Takagi Hisato, Niwa Masao, Mizuno Yusuke, Yamamoto Hirotaka, Goto Shin-nosuke, Umemoto Takuya
Department of Cardiovascular Surgery, Shizuoka Medical Center, 762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611, Japan,
Heart Vessels. 2014 May;29(3):287-99. doi: 10.1007/s00380-013-0358-6. Epub 2013 May 5.
In addition to their high-intensity effects on the reduction in low-density lipoprotein (LDL) levels, rosuvastatin and atorvastatin would be expected to also reduce small dense LDL (sdLDL) levels. To determine which reduces sdLDL levels more, we performed the first meta-analysis and meta-regression of randomized head-to-head trials of rosuvastatin versus atorvastatin therapy. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched through April 2012. Eligible studies were prospective, randomized controlled trials of rosuvastatin versus atorvastatin therapy reporting final sdLDL (directly measured or calculated) levels as an outcome. For each study, data regarding final sdLDL levels in both the rosuvastatin and atorvastatin groups were used to generate mean differences (MD) and 95 % confidence intervals (CI). Meta-regression analysis was performed to determine whether the effects of rosuvastatin therapy were modulated by the prespecified factors. Of 159 potentially relevant articles screened initially, 28 reports of randomized trials enrolling a total of 7802 patients were included. Pooled analysis suggested a significant reduction in final sdLDL levels among patients randomized to rosuvastatin versus atorvastatin therapy (MD, -1.56 mg/dl; 95 % CI, -2.30 to -0.83 mg/dl; P < 0.0001). The meta-regression coefficients were statistically significant for the baseline LDL/sdLDL level and the difference in LDL changes between the two groups. In conclusion, rosuvastatin rather than atorvastatin therapy is likely more effective in reduction of sdLDL levels. It should be further investigated whether the reduction in sdLDL levels implies overt clinical benefits of rosuvastatin over atorvastatin.
除了对降低低密度脂蛋白（LDL）水平有高强度作用外，瑞舒伐他汀和阿托伐他汀预计还能降低小而密低密度脂蛋白（sdLDL）水平。为了确定哪种药物降低sdLDL水平的效果更佳，我们对瑞舒伐他汀与阿托伐他汀治疗的随机头对头试验进行了首次荟萃分析和荟萃回归分析。检索了截至2012年4月的MEDLINE、EMBASE和Cochrane对照试验中央注册库。符合条件的研究为瑞舒伐他汀与阿托伐他汀治疗的前瞻性随机对照试验，将最终sdLDL（直接测量或计算得出）水平作为一项结果指标。对于每项研究，使用瑞舒伐他汀组和阿托伐他汀组的最终sdLDL水平数据来生成平均差值（MD）和95%置信区间（CI）。进行荟萃回归分析以确定瑞舒伐他汀治疗的效果是否受到预先设定因素的调节。在最初筛选的159篇可能相关的文章中，纳入了28篇随机试验报告，共涉及7802例患者。汇总分析表明，随机接受瑞舒伐他汀治疗的患者与接受阿托伐他汀治疗的患者相比，最终sdLDL水平显著降低（MD，-1.56mg/dl；95%CI，-2.30至-0.83mg/dl；P<0.0001）。基线LDL/sdLDL水平以及两组间LDL变化差异的荟萃回归系数具有统计学意义。总之，瑞舒伐他汀治疗而非阿托伐他汀治疗可能在降低sdLDL水平方面更有效。瑞舒伐他汀降低sdLDL水平是否意味着其相对于阿托伐他汀具有明显的临床益处，有待进一步研究。
