| Title | Effect of More Intensive LDL-C-Lowering Therapy on Long-term Cardiovascular Outcomes in Early-Phase Acute Coronary Syndrome: A Systematic Review and Meta-analysis |
| Authors | Jin, Siyao Nie, Xiaolu Li, Yuxi Yuan, Jinjie Cui, Yimin Zhao, Libo |
| Affiliation | Capital Med Univ, Beijing Childrens Hosp, Clin Res Ctr, Natl Ctr Childrens Hlth, 56 Nanlishi Rd, Beijing 100045, Peoples R China Capital Med Univ, Coll Pharmaceut Sci, Dept Clin Pharm, Beijing, Peoples R China Capital Med Univ, Beijing Childrens Hosp, Natl Ctr Childrens Hlth, Ctr Clin Epidemiol & Evidence Based Med, Beijing, Peoples R China Peking Univ, Sch Publ Hlth, Dept Epidemiol & Biostat, Beijing, Peoples R China Peking Univ First Hosp, Dept Cardiol, 6 Dahongluochang St, Beijing 100034, Peoples R China |
| Keywords | ACUTE MYOCARDIAL-INFARCTION STATIN THERAPY 80 MG INTERVENTION ATORVASTATIN EZETIMIBE CHOLESTEROL SIMVASTATIN EFFICACY ASSOCIATION |
| Issue Date | Jul-2021 |
| Publisher | CLINICAL THERAPEUTICS |
| Abstract | Purpose: The effect of more intensive LDL-C- lowering therapy (ILLT) on long-term cardiovascular outcomes during the early phase of acute coronary syndromes (ACSs) remains uncertain. We aimed to explore the influence of more intensive LDL-C- lowering therapyduring the early disease phase on long-term cardiovascular events among patients with ACSs. Methods: Randomized controlled trials that focused on the effect of more ILLT during early-phase ACSs on long-term major adverse cardiac events (MACEs) were searched in electronic databases (MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases) from database inception until November 23, 2019. The end points included the incidence of MACEs, myocardial infarction, stroke, revasculariza-tion, heart failure, and death events. Study risk of bias was assessed using the Cochrane Collaboration tools. Fixed-or random-effects models and meta-regression were performed to evaluate the association between baseline/proportional reduction of LDL-C levels during early-phase disease and the risk of end points using risk ratios with 95% CIs. Findings: A total of 53,199 participants were involved from 19 studies. The risk of MACEs decreased by 17% (95% CI, 0.76-0.90; P = 0.0012) for more intensive versus control therapy but varied by baseline and proportional reduction of LDL-C levels during early disease phase. The risk reduction of MACEs for more intensive versus control therapy among different subgroups was 26% (95% CI, 0.57-0.95; P = 0.06) with a baseline level > 130 mg/dL, 23% (95% CI, 0.63- 0.94; P = 0.02) with a baseline level of 100 to 130 mg/dL, and 10% (95% CI, 0.83-0.99; P = 0.07) with a baseline level < 100 mg/dL. A significant difference of risk reduction for MACEs existed between patients treated with statin plus ezetimibe versus statin alone in the subgroup with a baseline level > 130 mg/dL and proportional reduction > 50%. Patients treated with more intensive therapy benefited from reduced risk of myocardial infarction, stroke, revascularization, and heart failure compared with control therapy. Implications: More ILLT during early disease phase could significantly reduce the risk of longterm cardiovascular outcome in patients with ACSs. This benefit was most pronounced in patients with higher baseline and larger reduction of LDL-C levels in MACEs. (Clin Ther. 2021;43:e217-e229.) (c) 2021 Elsevier Inc. |
| URI | http://hdl.handle.net/20.500.11897/631083 |
| ISSN | 0149-2918 |
| DOI | 10.1016/j.clinthera.2021.04.019 |
| Indexed | SCI(E) |
| Appears in Collections: | 公共卫生学院 第一医院 |
