Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands.
J Am Coll Cardiol. 2014 Aug 5;64(5):485-94. doi: 10.1016/j.jacc.2014.02.615.
BACKGROUND: Levels of atherogenic lipoproteins achieved with statin therapy are highly variable, but the consequence of this variability for cardiovascular disease risk is not well-documented. OBJECTIVES: The aim of this meta-analysis was to evaluate: 1) the interindividual variability of reductions in low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), or apolipoprotein B (apoB) levels achieved with statin therapy; 2) the proportion of patients not reaching guideline-recommended lipid levels on high-dose statin therapy; and 3) the association between very low levels of atherogenic lipoproteins achieved with statin therapy and cardiovascular disease risk. METHODS: This meta-analysis used individual patient data from 8 randomized controlled statin trials, in which conventional lipids and apolipoproteins were determined in all study participants at baseline and at 1-year follow-up. RESULTS: Among 38,153 patients allocated to statin therapy, a total of 6,286 major cardiovascular events occurred in 5,387 study participants during follow-up. There was large interindividual variability in the reductions of LDL-C, non-HDL-C, and apoB achieved with a fixed statin dose. More than 40% of trial participants assigned to high-dose statin therapy did not reach an LDL-C target <70 mg/dl. Compared with patients who achieved an LDL-C >175 mg/dl, those who reached an LDL-C 75 to <100 mg/dl, 50 to <75 mg/dl, and <50 mg/dl had adjusted hazard ratios for major cardiovascular events of 0.56 (95% confidence interval [CI]: 0.46 to 0.67), 0.51 (95% CI: 0.42 to 0.62), and 0.44 (95% CI: 0.35 to 0.55), respectively. Similar associations were observed for non-HDL-C and apoB. CONCLUSIONS: The reductions of LDL-C, non-HDL-C, and apoB levels achieved with statin therapy displayed large interindividual variation. Among trial participants treated with high-dose statin therapy, >40% did not reach an LDL-C target <70 mg/dl. Patients who achieve very low LDL-C levels have a lower risk for major cardiovascular events than do those achieving moderately low levels.
背景：他汀类药物治疗所达到的致动脉粥样硬化脂蛋白水平存在高度变异性，但这种变异性对心血管疾病风险的影响尚未得到充分记录。
目的：本荟萃分析旨在评估：1）他汀类药物治疗降低低密度脂蛋白胆固醇（LDL-C）、非高密度脂蛋白胆固醇（non-HDL-C）或载脂蛋白 B（apoB）水平的个体间变异性；2）接受高剂量他汀类药物治疗的患者中未达到指南推荐血脂水平的比例；3）他汀类药物治疗后致动脉粥样硬化脂蛋白水平极低与心血管疾病风险之间的关联。
方法：本荟萃分析使用了 8 项随机对照他汀类药物试验的个体患者数据，其中所有研究参与者在基线和 1 年随访时均检测了常规血脂和载脂蛋白。
结果：在接受他汀类药物治疗的 38153 名患者中，共有 5387 名研究参与者在随访期间发生了 6286 例主要心血管事件。固定他汀类药物剂量下 LDL-C、non-HDL-C 和 apoB 的降低存在很大的个体间变异性。超过 40%的接受高剂量他汀类药物治疗的试验参与者未达到 LDL-C 目标<70mg/dl。与 LDL-C>175mg/dl 的患者相比，LDL-C 达到 75-<100mg/dl、50-<75mg/dl 和<50mg/dl 的患者发生主要心血管事件的调整风险比分别为 0.56（95%置信区间：0.46 至 0.67）、0.51（95%置信区间：0.42 至 0.62）和 0.44（95%置信区间：0.35 至 0.55）。类似的关联也见于 non-HDL-C 和 apoB。
结论：他汀类药物治疗降低 LDL-C、non-HDL-C 和 apoB 水平的幅度存在很大的个体间差异。在接受高剂量他汀类药物治疗的试验参与者中，超过 40%的患者未达到 LDL-C 目标<70mg/dl。与达到中等低水平的患者相比，LDL-C 水平极低的患者发生主要心血管事件的风险更低。
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