Stroke Center and Department of Neurology, Geffen School of Medicine, University of California, Los Angeles, USA.
Atherosclerosis. 2011 Aug;217(2):492-8. doi: 10.1016/j.atherosclerosis.2011.04.020. Epub 2011 Apr 27.
Recent data suggest that non-targeted treatment with fibrates modestly reduces the risk of incident cardiovascular events. However the effect of fibrate treatment may be particularly beneficial in patients with guideline-endorsed indications for therapy due to evidence of atherogenic dyslipidemia. We conducted a systematic review and meta-analysis to investigate the influence of fibrates on vascular risk reduction in persons with atherogenic dyslipidemia.
Systematic search of Pubmed, CENTRAL and recent reviews was conducted to identify atherogenic dyslipidemia (serum high density lipoprotein cholesterol [HDL-C]<40 mg/dl or triglycerides >200 mg/dl) cohorts from randomized controlled trials. RR with 95% CI was used as a measure of the association between fibrate therapy and risk of cardiovascular diseases, after pooling data across trials in a random-effects model.
Six trials met selection criteria. Compared to placebo, the greatest benefit with fibrate treatment was seen in 7389 subjects with high triglycerides, fibrate therapy reduced risk of vascular events (RR 0.75, 95% CI 0.65 to 0.86, P<0.001); and in 5068 subjects with both high triglycerides and low HDL-C (RR 0.71, 95% CI 0.62 to 0.82, P<0.001). Less benefit was noted in 15,303 subjects selected for low HDL-C (RR 0.84, 95% CI 0.77 to 0.91, P<0.001). Among 9872 subjects with neither high triglycerides nor low HDL-C, fibrate therapy did not reduce subsequent vascular events (RR 0.96, 95% CI 0.85 to 1.09, P=0.53).
Fibrate treatment directed at markers of atherogenic dyslipidemia substantially reduce subsequent vascular event risk.
最近的数据表明，非靶向性使用贝特类药物可适度降低心血管事件的发生风险。然而，由于存在动脉粥样硬化性血脂异常的证据，贝特类药物治疗可能对有指南推荐治疗指征的患者特别有益。我们进行了一项系统评价和荟萃分析，以研究贝特类药物对动脉粥样硬化性血脂异常患者血管风险降低的影响。
系统检索了 Pubmed、CENTRAL 和最近的综述，以确定来自随机对照试验的动脉粥样硬化性血脂异常（血清高密度脂蛋白胆固醇 [HDL-C] <40mg/dl 或甘油三酯 >200mg/dl）队列。使用 RR 和 95%CI 作为衡量贝特类药物治疗与心血管疾病风险之间关联的指标，在随机效应模型中对试验间的数据进行了汇总。
六项试验符合入选标准。与安慰剂相比，在 7389 名高甘油三酯患者中，贝特类药物治疗的获益最大，血管事件风险降低（RR 0.75，95%CI 0.65 至 0.86，P<0.001）；在 5068 名同时存在高甘油三酯和低 HDL-C 的患者中（RR 0.71，95%CI 0.62 至 0.82，P<0.001）。在 15303 名因低 HDL-C 而入选的患者中，获益较少（RR 0.84，95%CI 0.77 至 0.91，P<0.001）。在 9872 名既无高甘油三酯也无低 HDL-C 的患者中，贝特类药物治疗并未降低随后的血管事件（RR 0.96，95%CI 0.85 至 1.09，P=0.53）。
针对动脉粥样硬化性血脂异常标志物的贝特类药物治疗可显著降低随后的血管事件风险。
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