Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
JAMA. 2012 Mar 28;307(12):1302-9. doi: 10.1001/jama.2012.366.
The associations of low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), and apolipoprotein B (apoB) levels with the risk of cardiovascular events among patients treated with statin therapy have not been reliably documented.
To evaluate the relative strength of the associations of LDL-C, non-HDL-C, and apoB with cardiovascular risk among patients treated with statin therapy.
Meta-analysis of individual patient data from randomized controlled statin trials in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up.
Relevant trials were identified by a literature search updated through December 31, 2011. Investigators were contacted and individual patient data were requested and obtained for 62,154 patients enrolled in 8 trials published between 1994 and 2008.
Hazard ratios (HRs) and corresponding 95% CIs for risk of major cardiovascular events adjusted for established risk factors by 1-SD increase in LDL-C, non-HDL-C, and apoB.
Among 38,153 patients allocated to statin therapy, 158 fatal myocardial infarctions, 1678 nonfatal myocardial infarctions, 615 fatal events from other coronary artery disease, 2806 hospitalizations for unstable angina, and 1029 fatal or nonfatal strokes occurred during follow-up. The adjusted HRs for major cardiovascular events per 1-SD increase were 1.13 (95% CI, 1.10-1.17) for LDL-C, 1.16 (95% CI, 1.12-1.19) for non-HDL-C, and 1.14 (95% CI, 1.11-1.18) for apoB. These HRs were significantly higher for non-HDL-C than LDL-C (P = .002) and apoB (P = .02). There was no significant difference between apoB and LDL-C (P = .21).
Among statin-treated patients, on-treatment levels of LDL-C, non-HDL-C, and apoB were each associated with risk of future major cardiovascular events, but the strength of this association was greater for non-HDL-C than for LDL-C and apoB.
在接受他汀类药物治疗的患者中，低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）和载脂蛋白 B（apoB）水平与心血管事件风险的关联尚未得到可靠证实。
评估在接受他汀类药物治疗的患者中，LDL-C、non-HDL-C 和 apoB 与心血管风险的关联相对强度。
对 8 项于 1994 年至 2008 年发表的随机对照他汀类药物试验的个体患者数据进行荟萃分析，所有研究参与者在基线和 1 年随访时均测定常规血脂和载脂蛋白。
通过文献检索确定相关试验，检索截至 2011 年 12 月 31 日进行更新。与研究者联系并要求获取已发表的 8 项试验中的 62154 例患者的个体患者数据，这些试验于 1994 年至 2008 年发表。
通过 1-SD 增加 LDL-C、non-HDL-C 和 apoB 调整既定危险因素后，评估他汀类药物治疗患者主要心血管事件风险的风险比（HR）和相应的 95%可信区间。
在 38153 例接受他汀类药物治疗的患者中，随访期间发生 158 例致死性心肌梗死、1678 例非致死性心肌梗死、615 例其他冠状动脉疾病致死事件、2806 例不稳定型心绞痛住院、1029 例致死或非致死性卒中。每增加 1-SD，主要心血管事件的调整 HR 分别为 LDL-C 1.13（95%可信区间，1.10-1.17）、non-HDL-C 1.16（95%可信区间，1.12-1.19）和 apoB 1.14（95%可信区间，1.11-1.18）。non-HDL-C 与 LDL-C（P =.002）和 apoB（P =.02）的 HR 显著高于 LDL-C，而 apoB 与 LDL-C 之间的差异无统计学意义（P =.21）。
在接受他汀类药物治疗的患者中，治疗期间的 LDL-C、non-HDL-C 和 apoB 水平均与未来主要心血管事件的风险相关，但与 LDL-C 和 apoB 相比，non-HDL-C 与该风险的关联更强。
