Abourbih Samuel, Filion Kristian B, Joseph Lawrence, Schiffrin Ernesto L, Rinfret Stephane, Poirier Paul, Pilote Louise, Genest Jacques, Eisenberg Mark J
Division of Cardiology, Jewish General Hospital, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
Am J Med. 2009 Oct;122(10):962.e1-8. doi: 10.1016/j.amjmed.2009.03.030. Epub 2009 Aug 19.
Fibrates might represent a viable treatment option for patients who do not meet their target low-density lipoprotein levels on statins or who are resistant or intolerant to statins. New data from fibrate trials can be synthesized with the existing literature to better estimate their effects.
We systematically searched the literature to identify randomized, double-blind, placebo-controlled trials examining the effect of fibrates on lipid profiles or cardiovascular outcomes. We estimated the effect of fibrates on the incidence of nonfatal myocardial infarction and all-cause mortality using random effects models.
Compared with placebo, fibrates were associated with greater reductions in total cholesterol (range: -101.3 mg/dL to -5.0 mg/dL) and triglycerides (range: -321.3 mg/dL to -20.8 mg/dL), and a greater increase in high-density lipoprotein (range: +1.1 mg/dL to +17.9 mg/dL) in all trials. Fibrates tended to be associated with a greater reduction in low-density lipoprotein (range: -76.3 mg/dL to +38.7 mg/dL) than placebo, although these results were not consistent across all trials. Fibrates were more efficacious than placebo at preventing nonfatal myocardial infarction (odds ratio=0.78; 95% confidence interval, 0.69-0.89), but not all-cause mortality (odds ratio=1.05; 95% confidence interval, 0.95-1.15).
In addition to improving lipid profiles, fibrates are associated with an important decrease in nonfatal myocardial infarction, but do not substantially affect all-cause mortality. Potential applications include treatment for patients with statin resistance or isolated hypertriglyceridemia, or as an adjunct to other lipid-lowering therapies.
对于使用他汀类药物后低密度脂蛋白水平未达目标值或对他汀类药物耐药或不耐受的患者，贝特类药物可能是一种可行的治疗选择。可将贝特类药物试验的新数据与现有文献进行综合分析，以更好地评估其疗效。
我们系统检索文献，以确定考察贝特类药物对血脂谱或心血管结局影响的随机、双盲、安慰剂对照试验。我们使用随机效应模型评估贝特类药物对非致死性心肌梗死发生率和全因死亡率的影响。
在所有试验中，与安慰剂相比，贝特类药物与总胆固醇（范围：-101.3mg/dL至-5.0mg/dL）和甘油三酯（范围：-321.3mg/dL至-20.8mg/dL）的更大降幅以及高密度脂蛋白（范围：+1.1mg/dL至+17.9mg/dL）的更大升幅相关。贝特类药物降低低密度脂蛋白（范围：-76.3mg/dL至+38.7mg/dL）的幅度往往大于安慰剂，尽管这些结果在所有试验中并不一致。在预防非致死性心肌梗死方面，贝特类药物比安慰剂更有效（比值比=0.78；95%置信区间，0.69-0.89），但对全因死亡率无显著影响（比值比=1.05；95%置信区间，0.95-1.15）。
除改善血脂谱外，贝特类药物还与非致死性心肌梗死的显著降低相关，但对全因死亡率无实质性影响。其潜在应用包括治疗他汀类药物耐药或单纯高甘油三酯血症患者，或作为其他降脂疗法的辅助药物。
