他汀在75岁及以上老年人心血管病一级预防中疗效和安全性的Meta分析

Efficacy and safety of statins in primary prevention of cardiovascular disease in adults aged 75 years or older:a Meta-analysis

目的:系统评价他汀类药物在75岁及以上老年人心血管疾病一级预防中的有效性和安全性。方法:计算机检索PubMed、Embase、Cochrane图书馆、中国知网、中国生物医学文献数据库、维普、万方数据库发表的有关他汀作为75岁及以上老年人心血管病一级预防的随机对照研究或队列研究,检索时间均为建库至2020年12月。使用Stata 15.1软件进行荟萃分析。结果:纳入8项队列研究共394140例受试者。Meta分析结果显示,在≥2年的随访中,与不使用他汀相比,75岁及以上老年人使用他汀作为心血管病一级预防可能显著降低全因死亡风险(HR=0.81,95%CI:0.71~0.92,P=0.002)、主要血管事件风险(HR=0.84,95%CI:0.75~0.94,P=0.002)和冠心病风险(HR=0.87,95%CI:0.79~0.96,P=0.005),两组缺血性脑卒中风险(HR=0.91,95%CI:0.82~1.01,P=0.081)差异无统计学意义。对于安全性,使用他汀作为心血管病一级预防对75岁及以上老年人糖尿病(HR=0.95,95%CI:0.86~1.05,P=0.329)、肝脏损伤(HR=0.81,95%CI:0.63~1.05,P=0.113)、肌肉损害(HR=0.80,95%CI:0.55~1.17,P=0.25)和肿瘤(HR=0.98,95%CI:0.91~1.05,P=0.603)发生风险的影响未见显著差异。结论:使用他汀进行心血管病一级预防可能显著降低75岁及以上老年人的全因死亡、主要血管事件和冠心病风险,且不增加不良反应的发生,但能否降低缺血性脑卒中风险还需进一步研究。

Objective:To systematically evaluate the efficacy and safety of statins for primary prevention of cardiovascular disease in adults aged 75 years or older.Methods:We searched PubMed,Embase,Cochrane Library,CNKI,CBM,VIP,and Wanfang databases from inception to December 2020 and collected randomized controlled trials(RCTs)or cohort studies reporting the efficacy and safety of statins for primary prevention of cardiovascular disease in adults aged 75 years or older.Meta-analysis was then performed using Stata 15.1 software.Results:A total of 8 cohort studies involving 394140 older adults were included.The Meta-analysis indicated that the use of statins in adults aged 75 years or older significantly decreased the risk of all-cause death(HR=0.81,95%CI:0.71-0.92,P=0.002),major vascular events(HR=0.84,95%CI:0.75-0.94,P=0.002)and coronary heart disease(HR=0.87,95%CI:0.79-0.96,P=0.005)than the control group at more than 2-year follow-up.There was no significant difference in the risk of ischemic stroke(HR=0.91,95%CI:0.82-1.01,P=0.081).For safety,the use of statins was not associated with the risk of diabetes(HR=0.95,95%CI:0.86-1.05,P=0.329),hepatic dysfunction(HR=0.81,95%CI:0.63-1.05,P=0.113),myopathy(HR=0.80,95%CI:0.55-1.17,P=0.25)or tumor(HR=0.98,95%CI:0.91-1.05,P=0.603)in adults aged 75 years and older.Conclusion:The use of statins for primary prevention of cardiovascular disease in adults aged 75 years or older could significantly reduce the risk of all-cause death,coronary heart disease,and major vascular events.Meanwhile,no increase in adverse reactions has been found.However,further research should be conducted for the effect of statins on ischemic stroke.