Reriani Martin K, Dunlay Shannon M, Gupta Bhanu, West Colin P, Rihal Charanjit S, Lerman Lilach O, Lerman Amir
Division of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Eur J Cardiovasc Prev Rehabil. 2011 Oct;18(5):704-16. doi: 10.1177/1741826711398430. Epub 2011 Mar 4.
The purpose of this study was to quantify the effect of statins on peripheral and coronary endothelial function in patients with and without established cardiovascular disease.
Early atherosclerosis is characterized by endothelial dysfunction, a known prognostic factor for cardiovascular disease.
The search included MEDLINE, Cochrane Library, Scopus, and EMBASE to identify studies up to 1 December 2009. Eligible studies were randomized controlled trials on the effects of statins compared with placebo on endothelial function. Two reviewers extracted data on study characteristics, methods, and outcomes. Forty-six eligible trials enrolled a total of 2706 patients: 866 (32%) were women and 432 (16%) had established cardiovascular disease. Meta-analysis using random-effects models showed treatment with statins significantly improved endothelial function [standardized mean difference (SMD) 0.66, 95% CI 0.46-0.85, p < 0.001]. Subgroup analyses demonstrated statistically significant improvement in endothelial function assessed both peripherally by flow-mediated dilatation (SMD 0.68, 95% CI 0.46-0.90, p < 0.001) and venous occlusion plethysmography (SMD 0.59, 95% CI 0.06-1.13, p = 0.03) and centrally in the coronary circulation by infusion of acetylcholine (SMD 1.58, 95% CI 0.31-2.84, p = 0.01). Significant heterogeneity observed across studies was explained in part by the type of endothelial function measurement, statin type and dose, and study population differences. Exclusion of outlier studies did not significantly alter the results.
Statin therapy is associated with significant improvement in both peripheral and coronary endothelial function. The current study supports a role for statin therapy in patients with endothelial dysfunction.
本研究旨在量化他汀类药物对已患心血管疾病和未患心血管疾病患者外周及冠状动脉内皮功能的影响。
早期动脉粥样硬化的特征是内皮功能障碍，这是心血管疾病的一个已知预后因素。
检索MEDLINE、Cochrane图书馆、Scopus和EMBASE以识别截至2009年12月1日的研究。符合条件的研究为关于他汀类药物与安慰剂对内皮功能影响的随机对照试验。两名评审员提取了关于研究特征、方法和结果的数据。46项符合条件的试验共纳入2706例患者：866例（32%）为女性，432例（16%）已患心血管疾病。采用随机效应模型进行的荟萃分析显示，他汀类药物治疗显著改善了内皮功能[标准化均数差（SMD）0.66，95%可信区间0.46 - 0.85，p < 0.001]。亚组分析表明，通过血流介导的扩张在外周评估的内皮功能有统计学显著改善（SMD 0.68，95%可信区间0.46 - 0.90，p < 0.001），通过静脉阻塞体积描记法评估也有改善（SMD 0.59，95%可信区间0.06 - 1.13，p = 0.03），在冠状动脉循环中通过输注乙酰胆碱进行中心评估同样有改善（SMD 1.58，95%可信区间0.31 - 2.84，p = 0.01）。各研究中观察到的显著异质性部分可由内皮功能测量类型、他汀类药物类型和剂量以及研究人群差异来解释。排除异常值研究并未显著改变结果。
他汀类药物治疗与外周及冠状动脉内皮功能的显著改善相关。本研究支持他汀类药物治疗在内皮功能障碍患者中的作用。
