中国全科医学2026，Vol.29Issue(14)：1821-1826,6.DOI:10.12114/j.issn.1007-9572.2025.0341
他汀类药物累积限定日剂量对缺血性脑卒中复发风险的研究
Impact of Cumulative Defined Daily Dose of Statins on Recurrence Risk in Ischemic Stroke Patients
摘要
Abstract
Background Statins are the cornerstone of secondary prevention after ischemic stroke(IS)through low-density lipoprotein cholesterol(LDL-C)reduction,as endorsed by major clinical guidelines.Their effectiveness depends on both treatment intensity and long-term adherence.The cumulative defined daily dose(cDDD)integrates exposure intensity and adherence,yet its association with recurrent IS remains unclear.Objective To investigate the impact of statin cDDD on recurrence risk in IS patients.Methods The study enrolled patients aged≥18 years with first-ever acute ischemic stroke(AIS)admitted to the North China University of Science and Technology Affiliated Hospital between January 2023 and March 2024.Baseline data were collected within 24 h of admission.Standardized secondary prevention education was provided at discharge,and patients were followed for 1 year.Participants were categorized into quartiles according to statin cDDD(Group 1-Group 4).Low-,medium-,and high-dose groups were defined by cumulative dose.Kaplan-Meier analysis assessed 1-year recurrence.Restricted cubic splines(RCS)and Cox proportional hazards models were used to evaluate the association between cDDD and recurrence.Results The study enrolled 728 patients(males:455,62.5%;females:273,37.5%).Patients were stratified into quartiles as follows:Group 1(cDDD≤101,n=173),Group 2(101<cDDD≤152,n=191),Group 3(152<cDDD≤205,n=179),Group 4(cDDD>205,n=185).During follow-up,100 recurrent strokes occurred(13.7%).Kaplan-Meier analysis demonstrated significant differences among cDDD quartiles(P<0.000 1).Cumulative recurrence rates decreased from Group 1 to Group 4:29.5%(51/173),16.2%(31/191),6.7%(12/179),and 3.2%(6/185),respectively.Patients were categorized into low-(<2 400 mg,n=245),medium-(2 400-3 600 mg,n=251),and high-dose(>3 600 mg,n=232)groups based on cumulative statin exposure.Recurrence rates differed significantly among groups(χ2=62.46,P<0.000 1),with the highest rate in the low-dose group(26.9%,66/245),followed by the medium-dose(10.7%,27/251),and high-dose groups(3.0%,7/232).RCS analysis revealed a nonlinear inverse association between cDDD and recurrence(Pnonlinear<0.001),with significantly reduced risk when cDDD exceeded 75.Multivariable Cox proportional hazards models consistently demonstrated a significantly lower recurrence risk in Group 4 compared to Group 1,Model 1(HR=0.103,95%CI=0.044-0.241),Model 2(HR=0.107,95%CI=0.046-0.251),and Model 3(HR=0.123,95%CI=0.052-0.289)(P<0.05).Conclusion Statin cDDD shows a significant nonlinear inverse association with IS recurrence,with evidence of a dose-dependent threshold effect.关键词
缺血性脑卒中/他汀类药物/累积限定日剂量/复发Key words
Ischemic stroke/Statins/Cumulative defined daily dose/Recurrence分类
医药卫生引用本文复制引用
韩悦,边哲,谷昊辰,王大力,彭延波..他汀类药物累积限定日剂量对缺血性脑卒中复发风险的研究[J].中国全科医学,2026,29(14):1821-1826,6.基金项目
科技创新2030-"癌症、心脑血管、呼吸和代谢性疾病防治研究"重大项目2023年度公开项目(2023ZD0505600) （2023ZD0505600）
