Soran Handrean, Schofield Jonathan D, Durrington Paul N
aCardiovascular Research Group, School of Biomedicine, University of Manchester, bCardiovascular Trials Unit, University Department of Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
Curr Opin Lipidol. 2014 Aug;25(4):239-46. doi: 10.1097/MOL.0000000000000097.
Guidelines seeking to deploy statin treatment rely heavily on the use of estimates of absolute cardiovascular disease (CVD) risk as an arbiter of who should receive statins. We question whether this is an effective strategy unless the LDL-cholesterol (LDL-C) response is also considered.
Recently, meta-analyses of randomized clinical trials of statins have revealed that CVD risk decreases linearly by 22% for each 1 mmol/l reduction in LDL-C. Calculation of the number needed to treat with statins to prevent one CVD event using both the pretreatment absolute CVD risk and the LDL-C response that can be achieved is thus possible. Application of this evidence reveals that many people (including younger ones) with high LDL-C levels can benefit more than people currently receiving statin treatment solely on the basis of their absolute CVD risk, whereas others at higher CVD risk, but with lower LDL-C, will derive little benefit. This does not seem to have been adequately considered in recent clinical guidelines.
A simple additional mathematical step in risk assessment to take account of the LDL-C response to statins and provide knowledge of number needed to treat would greatly improve individual management, cost-effectiveness and the population impact of statins.
旨在指导他汀类药物治疗的指南严重依赖绝对心血管疾病（CVD）风险估计值，以此作为判断谁应接受他汀类药物治疗的依据。我们质疑，除非同时考虑低密度脂蛋白胆固醇（LDL-C）反应，否则这是否是一种有效的策略。
最近，他汀类药物随机临床试验的荟萃分析表明，LDL-C每降低1 mmol/L，CVD风险线性降低22%。因此，可以使用治疗前的绝对CVD风险和可实现的LDL-C反应来计算预防1例CVD事件所需的他汀类药物治疗人数。这一证据的应用表明，许多LDL-C水平高的人（包括年轻人）可能比目前仅根据其绝对CVD风险接受他汀类药物治疗的人受益更多，而其他CVD风险较高但LDL-C较低的人获益甚微。这一点在最近的临床指南中似乎没有得到充分考虑。
在风险评估中增加一个简单的数学步骤，以考虑LDL-C对他汀类药物的反应，并提供所需治疗人数的信息，将大大改善他汀类药物的个体化管理、成本效益及对人群的影响。
Zotero 插件