Masson Walter, Lobo Martín, Siniawski Daniel, Molinero Graciela, Huerín Melina, Nogueira Juan Patricio
Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, C1115AAD, Buenos Aires, Argentina.
Argentine Society of Lipids, Ambrosio Olmos 820, X5000JGQ, Córdoba, Argentina.
High Blood Press Cardiovasc Prev. 2019 Aug;26(4):263-272. doi: 10.1007/s40292-019-00330-8. Epub 2019 Jul 16.
Previous report showed that more intensive lipid-lowering therapy was associated with less mortality when baseline LDL-C levels were > 100 mg/dL. Non-HDL-C is a better predictor of cardiovascular risk than simpler LDL-C.
The objective of this meta-analysis was to define the impact of lipid-lowering therapy on the reduction of total and cardiovascular mortality by different baseline levels of non-HDL-C.
We performed a meta-analysis including randomized, controlled clinical trials of lipid-lowering therapy, reporting mortality with a minimum of 6 months of follow-up, searching in PubMed/Medline, EMBASE and Cochrane Clinical Trials databases. The random-effects model and meta-regression were performed.
Twenty nine trials of lipid-lowering drugs, including 233,027 patients, were considered eligible for the analyses. According to the baseline non-HDL-C level, the results on cardiovascular mortality were: (1) ≥ 190 mg/dL: OR 0.63 (95% CI 0.53-0.76); (2) 160-189 mg/dL: OR 0.82 (95% CI 0.75-0.89); (3) 130-159 mg/dL: OR 0.71 (95% CI 0.52-0.98); (4) < 130 mg/dL: OR 0.95 (95% CI 0.87-1.05). When evaluating mortality from any cause, the results were the following: (1) ≥ 190 mg/dL: OR 0.70 (95% CI 0.61-0.82); (2) 160-189 mg/dL: OR 0.91 (95% CI 0.83-0.98); (3) 130-159 mg/dL; OR 0.88 (95% CI 0.77-1.00); (4) < 130 mg/dL: OR 0.98 (95% CI 0.91-1.06). The meta-regression analysis showed a significant association between baseline non-HDL-C and mortality.
In these meta-analyses, lipid-lowering therapy was associated with reduction in the risk of all-cause and cardiovascular mortality when baseline non-HDL-C levels were above than 130 mg/dL.
先前的报告显示，当基线低密度脂蛋白胆固醇（LDL-C）水平>100mg/dL时，强化降脂治疗与较低的死亡率相关。非高密度脂蛋白胆固醇（Non-HDL-C）比单纯的LDL-C更能预测心血管风险。
本荟萃分析的目的是确定不同基线Non-HDL-C水平下，降脂治疗对降低总死亡率和心血管死亡率的影响。
我们进行了一项荟萃分析，纳入降脂治疗的随机对照临床试验，报告至少随访6个月的死亡率，检索PubMed/Medline、EMBASE和Cochrane临床试验数据库。采用随机效应模型和荟萃回归分析。
29项降脂药物试验，包括233,027例患者，被认为符合分析条件。根据基线Non-HDL-C水平，心血管死亡率结果如下：（1）≥190mg/dL：比值比（OR）0.63（95%置信区间[CI]0.53 - 0.76）；（2）160 - 189mg/dL：OR 0.82（95%CI 0.75 - 0.89）；（3）130 - 159mg/dL：OR 0.71（95%CI 0.52 - 0.98）；（4）<130mg/dL：OR 0.95（95%CI 0.87 - 1.05）。评估任何原因导致的死亡率时，结果如下：（1）≥190mg/dL：OR 0.70（95%CI 0.61 - 0.82）；（2）160 - 189mg/dL：OR 0.91（95%CI 0.83 - 0.98）；（3）130 - 159mg/dL：OR 0.88（95%CI 0.77 - 1.00）；（4）<130mg/dL：OR 0.98（95%CI 0.91 - 1.06）。荟萃回归分析显示基线Non-HDL-C与死亡率之间存在显著关联。
在这些荟萃分析中，当基线Non-HDL-C水平高于130mg/dL时，降脂治疗与全因死亡率和心血管死亡率风险降低相关。
