从瑞舒伐他汀转换至阿托伐他汀对于心血管事件发生率的影响

Purpose: This simulated study estimates the impact of switching patients treated with rosuvastatin to atorvastatin on rates of cardiovascular events over a 5-year period.

Methods:  A study of 50,038 virtual dyslipidemic patients aged 45-70 years was conducted using the Archimedes model. Virtual patients were created based on the profiles of patients in the National Health and Nutrition Examination Survey (NHANES). Statin treatment models were constructed based on data from published studies, including STELLAR, JUPITER, CARDS, ASCOT, and TNT. Patients were started on a dose of rosuvastatin based on their ATP III low-density lipoprotein cholesterol (LDL-C) goal and the distributions of statin use observed in U.S. pharmacy claims data. Patients were monitored for 5 years, during which time they received regular visits with the opportunity to increase their dosage if they were above their LDL-C goal. In the experimental arm, patients were switched from rosuvastatin to atorvastatin at the first clinic visit six weeks after initiating rosuvastatin (using an atorvastatin dose twice the rosuvastatin mg dose). No switching occurred in the control arm, and patients were titrated as necessary per ATP III cholesterol management guidelines. The rate of first occurrence of major adverse cardiovascular events (MACE) and their components (MI, stroke, or CV death) over a 5-year period was estimated for each study arm.

Findings: After 5 years, in the atorvastatin switched arm compared with continuing rosuvastatin, 4.8% fewer patients reached goal (from 91% to 87%). The 5-year relative risk of MACE from switching was 1.109 (95% CI: 1.092-1.127), and the number needed to harm (NNH) to incur one additional MACE over 5 years was 262, favoring treatment with rosuvastatin. For diabetic individuals who switched to atorvastatin, the 5-year relative risk of MACE was 1.121 (95% CI: 1.091-1.151) and the NNH over 5 years was 195, indicating greater risk for diabetic individuals. The results were insensitive to adherence rates and LDL-C goal values.

Implications: This study found that switching from rosuvastatin to atorvastatin leads to fewer patients attaining LDL-C goal and greater risk of MACE.

结论：从瑞舒伐他汀转换至阿托伐他汀使更少的患者达到LDL-C目标，且重大心血管不良事件的发生风险增加。