Statins for the Primary Prevention of Cardiovascular Events in Women With Elevated High-Sensitivity C-Reactive Protein or Dyslipidemia: Results From the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and Meta-Analysis of Women From Primary
Statins for the Primary Prevention of Cardiovascular Events in Women With Elevated High-Sensitivity C-Reactive Protein or Dyslipidemia: Results From the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and Meta-Analysis of Women From Primary
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2010
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他汀类药物在明显心血管疾病患者中的使用已经确立，在女性和男性中观察到类似的益处，但他汀类药物用于心血管疾病的一级预防是有争议的，特别是对于女性。我们分析了在预防中使用他汀类药物的理由：评估瑞舒伐他汀的干预试验（JUPITER）中的性别特异性结局，并对女性在一级预防中使用他汀类药物进行了更新的荟萃分析（20 147名女性; 276起心血管疾病事件;平均年龄，63至69岁）。JUPITER是一项多中心随机试验，旨在评估他汀类药物治疗在明显健康的个体中的获益和风险，这些个体是根据高敏C反应蛋白升高而选择的，高敏C反应蛋白是心血管风险较高的标志物，没有伴随低密度脂蛋白胆固醇升高。JUPITER参与者包括6801名60岁女性和11001名50岁男性，高敏C反应蛋白2 mg/L和低密度脂蛋白胆固醇130 mg/dL，随机接受瑞舒伐他汀20 mg/d与安慰剂。JUPITER研究中，瑞舒伐他汀和安慰剂组女性的绝对心血管疾病发生率低于男性，但女性（46%）和男性（42%）的相对风险降低相似且显著。在女性中，血运重建/不稳定型心绞痛显著减少，而主要终点的其他组成部分无显著减少。此外，在这项关于他汀类药物用于女性一级预防的最新荟萃分析中，他汀类药物分配使心血管疾病的相对风险显著降低三分之一，与男性和女性二级预防的既往结果相似。参见第1069页。
The use of statins in patients with manifest cardiovascular disease is established, with similar benefits seen in women and men, but statin use for the primary prevention of cardiovascular disease is controversial, particularly for women. We analyzed sex-specific outcomes in the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and conducted an updated meta-analysis of statin use for women in primary prevention (20 147 women; 276 cardiovascular disease events; mean age, 63 to 69 years). JUPITER was a multicenter randomized trial designed to assess the benefits and risks of statin therapy in apparently healthy individuals selected on the basis of elevated high-sensitivity C-reactive protein, a marker of higher cardiovascular risk, without a concomitant elevation in low-density lipoprotein cholesterol. JUPITER participants included 6801 women 60 years of age and 11 001 men 50 years of age with high-sensitivity C-reactive protein 2 mg/L and low-density lipoprotein cholesterol 130 mg/dL who were randomized to rosuvastatin 20 mg/d versus placebo. Absolute cardiovascular disease rates for rosuvastatin and placebo in JUPITER were lower for women than for men, but there were similar and significant relative risk reductions in both women (by 46%) and men (by 42%). In women, there was significant reduction in revascularization/unstable angina and nonsignificant reductions in other components of the primary end point. Furthermore, in this updated meta-analysis of statin therapy for primary prevention in women, statin allocation yielded a significant relative risk reduction in cardiovascular disease by one-third, similar to prior results in men and in secondary prevention in women. See p 1069.