■关于他汀类药物用于老年人心血管疾病(CVD)一级预防的证据需要扩展和更新,旨在为临床实践提供进一步的指导。
■PubMed,EMBASE,搜索了Cochrane图书馆和WebofScience,以比较他汀类药物使用与老年人(年龄≥65岁)不使用他汀类药物进行CVD一级预防。主要结果是全因死亡率,CVD死亡率,冠心病(CHD)/心肌梗死(MI),卒中和总CV事件。在随机效应模型中,将每个相关结果的风险估计值合成为具有95%置信区间(95%CI)的风险比(HR)。
■纳入了12项符合条件的观察性研究(n=1,627,434)。汇总结果表明,他汀类药物的使用与全因死亡率的风险显着降低相关(HR:0.54,95%CI:0.46-0.63),CVD死亡率(HR:0.51,95%CI:0.39-0.65),冠心病/心肌梗死(HR:0.83,95%CI:0.69-1.00),卒中(HR:0.79,95%CI:0.68-0.92)和总CV事件(HR:0.75,95%CI:0.66-0.85).在较高的年龄(≥70岁,HR:0.56,95%CI:0.44-0.71;≥75岁,HR:0.70,95%CI:0.60-0.80;≥85岁,HR:0.85,95%CI:0.74-0.97),≥20%(HR:0.47,95%CI:0.35-0.62)和<20%糖尿病人群(HR:0.50,95%CI:0.40-0.64),和≥50%(HR:0.68,95%CI:0.59-0.79)和<50%高血压人群(HR:0.38,95%CI:0.16-0.88)。
■他汀类药物的使用占46%,49%,17%,全因死亡率风险降低21%和25%,CVD死亡率,CHD/MI,老年患者的卒中和总CV事件,分别。对于CVD一级预防,老年患者和≥75岁的个体也有显著的相关性。
UNASSIGNED: Evidence on statin use for primary prevention of cardiovascular disease (CVD) in older people needs to be extended and updated, aiming to provide further guidance for clinical practice.
UNASSIGNED: PubMed, EMBASE, Cochrane Library and Web of Science were searched for eligible observational studies comparing statin use vs. no-statin use for primary prevention of CVD in older people (age ≥ 65 years). The primary outcomes were all-cause mortality, CVD mortality, coronary heart disease (CHD)/myocardial infraction (MI), stroke and total CV events. Risk estimates of each relevant outcome were synthesized as a hazard ratio (HR) with 95% confidence interval (95% CI) using in the random-effects model.
UNASSIGNED: Twelve eligible observational studies (n = 1,627,434) were enrolled. The pooled results suggested that statin use was associated with a significantly decreased risk of all-cause mortality (HR: 0.54, 95% CI: 0.46-0.63), CVD mortality (HR: 0.51, 95% CI: 0.39-0.65), CHD/MI (HR: 0.83, 95% CI: 0.69-1.00), stroke (HR: 0.79, 95% CI: 0.68-0.92) and total CV events (HR: 0.75, 95% CI: 0.66-0.85). The association in all-cause mortality still remained obvious at higher ages ( ≥ 70 years old, HR: 0.56, 95% CI: 0.44-0.71; ≥ 75 years old, HR: 0.70, 95% CI: 0.60-0.80; ≥ 85 years old, HR: 0.85, 95% CI: 0.74-0.97), ≥ 20% (HR: 0.47, 95% CI: 0.35-0.62) and < 20% diabetic populations (HR: 0.50, 95% CI: 0.40-0.64), and ≥ 50% (HR: 0.68, 95% CI: 0.59-0.79) and < 50% hypertensive populations (HR: 0.38, 95% CI: 0.16-0.88).
UNASSIGNED: Statin use was related to a 46%, 49%, 17%, 21% and 25% risk reduction on all-cause mortality, CVD mortality, CHD/MI, stroke and total CV events in older patients, respectively. The significant association was also addressed in older patients and ≥ 75 years old individuals for CVD primary prevention.