Huang Hao, Zhu Hechen, Ya Ru
Department of Critical Rehabilitation, Shanghai Third Rehabilitation Hospital, 200436 Shanghai, China.
Department of Critical Care Medicine, Huashan Hospital, Fudan University, 200031 Shanghai, China.
Rev Cardiovasc Med. 2022 Mar 24;23(4):114. doi: 10.31083/j.rcm2304114. eCollection 2022 Apr.
Evidence on statin use for primary prevention of cardiovascular disease (CVD) in older people needs to be extended and updated, aiming to provide further guidance for clinical practice.
PubMed, EMBASE, Cochrane Library and Web of Science were searched for eligible observational studies comparing statin use vs. no-statin use for primary prevention of CVD in older people (age 65 years). The primary outcomes were all-cause mortality, CVD mortality, coronary heart disease (CHD)/myocardial infraction (MI), stroke and total CV events. Risk estimates of each relevant outcome were synthesized as a hazard ratio (HR) with 95% confidence interval (95% CI) using in the random-effects model.
Twelve eligible observational studies (n = 1,627,434) were enrolled. The pooled results suggested that statin use was associated with a significantly decreased risk of all-cause mortality (HR: 0.54, 95% CI: 0.46-0.63), CVD mortality (HR: 0.51, 95% CI: 0.39-0.65), CHD/MI (HR: 0.83, 95% CI: 0.69-1.00), stroke (HR: 0.79, 95% CI: 0.68-0.92) and total CV events (HR: 0.75, 95% CI: 0.66-0.85). The association in all-cause mortality still remained obvious at higher ages ( 70 years old, HR: 0.56, 95% CI: 0.44-0.71; 75 years old, HR: 0.70, 95% CI: 0.60-0.80; 85 years old, HR: 0.85, 95% CI: 0.74-0.97), 20% (HR: 0.47, 95% CI: 0.35-0.62) and 20% diabetic populations (HR: 0.50, 95% CI: 0.40-0.64), and 50% (HR: 0.68, 95% CI: 0.59-0.79) and 50% hypertensive populations (HR: 0.38, 95% CI: 0.16-0.88).
Statin use was related to a 46%, 49%, 17%, 21% and 25% risk reduction on all-cause mortality, CVD mortality, CHD/MI, stroke and total CV events in older patients, respectively. The significant association was also addressed in older patients and 75 years old individuals for CVD primary prevention.
关于他汀类药物用于老年人心血管疾病（CVD）一级预防的证据需要扩展和更新，旨在为临床实践提供进一步指导。
检索PubMed、EMBASE、Cochrane图书馆和科学网，以查找比较他汀类药物使用与不使用他汀类药物对老年人（年龄≥65岁）CVD一级预防的合格观察性研究。主要结局为全因死亡率、CVD死亡率、冠心病（CHD）/心肌梗死（MI）、中风和总心血管事件。使用随机效应模型将每个相关结局的风险估计值合成为危险比（HR）及95%置信区间（95%CI）。
纳入12项合格的观察性研究（n = 1,627,434）。汇总结果表明，使用他汀类药物与全因死亡率（HR：0.54，95%CI：0.46 - 0.63）、CVD死亡率（HR：0.51，95%CI：0.39 - 0.65）、CHD/MI（HR：0.83，95%CI：0.69 - 1.00）、中风（HR：0.79，95%CI：0.68 - 0.92）和总心血管事件（HR：0.75，95%CI：0.66 - 0.85）风险显著降低相关。在较高年龄组（≥70岁，HR：0.56，95%CI：0.44 - 0.71；≥75岁，HR：0.70，95%CI：0.60 - 0.80；≥85岁，HR：0.85，95%CI：0.7r - 0.97）、糖尿病患病率≥20%的人群（HR：0.47，95%CI：0.35 - 0.62）以及糖尿病患病率≥20%的人群（HR：0.50，95%CI：0.40 - 0.64）、高血压患病率≥50%的人群（HR：0.68，95%CI：0.59 - 0.79）以及高血压患病率≥50%的人群（HR：0.38，95%CI：0.16 - 0.88）中，全因死亡率的相关性仍然明显。
使用他汀类药物分别使老年患者的全因死亡率、CVD死亡率、CHD/MI、中风和总心血管事件风险降低46%、49%、17%、21%和25%。在老年患者和≥75岁个体中，这种显著关联也适用于CVD一级预防。
