他汀类药物对心血管疾病的一级预防。

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泰勒F,霍夫曼博士马赛房颤,摩尔,伯克M,戴维史密斯G,病房K, Ebrahim年代

他汀类药物对心血管疾病的一级预防。

Cochrane数据库系统启2013年1月31日,(1):CD004816。cd004816.pub5 doi: 10.1002/14651858.。

PubMed ID
23440795 (在PubMed
]
文摘

背景:高血胆固醇,减少心血管疾病的危险因素(CVD)事件的人,没有过去的历史药物治疗的心血管疾病是一个重要的目标。他汀类药物是首选的代理。先前的评论的影响他汀类药物在心血管疾病患者强调自己的利益。一级预防的情况下是不确定当最后版本的综述发表(2011)和根据新数据更新的评论是必需的。目的:评估的影响,危害和益处,他汀类药物的患者无心血管疾病史。搜索方法:为了避免重复的工作,我们检查的参考列表之前的系统评价。2007年进行的搜索更新2012年1月。我们搜索Cochrane中央注册的对照试验(中央)Cochrane图书馆(2022年,问题4),MEDLINE奥维德(1950 - 2011年12月第4周)和EMBASE奥维德(1980年至2012年第一周)山顶没有语言的限制。选择标准:我们包括随机对照试验的他汀类药物与安慰剂或常规治疗控制最低一年治疗的疗程和随访6个月,在成人没有限制,低密度脂蛋白(LDL)、高密度脂蛋白(HDL)胆固醇水平,和有心血管疾病史10%或更少。数据收集和分析:两个独立作者选择研究夹杂物和提取数据。 Outcomes included all-cause mortality, fatal and non-fatal CHD, CVD and stroke events, combined endpoints (fatal and non-fatal CHD, CVD and stroke events), revascularisation, change in total and LDL cholesterol concentrations, adverse events, quality of life and costs. Odds ratios (OR) and risk ratios (RR) were calculated for dichotomous data, and for continuous data, pooled mean differences (MD) (with 95% confidence intervals (CI)) were calculated. We contacted trial authors to obtain missing data. MAIN RESULTS: The latest search found four new trials and updated follow-up data on three trials included in the original review. Eighteen randomised control trials (19 trial arms; 56,934 participants) were included. Fourteen trials recruited patients with specific conditions (raised lipids, diabetes, hypertension, microalbuminuria). All-cause mortality was reduced by statins (OR 0.86, 95% CI 0.79 to 0.94); as was combined fatal and non-fatal CVD RR 0.75 (95% CI 0.70 to 0.81), combined fatal and non-fatal CHD events RR 0.73 (95% CI 0.67 to 0.80) and combined fatal and non-fatal stroke (RR 0.78, 95% CI 0.68 to 0.89). Reduction of revascularisation rates (RR 0.62, 95% CI 0.54 to 0.72) was also seen. Total cholesterol and LDL cholesterol were reduced in all trials but there was evidence of heterogeneity of effects. There was no evidence of any serious harm caused by statin prescription. Evidence available to date showed that primary prevention with statins is likely to be cost-effective and may improve patient quality of life. Recent findings from the Cholesterol Treatment Trialists study using individual patient data meta-analysis indicate that these benefits are similar in people at lower (< 1% per year) risk of a major cardiovascular event. AUTHORS' CONCLUSIONS: Reductions in all-cause mortality, major vascular events and revascularisations were found with no excess of adverse events among people without evidence of CVD treated with statins.

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