他汀类药物用于老年患者的二级预防：一项分层贝叶斯荟萃分析。

Statins for secondary prevention in elderly patients: a hierarchical bayesian meta-analysis.

作者信息

Afilalo Jonathan, Duque Gustavo, Steele Russell, Jukema J Wouter, de Craen Anton J M, Eisenberg Mark J

机构信息

Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Canada.

出版信息

J Am Coll Cardiol. 2008 Jan 1;51(1):37-45. doi: 10.1016/j.jacc.2007.06.063.

DOI:10.1016/j.jacc.2007.06.063

PMID:18174034

Abstract

OBJECTIVES

This study was designed to determine whether statins reduce all-cause mortality in elderly patients with coronary heart disease.

BACKGROUND

Statins continue to be underutilized in elderly patients because evidence has not consistently shown that they reduce mortality.

METHODS

We searched 5 electronic databases, the Internet, and conference proceedings to identify relevant trials. In addition, we obtained unpublished data for the elderly patient subgroups from 4 trials and for the secondary prevention subgroup from the PROSPER (PROspective Study of Pravastatin in the Elderly at Risk) trial. Inclusion criteria were randomized allocation to statin or placebo, documented coronary heart disease, > or =50 elderly patients (defined as age > or =65 years), and > or =6 months of follow-up. Data were analyzed with hierarchical Bayesian modeling.

RESULTS

We included 9 trials encompassing 19,569 patients with an age range of 65 to 82 years. Pooled rates of all-cause mortality were 15.6% with statins and 18.7% with placebo. We estimated a relative risk reduction of 22% over 5 years (relative risk [RR] 0.78; 95% credible interval [CI] 0.65 to 0.89). Furthermore, statins reduced coronary heart disease mortality by 30% (RR 0.70; 95% CI 0.53 to 0.83), nonfatal myocardial infarction by 26% (RR 0.74; 95% CI 0.60 to 0.89), need for revascularization by 30% (RR 0.70; 95% CI 0.53 to 0.83), and stroke by 25% (RR 0.75; 95% CI 0.56 to 0.94). The posterior median estimate of the number needed to treat to save 1 life was 28 (95% CI 15 to 56).

CONCLUSIONS

Statins reduce all-cause mortality in elderly patients and the magnitude of this effect is substantially larger than had been previously estimated.

摘要

目的

本研究旨在确定他汀类药物是否能降低老年冠心病患者的全因死亡率。

背景

他汀类药物在老年患者中的使用仍未得到充分利用，因为证据并未始终表明它们能降低死亡率。

方法

我们检索了5个电子数据库、互联网和会议论文集以识别相关试验。此外，我们从4项试验中获取了老年患者亚组的未发表数据，并从PROSPER（普伐他汀对老年高危患者的前瞻性研究）试验中获取了二级预防亚组的数据。纳入标准为随机分配至他汀类药物组或安慰剂组、有记录的冠心病、≥50名老年患者（定义为年龄≥65岁）以及≥6个月的随访。数据采用分层贝叶斯模型进行分析。

结果

我们纳入了9项试验，涵盖19569名年龄在65至82岁之间的患者。他汀类药物组的全因死亡率合并率为15.6%，安慰剂组为18.7%。我们估计5年内相对风险降低22%（相对风险[RR]0.78；95%可信区间[CI]0.65至0.89）。此外，他汀类药物使冠心病死亡率降低30%（RR 0.70；95%CI 0.53至0.83），非致命性心肌梗死降低26%（RR 0.74；95%CI 0.60至0.89），血运重建需求降低30%（RR 0.70；95%CI 0.53至0.83），中风降低25%（RR 0.75；95%CI 0.56至0.94）。挽救1条生命所需治疗的人数的后验中位数估计为28（95%CI 15至56）。