Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials.
Very low levels of atherogenic lipoproteins and the risk for cardiovascular events: a meta-analysis of statin trials.
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DOI：
10.1016/j.jacc.2014.02.615
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发表时间：
2014-08-05
影响因子：
24
通讯作者：
Kastelein, John J. P.
中科院分区：
文献类型：
--
作者：
Boekholdt, S. Matthijs;Hovingh, G. Kees;Mora, Samia;Arsenault, Benoit J.;Amarenco, Pierre;Pedersen, Terje R.;LaRosa, John C.;Waters, David D.;DeMicco, David A.;Simes, R. John;Keech, Antony C.;Colquhoun, David;Hitman, Graham A.;Betteridge, John;Clearfield, Michael B.;Downs, John R.;Colhoun, Helen M.;Gotto, Antonio M., Jr.;Ridker, Paul M.;Grundy, Scott M.;Kastelein, John J. P.
评估(1)他汀类药物治疗后低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(Non-高密度脂蛋白胆固醇)或载脂蛋白B(ApoB)水平降低的个体间变异性，(2)在大剂量他汀类药物治疗中未达到指南推荐血脂水平的患者比例，以及(3)他汀类药物治疗中极低水平的致动脉粥样硬化性脂蛋白与心血管疾病风险之间的关系。他汀类药物治疗所达到的致动脉粥样硬化脂蛋白水平具有很高的变异性，但这种变异性对心血管疾病(CVD)风险的影响还没有很好的文献记载。对8个随机对照的他汀类药物试验的个体患者数据进行荟萃分析，在这些试验中，所有研究参与者在基线和一年的随访中都测定了常规的血脂和载脂蛋白。在38153名接受他汀类药物治疗的患者中，5387名研究参与者在随访期间总共发生了6286起重大心血管事件。在固定的他汀类药物剂量下，低密度脂蛋白-C、非高密度脂蛋白-C和载脂蛋白B的降低在个体间有很大的差异。被分配到大剂量他汀类药物治疗的试验参与者中，超过40%的人没有达到低于70 mg/dL的低密度脂蛋白-C目标。与低密度脂蛋白胆固醇水平达到175 mg/dL的患者相比，低密度脂蛋白胆固醇水平达到75-100 mg/dL、50-75 mg/dL和50 mg/dL的患者调整主要心血管事件的危险比分别为0.56(95%可信区间0.46-0.67)、0.51(95%可信区间0.42-0.62)和0.44(95%可信区间0.35-0.55)。在非高密度脂蛋白胆固醇和载脂蛋白B中也观察到了类似的关联。他汀类药物治疗可降低低密度脂蛋白、非高密度脂蛋白胆固醇和载脂蛋白B水平，但个体间差异很大。在接受大剂量他汀类药物治疗的试验参与者中，超过40%的人没有达到70 mg/dL的低密度脂蛋白目标。低密度脂蛋白胆固醇水平非常低的患者发生重大心血管事件的风险比那些水平中等低的患者低。
To evaluate (1) the inter-individual variability of reductions in low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C) or apolipoprotein B (apoB) levels achieved with statin therapy, (2) the proportion of patients not reaching guideline-recommended lipid levels on high-dose statin therapy, and (3) the association between very low levels of atherogenic lipoproteins achieved with statin therapy and CVD risk. Levels of atherogenic lipoproteins achieved with statin therapy are highly variable, but the consequence of this variability for cardiovascular disease (CVD) risk is not well documented. Meta-analysis of individual patient data from 8 randomized controlled statin trials in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up. Among 38,153 patients allocated to statin therapy, a total of 6,286 major cardiovascular events occurred in 5,387 study participants during follow-up. There was large inter-individual variability in the reductions of LDL-C, non-HDL-C and apoB achieved with a fixed statin dose. Over 40% of trial participants assigned to high-dose statin therapy did not reach an LDL-C target below 70 mg/dL. Compared to patients who achieved an LDL-C > 175 mg/dL, those who reached an LDL-C 75-100 mg/dL, 50-75 mg/dL and < 50 mg/dL had adjusted hazard ratios for major cardiovascular events of 0.56 (95%CI 0.46-0.67), 0.51 (95%CI 0.42-0,62) and 0.44 (95%CI 0.35-0.55), respectively. Similar associations were observed for non-HDL-C and apoB. The reduction of LDL-C, non-HDL-C and apoB levels achieved with statin therapy displays large inter-individual variation. Among trial participants treated with high-dose statin therapy, over 40% do not reach an LDL-C target <70 mg/dL. Patients who achieve very low LDL-C levels have a lower risk of major cardiovascular events than those achieving moderately low levels.
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DOI：
10.1016/s0735-1097(02)02030-2
发表时间：
2002-08-07
影响因子：
24
作者：
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Glynn, Robert J.
影响因子：
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作者：
DiMatteo, MR;Lepper, HS;Croghan, TW
通讯作者：
Croghan, TW