal and nonfatal myocardial infarction or ischemic stroke, ascertained via electronic medical records from emergency department, admitted patient, and mortality data collections using International Statistical Classification of Diseases, Tenth Revision, Australian Modification (ICD-10-AM) codes. Results A total of 4725 participants (mean [SD] age, 58.0 [1.7] years; 2433 male [52%]) were included in this study. There was no significant difference in the primary outcome (58 of 2366 events in the active PPV23 group compared with 64 of 2357 events in the control group, hazard ratio, 0.90; 95% CI, 0.63-1.28; P = .57). Similarly, no significant differences occurred in the exploratory outcomes of all-cause mortality, all-cause hospital presentations, and CVD-related hospital procedures. These results are tempered by the lower than expected event rate leading to low power. Conclusions and Relevance Results of this randomized clinical trial found that PPV23 did not reduce the rates of fatal and nonfatal acute coronary syndrome and ischemic stroke, although the study was underpowered. Trial Registration ANZCTR Identifier: ACTRN12615000536561.
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来源期刊
JAMA cardiology
JAMA cardiology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
45.80
自引率
1.70%
发文量
264
期刊介绍: JAMA Cardiology, an international peer-reviewed journal, serves as the premier publication for clinical investigators, clinicians, and trainees in cardiovascular medicine worldwide. As a member of the JAMA Network, it aligns with a consortium of peer-reviewed general medical and specialty publications. Published online weekly, every Wednesday, and in 12 print/online issues annually, JAMA Cardiology attracts over 4.3 million annual article views and downloads. Research articles become freely accessible online 12 months post-publication without any author fees. Moreover, the online version is readily accessible to institutions in developing countries through the World Health Organization's HINARI program. Positioned at the intersection of clinical investigation, actionable clinical science, and clinical practice, JAMA Cardiology prioritizes traditional and evolving cardiovascular medicine, alongside evidence-based health policy. It places particular emphasis on health equity, especially when grounded in original science, as a top editorial priority.
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