在降脂试验中,有没有从心血管死亡转变为癌症死亡? 一个系统的审查和元分析
Lucy Bolt1,2, Alexandre Speierer1,2, Sylvain Bétrisey1,2
1Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland.
PloS one
|February 8, 2024
概括
降脂疗法 (LLT) 不会增加总体癌症死亡率. 然而,在对老年人 (≥75岁) 的试验中,观察到可能从心血管死亡转变为癌症死亡,需要进一步调查.
科学领域:
- 心血管医学 心血管医学
- 在瘤学瘤学.
- 临床试验方法论 临床试验方法论
背景情况:
- 降脂疗法 (LLT) 是为了减少心血管 (CV) 事件而建立的.
- 关于LLT对全因死亡率的影响存在相互矛盾的数据,特别是在老年人群中.
- 一些随机临床试验 (RCT) 表明,LLT可能会增加癌症死亡率.
研究的目的:
- 在LLT试验中调查从心血管到癌症死亡的潜在转变.
- 根据LLT,确定参与者在癌症死亡风险较高的子组.
主要方法:
- 从MEDLINE,Embase和Cochrane Central获取到2023年8月的RCT的系统审查和元分析.
- 在治疗与对照组中提取并分析了心血管和癌症死亡的数据.
- 使用随机效应元分析计算聚合相对风险 (RR),根据预防类型和年龄进行子组分析.
主要成果:
- 包括27项试验 (188,259名参与者;23种他类药物,4种ezetimibe).
- 总体而言,没有发现增加癌症死亡风险 (RR1.03,95% CI 0.97-1.10),并且在初级和二级预防之间没有区别.
- 在具有≥15%年龄≥75岁参与者的RCT中,癌症死亡的RR为1.11 (1.00-1.23) 和心血管死亡的RR为0.96 (0.91-1.01).
结论:
- 总体而言,LLT似乎不会导致从心血管到癌症死亡率的转变.
- 在涉及较高比例的老年人 (≥75岁) 的试验中,可能存在增加癌症死亡的潜在模式.
- 为进一步深入调查,建议公开LLT试验中的个人参与者数据.
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