Ursoniu Sorin, Mikhailidis Dimitri P, Serban Maria-Corina, Penson Peter, Toth Peter P, Ridker Paul M, Ray Kausik K, Kees Hovingh G, Kastelein John J, Hernandez Adrian V, Manson JoAnn E, Rysz Jacek, Banach Maciej
Department of Functional Sciences, Discipline of Public Health, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
Department of Clinical Biochemistry, Royal Free Campus, University College London Medical School, University College London (UCL), London, UK.
Pharmacol Res. 2017 Aug;122:105-117. doi: 10.1016/j.phrs.2017.06.002. Epub 2017 Jun 9.
Smoking is an important risk factor for cardiovascular disease (CVD) morbidity and mortality. The impact of statin therapy on CVD risk by smoking status has not been fully investigated. Therefore we assessed the impact of statin therapy on CVD outcomes by smoking status through a systematic review of the literature and meta-analysis of available randomized controlled trials (RCTs). The literature search included EMBASE, ProQuest, CINAHL and PUBMED databases to 30 January 2016 to identify RCTs that investigated the effect of statin therapy on cumulative incidence of major CVD endpoints (e.g. non-fatal myocardial infarction, revascularization, unstable angina, and stroke). Relative risks (RR) ratios were calculated from the number of events in different treatment groups for both smokers and non-smokers. Finally 11 trials with 89,604 individuals were included. The number of smokers and non-smokers in the statin groups of the analyzed studies was 8826 and 36,090, respectively. The RR for major CV events was 0.73 (95% confidence interval [CI]: 0.67-0.81; p<0.001) in nonsmokers and 0.72 (95%CI: 0.64-0.81; p<0.001) in smokers. Moderate to high heterogeneity was observed both in non-smokers (I=77.1%, p<0.001) and in smokers (I=51.6%, p=0.024) groups. Smokers seemed to benefit slightly more from statins than non-smokers according to the number needed to treat (NNT) analysis (23.5 vs 26.8) based on RRs applied to the control event rates. The number of avoided events per 1000 individuals was 42.5 (95%CI: 28.9-54.6) in smokers and 37.3 (95%CI: 27.2-46.4) in non-smokers. In conclusion, this meta-analysis suggests that the effect of statins on CVD is similar for smokers and non-smokers, but in terms of NNTs and number of avoided events, smokers seem to benefit more although non-significantly.
吸烟是心血管疾病（CVD）发病和死亡的重要风险因素。他汀类药物治疗对不同吸烟状态人群CVD风险的影响尚未得到充分研究。因此，我们通过系统检索文献并对现有随机对照试验（RCT）进行荟萃分析，评估了他汀类药物治疗对不同吸烟状态人群CVD结局的影响。文献检索涵盖了截至2016年1月30日的EMBASE、ProQuest、CINAHL和PUBMED数据库，以确定研究他汀类药物治疗对主要CVD终点（如非致命性心肌梗死、血管重建、不稳定型心绞痛和中风）累积发生率影响的RCT。根据吸烟者和非吸烟者不同治疗组中的事件数计算相对风险（RR）比值。最终纳入了11项试验，共89,604名个体。分析研究中他汀类药物组的吸烟者和非吸烟者人数分别为8826人和36,090人。非吸烟者主要心血管事件的RR为0.73（95%置信区间[CI]：0.67 - 0.81；p<0.001），吸烟者为0.72（95%CI：0.64 - 0.81；p<0.001）。在非吸烟者组（I = 77.1%，p<0.001）和吸烟者组（I = 51.6%，p = 0.024）中均观察到中度至高度的异质性。根据基于应用于对照事件率的RR进行的需治疗人数（NNT）分析（23.5对26.8），吸烟者似乎比非吸烟者从他汀类药物中获益稍多。每1000名个体中避免的事件数在吸烟者中为42.5（CI：28.9 - 54.6），在非吸烟者中为37.3（CI：27.2 - 46.4）。总之，这项荟萃分析表明，他汀类药物对吸烟者和非吸烟者的CVD影响相似，但就NNT和避免的事件数而言，吸烟者似乎获益更多，尽管差异不显著。
