Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
Curr Atheroscler Rep. 2023 Nov;25(11):769-784. doi: 10.1007/s11883-023-01151-w. Epub 2023 Oct 5.
This review aimed to determine the association between statin use and coronary artery calcification (CAC), as detected by computed tomography in the general population, in previously published observational studies (OSs) and randomized controlled trials (RCTs).
A systematic search until February 2022 identified 41 relevant studies, comprising 29 OSs and 12 RCTs. We employed six meta-analysis models, stratifying studies based on design and effect metrics. For cohort studies, the pooled β of the association with CAC quantified by the Agatston score was 0.11 (95% CI = 0.05; 0.16), with an average follow-up time per person (AFTP) of 3.68 years. Cross-sectional studies indicated a pooled odds ratio of 2.11 (95% CI = 1.61; 2.78) for the presence of CAC. In RCTs, the pooled standardized mean differences (SMDs) for CAC, quantified by Agatston score or volume, over and AFTP of 1.25 years were not statistically significant (SMD = - 0.06, 95% CI = - 0.19; 0.06 and SMD = 0.26, 95% CI = - 0.66; 1.19), but significantly different (p-value = 0.04). Meta-regression and subgroup analyses did not show any significant differences in pooled estimates across covariates. The effect of statins on CAC differs across study designs. OSs demonstrate associations between statin use and higher CAC scores and presence while being prone to confounding by indication. Effects from RCTs do not reach statistical significance and vary depending on the quantification method, hampering drawing conclusions. Further investigations are required to address the limitations inherent in each approach.
本综述旨在确定在普通人群中通过计算机断层扫描（CT）检测到的他汀类药物使用与冠状动脉钙化（CAC）之间的关联，这些研究结果来自之前发表的观察性研究（OS）和随机对照试验（RCT）。
截至 2022 年 2 月的系统搜索确定了 41 项相关研究，包括 29 项 OS 和 12 项 RCT。我们使用了 6 种荟萃分析模型，根据设计和效应指标对研究进行分层。对于队列研究，CAC 与 Agatston 评分的关联的汇总 β 值为 0.11（95%CI=0.05;0.16），每个人的平均随访时间（AFTP）为 3.68 年。横断面研究表明，CAC 的存在的汇总比值比（OR）为 2.11（95%CI=1.61;2.78）。在 RCT 中，CAC 与 Agatston 评分或体积的汇总标准化均数差值（SMD）在 1.25 年的 AFTP 上无统计学意义（SMD=-0.06，95%CI=-0.19;0.06 和 SMD=0.26，95%CI=-0.66;1.19），但差异显著（p 值=0.04）。Meta 回归和亚组分析表明，在协变量方面，汇总估计值没有显著差异。他汀类药物对 CAC 的影响因研究设计而异。OS 显示了他汀类药物使用与 CAC 评分和 CAC 阳性之间的关联，但易受指示性偏倚的影响。RCT 的结果没有达到统计学意义，并且取决于量化方法，难以得出结论。需要进一步的研究来解决每种方法固有的局限性。
