Molecular Cardiology Research Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, and Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Ann Intern Med. 2010 Dec 21;153(12):800-8. doi: 10.7326/0003-4819-153-12-201012210-00006.
Low levels of high-density lipoprotein cholesterol (HDL-C) are associated with an increased risk for myocardial infarction (MI). Although statins reduce the risk for MI, most cardiovascular events still occur despite statin treatment.
Using meta-analysis of large randomized, controlled trials (RCTs) of statins to determine whether statins alter the relationship between HDL-C level and MI.
MEDLINE search to February 2010, ClinicalTrials.gov, and reference lists from eligible studies.
English-language RCTs of statin-treated patients versus control participants with 1000 or more person-years of follow-up and reported HDL-C levels and MI.
Two independent investigators extracted data from eligible RCTs.
Twenty eligible RCTs were identified (543,210 person-years of follow-up and 7838 MIs). After adjustment for on-treatment LDL-C levels, age, hypertension, diabetes, and tobacco use, there was a significant inverse association between HDL-C levels and risk for MI in statin-treated patients and control participants. In Poisson meta-regressions, every 0.26-mmol/L (10-mg/dL) decrease in HDL-C was associated with 7.1 (95% CI, 6.8 to 7.3) and 8.3 (CI, 8.1 to 8.5) more MIs per 1000 person-years in statin-treated patients and control participants, respectively. The inverse association between HDL-C levels and MI did not differ between statin-treated patients and control participants (P= 0.57).
The observed associations may be explained by unmeasured confounding and do not imply causality in the relationship between HDL-C level and cardiovascular risk.
Statins do not alter the relationship between HDL-C level and cardiovascular risk, such that low levels of HDL-C remain significantly and independently associated with increased risk despite statin treatment. The remaining risk seen in statin-treated patients may be partly explained by low HDL-C levels or other factors associated with low levels of HDL-C.
None.
高密度脂蛋白胆固醇（HDL-C）水平低与心肌梗死（MI）风险增加有关。尽管他汀类药物可降低 MI 的风险，但即使进行了他汀类药物治疗，大多数心血管事件仍会发生。
通过对他汀类药物的大型随机对照试验（RCT）进行荟萃分析，确定他汀类药物是否改变了 HDL-C 水平与 MI 之间的关系。
截至 2010 年 2 月的 MEDLINE 搜索、ClinicalTrials.gov 以及合格研究的参考文献列表。
针对他汀类药物治疗患者与对照组参与者的 RCT，随访时间超过 1000 人年，且报告了 HDL-C 水平和 MI。
两名独立的研究人员从合格的 RCT 中提取数据。
确定了 20 项合格的 RCT（543210 人年随访和 7838 例 MI）。在校正治疗后 LDL-C 水平、年龄、高血压、糖尿病和吸烟状况后，他汀类药物治疗患者和对照组参与者的 HDL-C 水平与 MI 风险之间存在显著的负相关。在泊松元回归中，HDL-C 每降低 0.26mmol/L（10mg/dL），他汀类药物治疗患者和对照组参与者的每 1000 人年分别多发生 7.1（95%CI，6.8 至 7.3）和 8.3（CI，8.1 至 8.5）例 MI。HDL-C 水平与 MI 之间的负相关在他汀类药物治疗患者和对照组参与者之间无差异（P=0.57）。
观察到的相关性可能由未测量的混杂因素解释，并不能暗示 HDL-C 水平与心血管风险之间的关系存在因果关系。
他汀类药物不会改变 HDL-C 水平与心血管风险之间的关系，因此，即使进行了他汀类药物治疗，HDL-C 水平低仍与风险增加显著且独立相关。在他汀类药物治疗患者中观察到的剩余风险可能部分归因于 HDL-C 水平低或与 HDL-C 水平低相关的其他因素。
无。
