背景:他汀类药物由于其降胆固醇作用和潜在的抗炎特性而被公认用于治疗心血管疾病(CVD)。尽管以前的系统评价表明,他汀类药物在心血管疾病的二级预防中减少炎症生物标志物,没有人在一级预防中检查它们对心脏和炎症生物标志物的影响.
方法:我们进行了系统评价和荟萃分析,以检查他汀类药物对无心血管疾病的个体中心血管和炎症生物标志物的影响。包括的生物标志物是:心肌肌钙蛋白,N末端B型利钠肽原(NT-proBNP),C反应蛋白(CRP),肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6),可溶性血管细胞粘附分子(sVCAM),可溶性细胞间粘附分子(sICAM),可溶性E-选择素(sE-selectin)和内皮素-1(ET-1)。通过OvidMEDLINE进行了文献检索,Embase和CINAHLPlus用于随机对照试验(RCT),截至2021年6月发表。
结果:总体而言,我们的荟萃分析包括35个RCT,26,521名参与者。使用随机效应模型将数据汇总,这些模型表示为具有95%置信区间(CI)的标准化平均差(SMD)。结合29个随机对照试验的36个效果大小,他汀类药物的使用导致CRP水平显着降低(SMD-0.61;95%CI-0.91,-0.32;P<0.001)。对于亲水性(SMD-0.39;95%CI-0.62,-0.16;P<0.001)和亲脂性他汀(SMD-0.65;95%CI-1.01,-0.29;P<0.001)均观察到这种降低。血清肌钙蛋白浓度无明显变化,NT-proBNP,TNF-α,IL-6,sVCAM,sICAM,sE-选择素和ET-1。
结论:这项荟萃分析表明,在CVD一级预防中,使用他汀类药物可降低血清CRP水平,对其他八种生物标志物没有明显影响。
BACKGROUND: Statins are well-established for their treatment of cardiovascular disease (CVD) due to their cholesterol-lowering effects and potential anti-inflammatory properties. Although previous systematic reviews demonstrate that statins reduce inflammatory biomarkers in the secondary prevention of CVD, none examine their effects on cardiac and inflammatory biomarkers in a primary prevention setting.
METHODS: We conducted a systematic
review and meta-analysis to examine the effects of statins on cardiovascular and inflammatory biomarkers among individuals without established CVD. The biomarkers included are: cardiac troponin, N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), soluble vascular cell adhesion molecule (sVCAM), soluble intercellular adhesion molecule (sICAM), soluble E-selectin (sE-selectin) and endothelin-1 (ET-1). A literature search was performed through Ovid MEDLINE, Embase and CINAHL Plus for randomised controlled trials (RCTs) published up to June 2021.
RESULTS: Overall, 35 RCTs with 26,521 participants were included in our meta-analysis. Data was pooled using random effects models presented as standardised mean differences (SMD) with 95% confidence intervals (CI). Combining 36 effect sizes from 29 RCTs, statin use resulted in a significant reduction in CRP levels (SMD -0.61; 95% CI -0.91, -0.32; P<0.001). This reduction was observed for both hydrophilic (SMD -0.39; 95% CI -0.62, -0.16; P<0.001) and lipophilic statins (SMD -0.65; 95% CI -1.01, -0.29; P<0.001). There were no significant changes in serum concentrations of cardiac troponin, NT-proBNP, TNF-α, IL-6, sVCAM, sICAM, sE-selectin and ET-1.
CONCLUSIONS: This meta-analysis demonstrates that statin use reduces serum CRP levels in a primary prevention setting for CVD, with no clear effect on the other eight biomarkers studied.