Laboratorio de Investigación Molecular, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Heart. 2010 Sep;96(17):1345-51. doi: 10.1136/hrt.2010.195396.
Many observational prospective studies have confirmed the inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease. However, the potential benefit of the pharmacological increase in HDL cholesterol has not been clearly demonstrated. Moreover, in some interventions an increase in total mortality has been reported.
The objective of this meta-analysis was to determine the relationship between HDL cholesterol increase and non-cardiovascular mortality in randomised trials.
Authors searched Medline up to December 2008.
Four reviewers identified randomised trials in which, through different types of interventions, HDL cholesterol increase in the treatment group was >4% compared to control group, both groups reported separately non-cardiovascular mortality and the duration of the study was, at least, one year.
Data of HDL cholesterol concentrations and deaths were collected as they appeared in the original studies. If necessary, reviewers calculated data by using trial information.
Meta-regression analysis included 44 articles corresponding to 107 773 participants. Analysis showed an association between HDL cholesterol increase and non-cardiovascular mortality (p=0.023), however, the correlation disappeared when we excluded the ILLUMINATE (Investigation of Lipid Level Management to Understand its Impact in Atherosclerosis Events) trial from the analysis (p=0.972).
Meta-regression analysis results suggest that increases in HDL cholesterol up to 40% are not associated with higher non-cardiovascular death. The increase in adverse events observed in some trials where HDL cholesterol was raised in large amounts could be related with the drug mechanisms more than the HDL cholesterol increase itself.
许多观察性前瞻性研究证实了高密度脂蛋白（HDL）胆固醇与冠心病之间呈负相关。然而，药物增加 HDL 胆固醇的潜在益处尚未得到明确证实。此外，一些干预措施报告了总死亡率的增加。
本荟萃分析的目的是确定随机试验中 HDL 胆固醇升高与非心血管死亡率之间的关系。
作者检索了截至 2008 年 12 月的 Medline。
四位审稿人确定了随机试验，其中通过不同类型的干预措施，治疗组的 HDL 胆固醇升高超过对照组的 4%，两组分别报告了非心血管死亡率，且研究持续时间至少为一年。
以原始研究中出现的形式收集 HDL 胆固醇浓度和死亡数据。如果需要，审稿人使用试验信息计算数据。
荟萃回归分析包括 44 篇文章，涉及 107773 名参与者。分析表明，HDL 胆固醇升高与非心血管死亡率之间存在关联（p=0.023），但当我们从分析中排除 ILLUMINATE（脂质水平管理研究以了解其对动脉粥样硬化事件的影响）试验时，相关性消失（p=0.972）。
荟萃回归分析结果表明，HDL 胆固醇增加 40%不会导致更高的非心血管死亡。在大量升高 HDL 胆固醇的试验中观察到的不良事件增加可能与药物机制有关，而不仅仅是 HDL 胆固醇升高本身。
