Atkins D, Psaty B M, Koepsell T D, Longstreth W T, Larson E B
Cardiovascular Health Research Unit, University of Washington, Seattle.
Ann Intern Med. 1993 Jul 15;119(2):136-45. doi: 10.7326/0003-4819-119-2-199307150-00008.
Reducing serum cholesterol lowers the risk for ischemic heart disease, but its effects on other vascular diseases are unknown. Published trials were reviewed to determine the effect of cholesterol-lowering interventions on fatal and nonfatal stroke.
Meta-analysis of randomized, controlled trials.
A literature search of English-language studies examining the effect of modified diets or medications on cardiovascular end points from 1965 to 1992 using MEDLINE and a review of references of five quantitative overviews of cholesterol reduction and coronary disease.
Thirteen studies met three eligibility criteria: patients randomized to intervention or control; fatal or nonfatal stroke reported separately; and end points assessed without knowledge of treatment status. Heterogeneity among studies and overall effects of treatment on fatal and nonfatal stroke were estimated using the Mantel-Haenszel-Peto method to combine independent study results. The influence of various study designs and interventions was explored using subgroup comparisons.
For fatal stroke, the overall odds ratio associated with cholesterol-lowering interventions in 13 trials was 1.32 (95% Cl, 0.94 to 1.86), and the odds ratio for the 10 single-intervention trials was 1.34 (Cl, 0.91 to 1.96). Among eight trials reporting nonfatal events, the summary odds ratio for nonfatal stroke for treated participants compared with controls was 0.88 (Cl, 0.70 to 1.11), and the odds ratio for total strokes was 0.98 (Cl, 0.80 to 1.19). Among three trials using clofibrate, treatment significantly increased the risk for fatal stroke (odds ratio, 2.64; Cl, 1.42 to 4.92) but not for nonfatal stroke (odds ratio, 0.87; Cl, 0.61 to 1.26). Regression analysis showed no statistical association between the magnitude of cholesterol reduction and the risk for fatal stroke.
Lowering serum cholesterol through modified diets or medications does not reduce stroke mortality or morbidity in middle-aged men. Clofibrate appears to increase the risk for fatal strokes, but the mechanism for this effect is unknown.
降低血清胆固醇可降低缺血性心脏病的风险，但其对其他血管疾病的影响尚不清楚。对已发表的试验进行综述，以确定降低胆固醇干预措施对致命性和非致命性卒中的影响。
对随机对照试验进行荟萃分析。
使用MEDLINE对1965年至1992年期间研究改良饮食或药物对心血管终点影响的英文研究进行文献检索，并对五项胆固醇降低与冠心病定量综述的参考文献进行回顾。
13项研究符合三项纳入标准：患者随机分为干预组或对照组；分别报告致命性或非致命性卒中；在不知道治疗状态的情况下评估终点。使用Mantel-Haenszel-Peto方法合并独立研究结果，估计研究间的异质性以及治疗对致命性和非致命性卒中的总体影响。通过亚组比较探讨各种研究设计和干预措施的影响。
对于致命性卒中，13项试验中与降低胆固醇干预措施相关的总体比值比为1.32（95%可信区间，0.94至1.86），10项单一干预试验的比值比为1.34（可信区间，0.91至1.96）。在报告非致命事件的8项试验中，治疗参与者与对照组相比非致命性卒中的汇总比值比为0.88（可信区间，0.70至1.11），总卒中的比值比为0.98（可信区间，0.80至1.19）。在三项使用氯贝丁酯的试验中，治疗显著增加了致命性卒中的风险（比值比，2.64；可信区间，1.42至4.92），但未增加非致命性卒中的风险（比值比，0.87；可信区间，0.61至1.26）。回归分析显示胆固醇降低幅度与致命性卒中风险之间无统计学关联。
通过改良饮食或药物降低血清胆固醇并不能降低中年男性的卒中死亡率或发病率。氯贝丁酯似乎会增加致命性卒中的风险，但其作用机制尚不清楚。
