Meta-Analysis of the Relationship Between Non-High-Density Lipoprotein Cholesterol Reduction and Coronary Heart Disease Risk
Meta-Analysis of the Relationship Between Non-High-Density Lipoprotein Cholesterol Reduction and Coronary Heart Disease Risk
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DOI：
10.1016/j.jacc.2008.10.024
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发表时间：
2009-01-27
影响因子：
24
通讯作者：
Jacobson, Terry A.
中科院分区：
文献类型：
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作者：
Robinson, Jennifer G.;Wang, Songfeng;Jacobson, Terry A.
非高密度脂蛋白胆固醇（non-high density lipoprotein cholesterol，HDL-C）是继低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL-C）之后的第二个调脂治疗目标，目的探讨各种调脂治疗降低非高密度脂蛋白胆固醇（non-high density lipoprotein cholesterol，HDL-C）与降低冠心病（coronary heart disease，CHD）风险之间的关系。使用贝叶斯随机效应荟萃分析模型，根据研究持续时间调整，评估平均非HDL-C降低对非致死性心肌梗死和CHD死亡相对风险的影响。结果14项他汀类药物（n = 100，827）、7项贝特类药物（n = 21，647）和6项烟酸（n = 4，445）试验符合纳入标准，胆汁酸螯合剂（n = 3，806）、饮食（n = 458）和回肠旁路手术（n = 838）各1项试验符合纳入标准。对于他汀类药物，非HDL-C每降低1%，估计4.5年CHD相对风险为0.99（95%贝叶斯置信区间：0.98至1.00）。贝特类药物模型与他汀类药物模型没有差异（贝叶斯因子K = 0.49），没有异质性的证据。烟酸模型与他汀类药物模型存在中度差异（K = 7.43），试验间存在异质性（Q = 11.8，5 df; p = 0.038）。唯一的烟酸单药治疗试验（n = 3，908）在非HDL-C和风险降低之间存在1：1的关系。烟酸联合用药的5项小型试验没有明显的一致性关系。饮食、胆汁酸螯合剂和手术的单次试验的95%可信区间也包括1：1的关系。结论非HDL-C是冠心病预防治疗的重要靶点。大多数用作单药治疗的调脂药物在非HDL-C降低百分比和CHD减少之间具有近似1：1的关系。（美国科尔心脏病学杂志2009; 53：316-22）（C）2009年美国心脏病学会基金会
Objectives To determine the relationship between non-high-density lipoprotein cholesterol (HDL-C) lowering and coronary heart disease (CHD) risk reduction for various lipid-modifying therapies.Background Non-HDL-C is the second lipid target of therapy after low-density lipoprotein cholesterol (LDL-C).Methods Randomized placebo or active-controlled trials were evaluated. The effect of mean non-HDL-C reduction on the relative risk of nonfatal myocardial infarction and CHD death was estimated using Bayesian random-effects meta-analysis models adjusted for study duration. Cochrane's Q was used to test for heterogeneity.Results Inclusion criteria were met by 14 statin (n = 100,827), 7 fibrate (n = 21,647), and 6 niacin (n = 4,445) trials, and 1 trial each of a bile acid sequestrant (n = 3,806), diet (n = 458), and ileal bypass surgery (n = 838). For statins, each 1% decrease in non-HDL-C resulted in an estimated 4.5-year CHD relative risk of 0.99 (95% Bayesian confidence interval: 0.98 to 1.00). The fibrate model did not differ from the statin model ( Bayes factor K = 0.49) with no evidence of heterogeneity. The niacin model was moderately different from the statin model (K = 7.43), with heterogeneity among the trials (Q = 11.8, 5 df; p = 0.038). The only niacin monotherapy trial (n = 3,908) had a 1:1 relationship between non-HDL-C and risk reduction. No consistent relationships were apparent for the 5 small trials of niacin in combination. The 95% confidence intervals for the single trials of diet, bile acid sequestrants, and surgery also included the 1: 1 relationship.Conclusions Non-HDL-C is an important target of therapy for CHD prevention. Most lipid-modifying drugs used as monotherapy have an approximate to 1:1 relationship between percent non-HDL-C lowering and CHD reduction. (J Am Coll Cardiol 2009; 53: 316-22) (C) 2009 by the American College of Cardiology Foundation