Effectiveness of statin therapy in adults with coronary heart disease
Effectiveness of statin therapy in adults with coronary heart disease
复制标题
DOI：
10.1001/archinte.164.13.1427
复制
发表时间：
2004-07-12
影响因子：
--
通讯作者：
Sales, A
中科院分区：
文献类型：
--
作者：
Wilt, TJ;Bloomfield, HE;Sales, A
背景：我们对冠心病患者进行了荟萃分析。确定他汀类药物治疗的有效性；有效性是否根据患者特征、结局或预处理低密度脂蛋白胆固醇（LDL-C）水平而变化；以及LDL-C的最佳目标和开始他汀类药物治疗的水平。方法：通过MEDLINE和Cochrane图书馆检索1966年1月至2002年12月发表的关于他汀类药物二级预防冠心病的随机试验或系统评价。如果将成年冠心病患者随机分配到他汀治疗组或对照组，每组至少入组100人，报告临床结果和LDL-C水平，并以完整的英文研究发表，则纳入研究。两位审稿人使用前瞻性设计的方案提取数据。结果：纳入25项研究，共69 511名受试者。19项安慰剂对照试验的参与者平均年龄为63岁，平均预处理LDL-C水平为149 mg/dL (3.85 mmol/L)；23%是女性。他汀类药物治疗降低冠心病死亡率或非致死性心肌梗死25%（相对危险度[RR]， 0.75； 95%可信区间[CI]， 0.71-0.79），全因死亡率16% (RR, 0.84; 95% CI, 0.79-0.89)，冠心病死亡率23% （RR, 0.77; 95% CI, 0.71-0.83）。在女性和老年人中可以看到有益的效果。没有数据确定将LDL-C水平降低到低于100毫克/分升(
Background: We conducted a meta-analysis of patients with coronary. heart disease (CHD) to determine the effectiveness of statin therapy; whether effectiveness varied according to patient characteristics, outcomes, or pretreatment low-density lipoprotein cholesterol (LDL-C) levels; and the optimal LDL-C goal and the level at which to initiate statin therapy.Methods: Randomized trials or systematic reviews for secondary prevention of CHD with statin therapy published between January 1966 and December 2002 were identified through MEDLINE and the Cochrane Library. Studies were included if they randomly assigned adults with CHD to statin therapy or control, enrolled at least 100 individuals per arm, reported clinical outcomes and LDL-C levels, and were published as full studies in English. Two reviewers abstracted data using a prospectively designed protocol.Results: Twenty-five studies enrolling 69 511 individuals were included. Participants in 19 placebo-controlled trials had a mean age of 63 years and a mean pretreatment LDL-C level of 149 mg/dL (3.85 mmol/L); 23% were women. Statin therapy reduced CHD mortality or non-fatal myocardial infarction 25% (relative risk [RR], 0.75; 95% confidence interval [CI], 0.71-0.79), all-cause mortality 16% (RR, 0.84; 95% CI, 0.79-0.89), and CHD mortality 23% (RR, 0.77; 95% CI, 0.71-0.83). Beneficial effects were seen in women and the elderly. There were no data to determine whether lowering the LDL-C level to less than 100 mg/dL (