Shin Jaewon, Chung Jong-Won, Jang Hyun-Soon, Lee Juneyoung, Hong Keun-Sik, Bang Oh Young, Kim Gyeong-Moon, Seo Woo-Keun
Department of Neurology, Sungkyunkwan University School of Medicine, Republic of Korea.
Department of Biostatistics, Korea University College of Medicine, Republic of Korea.
Eur J Prev Cardiol. 2021 Jul 23;28(8):905-916. doi: 10.1177/2047487319830503.
Lowering the low-density lipoprotein cholesterol level reduces the risk of stroke, but it has not been clear whether the stroke risk would continuously decrease by lowering low-density lipoprotein cholesterol to a very low level. The purpose of this study was to evaluate the association between achieved low-density lipoprotein cholesterol levels and stroke risk.
A systematic search of MEDLINE, EMBASE and Cochrane Library databases was conducted to identify randomised controlled trials that tested cholesterol-lowering pharmacological therapies and reported both achieved low-density lipoprotein cholesterol levels and stroke outcomes. A meta-regression analysis was conducted to assess the linear association between the achieved low-density lipoprotein cholesterol levels and stroke risk. In addition, we evaluated pooled estimates of low-density lipoprotein cholesterol-lowering effect stratified by achieved low-density lipoprotein cholesterol levels of active arms. A total of 222,149 participants in 23 trials (52 arms of 26 studies) were included. The meta-regression analysis showed that each 1 mmol/L decrease in the achieved low-density lipoprotein cholesterol level (down to 0.78 mmol/L) was associated with a significant reduction of 23.5% (slope 0.235, 95% confidence interval 0.007-0.464, P = 0.044) in stroke risk. Irrespective of achieved low-density lipoprotein cholesterol levels in the active arms, the effects of lowering the low-density lipoprotein cholesterol level on stroke risk were significant and consistent (test for subgroup difference, P = 0.23, I2 = 31%). However, there was no significant increase in haemorrhagic stroke risk with lower achieved low-density lipoprotein cholesterol levels.
In this meta-analysis of randomised controlled trials, the stroke risk monotonically reduced with lowering of low-density lipoprotein cholesterol to very low levels.
降低低密度脂蛋白胆固醇水平可降低中风风险，但将低密度脂蛋白胆固醇降至极低水平时中风风险是否会持续降低尚不清楚。本研究旨在评估所达到的低密度脂蛋白胆固醇水平与中风风险之间的关联。
对MEDLINE、EMBASE和Cochrane图书馆数据库进行系统检索，以识别测试降胆固醇药物治疗并报告所达到的低密度脂蛋白胆固醇水平和中风结局的随机对照试验。进行荟萃回归分析以评估所达到的低密度脂蛋白胆固醇水平与中风风险之间的线性关联。此外，我们评估了按活性组所达到的低密度脂蛋白胆固醇水平分层的低密度脂蛋白胆固醇降低效果的汇总估计值。共纳入23项试验（26项研究的52个组）中的222,149名参与者。荟萃回归分析表明，所达到的低密度脂蛋白胆固醇水平每降低1 mmol/L（降至0.78 mmol/L），中风风险显著降低23.5%（斜率0.235，95%置信区间0.007 - 0.464，P = 0.044）。无论活性组中所达到的低密度脂蛋白胆固醇水平如何
，降低低密度脂蛋白胆固醇水平对中风风险的影响均显著且一致（亚组差异检验，P = 0.23，I² = 31%）。然而，所达到的低密度脂蛋白胆固醇水平较低时，出血性中风风险没有显著增加。
在这项随机对照试验的荟萃分析中，随着低密度脂蛋白胆固醇降至极低水平，中风风险单调降低。
