Are Cardiovascular Benefits in Statin Lipid Effects Dependent on Baseline Lipid Levels?
Are Cardiovascular Benefits in Statin Lipid Effects Dependent on Baseline Lipid Levels?
复制标题
DOI：
10.1007/s11883-010-0149-9
复制
发表时间：
2011-02-01
影响因子：
5.8
通讯作者：
Ferdinand, Keith C.
中科院分区：
文献类型：
--
作者：
Ferdinand, Keith C.
他汀类药物可降低冠心病（CHD）的发病率和死亡率。使用他汀类药物预防的理由：一项在C反应蛋白升高、无血管疾病和低密度脂蛋白胆固醇（LDL-C）低于平均水平的受试者中评价瑞舒伐他汀（JUPITER）的干预试验显示，瑞舒伐他汀20 mg/d可使LDL-C降低50%，并减少心血管事件（风险比0.56 [95%CI，0.46-0.69]; P < 0.00001），总死亡率降低（20%;P < 0.02）。最近的评论批评了木星的设计缺陷和不适当的影响。然而，加拿大2009年指南将JUPITER列为他汀类药物获益的I类证据。尽管胆固醇治疗试验者（CTT）合作者表明，无论治疗前水平如何，他汀类药物都可以显着降低CHD，主要血管事件和总体死亡率，但最近的一项一级预防荟萃分析显示，全因死亡率没有降低。对他汀类药物的益处或危害的先入为主的观念并不能加强对患者的护理，临床医生应该个性化长期他汀类药物治疗。
Statins reduce coronary heart disease (CHD) morbidity and mortality over a wide range of patients. The Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) in subjects with elevated C-reactive protein, without vascular disease and below average low-density lipoprotein cholesterol (LDL-C) showed a 50% reduction in LDL-C with 20 mg/d of rosuvastatin and a reduction in cardiovascular events (hazard ratio 0.56 [95% CI, 0.46-0.69]; P < 0.00001), and a reduction in total mortality (20%;P < 0.02). Recent commentary has criticized perceived JUPITER design flaws and inappropriate influence. However, the Canadian 2009 guidelines cite JUPITER as class I evidence for statin benefit. Although the Cholesterol Treatment Trialists' (CTT) Collaborators showed that, regardless of pre-treatment levels, statins can significantly reduce CHD, major vascular events, and overall mortality, a recent primary prevention meta-analysis showed no decrease in all-cause mortality. Preconceived notions on statin benefit or harm do not enhance patient care and clinicians should individualize long-term statin therapy.