JAMA子刊:2万多人的研究发现,LDL-C小于1.8 mmol/L可能会降低复发性中风

2022-03-14 K.K MedSci原创

缺血性卒中病史的患者,以他汀为基础的强化降脂治疗,LDL-C水平降至<1.8 mmol/L,能降低复发性卒中风险,但仅限于有动脉粥样硬化的患者。

JAMA子刊:2万多人的研究发现,LDL-C小于1.8 mmol/L可能会降低复发中风的风险

近期,发表在《JAMA Neurology》上的一项荟萃分析发现,有缺血性中风病史的患者中,降低低密度脂蛋白胆固醇(LDL-C)的他汀类药物疗法可能降低复发中风的风险,但出血性中风的风险却增加。

 

Meng Lee et al, Association Between Intensity of Low-Density Lipoprotein Cholesterol Reduction With Statin-Based Therapies and Secondary Stroke Prevention, JAMA Neurology (2022). DOI: 10.1001/jamaneurol.2021.5578

来自台湾嘉义长庚大学医学院的医学博士Meng Lee及其同事进行了一项随机临床试验的荟萃分析,以研究对缺血性中风患者进行降低LDL-C的他汀类疗法。最终分析包括11项随机临床试验,涉及20163名中风患者,平均随访时间为4年。汇总结果显示,与强度较低的降LDL-C他汀类疗法相比,强度较高的降LDL-C他汀类疗法与复发卒中风险的降低有关(绝对风险8.1vs9.3%;相对风险0.88),而且与这些降LDL-C疗法有关的益处在不同的降LDL-C策略之间没有差异。

与强度较低的降LDL-C的他汀类药物相比,强度较高的降LDL-C的他汀类药物疗法与主要血管事件的风险降低有关,但出血性中风的风险增加。在所有有动脉粥样硬化证据的患者的试验中,较密集的降LDL-C他汀类药物疗法与复发中风的风险降低有关但在大多数没有动脉粥样硬化证据的患者的试验中,与较密集的降LDL-C他汀类药物疗法无关。

也就是说,缺血性卒中病史的患者,以他汀为基础的强化降脂治疗,LDL-C水平降至<1.8 mmol/L,能降低复发性卒中风险,但仅限于有动脉粥样硬化的患者。

研究者指出,缺血性卒中患者应用强化降脂治疗仅限于有动脉粥样硬化的患者。对于有动脉粥样硬化证据的缺血性中风患者,将LDL-C降至1.8 mmol/L以下是合理的。

"给临床医生的信息是,在有动脉粥样硬化证据的患者发生缺血性卒中后,应通过任何手段将低密度脂蛋白胆固醇水平降低到70mg/dL以下。"社论作者写道。

参考资料:

Meng Lee et al, Association Between Intensity of Low-Density Lipoprotein Cholesterol Reduction With Statin-Based Therapies and Secondary Stroke Prevention, JAMA Neurology (2022). DOI: 10.1001/jamaneurol.2021.5578

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    2022-04-10 屋顶瞄爱赏月

    学习了

    0

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    2022-03-28 屋顶瞄爱赏月

    学习了

    0

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    2022-03-16 zhwj
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    2022-03-14 医者仁者

    降脂不嫌低!#卒中#

    0

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    2022-03-14 forvalen

    努力达标

    0

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