Key Laboratories of Education Ministry for Myocardial Ischemia, Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin 150086, PR China.
BMC Cardiovasc Disord. 2012 Sep 1;12:70. doi: 10.1186/1471-2261-12-70.
An increasing number of authors employing intravascular ultrasound (IVUS) and virtual histology (VH-IVUS) have investigated the effect of statin use on plaque volume (PV) and plaque composition. However, inconsistent results have been reported. Therefore, we conducted a meta-analysis to determine the appropriate regimen of statins to effectively stabilize vulnerable coronary plaques.
Online electronic databases were carefully searched for all relevant studies. We compared mean values of PV and plaque composition between baseline and follow-up in patients receiving statin therapy. We pooled treatment effects and calculated mean differences (MD) with the 95% confidence interval (CI) using a random-effects model. By stratified analyses, we explored the influence of clinical presentation, dose and duration of statin treatment, and low-density lipoprotein-cholesterol (LDL-C) levels on the effects of statins.
Seventeen studies involving 2,171 patients were analyzed. Statin therapy significantly decreased PV (-5.3 mm(3); 95% CI: -3.3 mm(3) to -7.2 mm(3) P < 0.001), without heterogeneity. When considering the dose and duration of statins used, only subgroups employing a high dose and long duration demonstrated a significant reduction in PV (p < 0.001). A significant decrease in PV was noted if achieved LDL-C levels were <100 mg/dL (p < 0.001). Statin treatment could induce a twofold decrease in PV in patients with acute coronary syndrome (ACS) compared with that observed in patients with stable angina pectoris (SAP). A regressive trend was seen for necrotic core volume (MD: -2.1 mm(3); 95% CI: -4.7 mm(3) to 0.5 mm(3), P = 0.11). However, statin use did not induce a significant change for fibrotic, fibro-fatty, or dense calcium compositions.
Our meta-analysis demonstrated that statin therapy (especially that involving a high dose and long duration and achieving <100 mg/dL LDL-C levels) can significantly decrease PV in patients with SAP or ACS. These data suggested that statins can be used to reduce the atheroma burden for secondary prevention by appropriately selecting the statin regimen. No significant change in plaque composition was seen after statin therapy.
越来越多的作者采用血管内超声（IVUS）和虚拟组织学（VH-IVUS）来研究他汀类药物对斑块体积（PV）和斑块成分的影响。然而，报告的结果并不一致。因此，我们进行了一项荟萃分析，以确定适当的他汀类药物治疗方案，有效稳定易损冠状动脉斑块。
仔细在线检索电子数据库中的所有相关研究。我们比较了接受他汀类药物治疗的患者在基线和随访时的 PV 和斑块成分的平均值。我们使用随机效应模型比较治疗效果，并计算平均值差异（MD）及其 95%置信区间（CI）。通过分层分析，我们探讨了临床表型、他汀类药物治疗的剂量和时间以及低密度脂蛋白胆固醇（LDL-C）水平对他汀类药物作用的影响。
共分析了 17 项涉及 2171 例患者的研究。他汀类药物治疗可显著降低 PV（-5.3mm³；95%CI：-3.3mm³至-7.2mm³，P<0.001），且无异质性。考虑到他汀类药物的剂量和时间，仅使用高剂量和长时间的亚组可显著降低 PV（p<0.001）。如果 LDL-C 水平<100mg/dL，可观察到 PV 显著降低（p<0.001）。与稳定型心绞痛（SAP）患者相比，急性冠状动脉综合征（ACS）患者接受他汀类药物治疗后，PV 可降低两倍。坏死核心体积呈下降趋势（MD：-2.1mm³；95%CI：-4.7mm³至 0.5mm³，P=0.11）。然而，他汀类药物治疗不会显著改变纤维、纤维脂肪或致密钙成分。
我们的荟萃分析表明，他汀类药物治疗（尤其是高剂量、长时间治疗，且 LDL-C 水平<100mg/dL）可显著降低 SAP 或 ACS 患者的 PV。这些数据表明，通过适当选择他汀类药物治疗方案，他汀类药物可用于减少动脉粥样硬化斑块负担，进行二级预防。他汀类药物治疗后，斑块成分无明显变化。
