降低低密度脂蛋白胆固醇的影响在低风险的人与他汀类药物治疗血管疾病:单独的数据来自27个随机试验的荟萃分析。

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Mihaylova B,埃柏森J,布莱克威尔L, Keech,西梅斯J,巴恩斯呃,Voysey M,灰色,柯林斯R,白根特C

降低低密度脂蛋白胆固醇的影响在低风险的人与他汀类药物治疗血管疾病:单独的数据来自27个随机试验的荟萃分析。

柳叶刀》。2012年8月11日,380 (9841):581 - 90。doi: 10.1016 / s0140 - 6736 (12) 60367 - 5。2012年5月17日Epub。

PubMed ID
22607822 (在PubMed
]
文摘

背景:他汀类药物降低胆固醇和预防血管事件,但它们的净效应在低风险的人血管事件仍然不确定。方法:本荟萃分析包括个体参与者22试验的数据他汀类药物和控制(n = 134537;意思是低密度脂蛋白胆固醇差异1.08更易/ L;平均随访4.8年)和五个试验的多与少他汀类药物(n = 39612;差异0.51更易/ L;5.1年)。主要血管事件主要冠状动脉事件(即非致命性心肌梗死或冠状动脉死亡),中风,或冠状血管形成。参与者被分为五个类别的基线5年主要血管事件风险控制疗法(没有他汀类药物或低强度他汀类)(< 5%,> / = 5% < 10%,> / = 10% < 20%,> / = 20% < 30%,> / = 30%);在每一个,比(RR) / 1.0 L更易与低密度脂蛋白胆固醇降低估计。发现:降低低密度脂蛋白胆固醇的他汀类药物降低风险的主要血管事件(相对危险度0.79,95%可信区间0.77 - -0.81,每1.0减少更易/ L),基本上不分年龄,性别,基线的低密度脂蛋白胆固醇或先前的血管疾病,血管和全因死亡率。 The proportional reduction in major vascular events was at least as big in the two lowest risk categories as in the higher risk categories (RR per 1.0 mmol/L reduction from lowest to highest risk: 0.62 [99% CI 0.47-0.81], 0.69 [99% CI 0.60-0.79], 0.79 [99% CI 0.74-0.85], 0.81 [99% CI 0.77-0.86], and 0.79 [99% CI 0.74-0.84]; trend p=0.04), which reflected significant reductions in these two lowest risk categories in major coronary events (RR 0.57, 99% CI 0.36-0.89, p=0.0012, and 0.61, 99% CI 0.50-0.74, p<0.0001) and in coronary revascularisations (RR 0.52, 99% CI 0.35-0.75, and 0.63, 99% CI 0.51-0.79; both p<0.0001). For stroke, the reduction in risk in participants with 5-year risk of major vascular events lower than 10% (RR per 1.0 mmol/L LDL cholesterol reduction 0.76, 99% CI 0.61-0.95, p=0.0012) was also similar to that seen in higher risk categories (trend p=0.3). In participants without a history of vascular disease, statins reduced the risks of vascular (RR per 1.0 mmol/L LDL cholesterol reduction 0.85, 95% CI 0.77-0.95) and all-cause mortality (RR 0.91, 95% CI 0.85-0.97), and the proportional reductions were similar by baseline risk. There was no evidence that reduction of LDL cholesterol with a statin increased cancer incidence (RR per 1.0 mmol/L LDL cholesterol reduction 1.00, 95% CI 0.96-1.04), cancer mortality (RR 0.99, 95% CI 0.93-1.06), or other non-vascular mortality. INTERPRETATION: In individuals with 5-year risk of major vascular events lower than 10%, each 1 mmol/L reduction in LDL cholesterol produced an absolute reduction in major vascular events of about 11 per 1000 over 5 years. This benefit greatly exceeds any known hazards of statin therapy. Under present guidelines, such individuals would not typically be regarded as suitable for LDL-lowering statin therapy. The present report suggests, therefore, that these guidelines might need to be reconsidered. FUNDING: British Heart Foundation; UK Medical Research Council; Cancer Research UK; European Community Biomed Programme; Australian National Health and Medical Research Council; National Heart Foundation, Australia.

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