不同队列中家族性高胆固醇血症与心血管事件及死亡风险之间的关联：一项对110万受试者的荟萃分析
Association Between Familial Hypercholesterolemia and Risk of Cardiovascular Events and Death in Different Cohorts: A Meta-Analysis of 1.1 Million Subjects.
作者信息
Yu Yani, Chen Lei, Zhang Honghong, Fu Zihao, Liu Qi, Zhao Haijing, Liu Yuqi, Chen Yundai
机构信息
Medical College of Nankai University, Tianjing, China.
Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China.
出版信息
Front Cardiovasc Med. 2022 Jun 21;9:860196. doi: 10.3389/fcvm.2022.860196. eCollection 2022.
BACKGROUND AND AIMS
The association of familial hypercholesterolemia (FH) with risk of cardiovascular events (CVE) and death in different cohorts is controversial. We aimed to assess the risk of CVE and death in patients with FH in different cohorts, including CHD and ACS patients, White and Asian, different diagnostic criteria.
METHODS
We searched PubMed, MEDLINE, and Web of Science electronic databases through May 2021 to identify cohort studies of CVE and death in patients with FH.
RESULTS
We found 18 eligible studies with 1,139,788 participants, including 34,261 patients. There were 31,287 ACS patients, of whom 2,338 were combined with FH. Randomized-effects meta-analysis showed that in patients with FH, relative risk (RR) of CVE and death was 1.87 (95% CI 1.21-2.88), among which CVE was 2.14 (95%CI 1.26-3.64), all-cause of death RR = 1.12 (95% CI 0.89-1.41), and cardiac death RR = 1.03 (95% CI 0.59-1.79). Risk of CVE and death in general population with FH was 2.85 (95% CI 0.72-11.21), hyperlipidemia population RR = 1.59 (95% CI 1.05-2.41), coronary heart disease patients (CHD) RR = 1.46 (95% CI 1.24-1.72), and acute coronary syndrome patients (ACS) RR = 1.71 (95% CI 1.19-2.46). Among ACS patients, the RR of CVE in patients with FH was 1.91 (95% CI 1.55-2.35), the RR of all-cause of death was 1.03 (95% CI 0.80-1.32), and the RR of cardiac death was 1.03 (95% CI 0.59-1.79). The risk of CVE and death in ACS patients with FH in White was 1.69 (95% CI 1.09-2.64) and Asian 1.90 (95% CI 1.31-2.75). RR in patients with Dutch Lipid Network criteria (DLCN) ≥6 vs. <3 points was higher (RR = 2.24, 95% CI 1.69-2.97). RR for long-term follow-up was 1.68 (95% CI 1.09-2.61) and for short-term follow-up was 1.80 (95% CI 1.16-2.78). The results of the overall population were similar, but RR for overall population during a short-term follow-up was 1.49 (95% CI 0.81-2.73). We followed PRISMA checklist to complete meta-analysis.
CONCLUSIONS
The risk of CVE and death was increased in patients with CHD, especially in patients with ACS. DLCN ≥ 6 points was suggested for clinical diagnosis of FH. The risk of long-term and short-term CVE and death increased in ACS patients with FH.
REGISTRATION NUMBER
INPLASY2021110010.
背景与目的
家族性高胆固醇血症（FH）与不同队列中心血管事件（CVE）风险及死亡的关联存在争议。我们旨在评估不同队列中FH患者发生CVE和死亡的风险，包括冠心病（CHD）和急性冠状动脉综合征（ACS）患者、白种人和亚洲人，以及不同的诊断标准。
方法
我们检索了截至2021年5月的PubMed、MEDLINE和Web of Science电子数据库，以确定FH患者CVE和死亡的队列研究。
结果
我们发现了18项符合条件的研究，共1,139,788名参与者，其中包括34,261例患者。有31,287例ACS患者，其中2,338例合并FH。随机效应荟萃分析显示，FH患者发生CVE和死亡的相对风险（RR）为1.87（95%CI 1.21 - 2.88），其中CVE为2.14（95%CI 1.26 - 3.64），全因死亡RR = 1.12（95%CI 0.89 - 1.41），心源性死亡RR = 1.03（95%CI 0.59 - 1.79）。一般FH人群发生CVE和死亡的风险为2.85（95%CI 0.72 - 11.21），高脂血症人群RR = 1.59（95%CI 1.05 - 2.41），冠心病患者（CHD）RR = 1.46（95%CI 1.24 - 1.72），急性冠状动脉综合征患者（ACS）RR = 1.71（95%CI 1.19 - 2.46）。在ACS患者中，FH患者发生CVE的RR为1.91（95%CI 1.55 - 2.35），全因死亡RR为1.03（95%CI 0.80 - 1.32），心源性死亡RR为1.03（95%CI 0.59 - 1.79）。白种人ACS患者中FH患者发生CVE和死亡的风险为1.69（95%CI 1.09 - 2.64），亚洲人为1.90（95%CI 1.31 - 2.75）。荷兰脂质网络标准（DLCN）≥6分与<3分的患者相比RR更高（RR = 2.24，95%CI 1.69 - 2.97）。长期随访的RR为1.68（95%CI 1.09 - 2.61），短期随访的RR为1.80（95%CI 1.16 - 2.78）。总体人群的结果相似，但总体人群短期随访的RR为1.49（95%CI 0.81 - 2.73）。我们遵循PRISMA清单完成荟萃分析。
结论
CHD患者发生CVE和死亡的风险增加，尤其是ACS患者。建议DLCN≥6分用于FH的临床诊断。FH的ACS患者发生长期和短期CVE及死亡的风险增加。
注册号
INPLASY2021110010。
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