Efficacy and safety of long-term treatment with statins for coronary heart disease: A Bayesian network meta-analysis
Efficacy and safety of long-term treatment with statins for coronary heart disease: A Bayesian network meta-analysis
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DOI：
10.1016/j.atherosclerosis.2016.10.025
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发表时间：
2016-11-01
期刊：
影响因子：
5.3
通讯作者：
Cheng, Ning
中科院分区：
文献类型：
--
作者：
Lu, Yongbin;Cheng, Zhiyuan;Cheng, Ning
背景和目的：我们的研究旨在评估他汀类药物长期治疗冠心病（CHD）的有效性和安全性。方法：疗效结果包括血脂变化、冠心病死亡风险和全因死亡率。安全性结果通过不良事件（AE）的风险进行评估。采用贝叶斯网络荟萃分析比较不同他汀类药物之间的直接和间接影响。结果：系统评价显示他汀类药物治疗期间血脂水平下降。大剂量阿托伐他汀是降低血脂最明显的治疗方法。网络荟萃分析显示，他汀类药物在降低冠心病死亡率（比值比（OR）0.69，95% CI 0.61-0.77）和全因死亡率（OR 0.84，95% CI 0.80-0.87）方面明显比对照组更有效。在降低冠心病道德风险方面，氟伐他汀（77.3%）、阿托伐他汀（72.3%）和洛伐他汀（68.4%）比其他他汀类药物的累积概率更高，是降低冠心病道德风险更有效的治疗方法。在降低全因死亡率方面，阿托伐他汀（78.6%）、氟伐他汀（77.1%）和匹伐他汀（74.1%）的累积概率高于其他他汀类药物，是降低全因死亡率更有效的治疗方法。与安慰剂相比，他汀类药物增加了肌肉疾病（OR 1.05，95% CI 1.00-1.10）和肾脏疾病（OR 1.11，95% CI 1.05-1.72）的发病风险。结论：他汀类药物可显着降低血脂水平，其中高剂量阿托伐他汀调节血脂水平最有效。他汀类药物可降低冠心病死亡率和全因死亡率的风险，其中阿托伐他汀和氟伐他汀是降低冠心病死亡率和全因死亡率风险最有效的药物。他汀类药物会增加肌肉疾病和肾脏损伤的风险。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Background and aims: Our study aims to evaluate the efficacy and safety of long-term treatment of statins for coronary heart disease (CHD).Methods: Efficacy outcomes included changes in blood lipids, risk of CHD mortality and all-cause mortality. Safety outcomes were evaluated by the risk of adverse events (AE). Bayesian network meta-analysis was used to compare the direct and indirect effects between different statins.Results: The systematic review showed that levels of blood lipids decreased during statin treatment. High dose of atorvastatin was the most obvious treatment for the reduction of blood lipids. Network meta-analysis showed that statins were significantly more effective than the control in reducing the risk of CHD mortality (Odds Ratio (OR) 0.69, 95% CI 0.61-0.77) and all-cause mortality (OR 0.84, 95% CI 0.80-0.87). In terms of reducing the risk of CHD morality, fluvastatin (77.3%), atorvastatin (72.3%) and lovastatin (68.4%) had higher cumulative probability than other statins, which were more effective treatments for the reduction of CHD morality. In terms of reducing all-cause mortality, atorvastatin (78.6%), fluvastatin (77.1%) and pitavastatin (74.1%) had higher cumulative probability than other statins, which were more effective treatment for reducing the all-cause mortality. Compared with placebo, statins increased the incidence risk of muscle disease (OR 1.05, 95% CI 1.00-1.10) and kidney disease (OR 1.11, 95% CI 1.05-1.72).Conclusions: Statins significantly reduced levels of blood lipids, with a high dose of atorvastatin being the most effective in blood-lipid level modification. Statins reduced the risk of CHD mortality and all-cause mortality, with atorvastatin and fluvastatin being the most effective in reducing the risk of CHD mortality and all-cause mortality. Statins increased the risk of muscle disease and kidney damage. (C) 2016 Elsevier Ireland Ltd. All rights reserved.