Tang Xuejiao, Yang Yuan, Luo Suxin, Zhao Yue, Lu Chunyan, Luo Yongbai, Zhang Fan, Xiao Hua
aDepartment of Cardiology, the First Affiliated Hospital of Chongqing Medical University bSchool of Public Health and Health Management, Chongqing Medical University, Chongqing cDepartment of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province dDepartment of Cardiology, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shanxi Province, China.
Coron Artery Dis. 2016 Dec;27(8):636-649. doi: 10.1097/MCA.0000000000000403.
To investigate the effect of statins on plaque regression after acute coronary syndrome (ACS).
We carried out a meta-analysis to assess the change in plaque and plaque components in patients with ACS under statin therapy. This meta-analysis combined data of 1623 participants from eight randomized-controlled trials and seven observational studies.
The benefits of high-intensity statin therapy on plaque regression occurred after 6 months [standardized mean difference (SMD): -0.27; 95% confidence interval (CI): -0.43 to -0.12; P=0.0006] and were sustained over 12 months (SMD: -0.14; 95% CI: -0.25 to -0.03; P=0.01). No significant decrease was observed in the plaque volume and percent plaque volume under low-dose statin treatment. After 6 months of intensive statin treatment, the plaque volume reduced significantly in patients whose follow-up LDL cholesterol levels did (SMD: -0.16; 95% CI: -0.29 to -0.03; P=0.02) or did not (SMD: -0.21; 95% CI: -0.32 to -0.09; P=0.0007) decrease to 70 mg/dl or less. There was no significant change in plaque composition volumes, but an increase was found in the percent dense calcium volume of 1.31% (95% CI: 0.55-2.07%; P=0.0007).
Intensive statin therapy duration over 6 months may be as important as achieved LDL-C of less than or equal to 70 mg/dl in plaque regression following ACS. Intensive statin treatment may lead to an earlier regression compared with low-dose statin therapy.
探讨他汀类药物对急性冠状动脉综合征（ACS）后斑块消退的影响。
我们进行了一项荟萃分析，以评估接受他汀类药物治疗的ACS患者斑块及斑块成分的变化。该荟萃分析合并了来自8项随机对照试验和7项观察性研究的1623名参与者的数据。
高强度他汀类药物治疗对斑块消退的益处出现在6个月后[标准化均数差（SMD）：-0.27；95%置信区间（CI）：-0.43至-0.12；P = 0.0006]，并在12个月内持续存在（SMD：-0.14；95% CI：-0.25至-0.03；P = 0.01）。低剂量他汀类药物治疗下，未观察到斑块体积和斑块体积百分比有显著下降。强化他汀类药物治疗6个月后，随访时低密度脂蛋白胆固醇水平下降至70mg/dl及以下（SMD：-0.16；95% CI：-0.29至-0.03；P = 0.02）或未下降至70mg/dl及以下（SMD：-0.21；95% CI：-0.32至-0.09；P = 0.0007）的患者，其斑块体积均显著减小。斑块组成体积无显著变化，但致密钙体积百分比增加了1.31%（95% CI：0.55 - 2.07%；P = 0.0007）。
在ACS后的斑块消退中，强化他汀类药物治疗持续6个月以上可能与将低密度脂蛋白胆固醇（LDL-C）降至小于或等于70mg/dl同样重要。与低剂量他汀类药物治疗相比，强化他汀类药物治疗可能导致更早的斑块消退。
