Li Yingrui, Deng Songbai, Liu Bin, Yan Yulin, Du Jianlin, Li Yu, Jing Xiaodong, Liu Yajie, Wang Jing, Du Jun, She Qiang
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Sci Rep. 2021 Apr 12;11(1):7999. doi: 10.1038/s41598-021-87528-w.
To assess the influence of lipid-lowering therapy on coronary plaque volume, and to identify the LDL and HDL targets for plaque regression to provide a comprehensive overview. The databases searched (from inception to 15 July 2020) to identify prospective studies investigating the impact of lipid-lowering therapy on coronary plaque volume and including quantitative measurement of plaque volume by intravascular ultrasound after treatment. Thirty-one studies that included 4997 patients were selected in the final analysis. Patients had significantly lower TAV (SMD: 0.123 mm; 95% CI 0.059, 0.187; P = 0.000) and PAV (SMD: 0.123%; 95% CI 0.035, 0.212; P = 0.006) at follow-up. According to the subgroup analyses, TAV was significantly reduced in the LDL < 80 mg/dL and HDL > 45 mg/dL group (SMD: 0.163 mm; 95% CI 0.092, 0.234; P = 0.000), and PAV was significantly reduced in the LDL < 90 mg/dL and HDL > 45 mg/dL group (SMD: 0.186%; 95% CI 0.081, 0.291; P = 0.001).Thirty-one studies that included 4997 patients were selected in the final analysis. Patients had significantly lower TAV (SMD: 0.123 mm; 95% CI 0.059, 0.187; P = 0.000) and PAV (SMD: 0.123%; 95% CI 0.035, 0.212; P = 0.006) at follow-up. According to the subgroup analyses, TAV was significantly reduced in the LDL < 80 mg/dL and HDL > 45 mg/dL group (SMD: 0.163 mm; 95% CI 0.092, 0.234; P = 0.000), and PAV was significantly reduced in the LDL < 90 mg/dL and HDL > 45 mg/dL group (SMD: 0.186%; 95% CI 0.081, 0.291; P = 0.001). Our meta-analysis suggests that not only should LDL be reduced to a target level of < 80 mg/dL, but HDL should be increased to a target level of > 45 mg/dL to regress coronary plaques.Trial Registration PROSPERO identifier: CRD42019146170.
评估降脂治疗对冠状动脉斑块体积的影响，并确定使斑块消退的低密度脂蛋白（LDL）和高密度脂蛋白（HDL）目标，以提供全面概述。检索数据库（从建库至2020年7月15日），以识别研究降脂治疗对冠状动脉斑块体积影响并包括治疗后通过血管内超声对斑块体积进行定量测量的前瞻性研究。最终分析纳入了31项研究，共4997例患者。随访时患者的总动脉粥样硬化斑块体积（TAV）显著降低（标准化均数差：0.123mm；95%置信区间0.059，0.187；P = 0.000），斑块总体积（PAV）也显著降低（标准化均数差：0.123%；95%置信区间0.035，0.212；P = 0.006）。根据亚组分析，在LDL＜80mg/dL且HDL＞45mg/dL组中TAV显著降低（标准化均数差：0.163mm；95%置信区间0.092，0.234；P = 0.000），在LDL＜90mg/dL且HDL＞45mg/dL组中PAV显著降低（标准化均数差：0.186%；95%置信区间0.081，0.291；P = 0.001）。我们的荟萃分析表明，为使冠状动脉斑块消退，不仅应将LDL降至＜80mg/dL的目标水平，还应将HDL升至＞45mg/dL的目标水平。试验注册号：PROSPERO标识符：CRD42019146170。
