目的:贝特类药物治疗对心血管风险的影响不一致。这项荟萃分析旨在评估贝特类药物对主要不良心血管结局(MACE)减少的影响。
方法:PubMed,Embase,截至2023年2月,我们在Cochrane图书馆数据库中搜索了比较贝特类药物治疗和安慰剂治疗以及报告心血管结局和血脂变化的随机对照试验.主要结果是与MACE最接近的每个试验的临床结果,心血管死亡的复合物,急性心肌梗死,中风,和冠状动脉血运重建。还进行了预先指定的荟萃回归分析,以检查贝特类药物治疗后血脂水平的变化与MACE风险之间的关系。
结果:选择了12项试验进行最终分析,贝特组有25,781例患者和2,741例MACEs,对照组有27,450例患者和3,754例MACEs。总的来说,贝特类药物治疗与MACE风险降低相关(RR0.87,95%可信区间[CI]0.81~0.94),且存在中度异质性(I2=47%).在荟萃回归分析中,贝特治疗后低密度脂蛋白胆固醇(LDL-C)每降低1mmol/L可降低MACE(RR0.71,95%CI0.49-0.94,p=0.01),而甘油三酯水平的变化没有显示出显著的相关性。(RR0.96,95%CI0.53-1.40,p=0.86)与心血管死亡或急性心肌梗塞复合结局的敏感性分析产生了相似的结果。
结论:贝特类药物治疗与MACE风险降低相关。贝特类药物治疗的MACE风险降低似乎归因于LDL-C降低,而不是甘油三酯水平降低。
进行了一项包括12项试验和53,231例患者的系统评价和荟萃分析,以研究贝特类药物对降低心血管风险的作用。总的来说,贝特类药物治疗与心血管事件风险显著降低相关.在进一步分析中,发现贝特类药物治疗降低心血管风险主要归因于低密度脂蛋白胆固醇降低.
OBJECTIVE: The effect of
fibrate treatment on cardiovascular risk is inconsistent. This meta-analysis aimed to assess the effect of fibrates on major adverse cardiovascular outcome (MACE) reduction.
RESULTS: PubMed, Embase, and Cochrane library databases were searched up to February 2023 for randomized controlled trials comparing fibrate therapy against placebo and reporting cardiovascular outcomes and lipid profile changes. The primary outcome was the clinical outcomes of each trial that most closely corresponding to MACE, a composite of cardiovascular death, acute myocardial infarction, stroke, and coronary revascularization. A pre-specified meta-regression analysis to examine the relationship between the changes in lipid levels after fibrate treatment and the risk of MACE was also performed. Twelve trials were selected for final analysis, with 25 781 patients and 2741 MACEs in the
fibrate group and 27 450 patients and 3754 MACEs in the control group. Overall,
fibrate therapy was associated with decreased risk of MACE [RR 0.87, 95% confidence interval (CI) 0.81-0.94] with moderate heterogeneity (I2 = 47%). In meta-regression analysis, each 1 mmol/L reduction in low-density lipoprotein cholesterol (LDL-C) after fibrate treatment reduced MACE (RR 0.71, 95% CI 0.49-0.94, P = 0.01), while triglyceride level changes did not show a significant association (RR per 1mmol/L reduction 0.96, 95% CI 0.53-1.40, P = 0.86). A sensitivity analysis with the composite outcome of cardiovascular death or acute myocardial infarction produced similar results.
CONCLUSIONS: Treatment with fibrates was associated with decreased risk of MACE. The reduction in MACE risk with
fibrate therapy appears to be attributable to LDL-C reduction rather than a decrease in triglyceride levels.
A systematic review and meta-analysis including 12 trials and 53 231 patients were performed to investigate the effect of fibrates on lowering cardiovascular risk. Overall,
fibrate therapy was associated with significantly decreased risk of cardiovascular events. In further analysis, the decrease in cardiovascular risk achieved with fibrate treatment was found to be largely attributable to low-density lipoprotein cholesterol reduction.