韩国大学Anam医院Sin Gon Kim团队在最新研究中，探讨了非诺贝特作为他汀类药物的辅助治疗能否降低成人代谢综合征患者持续性心血管事件的风险。相关论文2919年9月27日在线发表于《英国医学杂志》。

　　29771名患有代谢综合征的成人(年龄超过40岁)接受他汀类药物治疗。根据参与者的倾向性评分按1：5进行加权，2156名接受联合治疗(他汀类药物加非诺贝特)，8549名仅使用他汀类药物治疗。观察两组患者的复合心血管事件，包括冠心病、缺血性卒中和心血管死亡。

　　联合治疗组每1000人年复合心血管事件的发生率为17.7，他汀类药物组为22.0。与他汀类药物组相比，联合治疗组发生复合心血管事件的风险显著降低，校正风险比为0.74。在治疗分析中仍保持显著性，风险比为0.63。联合治疗组发生冠心病、缺血性卒中和心血管死亡的风险均低于他汀类药物组，但不显著。参与者的特征似乎与联合治疗组复合心血管事件的低风险无关。

　　在这项代谢综合征成人倾向加权队列研究中，非诺贝特作为他汀类药物的补充治疗与单独他汀类药物治疗相比，可显著降低主要心血管疾病事件的风险。

　　附：英文原文

　　Title: Use of fenofibrate on cardiovascular outcomes in statin users with metabolic syndrome: propensity matched cohort study

　　Author: Nam Hoon Kim, associate professor1, Ki Hoon Han, professor2, Jimi Choi, statistician3, Juneyoung Lee, professor3, Sin Gon Kim, professor

　　Issue&Volume: 2019/09/27

　　Abstract:

　　Objective To investigate whether fenofibrate as add-on to statin treatment reduce persistent cardiovascular risk in adults with metabolic syndrome in a real world setting.

　　Design Propensity matched cohort study.

　　Setting Population based cohort in Korea.

　　Participants 29 771 adults with metabolic syndrome (≥40 years) receiving statin treatment. 2156 participants receiving combined treatment (statin plus fenofibrate) were weighted based on propensity score in a 1:5 ratio with 8549 participants using statin only treatment.

　　Main outcome measure Primary outcome was composite cardiovascular events including incident coronary heart disease, ischaemic stroke, and death from cardiovascular causes.

　　Results The incidence rate per 1000 person years of composite cardiovascular events was 17.7 (95% confidence interval 14.4 to 21.8) in the combined treatment group and 22.0 (20.1 to 24.1) in the statin group. The risk of composite cardiovascular events was significantly reduced in the combined treatment group compared with statin group (adjusted hazard ratio 0.74, 95% confidence interval 0.58 to 0.93; P=0.01). The significance was maintained in the on-treatment analysis (hazard ratio 0.63, 95% confidence interval 0.44 to 0.92; P=0.02). The risk of incident coronary heart disease, ischaemic stroke, and cardiovascular death was lower in the combined treatment group than statin group but was not significant. Participant characteristics did not appear to be associated with the low risk of composite cardiovascular events with combined treatment.

　　Conclusion In this propensity weighted cohort study of adults with metabolic syndrome, the risk of major cardiovascular events was significantly lower with fenofibrate as add-on to statin treatment than with statin treatment alone.

　　DOI: 10.1136/bmj.l5125

　　Source: https://www.bmj.com/content/366/bmj.l5125