The Lancet：他汀疗法或可降低女性心血管疾病风险

  近日，一篇发表于国际杂志The Lancet上的研究论文中，来自悉尼大学的研究人员发现，他汀类药物疗法可以降低女性患心血管疾病的风险；截至本研究之前，研究者关于他汀类药物疗法对女性的作用是否和对男性一样有效尚无定论。

  文章中，研究者证实，他汀类药物不仅对患心血管疾病的女性（比如患中风及心脏病发作的女性）有益，还对相关心血管疾病风险增加的个体有益；Anthony Keech教授说道，我们的研究解决了一个不确定性的问题，即利用他汀类药物治疗女性的价值，以及加强该疗法对女性个体治疗的推荐程度。我们都知道，他汀类药物可以通过降低机体低密度脂蛋白胆固醇的水平来抑制高风险个体的心脏病发作及中风的风险。

  然而在后期生活中相比男性，女性更易发生心血管疾病，因此其应该早期使用他汀类药物进行预防，目前他汀类药物对女性产生益处的机制尚不清楚，尤其是对那些无心血管疾病史的个体而言。这项研究中，研究人员通过结合27项不同的试验，分析了他汀类药物治疗174000位病人的效果，揭示女性和男性一样，都可以从他汀类药物疗法中获益。总的来讲，他汀类药物疗法可以降低个体患主要心血管疾病的风险，每当机体低密度脂蛋白水平减少1mmol/L，患病风险就会降低21%，而且男性和女性疾病降低的风险相似，不论其是否有心血管疾病的历史。

  最后研究者Jordan Fulcher说道，不管是男性还是女性，心脏病发作和中风都是引发其死亡的主要风险因素，在澳大利亚每年有超过11500名女性因这两种疾病死亡。很少有女性会意识到，他们因心脏病发作死亡的风险高于乳腺癌引发的死亡风险，如果医生可以及时建议她们服用他汀类药物，那么或可明显降低其患心血管疾病的风险。

  本研究阐明，他汀类药物在改善女性个体总体生存率上同男性相同，而根据相关研究结果，研究者们鼓励患者及其医生及时配合治疗，通过他汀类药物降低机体坏胆固醇的水平来抑制心血管疾病的发生。（转化医学网360zhyx.com）

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转化医学网推荐的原文摘要：

Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174 000 participants in 27 randomised trials
The Lancet    doi:10.1016/S0140-6736(14)61368-4
Cholesterol Treatment Trialists' (CTT) Collaboration
Background
Whether statin therapy is as effective in women as in men is debated, especially for primary prevention. We undertook a meta-analysis of statin trials in the Cholesterol Treatment Trialists' (CTT) Collaboration database to compare the effects of statin therapy between women and men.
Methods
We performed meta-analyses on data from 22 trials of statin therapy versus control (n=134 537) and five trials of more-intensive versus less-intensive statin therapy (n=39 612). Effects on major vascular events, major coronary events, stroke, coronary revascularisation and mortality were weighted per 1·0 mmol/L reduction in LDL cholesterol and effects in men and women compared with a Cox model that adjusted for non-sex differences. For subgroup analyses, we used 99% CIs to make allowance for the multiplicity of comparisons.
Findings
46 675 (27%) of 174 149 randomly assigned participants were women. Allocation to a statin had similar absolute effects on 1 year lipid concentrations in both men and women (LDL cholesterol reduced by about 1·1 mmol/L in statin vs control trials and roughly 0·5 mmol/L for more-intensive vs less-intensive therapy). Women were generally at lower cardiovascular risk than were men in these trials. The proportional reductions per 1·0 mmol/L reduction in LDL cholesterol in major vascular events were similar overall for women (rate ratio [RR] 0·84, 99% CI 0·78–0·91) and men (RR 0·78, 99% CI 0·75–0·81, adjusted p value for heterogeneity by sex=0·33) and also for those women and men at less than 10% predicted 5 year absolute cardiovascular risk (adjusted heterogeneity p=0·11). Likewise, the proportional reductions in major coronary events, coronary revascularisation, and stroke did not differ significantly by sex. No adverse effect on rates of cancer incidence or non-cardiovascular mortality was noted for either sex. These net benefits translated into all-cause mortality reductions with statin therapy for both women (RR 0·91, 99% CI 0·84–0·99) and men (RR 0·90, 99% CI 0·86–0·95; adjusted heterogeneity p=0·43).
Interpretation
In men and women at an equivalent risk of cardiovascular disease, statin therapy is of similar effectiveness for the prevention of major vascular events.
Funding
UK Medical Research Council, British Heart Foundation, Australian National Health and Medical Research Council, European Community Biomed Program.