降脂干预与卒中：来自随机对照试验荟萃分析的见解。

Cholesterol-lowering interventions and stroke: insights from a meta-analysis of randomized controlled trials.

机构信息

Institute of Cardiology and University Cardiology Division, G d'Annunzio University, Chieti, Italy.

出版信息

J Am Coll Cardiol. 2010 Jan 19;55(3):198-211. doi: 10.1016/j.jacc.2009.07.062.

DOI:10.1016/j.jacc.2009.07.062

PMID:20117400

Abstract

OBJECTIVES

This meta-analysis was performed to determine the effects of various cholesterol-lowering treatments on the risk of stroke and its relationship with the extent of cholesterol lowering.

BACKGROUND

Statins reduce the incidence of stroke, and it has been proposed that such effect is independent of cholesterol lowering and is explained by alternative mechanisms.

METHODS

We performed a meta-analysis of randomized trials of cholesterol-lowering treatments in cardiovascular disease reporting on stroke, involving 266,973 patients investigated and a cumulative 946,582 person-years of exposure, and a meta-regression analysis of the extent of stroke reduction as a function of changes in total cholesterol.

RESULTS

The odds ratio (OR) for the incidence of stroke in actively treated groups versus controls was 0.88 (95% confidence interval: 0.83 to 0.94, p < 0.001). No treatment affected fatal strokes. Whereas statins decreased the risk of total stroke significantly (OR: 0.85, 95% confidence interval: 0.78 to 0.92; p < 0.001), the benefit of nonstatin interventions was smaller and not statistically significant (diet OR: 0.92, fibrates OR: 0.98, other treatments OR: 0.81). We found a significant relationship between percent reduction of total (and low-density lipoprotein) cholesterol and percent reduction of total strokes (p = 0.0017), with each 1% reduction of total cholesterol predicting a 0.8% relative risk reduction of stroke. We found no significant association between stroke reduction and changes of high-density lipoprotein cholesterol levels, and inconsistent associations with reduction of triglycerides.

CONCLUSIONS

Among cholesterol-lowering treatments, statins are the most effective at decreasing the risk of total stroke, but their benefit is proportional to the percent reduction of total cholesterol and low-density lipoprotein cholesterol. No lipid-lowering intervention was associated with a reduction of fatal stroke.

摘要

目的

本荟萃分析旨在确定各种降脂治疗对卒中风险的影响及其与降脂程度的关系。

背景

他汀类药物可降低卒中发生率，有人提出这种作用与降脂无关，而是通过其他机制来解释。

方法

我们对心血管疾病中降脂治疗与卒中相关的随机试验进行了荟萃分析，共纳入 266973 例患者，累计暴露 946582 人年，并对卒中减少程度与总胆固醇变化的关系进行了荟萃回归分析。

结果

与对照组相比，积极治疗组卒中发生率的比值比（OR）为 0.88（95%可信区间：0.83 至 0.94，p < 0.001）。无治疗措施影响致死性卒中。他汀类药物显著降低总卒中风险（OR：0.85，95%可信区间：0.78 至 0.92；p < 0.001），而非他汀类药物干预的获益较小且无统计学意义（饮食 OR：0.92，贝特类 OR：0.98，其他治疗 OR：0.81）。我们发现总胆固醇（和低密度脂蛋白）降低百分比与总卒中降低百分比之间存在显著关系（p = 0.0017），总胆固醇每降低 1%，卒中相对风险降低 0.8%。我们未发现卒中减少与高密度脂蛋白胆固醇水平变化之间存在显著关联，且与甘油三酯降低之间的关联不一致。