Xiong Xiaowei, Wu Zhaoyu, Qin Xuan, Huang Qun, Wang Xin, Qin Jinbao, Lu Xinwu
Department of General Surgery, The First Hospital of Nanchang, Nanchang, China.
Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China.
J Vasc Surg. 2022 Jan;75(1):356-362.e4. doi: 10.1016/j.jvs.2021.06.033. Epub 2021 Jun 28.
The necessity and efficacy of statin treatment for abdominal aortic aneurysm (AAA) remains controversial. This systematic review and meta-analysis was conducted to investigate the effects of statin therapy on the outcomes of patients with AAA.
The Cochrane library, Embase, and MedLine were searched comprehensively to identify relevant cohort studies and randomized controlled trials. The primary outcomes included short- and long-term mortality after AAA repair, and secondary outcomes included the incidence of perioperative cardiovascular complications, sac shrinkage after endovascular aneurysm repair, and the growth rate of the aneurysms. Short-term mortality was defined as all-cause 30-day or in-hospital postoperative mortality. Long-term mortality was defined as the all-cause mortality at the end of follow-up period (≥1 year). A random effects model was used to combine the results of included studies. Forest plots were created to show the pooled results of each outcome.
One post hoc analysis of a randomized trial and 36 cohort studies (n = 134,290 patients) were included in this systematic review. The average score of included studies by Newcastle-Ottawa Scale was 7.76. Patients taking or not taking statin therapy were all diagnosed with unruptured AAA, and 59.9% of these patients were given statin therapy. Compared with statin nonusers, patients in statin therapy had significantly lower long-term mortality (odds ratio, 0.67; 95% confidence interval, 0.59-0.75; P < .001; I = 71.7%), and short-term mortality after aneurysmal repair (odds ratio, 0.51; 95% confidence interval, 0.36-0.73; P < .001; I = 81.4%). No significant difference was found between patients taking or not taking statin treatment on perioperative cardiovascular complications or sac shrinkage after endovascular aneurysm repair or growth rate of AAA under surveillance.
These findings suggest that statin use is associated with a significant decrease in long- and short-term mortality in patients after AAA repair. Based on these results, statin therapy is worth being used in clinical practice for the management of AAA.
他汀类药物治疗腹主动脉瘤（AAA）的必要性和疗效仍存在争议。本系统评价和荟萃分析旨在研究他汀类药物治疗对AAA患者预后的影响。
全面检索Cochrane图书馆、Embase和MedLine，以识别相关队列研究和随机对照试验。主要结局包括AAA修复术后的短期和长期死亡率，次要结局包括围手术期心血管并发症的发生率、血管内动脉瘤修复术后瘤体缩小情况以及动脉瘤的生长速率。短期死亡率定义为全因30天或术后住院死亡率。长期死亡率定义为随访期结束时（≥1年）的全因死亡率。采用随机效应模型合并纳入研究的结果。绘制森林图以展示各结局的汇总结果。
本系统评价纳入了一项随机试验的事后分析和36项队列研究（n = 134,290例患者）。纳入研究的纽卡斯尔-渥太华量表平均评分为7.76。服用或未服用他汀类药物治疗的患者均被诊断为未破裂AAA，其中59.9%的患者接受了他汀类药物治疗。与未使用他汀类药物的患者相比，接受他汀类药物治疗的患者长期死亡率显著降低（比值比，0.67；95%置信区间，0.59 - 0.75；P <.001；I² = 71.7%），动脉瘤修复术后短期死亡率也显著降低（比值比，0.51；95%置信区间，0.36 - 0.73；P <.001；I² = 81.4%）。在围手术期心血管并发症、血管内动脉瘤修复术后瘤体缩小情况或监测下AAA的生长速率方面，服用或未服用他汀类药物治疗的患者之间未发现显著差异。
这些发现表明，他汀类药物的使用与AAA修复术后患者的短期和长期死亡率显著降低相关。基于这些结果，他汀类药物治疗在AAA的临床管理中值得应用。
