目的:尽管各种随机对照试验(RCT)已经评估了雷洛昔芬对绝经后妇女载脂蛋白和脂蛋白(a)浓度的影响,结果不一致且尚无定论。因此,我们对RCT进行了这项荟萃分析,以研究雷洛昔芬给药对绝经后妇女载脂蛋白和脂蛋白(a)[Lp(a)]浓度的影响.
方法:两名独立研究人员系统地搜索了科学文献(包括PubMed/Medline,Scopus,WebofScience,和EMBASE)用于截至2024年6月发表的英语随机对照试验(RCT)。我们纳入了RCT报告雷洛昔芬对载脂蛋白A-I(ApoA-I)的影响,载脂蛋白B(ApoB),绝经后妇女的Lp(a)水平。感兴趣的主要结果是Lp(a)的变化,次要结局是ApoA-I和ApoB的变化.
结果:本荟萃分析纳入了12篇出版物和14个RCT组。从随机效应模型得出的综合结果显示ApoA-I的统计学显着增加(WMD:6.06mg/dL,95%CI:4.38,7.75,P<0.001)和ApoB浓度降低(WMD:-8.48mg/dL,95%CI:-10.60,-6.36,P<0.001)和Lp(a)(WMD:-3.02mg/dL,绝经后妇女服用雷洛昔芬后,95%CI:-4.83,-1.21,P<0.001)。在亚组分析中,在参与者平均年龄≥60岁,持续时间≤12周的RCT中,ApoA-I的升高以及ApoB和Lp(a)水平的降低更大.
结论:当前对RCT的荟萃分析表明,雷洛昔芬治疗可降低绝经后妇女的ApoB和Lp(a)水平,同时增加ApoA-I水平。由于这些对脂质成分的影响与心血管疾病(CVD)的风险降低有关,雷洛昔芬可能是绝经后妇女的合适疗法,这些妇女患CVD的风险增加,并且有雷洛昔芬给药的其他医学指征。
OBJECTIVE: Although various randomized controlled trials (RCTs) have evaluated the effect of
raloxifene on apolipoproteins and lipoprotein(a) concentrations in postmenopausal women, the results have been inconsistent and inconclusive. Therefore, we conducted this meta-analysis of RCTs to investigate the effect of
raloxifene administration on apolipoproteins and lipoprotein(a) [Lp(a)] concentrations in postmenopausal women.
METHODS: Two independent researchers systematically searched the scientific literature (including PubMed/Medline, Scopus, Web of Science, and EMBASE) for English-language randomized controlled trials (RCTs) published up to June 2024. We included RCTs reporting the impact of
raloxifene on apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB), and Lp(a) levels in postmenopausal women. The primary outcome of interest was change in Lp(a), and the secondary outcomes were changes in ApoA-I and ApoB.
RESULTS: The present meta-analysis incorporated 12 publications with 14 RCT arms. The comprehensive outcomes derived from the random-effects model revealed a statistically significant increase in ApoA-I (WMD: 6.06 mg/dL, 95% CI: 4.38, 7.75, P < 0.001) and decrease in ApoB concentrations (WMD: -8.48 mg/dL, 95% CI: -10.60, -6.36, P < 0.001) and Lp(a) (WMD: -3.02 mg/dL, 95% CI: -4.83, -1.21, P < 0.001) following the administration of
raloxifene in postmenopausal women. In the subgroup analyses, the increase in ApoA-I and the decrease in ApoB and Lp(a) levels were greater in RCTs with a mean participant age of ≥60 years and a duration of ≤12 weeks.
CONCLUSIONS: The current meta-analysis of RCTs demonstrates that treatment with
raloxifene reduces ApoB and Lp(a) levels while increasing ApoA-I levels in postmenopausal women. Since these effects on lipid components are associated with a reduced risk of cardiovascular disease (CVD), raloxifene could be a suitable therapy for postmenopausal women who are at an increased risk of CVD and have other medical indications for raloxifene administration.