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在患有CAD的患者中使用胆固醇的长期二次预防:更新的系统性审查和元分析

Patrizia Boracchi¹, Giuseppe Marano¹, Ester Luconi²

¹Medical Statistics Unit, Department of Biomedical and Clinical Sciences, University of Studies of Milan, Milan, Italy.

European journal of internal medicine

|June 7, 2025

概括

在冠状动脉疾病 (CAD) 患者中,素显示心肌梗塞 (MI) 和复合心血管事件的风险降低. 虽然好处似乎减弱了,但对减少心脏病发作和主要心血管不良事件 (MACE) 的价值仍然很高.

科学领域:

心脏病学心脏病学
药理学药理学是指药理学的学科.
临床试验临床试验

背景情况:

作为一种抗炎药物,素已被研究其在心血管疾病管理中的作用.
以前的研究表明潜在的益处,但最近的试验,如CLEAR SYNERGY,对急性心肌梗塞 (MI) 产生了中性结果.
需要进行全面的元分析来重新评估胆固醇在冠状动脉疾病 (CAD) 中的疗效和安全性.

研究的目的:

对随机临床试验 (RCT) 进行元分析,评估菌素对CAD患者心血管事件的影响.
更新对单个终点和复合结果,包括心脏病发作,紧急重血管化 (UR),中风和死亡率的科尔奇辛益处的估计.
为了评估这种患者群体中黄素的安全概况.

主要方法:

在CAD患者中搜索了最大的素RCT.
通过考克斯模型,对个别事件 (MI,UR,中风,心血管死亡率,总死亡率) 的聚合分析使用危险比率 (HR) 和95%置信区间 (CI).
用固定效应或随机效应模型进行分析.
评估的复合终点:MACE 1 (心脏病发作,心脏病发作,心血管死亡率) 和MACE 2 (中风,心脏病发作,总死亡率).
评估安全结果,包括非心血管死亡率和严重不良事件.

主要成果:

包括5项研究,包括18656名患者.
胆固醇显著降低了21%的心脏病发作的风险 (HR 0.79,95% CI:0.68 - 0.92).
综合终点MACE 1和MACE 2的降低 (HR 0.81,95% CI:0.68 - 0.98和HR 0.88,95% CI:0.79 - 0.98,分别).
没有观察到对总或心血管死亡率的显著影响.
安全性评估显示,非心血管死亡率,癌症或严重的胃肠道/传染病事件没有差异.

结论:

胆固醇在降低心脏病患者心脏病发作和复合心血管事件的风险方面发挥了宝贵的作用.
尽管与早期分析相比,效益明显减弱,但该药物对于预防心脏病发作和MACE仍然具有重要意义.
安全性概况似乎令人放心,在分析中没有发现严重不良反应的风险增加.

关键词:

科尔奇辛 (Colchicine) 是一种可口药.冠状动脉疾病是一种冠状动脉疾病.进行元分析分析.二次预防二次预防

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