Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina (Masson, Barbagelata and Siniawski).
Facultad Medicina, Universidad FASTA. Mar del Plata, Argentina (Corral).
J Clin Lipidol. 2022 Sep-Oct;16(5):562-573. doi: 10.1016/j.jacl.2022.07.004. Epub 2022 Jul 22.
Lipid-lowering medication is effective in reducing the risk of cardiovascular disease in several clinical scenarios. However, the evidence in patients with familial hypercholesterolemia (FH) and severe primary hypercholesterolemia is less robust.
The main objective of the present systematic review was to analyze the association between lipid-lowering medication and cardiovascular risk reduction in patients with FH or severe primary hypercholesterolemia.
This systematic review was performed according to PRISMA guidelines. A literature search was performed to detect studies that evaluated the association between lipid-lowering medication and cardiovascular events in FH patients. The diagnosis of FH varied in the studies analyzed. Genetic and clinical criteria or a combination of both were used. Likewise, we considered patients with severe primary hypercholesterolemia.
Fourteen studies including 21059 patients were considered eligible for this research. This systematic review showed that the vast majority of the studies with statins reported a significant cardiovascular risk reduction. Statin use was associated with a lower risk of major adverse cardiovascular events (3 studies), coronary heart disease (2 studies), cardiovascular death (4 studies), all-cause mortality (4 studies) and combined endpoint of coronary heart disease and mortality (1 study). When analyzing the association between non-statin lipid-lowering medications and the incidence of cardiovascular events, the results were conflicting.
Despite the low level of evidence, this systematic review showed that statins reduce cardiovascular events in patients with HeFH. Evidence for other lipid-lowering drugs is not conclusive.
降脂药物在多种临床情况下降低心血管疾病风险的效果显著。然而，在家族性高胆固醇血症（FH）和严重原发性高胆固醇血症患者中的证据则不那么确凿。
本系统评价的主要目的是分析降脂药物与 FH 或严重原发性高胆固醇血症患者心血管风险降低之间的关联。
本系统评价根据 PRISMA 指南进行。进行文献检索以检测评估降脂药物与 FH 患者心血管事件之间关联的研究。分析中使用的 FH 诊断标准各不相同。采用了遗传和临床标准或两者的组合。同样，我们还考虑了严重原发性高胆固醇血症患者。
纳入了 14 项研究，共 21059 例患者符合本研究的纳入标准。本系统评价表明，绝大多数他汀类药物研究报告了显著的心血管风险降低。他汀类药物的使用与主要不良心血管事件（3 项研究）、冠心病（2 项研究）、心血管死亡（4 项研究）、全因死亡率（4 项研究）和冠心病及死亡率综合终点（1 项研究）的风险降低相关。在分析非他汀类降脂药物与心血管事件发生率之间的关联时，结果存在矛盾。
尽管证据水平较低，但本系统评价表明他汀类药物可降低 HeFH 患者的心血管事件发生率。其他降脂药物的证据尚不确定。
