急性冠脉综合征患者强化降脂治疗的获益：系统评价和荟萃分析。
Benefits of intensive lipid-lowering therapies in patients with acute coronary syndrome: a systematic review and meta-analysis.
机构信息
Department of General Medicine, The First people's hospital of Wenling, Taizhou, Zhejiang, China.
Shanghai Jiao Tong University, Shanghai, China.
出版信息
Ann Med. 2024 Dec;56(1):2389470. doi: 10.1080/07853890.2024.2389470. Epub 2024 Aug 10.
BACKGROUND
Previous meta-analyses have investigated the efficacy of lipid-lowering therapies for atherosclerotic cardiovascular disease; however, few have focused on patients with acute coronary syndrome (ACS). This meta-analysis aimed to compare the benefits of intensive lipid-lowering therapy with those of background statin therapy in patients with ACS.
METHODS
Searches were performed on PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for articles published until April 13, 2023. Randomized controlled trials that compared intensive lipid-lowering therapies and background statin therapies in patients with prior ACS and recorded the outcome of three-point major cardiovascular events (MACE) were included. The risk ratio (RR) with 95% confidence interval (CI) was used as a measure of primary and secondary outcomes.
RESULTS
Nine trials involving 38,640 patients with ACS were identified. Pooled results suggested that intensive lipid-lowering therapies are associated with a reduction in the risk of three-point MACE (RR, 0.88; 95% CI, 0.83-0.94; < 0.001), recurrent ACS (RR, 0.82; 95% CI, 0.71-0.96; = 0.013), nonfatal myocardial infarction (MI) (RR, 0.87; 95% CI, 0.81-0.93; < 0.001), stroke (RR, 0.83; 95% CI, 0.73-0.94; = 0.003), and unstable angina-related hospitalization (RR, 0.57; 95% CI, 0.33-0.99; = 0.046), but not all-cause mortality (RR, 0.94; 95% CI, 0.82-1.07; = 0.329), cardiovascular disease-related mortality (RR, 0.96; 95% CI, 0.88-1.06; = 0.457) or coronary revascularization (RR, 0.89; 95% CI, 0.79-1.00; = 0.057).
CONCLUSIONS
Intensive lipid-lowering therapies may reduce the risk of three-point MACE, recurrent ACS, nonfatal MI, stroke, and hospitalization for unstable angina in patients with ACS undergoing background statin therapy. These results may assist in clinical decision-making for the secondary prevention of cardiovascular events to initiate intensive lipid-lowering therapies immediately after ACS.
背景
先前的荟萃分析已经研究了降脂疗法在动脉粥样硬化性心血管疾病中的疗效；然而，很少有研究关注急性冠脉综合征（ACS）患者。本荟萃分析旨在比较强化降脂治疗与 ACS 患者的基础他汀治疗的益处。
方法
检索了 PubMed、Embase、Cochrane 对照试验中心注册库和 ClinicalTrials.gov 数据库，以获取截至 2023 年 4 月 13 日发表的文章。纳入了比较既往 ACS 患者强化降脂治疗与基础他汀治疗并记录三点主要心血管事件（MACE）结局的随机对照试验。使用风险比（RR）和 95%置信区间（CI）作为主要和次要结局的衡量指标。
结果
共纳入了 9 项涉及 38640 例 ACS 患者的试验。汇总结果表明，强化降脂治疗可降低三点 MACE（RR，0.88；95%CI，0.83-0.94； < 0.001）、复发性 ACS（RR，0.82；95%CI，0.71-0.96； = 0.013）、非致死性心肌梗死（RR，0.87；95%CI，0.81-0.93； < 0.001）、卒中（RR，0.83；95%CI，0.73-0.94； = 0.003）和不稳定型心绞痛相关住院（RR，0.57；95%CI，0.33-0.99； = 0.046）的风险，但不包括全因死亡率（RR，0.94；95%CI，0.82-1.07； = 0.329）、心血管疾病相关死亡率（RR，0.96；95%CI，0.88-1.06； = 0.457）或冠状动脉血运重建（RR，0.89；95%CI，0.79-1.00； = 0.057）。
结论
在接受基础他汀治疗的 ACS 患者中，强化降脂治疗可能降低三点 MACE、复发性 ACS、非致死性心肌梗死、卒中和不稳定型心绞痛住院的风险。这些结果可能有助于临床决策，以便在 ACS 后立即开始强化降脂治疗，以预防心血管事件的二次发生。
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