Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA
Internal Medicine, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
BMJ Open. 2019 Dec 15;9(12):e028638. doi: 10.1136/bmjopen-2018-028638.
To examine the effect of HLP, defined as having a pre-existing or a new in-hospital diagnosis based on low density lipoprotein cholesterol (LDL-C) level ≥100 mg/dL during index hospitalisation or within the preceding 6 months, on all-cause mortality after hospitalisation for acute myocardial infarction (AMI) or acute decompensated heart failure (ADHF) and to determine whether HLP modifies mortality associations of other competing comorbidities. A systematic review and meta-analysis to place the current findings in the context of published literature.
Retrospective study, 1:1 propensity-score matching cohorts; a meta-analysis.
Large academic centre, 1996-2015.
Hospitalised patients with AMI or ADHF.
All-cause mortality and meta-analysis of relative risks (RR).
Unmatched cohorts: 13 680 patients with AMI (age (mean) 68.5 ± (SD) 13.7 years; 7894 (58%) with HLP) and 9717 patients with ADHF (age, 73.1±13.7 years; 3668 (38%) with HLP). In matched cohorts, the mortality was lower in AMI patients (n=4348 pairs) with HLP versus no HLP, 5.9 versus 8.6/100 person-years of follow-up, respectively (HR 0.76, 95% CI 0.72 to 0.80). A similar mortality reduction occurred in matched ADHF patients (n=2879 pairs) with or without HLP (12.4 vs 16.3 deaths/100 person-years; HR 0.80, 95% CI 0.75 to 0.86). HRs showed modest reductions when HLP occurred concurrently with other comorbidities. Meta-analyses of nine observational studies showed that HLP was associated with a lower mortality at ≥2 years after incident AMI or ADHF (AMI: RR 0.72, 95% CI 0.69 to 0.76; heart failure (HF): RR 0.67, 95% CI 0.55 to 0.81).
Among matched AMI and ADHF cohorts, concurrent HLP, compared with no HLP, was associated with a lower mortality and attenuation of mortality associations with other competing comorbidities. These findings were supported by a systematic review and meta-analysis.
探讨高脂蛋白血症（HLP）对急性心肌梗死（AMI）或急性失代偿性心力衰竭（ADHF）住院后全因死亡率的影响，并确定 HLP 是否改变了其他竞争性合并症的死亡率关联。进行系统评价和荟萃分析，以便将当前的发现置于已发表文献的背景下。
回顾性研究，1:1 倾向评分匹配队列；荟萃分析。
大型学术中心，1996-2015 年。
患有 AMI 或 ADHF 的住院患者。
全因死亡率和相对风险（RR）荟萃分析。
未匹配队列：13680 例 AMI 患者（年龄（平均）68.5±13.7 岁；7894 例（58%）有 HLP）和 9717 例 ADHF 患者（年龄 73.1±13.7 岁；3668 例（38%）有 HLP）。在匹配队列中，有 HLP 的 AMI 患者（n=4348 对）的死亡率低于无 HLP 的患者，分别为每 100 人年随访 5.9 例和 8.6 例（HR 0.76，95%CI 0.72 至 0.80）。在有或没有 HLP 的匹配 ADHF 患者（n=2879 对）中也发生了类似的死亡率降低（12.4 与 16.3 例死亡/100 人年；HR 0.80，95%CI 0.75 至 0.86）。当 HLP 与其他合并症同时发生时，HR 略有降低。对 9 项观察性研究的荟萃分析显示，在发生 AMI 或 ADHF 后≥2 年，HLP 与较低的死亡率相关（AMI：RR 0.72，95%CI 0.69 至 0.76；心力衰竭（HF）：RR 0.67，95%CI 0.55 至 0.81）。
在匹配的 AMI 和 ADHF 队列中，与无 HLP 相比，同时存在 HLP 与较低的死亡率相关，并减弱了与其他竞争性合并症的死亡率关联。这些发现得到了系统评价和荟萃分析的支持。
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