阿托伐他汀联合依折麦布治疗老年冠心病或急性冠脉综合征的有效性与安全性Meta分析

目的 系统评价阿托伐他汀联合依折麦布治疗老年冠心病(CHD)或急性冠脉综合征(ACS)的有效性和安全性,为临床提供循证参考.方法 计算机检索PubMed、EMbase、The Cochrane Library、中国知网(CNKI)、CBM、VIP、Wanfang数据库,收集阿托伐他汀联合依折麦布相比单用中高强度阿托伐他...

Efficacy and Safety of Atorvastatin Combined with Ezetimibe in the Treatment of Elderly Patients with Coronary Heart Disease or Acute Coronary Syndrome:A Meta-Analysis

Objective To systematically review the efficacy and safety of atorvastatin combined with ezetimibe in the treatment of elderly patients with coronary heart disease(CHD)or acute coronary syndrome(ACS),and to provide an evidence-based reference for clinical practice.Methods PubMed,Embase,The Cochrane Library,CNKI,CBM,VIP and Wanfang databases were electronically searched to collect the randomized controlled trials(RCTs)about atorvastatin combined with ezetimibe versus medium-high dose atorvastatin in the treatment of elderly patients with CHD or ACS.The data were extracted and assessed according to the Cochrane Reviewers’Handbook5.1.0.The Meta-analysis was performed by using Revman 5.3 software.Results Six RCTs involving 1720 patients were included.The results of Meta-analysis showed that the effect of atorvastatin combined with ezetimibe on reducing low-density lipoprotein cholesterol(LDL-C)was better than that of medium-high dose atorvastatin alone[MD=-5.83,95%CI(-11.01,-0.64),P=0.03].In subgroups,the effect of atorvastatin combined with ezetimibe on reducing LDL-C in elderly patients with ACS was similar to that of medium-high dose atorvastatin alone[MD=1.85,95%CI(-13.83,17.52),P=0.82],the effect of atorvastatin combined with ezetimibe on reducing LDL-C in patients with only CHD or high risk of CHD was better than that of medium-high dose atorvastatin alone[MD=-8.72,95%CI(-13.21,-4.23),P=0.0001].The LDL-C compliance rate of elderly patients with ACS treated with atorvastatin combined with ezetimibe was significantly higher than that of patients treated with medium-high dose atorvastatin alone[OR=0.68,95%CI(0.53,0.86),P=0.001].There was no significant difference in the incidence of adverse drug reactions in elderly patients with only CHD or high risk of CHD between atorvastatin combined with ezetimibe and medium-high dose atorvastatin alone[OR=0.97,95%CI(0.59,1.58),P=0.89],also no significant difference in the incidence of major adverse cardiovascular events(MACE)in elderly patients with ACS[OR=1.27,95%CI(0.78,2.08),P=0.34].After administration of atorvastatin combined with ezetimibe or medium-high dose atorvastatin alone,there was no significant difference in the number of patients whose alanine aminotransferase(ALT)increased more than 3-fold[OR=0.29,95%CI(0.07,1.21),P=0.09].Conclusion For elderly patients over 60 years old with CHD or high risk of CHD,atorvastatin combined with ezetimibe had a better effect of reducing LDL-C than medium-high dose atorvastatin alone.For elderly patients with ACS,there is no significant difference in clinical efficacy between the two treatment plans.There was no significant difference in adverse drug reactions between the two treatment plans.