他汀类药物用于心血管疾病的一级预防。

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Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, Ward K, ibrahim S

他汀类药物用于心血管疾病的一级预防。

Cochrane Database system Rev. 2013 Jan 31;(1):CD004816。cd004816.pub5 doi: 10.1002/14651858.。

PubMed ID
23440795 (PubMed视图
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摘要

背景:降低高血胆固醇是有或无CVD病史人群心血管疾病(CVD)事件的危险因素，是药物治疗的一个重要目标。他汀类药物是首选药物。先前关于他汀类药物作用的综述强调了其对心血管疾病患者的益处。当本综述的上一版(2011年)发表时，初级预防的情况是不确定的，鉴于新的数据，需要对本综述进行更新。目的:评估他汀类药物对无心血管疾病史患者的影响，包括危害和益处。必威国际app检索方法:为了避免重复工作，我们检查了以前系统评价的参考文献列表。2007必威国际app年进行的搜索在2012年1月进行了更新。我们在必威国际appCochrane图书馆(2022年第4期)、MEDLINE OVID(1950年至2011年12月第4周)和EMBASE OVID(1980年至2012年第1周)中检索了Cochrane中央对照试验注册库(Central)，没有语言限制。选择标准:我们纳入了他汀类药物与安慰剂或常规护理对照的随机对照试验，最低治疗时间为1年，随访6个月，受试者无总胆固醇、低密度脂蛋白(LDL)或高密度脂蛋白(HDL)水平限制，且10%或以下有心血管疾病史。资料收集和分析:两位综述作者独立选择研究纳入并提取数据。 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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