Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117 411 patients
Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117 411 patients
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DOI：
10.1136/bmj.g4379
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发表时间：
2014-07-18
影响因子：
105.7
通讯作者：
Francis, Darrel P.
中科院分区：
文献类型：
--
作者：
Keene, Daniel;Price, Clare;Francis, Darrel P.
目的探讨增加高密度脂蛋白水平的药物干预对心血管事件结局的影响。设计Meta分析。研究回顾了烟酸、贝特类和胆固醇酯转移蛋白（CETP）抑制剂对心血管事件的治疗益处（全因死亡率、冠心病死亡率、非致命性心肌梗死、结果117 411例患者随机分配到39个试验中。所有干预措施均增加了高密度脂蛋白胆固醇水平。烟酸对全因死亡率无显著影响（比值比1.03，95%置信区间0.92 - 1.15，P=0.59），贝特类（0.98，0.89至1.08，P=0.66）或CETP抑制剂（1.16，0.93 ~ 1.44，P=0.19）;烟酸对冠心病死亡率的影响（0.93，0.76至1.12，P=0.44），贝特类（0.92，0.81至1.04，P=0.19）或CETP抑制剂（1.00，0.80 ~ 1.24，P=0.99）;或烟酸（0.96，0.75 - 1.22，P=0.72）、贝特类（1.01，0.90 - 1.13，P=0.84）或CETP抑制剂（1.14，0.90 - 1.45，P=0.29）对卒中结局的影响。在未接受他汀类药物治疗的患者（在他汀类药物时代之前）的研究中，烟酸与非致死性心肌梗死的显著减少相关（0.69，0.56至0.85，P=0.0004）。然而，在已经服用他汀类药物的研究中，烟酸没有显示出显著影响（0.96，0.85至1.09，P=0.52）。在这些亚组之间观察到显著差异（P=0.007）。贝特类药物组与未接受他汀类药物治疗组的非致死性心肌梗死发生率趋势相似（0.78，0.71 - 0.86，P
Objective To investigate the effects on cardiovascular outcomes of drug interventions that increase high density lipoprotein levels.Design Meta-analysis.Studies reviewed Therapeutic benefit of niacin, fibrates, and cholesteryl ester transfer protein (CETP) inhibitors on cardiovascular events (all cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke).Results 117 411 patients were randomised in a total of 39 trials. All interventions increased the levels of high density lipoprotein cholesterol. No significant effect was seen on all cause mortality for niacin (odds ratio 1.03, 95% confidence interval 0.92 to 1.15, P=0.59), fibrates (0.98, 0.89 to 1.08, P=0.66), or CETP inhibitors (1.16, 0.93 to 1.44, P=0.19); on coronary heart disease mortality for niacin (0.93, 0.76 to 1.12, P=0.44), fibrates (0.92, 0.81 to 1.04, P=0.19), or CETP inhibitors (1.00, 0.80 to 1.24, P=0.99); or on stroke outcomes for niacin (0.96, 0.75 to 1.22, P=0.72), fibrates (1.01, 0.90 to 1.13, P=0.84), or CETP inhibitors (1.14, 0.90 to 1.45, P=0.29). In studies with patients not receiving statins (before the statin era), niacin was associated with a significant reduction in non-fatal myocardial infarction (0.69, 0.56 to 0.85, P=0.0004). However, in studies where statins were already being taken, niacin showed no significant effect (0.96, 0.85 to 1.09, P=0.52). A significant difference was seen between these subgroups (P=0.007). A similar trend relating to non-fatal myocardial infarction was seen with fibrates: without statin treatment (0.78, 0.71 to 0.86, P