Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials

被引：1083

作者：

Fulcher, Jordan

O'Connell, Rachel

Voysey, Merryn

Emberson, Jonathan

Blackwell, Lisa

Mihaylova, Borislava

Simes, John ^{[21
,32
]}

Collins, Rory ^{[16
,28
,29
,33
]}

Kirby, Adrienne

Colhoun, Helen

Braunwald, Eugene ^{[1
,11
,27
]}

La Rosa, John ^{[30
]}

Pedersen, T. R. ^{[17
]}

Tonkin, Andrew ^{[21
]}

Davis, Barry ^{[3
]}

Sleight, Peter ^{[16
,28
]}

Franzosi, Maria Grazia ^{[14
]}

Baigent, Colin ^{[29
,33
]}

Keech, Anthony ^{[16
,21
]}

de Lemos, J. ^{[1
]}

Blazing, M. ^{[1
]}

Murphy, S. ^{[1
,27
]}

Downs, J. R. ^{[2
]}

Gotto, A. ^{[2
]}

Clearfield, M. ^{[2
]}

Holdaas, H. ^{[7
]}

Gordon, D. ^{[3
]}

Koren, M. ^{[4
]}

Dahloef, B. ^{[5
]}

Poulter, N. ^{[5
]}

Sever, P. ^{[5
]}

Knopp, R. H. ^{[6
]}

Fellstroem, B. ^{[7
]}

Holdaas, H. ^{[7
]}

Jardine, A. ^{[7
]}

Schmieder, R. ^{[7
]}

Zannad, F. ^{[7
]}

Goldbourt, U. ^{[8
]}

Kaplinsky, E. ^{[8
]}

Colhoun, H. M. ^{[9
]}

Betteridge, D. J. ^{[9
]}

Durrington, P. N. ^{[9
]}

Hitman, G. A. ^{[9
]}

Fuller, J. ^{[9
]}

Neil, A. ^{[9
]}

Wanner, C. ^{[10
]}

Krane, V. ^{[10
]}

Sacks, F. ^{[11
]}

Moye, L. ^{[11
]}

Pfeffer, M. ^{[11
]}

机构：

[1] AFCAPS TEXCAPS AirForce Texas Coronary Atherosc, Bethesda, MD USA

[2] ALERT Assessment Lescol Renal Transplantat, Bethesda, MD USA

[3] ALLIANCE Aggress Lipid Lowering Initiat Abates Ne, Bethesda, MD USA

[4] ASCOT Angloscandinavian Cardiac Outcomes Trial, Bethesda, MD USA

[5] ASPEN Atorvastatin Study Prevent Coronary Heart D, Bethesda, MD USA

[6] AURORA Study Evaluate Use Rosuvastatin Subjects R, Bethesda, MD USA

[7] BIP Bezafibrate Infarct Prevent Study, Tel Hashomer, Israel

[8] CARDS Collaborat Atorvastatin Diabet Study, Dublin, Ireland

[9] 4D Die Deutsch Diabet Dialyse Studie, Wurzburg, Germany

[10] CARE Cholesterol & Recurrent Events Study, Bethesda, MD USA

[11] CORONA Controlled Rosuvastatin Multinat Trial Hea, Bethesda, MD USA

[12] GISSI Grp Italiano Studio Sopravvivenza Infarto M, Chieti, Italy

[13] GISSI Prevent, Chieti, Italy

[14] HIT Vet Affairs HDL Intervent Trial, Bethesda, MD USA

[15] Heart Protect Study, Bethesda, MD USA

[16] IDEAL Incremental Decrease Endpoints Aggress Lipi, Oslo, Norway

[17] JUPITER Justificat Use Statins Prevent Intervent, Bethesda, MD USA

[18] Lipids Diabet Study, Bethesda, MD USA

[19] LEADER Lower Extrem Arterial Dis Event Reduct Tri, Bethesda, MD USA

[20] LIPID Long Term Intervent Pravastatin Ischaem Dis, Bethesda, MD USA

[21] Lescol Intervent Prevent Study, Iowa City, IA USA

[22] MEGA Management Elevated Cholesterol Primary Prev, Bethesda, MD USA

[23] Post CABG Postcoronary Artery Bypass Graft Study, Bethesda, MD USA

[24] Pravastatin Pooling Project, Bethesda, MD USA

[25] PROSPER Prospect Study Pravastatin Elderly Risk, Bethesda, MD USA

[26] PROVE IT Pravastatin Atorvastatin Evaluat & Infec, Bethesda, MD USA

[27] Study Effectiveness Addit Reduct Cholesterol & Ho, Bethesda, MD USA

[28] SHARP Study Heart & Renal Protect, Bethesda, MD USA

[29] Treating New Targets, Bethesda, MD USA

[30] Womens Hlth Initiat, Bethesda, MD USA

[31] WOSCOPS West Scotland Coronary Prevent Study, Glasgow, Lanark, Scotland

[32] Univ Sydney, CTC, Sydney, NSW 2006, Australia

[33] Univ Oxford, CTSU, Oxford OX1 2JD, England

来源：

LANCET | 2015年 / 385卷 / 9976期

基金：

英国医学研究理事会;

关键词：

CORONARY-HEART-DISEASE; PRIMARY PREVENTION; CARDIOVASCULAR EVENTS; MYOCARDIAL-INFARCTION; SECONDARY PREVENTION; STATIN THERAPY; SIMVASTATIN; ROSUVASTATIN; GUIDELINES; GENDER;

D O I：

10.1016/S0140-6736(14)61368-4

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Whether statin therapy is as effective in women as in men is debated, especially for primary prevention. We undertook a meta-analysis of statin trials in the Cholesterol Treatment Trialists' (CTT) Collaboration database to compare the effects of statin therapy between women and men. Methods We performed meta-analyses on data from 22 trials of statin therapy versus control (n=134 537) and five trials of more-intensive versus less-intensive statin therapy (n=39 612). Effects on major vascular events, major coronary events, stroke, coronary revascularisation and mortality were weighted per 1.0 mmol/L reduction in LDL cholesterol and effects in men and women compared with a Cox model that adjusted for non-sex differences. For subgroup analyses, we used 99% CIs to make allowance for the multiplicity of comparisons. Findings 46 675 (27%) of 174 149 randomly assigned participants were women. Allocation to a statin had similar absolute effects on 1 year lipid concentrations in both men and women (LDL cholesterol reduced by about 1.1 mmol/L in statin vs control trials and roughly 0.5 mmol/L for more-intensive vs less-intensive therapy). Women were generally at lower cardiovascular risk than were men in these trials. The proportional reductions per 1.0 mmol/L reduction in LDL cholesterol in major vascular events were similar overall for women (rate ratio [RR] 0.84, 99% CI 0.78-0.91) and men (RR 0.78, 99% CI 0.75-0.81, adjusted p value for heterogeneity by sex=0.33) and also for those women and men at less than 10% predicted 5 year absolute cardiovascular risk (adjusted heterogeneity p=0.11). Likewise, the proportional reductions in major coronary events, coronary revascularisation, and stroke did not differ significantly by sex. No adverse effect on rates of cancer incidence or non-cardiovascular mortality was noted for either sex. These net benefits translated into all-cause mortality reductions with statin therapy for both women (RR 0.91, 99% CI 0.84-0.99) and men (RR 0.90, 99% CI 0.86-0.95; adjusted heterogeneity p=0.43). Interpretation In men and women at an equivalent risk of cardiovascular disease, statin therapy is of similar effectiveness for the prevention of major vascular events.

引用

页码：1397 / 1405

页数：9

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