Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systematic review and meta-regression analysis.
Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systematic review and meta-regression analysis.
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DOI：
10.1136/bmj.b92
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发表时间：
2009-02-16
期刊：
影响因子：
--
通讯作者：
Guyatt GH
中科院分区：
文献类型：
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作者：
Briel M;Ferreira-Gonzalez I;You JJ;Karanicolas PJ;Akl EA;Wu P;Blechacz B;Bassler D;Wei X;Sharman A;Whitt I;Alves da Silva S;Khalid Z;Nordmann AJ;Zhou Q;Walter SD;Vale N;Bhatnagar N;O'Regan C;Mills EJ;Bucher HC;Montori VM;Guyatt GH
目的探讨在脂质修饰干预的随机试验中，治疗引起的高密度脂蛋白胆固醇变化与总死亡、冠心病死亡和冠心病事件（冠心病死亡和非致死性心肌梗死）的关系，并对低密度脂蛋白胆固醇和药物类别的变化进行校正。设计对随机对照试验进行系统评价和meta回归分析。数据来源Medline， Embase, Central， CINAHL和AMED至2006年10月，并补充了与该领域专家的联系。研究选择在两组中，审稿人独立确定随机试验的资格，这些试验测试脂质修饰干预措施以降低心血管风险，为治疗组分别报告高密度脂蛋白胆固醇和死亡率或心肌梗死，并对参与者进行至少6个月的治疗和随访。使用标准化的、预先试点的表格，审稿人独立地从每篇文章中提取相关信息。计算每个试验的脂质浓度变化和临床结果的加权风险比。meta回归分析包括108项随机试验，涉及299 310名有心血管事件风险的参与者。所有对低密度脂蛋白胆固醇变化进行校正的分析均显示，治疗引起的高密度脂蛋白胆固醇变化与冠心病死亡、冠心病事件或总死亡的风险比之间没有关联。在所有试验中，高密度脂蛋白胆固醇的变化几乎没有解释任何结果的可变性（<1%）。与单独的低密度脂蛋白胆固醇变化相比，低密度脂蛋白胆固醇和高密度脂蛋白胆固醇比值的变化并不能解释任何结果的变异性。低密度脂蛋白胆固醇降低10 mg/dl (0.26 mmol/l)，冠心病死亡的相对风险降低7.2%(95%置信区间3.1% - 11%；P=0.001)，冠心病事件的相对风险降低7.1% (4.5% - 9.8%；P<0.001)，总死亡的相对风险降低4.4% (1.6% - 7.2%；P=0.002)，经高密度脂蛋白胆固醇和药物类别变化调整后。结论：现有数据表明，仅仅增加循环高密度脂蛋白胆固醇的数量并不能降低冠心病事件、冠心病死亡或总死亡的风险。结果支持降低低密度脂蛋白胆固醇作为脂质修饰干预的主要目标。
Objective To investigate the association between treatment induced change in high density lipoprotein cholesterol and total death, coronary heart disease death, and coronary heart disease events (coronary heart disease death and non-fatal myocardial infarction) adjusted for changes in low density lipoprotein cholesterol and drug class in randomised trials of lipid modifying interventions. Design Systematic review and meta-regression analysis of randomised controlled trials. Data sources Medline, Embase, Central, CINAHL, and AMED to October 2006 supplemented by contact with experts in the field. Study selection In teams of two, reviewers independently determined eligibility of randomised trials that tested lipid modifying interventions to reduce cardiovascular risk, reported high density lipoprotein cholesterol and mortality or myocardial infarctions separately for treatment groups, and treated and followed participants for at least six months. Data extraction and synthesis Using standardised, pre-piloted forms, reviewers independently extracted relevant information from each article. The change in lipid concentrations for each trial and the weighted risk ratios for clinical outcomes were calculated. Results The meta-regression analysis included 108 randomised trials involving 299 310 participants at risk of cardiovascular events. All analyses that adjusted for changes in low density lipoprotein cholesterol showed no association between treatment induced change in high density lipoprotein cholesterol and risk ratios for coronary heart disease deaths, coronary heart disease events, or total deaths. With all trials included, change in high density lipoprotein cholesterol explained almost no variability (<1%) in any of the outcomes. The change in the quotient of low density lipoprotein cholesterol and high density lipoprotein cholesterol did not explain more of the variability in any of the outcomes than did the change in low density lipoprotein cholesterol alone. For a 10 mg/dl (0.26 mmol/l) reduction in low density lipoprotein cholesterol, the relative risk reduction was 7.2% (95% confidence interval 3.1% to 11%; P=0.001) for coronary heart disease deaths, 7.1% (4.5% to 9.8%; P<0.001) for coronary heart disease events, and 4.4% (1.6% to 7.2%; P=0.002) for total deaths, when adjusted for change in high density lipoprotein cholesterol and drug class. Conclusions Available data suggest that simply increasing the amount of circulating high density lipoprotein cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in low density lipoprotein cholesterol as the primary goal for lipid modifying interventions.