Association between change in high density lipoprotein cholesterol and cardiovascular disease morbidity and mortality: systematic review and meta-regression analysis

被引：365

作者：

Briel, Matthias ^{[1
,2
]}

Ferreira-Gonzalez, Ignacio ^{[3
,4
]}

You, John J. ^{[1
,5
]}

Karanicolas, Paul J. ^{[6
]}

Akl, Elie A. ^{[7
]}

Wu, Ping ^{[8
]}

Blechacz, Boris ^{[9
]}

Bassler, Dirk ^{[10
]}

Wei, Xinge ^{[1
]}

Sharman, Asheer ^{[5
]}

Whitt, Irene ^{[9
]}

da Silva, Suzana Alves ^{[11
]}

Khalid, Zahira ^{[5
]}

Nordmann, Alain J. ^{[2
]}

Zhou, Qi ^{[1
]}

Walter, Stephen D. ^{[1
]}

Vale, Noah ^{[1
]}

Bhatnagar, Neera ^{[1
]}

O'Regan, Christopher ^{[12
]}

Mills, Edward J. ^{[13
]}

Bucher, Heiner C. ^{[2
]}

Montori, Victor M. ^{[14
,15
]}

Guyatt, Gordon H. ^{[1
,5
]}

机构：

[1] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON, Canada

[2] Univ Basel Hosp, Basel Inst Clin Epidemiol, CH-4031 Basel, Switzerland

[3] Hosp Gen Valle Hebron, Dept Cardiol, Barcelona, Spain

[4] CIBERESP, Barcelona, Spain

[5] McMaster Univ, Dept Med, Hamilton, ON, Canada

[6] Univ Western Ontario, Dept Surg, London, ON N6A 3K7, Canada

[7] SUNY Buffalo, Dept Med, Buffalo, NY 14260 USA

[8] Canadian Coll Naturopath Med, Toronto, ON, Canada

[9] Mayo Clin, Dept Med, Rochester, MN USA

[10] Univ Childrens Hosp, Dept Neonatol, Tubingen, Germany

[11] Teaching & Res Ctr Procardiaco PROCEP, Dept Res, Rio De Janeiro, Brazil

[12] Pfizer Ltd, Surrey, England

[13] St Pauls Hosp, British Columbia Ctr Excellence HIV AIDS, Vancouver, BC V6Z 1Y6, Canada

[14] Mayo Clin, Div Endocrinol, Rochester, MN USA

[15] Mayo Clin, Knowledge & Encounter Res Unit, Rochester, MN USA

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2009年 / 338卷

关键词：

CORONARY-HEART-DISEASE; CLINICAL-TRIALS; LIPID-LEVELS; TORCETRAPIB; ATHEROSCLEROSIS; HDL; PROGRESSION; RISK; MEN; METAANALYSIS;

D O I：

10.1136/bmj.b92

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective To investigate the association between treatment induced change in high density lipoprotein cholesterol and total death, coronary heart disease death, and coronary heart disease events ( coronary heart disease death and non-fatal myocardial infarction) adjusted for changes in low density lipoprotein cholesterol and drug class in randomised trials of lipid modifying interventions. Design Systematic review and meta-regression analysis of randomised controlled trials. Data sources Medline, Embase, Central, CINAHL, and AMED to October 2006 supplemented by contact with experts in the field. Study selection In teams of two, reviewers independently determined eligibility of randomised trials that tested lipid modifying interventions to reduce cardiovascular risk, reported high density lipoprotein cholesterol and mortality or myocardial infarctions separately for treatment groups, and treated and followed participants for at least six months. Data extraction and synthesis Using standardised, pre-piloted forms, reviewers independently extracted relevant information from each article. The change in lipid concentrations for each trial and the weighted risk ratios for clinical outcomes were calculated. Results The meta-regression analysis included 108 randomised trials involving 299 310 participants at risk of cardiovascular events. All analyses that adjusted for changes in low density lipoprotein cholesterol showed no association between treatment induced change in high density lipoprotein cholesterol and risk ratios for coronary heart disease deaths, coronary heart disease events, or total deaths. With all trials included, change in high density lipoprotein cholesterol explained almost no variability (<1%) in any of the outcomes. The change in the quotient of low density lipoprotein cholesterol and high density lipoprotein cholesterol did not explain more of the variability in any of the outcomes than did the change in low density lipoprotein cholesterol alone. For a 10 mg/dl (0.26 mmol/l) reduction in low density lipoprotein cholesterol, the relative risk reduction was 7.2% (95% confidence interval 3.1% to 11%; P=0.001) for coronary heart disease deaths, 7.1% (4.5% to 9.8%; P<0.001) for coronary heart disease events, and 4.4% (1.6% to 7.2%; P=0.002) for total deaths, when adjusted for change in high density lipoprotein cholesterol and drug class. Conclusions Available data suggest that simply increasing the amount of circulating high density lipoprotein cholesterol does not reduce the risk of coronary heart disease events, coronary heart disease deaths, or total deaths. The results support reduction in low density lipoprotein cholesterol as the primary goal for lipid modifying interventions.

引用

页数：8

共 53 条

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