A meta-regression analysis suggested that statin and nonstatin therapies that act via up regulation of LDL receptor expression to reduce LDL-C were associated with similar reductions of major vascular events (a composite of cardiovascular death, acute myocardial infarction or other acute coronary syndrome, coronary revascularization, or stroke) per change in LDL-C. The analysis included 312 175 participants (mean age, 62 years; 24% women; mean baseline LDL-C level of 3.16 mmol/L [122.3 mg/dL]) from 49 trials with 39 645 major vascular events. The relative risk (RR) for major vascular events per 1-mmol/L (38.7-mg/dL) reduction in LDL-C level was 0.77 for statins and 0.75 for established nonstatin interventions that work primarily via up regulation of LDL receptor expression (ie, diet, bile acid sequestrants, ileal bypass, and ezetimibe). The combined RR of the 5 therapies was 0.77 for major vascular events per 1-mmol/L reduction in LDL-C level. For other interventions, the observed RRs vs the expected RRs based on the degree of LDL-C reduction in the trials were 0.94 vs 0.91 for niacin; 0.88 vs 0.94 for fibrates, which was lower than expected (ie, greater risk reduction); 1.01 vs 0.90 for cholesteryl ester transfer protein inhibitors, which was higher than expected (ie, less risk reduction); and 0.49 vs 0.61 for proprotein convertase subtilisin/kexin type 9 inhibitors. The achieved absolute LDL-C level was significantly associated with the absolute rate of major coronary events (11 301 events, including coronary death or myocardial infarction) for primary prevention trials (1.5% lower event rate per each 1-mmol/L lower LDL-C level) and secondary prevention trials (4.6% lower event rate per each 1-mmol/L lower LDL-C level. Source: http://jama.jamanetwork.com/
一项综合回归分析表明，通过上调低密度脂蛋白受体表达来降低低密度脂蛋白胆固醇的他汀类及非他汀类措施，由低密度脂蛋白胆固醇变化所致主要血管事件的减少（包括心血管死亡，急性心梗或其它急性冠脉综合征，冠脉血运重建，或中风）相似。该分析包括49个试验的312 175名参与者（平均年龄62岁，24％为女性，平均基线低密度脂蛋白胆固醇3.16毫摩尔/升[122.3毫克/分升]），39 645例主要血管事件。通过上调低密度脂蛋白受体表达使低密度脂蛋白胆固醇每降低1毫摩尔/升（38.7毫克/分升），主要血管事件的相对风险度分别为他汀类药物的0.77和非他汀类措施（即，饮食控制，胆汁酸多价螯合剂，回肠分流术，和依泽替米贝）的0.75。 五种疗法综合，低密度脂蛋白胆固醇每降低1毫摩尔/升，主要血管事件的相对风险度为0.77。对于其它疗法，观察到的和基于低密度脂蛋白胆固醇降低程度预期的相对风险度分别为烟酸的0.94 和0.91; 贝特类的0.88和0.94，低于预期（即风险降低更大）; 胆固醇酯转运蛋白抑制剂的1.01和0.9，高于预期（即，风险降低更小）;以及枯草杆菌前蛋白转化酶/科信类型9抑制剂的0.49和0.61。所达到的低密度脂蛋白胆固醇绝对水平与主要冠脉事件（11 301例事件，包括冠心病死亡或心梗）显著相关，分别为一级预防试验低密度脂蛋白胆固醇每降低1毫摩尔/升，事件绝对发生率降低1.5％，和二级预防试验低密度脂蛋白胆固醇每降低1毫摩尔/升，事件绝对发生率降低4.6%。来源：http://jama.jamanetwork.com/