在≥75岁的患者中,脂质降低在减少患者中的心血管事件时有效<75岁。这些结果来自系统审查和荟萃分析,应加强对老年患者在内的降脂治疗(包括非他汀类药物治疗)的指导建议。

Data from 6 articles was included in the systematic review and meta-analysis, which included 24 trials from the Cholesterol Treatment Trialists’ Collaboration meta-analysis, in addition to 5 individual trials, presented by Dr. Baris Gencer (Brigham and Women’s Hospital, USA) [1,2]. The meta-analysis included a total of 244,090 patients from 29 trials, 21,492 (8.8%) of whom were aged at least 75 years. Of those, 11,750 (54.7%) were from statin trials, 6,209 (28.9%) from ezetimibe trials, and 3,533 (16.4%) from PCSK9 inhibitor trials. Median follow-up was between 2.2 years and 6.0 years.

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结果表明,降低LDL胆固醇显着改善了老年患者主要血管事件(n = 3,519)的风险,每1mmol / L的LDL胆固醇减少26%(RR 0.74; 95%CI 0.61-0.89; P = 0.0019),没有统计学上有显着差异,患者的风险减少<75岁(RR 0.85; 95%CI 0.78-0.92; P相互作用= 0.37)。在老年患者中,对他汀类药物的相对风险没有统计学不同(RR 0.82; 95%CI 0.73-0.91)和非他汀类药物治疗(RR 0.67; 95%CI 0.47-0.95; p相互作用= 0.64)。在复合材料的每种组分中,包括心血管死亡(RR 0.85; 95%CI 0.74-0.98),心肌梗塞(RR 0.80; 95%CI 0.71-0.90),中风(RR0.73; 95%CI 0.61-0.87),冠状动脉血管体外(RR 0.80; 95%CI 0.66-0.96)。

总之,75岁或以上的患者发现,降低脂质疗法降低了老年患者的主要心血管事件的风险,就像他们在较年轻的患者那样的那样,每1mmol / L每1mmol / L的主要心血管事件减少26%LDL胆固醇。

  1. Gencer B等人。降低低密度脂蛋白胆固醇在老年科对象中的疗效:随机对照试验的系统审查和荟萃分析。摘要13787,Virtual AHA科学课程2020,13-17 11月
  2. Gencer B等人。降低LDL胆固醇在老年患者中的功效和安全性:随机对照试验的系统回顾与荟萃分析。柳叶刀。2020年11月9日:S0140-6736(20)32332-1。