Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107, the West of Yanjiang Road, Guangzhou, 510120, China.
Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, 510120, China.
Eur J Clin Pharmacol. 2021 Aug;77(8):1133-1145. doi: 10.1007/s00228-021-03113-0. Epub 2021 Feb 18.
To compare the impact of different statins therapies on the reduction of carotid intima-media thickness (CIMT) may reflect their cardiovascular benefits which is useful in clinical decision.
PubMed, EMBASE, Cochrane Library, and Web of Science were searched, and 3539 articles published from 1992 to 2020 were retrieved. CIMT in randomized controlled trials for statins therapies were included for traditional and network meta-analyses analyzed by Stata 16. The quality of included studies was assessed by the Cochrane Collaboration's tool.
Thirty-three randomized controlled trials (n=8762) were eligible for network meta-analysis, of which 18 randomized controlled trials (n=5252) were included for comparison between statins and no statins and 11 randomized controlled trials (n=1338) were included for comparison between high-intensity statins or combination with niacin/ezetimibe and moderate/low-intensity statins in 2 traditional meta-analyses. In the traditional meta-analyses, the statins groups significantly reduce CIMT compared to no statins (standard mean difference=-0.207, 95% confidence interval: -0.291 to -0.123, p<0.001), while high-intensity statins or combination with niacin/ezetimibe performed significant CIMT reduction compared to moderate/low-intensity statins (standard mean difference=-0.287, 95% confidence interval: -0.460 to -0.114, p=0.001). In the network meta-analysis, a relative rank for the ability to reduce CIMT was given as follows: combination therapy with niacin (mean rank: 1.7), high-intensity statins, combination therapy with ezetimibe, and moderate/low-intensity statins.
Statins combined with niacin performed a greater CIMT reduction compared to high-intensity statins alone and combination therapies with ezetimibe. The advantage of niacin-combined statins therapies to improve cardiovascular endpoint needs further validation through randomized controlled trials.
PROSPERO, CRD42020175972.
比较不同他汀类药物治疗对颈动脉内膜中层厚度（CIMT）减少的影响，可能反映其心血管获益，这在临床决策中很有用。
检索了 PubMed、EMBASE、Cochrane 图书馆和 Web of Science，检索了 1992 年至 2020 年发表的 3539 篇文章。纳入了他汀类药物治疗的随机对照试验中 CIMT 的传统和网络荟萃分析，并使用 Stata 16 进行分析。纳入研究的质量由 Cochrane 协作组工具评估。
33 项随机对照试验（n=8762）符合网络荟萃分析的条件，其中 18 项随机对照试验（n=5252）纳入他汀类药物与无他汀类药物的比较，11 项随机对照试验（n=1338）纳入高强度他汀类药物或与烟酸/依折麦布联合治疗与中/低强度他汀类药物的比较。在传统荟萃分析中，与无他汀类药物相比，他汀类药物组 CIMT 显著降低（标准均数差=-0.207，95%置信区间：-0.291 至-0.123，p<0.001），而高强度他汀类药物或与烟酸/依折麦布联合治疗与中/低强度他汀类药物相比，CIMT 显著降低（标准均数差=-0.287，95%置信区间：-0.460 至-0.114，p=0.001）。在网络荟萃分析中，根据降低 CIMT 的能力对他汀类药物进行了相对排名：烟酸联合治疗（平均秩：1.7）、高强度他汀类药物、依折麦布联合治疗和中/低强度他汀类药物。
与高强度他汀类药物单独治疗相比，烟酸联合他汀类药物治疗能更显著地降低 CIMT，与依折麦布联合治疗相比，联合治疗也有优势。烟酸联合他汀类药物治疗改善心血管终点的优势需要通过随机对照试验进一步验证。
PROSPERO，CRD42020175972。
