基线LDL-C水平与LDL-C降低后的总和心血管死亡率之间的关联:系统性审查和元分析
Eliano P Navarese1,2,3, Jennifer G Robinson4, Mariusz Kowalewski2,5
1Interventional Cardiology and Cardiovascular Medicine Research, Inova Center for Thrombosis Research and Drug Development, Inova Heart and Vascular Institute, Falls Church, Virginia.
JAMA
|April 21, 2018
概括
降低低密度脂蛋白胆固醇 (LDL- C) 的强化治疗显著降低了总和心血管死亡率,特别是在基线LDL- C水平较高 (≥100 mg/ dL) 的患者中. 当基线LDL-C为160mg/dL或更高时,益处最为明显.
科学领域:
- 心血管医学
- 药理学
- 临床试验
背景情况:
- 低密度脂蛋白胆固醇 (LDL-C) 降低药物的试验显示,对致命和非致命的终点有不同的影响.
- 基线LDL- C水平与降低死亡风险之间的关联需要进一步调查.
研究的目的:
- 评估基线LDL- C水平与总和心血管死亡风险的降低是否相关.
- 分析不同LDL-C降低强度对死亡率和主要心脏不良事件的影响.
主要方法:
- 对降低LDL-C药物的随机临床试验进行电子数据库和会议记录的系统搜索 (他类药物,ezetimibe,PCSK9抑制剂).
- 使用元回归和元分析来评估基线LDL- C水平与死亡风险降低之间的关联.
- 干预组被分为"更强烈"或"不那么强烈"的LDL- C降低.
主要成果:
- 更强烈的降低LDL- C治疗与较低的全因死亡率 (7. 08% vs 7. 70%) 和心血管死亡率 (3. 48% vs 4. 07%) 相关.
- 较高的LDL- C水平 (≥100 mg/ dL) 观察到较大的死亡率降低,最显著的益处在≥160 mg/ dL.
- 在LDL-C水平较高的患者中,强度降低LDL-C也导致心肌梗塞,再血管和MACE的风险降低.
结论:
- 在LDL- C水平较高的患者中,更强烈的LDL- C降低可降低总和心血管死亡的风险.
- 当基线LDL- C低于100 mg/ dL时,强度降低LDL- C与死亡益处之间的关联是不显著的.
- 较高的LDL- C水平可能表明降低LDL- C的疗法具有最大的潜在益处.
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