Leng G C, Price J F, Jepson R G
Primary Care and Population Sciences, Royal Free and University College Medical School, Royal Free Campus, Rowland Hill Street, London, UK, NW3 2PF.
Cochrane Database Syst Rev. 2000(2):CD000123. doi: 10.1002/14651858.CD000123.
Raised lipid levels, including cholesterol, are important risk factors in the development of lower limb arterial disease (atherosclerosis).
The objective of this review was to assess the effects of lipid lowering therapy in patients with lower limb atherosclerosis.
The reviewers searched the Cochrane Peripheral Vascular Diseases Group trials register, Embase, reference lists of relevant articles, and contacted trial investigators in Europe and pharmaceutical companies.
Randomised trials of lipid-lowering therapy in patients with lower limb atherosclerosis. The main outcomes were mortality, non-fatal events, direct tests of disease progression, indirect measurements of disease, and subjective measures.
Two reviewers extracted data and assessed trial quality independently. The reviewers contacted investigators to obtain information needed for the review that could not be found in published reports.
There were nine eligible trials, but two were excluded because of poor methodology. The seven remaining trials involved a total of 698 participants from seven different countries. Men and women participated in all but one trial and were generally middle aged to elderly. The follow-up period varied from four months to three years. The overall quality of the included trials was high. The trials were heterogeneous in terms of inclusion criteria, type of drugs used and outcomes measured. Lipid-lowering therapy produced a marked but non-significant reduction in mortality (odds ratio 0.21, 95% confidence interval 0. 03 to 1.17), but little change in non-fatal events (odds ratio 1.21, 95% confidence interval 0.80 to 1.83). In two trials there was a significant overall reduction in disease progression on angiogram (odds ratio 0.47, 95% confidence interval 0.29 to 0.77). The changes in ankle brachial pressure index and walking distance were inconsistent, although trials showed a general improvement in symptoms that could not be combined in a meta-analysis. Side effects were generally mild, with the exceptions of liver toxicity produced by betapyridil and the adverse effect of probucol on lipoprotein profile.
REVIEWER'S CONCLUSIONS: Lipid-lowering therapy may be useful in preventing deterioration of underlying disease and alleviating symptoms. These results cannot determine whether one lipid-lowering regimen is better than another.
血脂水平升高，包括胆固醇升高，是下肢动脉疾病（动脉粥样硬化）发展的重要危险因素。
本综述的目的是评估降脂治疗对下肢动脉粥样硬化患者的影响。
综述作者检索了Cochrane外周血管疾病组试验注册库、Embase、相关文章的参考文献列表，并联系了欧洲的试验研究者和制药公司。
下肢动脉粥样硬化患者降脂治疗的随机试验。主要结局包括死亡率、非致命事件、疾病进展的直接检测、疾病的间接测量以及主观测量。
两名综述作者独立提取数据并评估试验质量。综述作者联系研究者以获取综述所需但在已发表报告中未找到的信息。
有9项符合条件的试验，但两项因方法学欠佳而被排除。其余7项试验共纳入来自7个不同国家的698名参与者。除一项试验外，其余试验均有男性和女性参与，且参与者一般为中老年人。随访期从4个月到3年不等。纳入试验的总体质量较高。这些试验在纳入标准、所用药物类型和测量结局方面存在异质性。降脂治疗使死亡率有显著但无统计学意义的降低（比值比0.21，95%置信区间0.03至1.17），但非致命事件变化不大（比值比1.21，95%置信区间0.80至1.83）。在两项试验中，血管造影显示疾病进展有显著的总体降低（比值比0.47，95%置信区间0.29至0.77）。踝臂压力指数和步行距离的变化不一致，尽管试验显示症状总体有所改善，但无法进行荟萃分析。副作用一般较轻，但β-吡啶醇引起的肝毒性以及普罗布考对脂蛋白谱的不良影响除外。
降脂治疗可能有助于预防基础疾病恶化并缓解症状。这些结果无法确定一种降脂方案是否优于另一种。
