Wilt Timothy J, Bloomfield Hanna E, MacDonald Roderick, Nelson David, Rutks Indulis, Ho Michael, Larsen Gregory, McCall Anthony, Pineros Sandra, Sales Anne
Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minn. 55417, USA.
Arch Intern Med. 2004 Jul 12;164(13):1427-36. doi: 10.1001/archinte.164.13.1427.
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.
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.
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 nonfatal 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 (<2.59 mmol/L) was superior to lowering it to 100 to 130 mg/dL (2.59-3.36 mmol/L). Meta-regression analyses revealed risk reductions for CHD mortality or nonfatal myocardial infarction and major vascular events across available pretreatment LDL-C levels.
Statin therapy reduces mortality and morbidity in adults with CHD, even at pretreatment LDL-C levels as low as 100 mg/dL (2.59 mmol/L).
我们对冠心病（CHD）患者进行了一项荟萃分析，以确定他汀类药物治疗的有效性；其有效性是否因患者特征、结局或治疗前低密度脂蛋白胆固醇（LDL-C）水平而异；以及最佳LDL-C目标和启动他汀类药物治疗的水平。
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治疗冠心病二级预防的随机试验或系统评价。纳入的研究需将成年冠心病患者随机分配至他汀类药物治疗组或对照组，每组至少纳入100例个体，报告临床结局和LDL-C水平，并以英文全文发表。两名研究者使用前瞻性设计的方案提取数据。
纳入了25项研究，共69511例个体。19项安慰剂对照试验的参与者平均年龄为63岁，治疗前LDL-C平均水平为149mg/dL（3.85mmol/L）；23%为女性。他汀类药物治疗使冠心病死亡率或非致命性心肌梗死降低25%（相对危险度[RR]为0.75；95%置信区间[CI]为0.71 - 0.79），全因死亡率降低16%（RR为0.84；95%CI为0.79 - 0.89），冠心病死亡率降低23%（RR为0.77；95%CI为0.71 - 0.83）。在女性和老年人中也观察到了有益效果。没有数据可确定将LDL-C水平降至低于100mg/dL（<2.59mmol/L）是否优于降至100至130mg/dL（2.59 - 3.36mmol/L）。荟萃回归分析显示在所有可用的治疗前LDL-C水平上，冠心病死亡率或非致命性心肌梗死以及主要血管事件的风险均降低了。
他汀类药物治疗可降低成年冠心病患者的死亡率和发病率，即使在治疗前LDL-C水平低至100mg/dL（2.59mmol/L）时也是如此。
