Rembold C M
Cardiovascular Division, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
J Fam Pract. 1996 Jun;42(6):577-86.
Atherosclerosis of the coronary arteries is the most common cause of death in the United States for persons over the age of 45. Dyslipidemia is one of the risk factors for the development of coronary atherosclerosis. Recent studies suggest that treating dyslipidemia in persons with coronary atherosclerosis may decrease morbidity and mortality.
A meta-analysis of 33 studies on the clinical and angiographic benefits of treating dyslipidemia in the prevention of morbidity and mortality from cardiovascular disease was performed. These benefits are quantitated in the form of "number needed to treat" (NNT) as an estimate of the public health benefit. The NNT is defined as the number of people that need to be treated to prevent one event.
Treatment of dyslipidemia in persons with multiple atherosclerosis risk factors alone, ie, primary prevention, was effective in preventing myocardial infarction and all-cause death. In six trials of primary prevention, excluding the British cooperative trial using clofibrate, the NNT was 53 to prevent a nonfatal MI and 190 to prevent all-cause death (4.8 years treatment with total cholesterol reduction of 15%). Treatment of dyslipidemia in people with known atherosclerosis, ie, secondary and tertiary prevention, was also effective in preventing myocardial infarctions and death from all causes. For 23 trials of secondary and tertiary prevention, the NNT was 37 to prevent death from any cause (4.9 years treatment with total cholesterol reduction of 18%). In the trials with quantitative angiography, the NNT was 7 to prevent progression of coronary atherosclerosis and 10 to induce regression of coronary atherosclerosis (2.5 years treatment with a low-density lipoprotein cholesterol reduction of 28%). Similar benefits were observed in those trials employing HMG CoA reductase inhibitors. Benefits may be similar with niacin or dietary therapy, but these therapies did not reach significance in all categories of benefits, potentially due to beta error. These treatment benefits are comparable to other secondary prevention measures such as aspirin or beta blockers. The benefits appeared to extend to persons over 65, with less clearly defined benefits for women.
These results support the overall clinical benefit of treating dyslipidemia, both in persons with and without known atherosclerosis.
冠状动脉粥样硬化是美国45岁以上人群最常见的死因。血脂异常是冠状动脉粥样硬化发生的危险因素之一。最近的研究表明，治疗冠状动脉粥样硬化患者的血脂异常可能会降低发病率和死亡率。
对33项关于治疗血脂异常在预防心血管疾病发病率和死亡率方面的临床及血管造影益处的研究进行了荟萃分析。这些益处以“需治疗人数”（NNT）的形式进行量化，作为对公共卫生益处的一种估计。NNT定义为预防一例事件所需治疗的人数。
仅对具有多种动脉粥样硬化危险因素的人群进行血脂异常治疗，即一级预防，在预防心肌梗死和全因死亡方面是有效的。在六项一级预防试验中，不包括使用氯贝丁酯的英国合作试验，预防非致命性心肌梗死的NNT为53，预防全因死亡的NNT为190（治疗4.8年，总胆固醇降低15%）。对已知患有动脉粥样硬化的人群进行血脂异常治疗，即二级和三级预防，在预防心肌梗死和全因死亡方面也有效。在23项二级和三级预防试验中，预防任何原因死亡的NNT为37（治疗4.9年，总胆固醇降低18%）。在有定量血管造影的试验中，预防冠状动脉粥样硬化进展所需的NNT为7，使冠状动脉粥样硬化消退所需的NNT为10（治疗2.5年，低密度脂蛋白胆固醇降低28%）。在使用HMG CoA还原酶抑制剂的试验中也观察到了类似的益处。烟酸或饮食疗法可能也有类似益处，但这些疗法在所有益处类别中未达到显著水平，可能是由于Ⅱ类错误。这些治疗益处与其他二级预防措施如阿司匹林或β受体阻滞剂相当。益处似乎也适用于65岁以上人群，对女性的益处定义不太明确。
这些结果支持治疗血脂异常的总体临床益处，无论患者是否已知患有动脉粥样硬化。
