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【medical-news】他汀类药物用于一级预防的指南受
29 January 2007
Guidelines recommending statin therapy for primary prevention in women or people over the age of 65 years are not evidence-based, experts claim.
Writing in a Comment article in The Lancet, John Abramson (Harvard Medical School, Boston, Massachusetts, USA) and Jim Wright (University of British Columbia, Vancouver, Canada) argue that the trials cited in support of their use in primary prevention by the 2001 US National Cholesterol Education Program do not, in fact, provide the necessary evidence.
The researchers pooled data from eight randomized trials comparing statins with placebo in primary prevention populations deemed at increased cardiovascular disease (CVD) risk.
They found that neither total mortality nor total serious adverse events were reduced by statin use (relative risks [RRs] of 0.95 and 1.01, respectively).
They did find that CVD event rate was reduced by statins (RR=0.82).
"However, the absolute risk reduction of 1.5% is small and means that 67 people have to be treated for 5 years to prevent one such event," say Abramson and Wright.
Furthermore, they say that the benefit appears to be limited to high-risk men aged 30-69 years, with no reduction in coronary heart disease events in over 10,000 women in the primary prevention trials, or in over 3000 men and women over the age of 69 years.
"Our analysis suggests that lipid-lowering statins should not be prescribed for true primary prevention in women of any age or for men older than 69 years," the authors write.
Furthermore, they say that high-risk men aged 30-69 years should be advised that around 50 patients need to be treated for 5 years to prevent one event.
"In our experience," they continue, "many men presented with this evidence do not choose a statin, especially when informed of the potential benefits of lifestyle medication on cardiovascular risk and overall health."
Such an approach would lead to a much smaller proportion of the population using statins than is currently recommended.
Abramson and Wright believe that the recommendations are based on the assumptions that cardiovascular risk is a continuum and the evidence from secondary prevention populations can be extrapolated to the primary prevention setting, and that cardiovascular risk can be predicted accurately.
They add that the Cholesterol Treatment Trialists' collaboration have the necessary data to report on a purely primary prevention population and say that two questions need to be addressed.
These are, firstly: Do data on primary prevention confirm there is an overall benefit in adult women and in men aged 70 years and over? And, secondly: Is there significant heterogeneity between the statin treatment effect in primary prevention subgroups compared with that in secondary prevention subgroups?
"If the answer to both these questions is yes, the assumption that the benefits for secondary prevention populations can be extrapolated to primary prevention populations is false and the cholesterol treatment guidelines based on this assumption should be revised," Abramson and Wright conclude.
Lancet 2007; 369: 168-169
http://www.incirculation.net/NewsItem/Lipidlowering-guidelines-for-primary-prevention-ch.aspx 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Lipid-lowering guidelines for primary prevention challenged
他汀类药物用于一级预防的指南受到质疑
29 January 2007
Guidelines recommending statin therapy for primary prevention in women or people over the age of 65 years are not evidence-based, experts claim.
专家宣称，指南推荐的他汀治疗用于妇女或65岁以上人群的一级预防是没有证据基础的。
Writing in a Comment article in The Lancet, John Abramson (Harvard Medical School, Boston, Massachusetts, USA) and Jim Wright (University of British Columbia, Vancouver, Canada) argue that the trials cited in support of their use in primary prevention by the 2001 US National Cholesterol Education Program do not, in fact, provide the necessary evidence.
John Abramson（美国马萨诸塞州波士顿哈佛医学院）和Jim Wright（加拿大温哥华哥伦比亚不列颠大学）在《柳叶刀》的一篇评论文章中写到，由2001年美国全国胆固醇教育计划引用来证明他汀药物在一级预防中的使用的实验，实际上并不能提供必需的证据。
The researchers pooled data from eight randomized trials comparing statins with placebo in primary prevention populations deemed at increased cardiovascular disease (CVD) risk.
研究人员集合了8个随机实验数据，这些实验比较了他汀药物和安慰剂在心血管疾病高风险人群的一级预防中的作用。
They found that neither total mortality nor total serious adverse events were reduced by statin use (relative risks [RRs] of 0.95 and 1.01, respectively).
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作者:admin@医学,生命科学 2011-02-28 17:12
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