| Background Statins are effective in lowering plasma low-density lipoprotein cholesterol(LDL-C)and reducing the risk of cardiovascular disease.However,patients with good LDL-C control still have a “residual risk” of cardiovascular disease.It is unclear whether high-density lipoprotein cholesterol(HDL-C)or apolipoprotein A-1(Apo-A1)is associated with cardiovascular disease.AIM To analyze the association of HDL-C and Apo-A1 with cardiovascular events in patients receiving statin therapy and to explore whether it could be a new target for cardiovascular disease prevention.Method Literature search was conducted according to the literature search process stipulated by the Cochrane Library and PRISMA.Based on relevant search terms,we searched for randomized clinical trials published in December 2018 from CNKI,Wanfang,Weipu,SinoMed and Pubmed,MEDLINE,Embase,ScienceDirect,and Cochrane library and ClinicalTrial databases.For screening for documents that may meet the requirements,clinical characteristics at baseline and at the time of the trial,blood lipids and apolipoprotein levels,and rates of change,absolute values during baseline and trial periods were calculated.The baseline of statin therapy and the 1-year follow-up of HDL-C and Apo-A1 were counted and the variables were calculated.According to the values,HDL-C,Apo-A1 and variables were followed up for quintile subgroups.The Cox proportional hazard model was used to quantify the risk ratio of HDL-C,Apo-A1,HDL-C,and Apo-A1 variables to major cardiovascular events,coronary events,and cerebrovascular events at 1-year follow-up.Linear trend was cross-tested using a trend test to analyze HRs and 95% CI for the primary clinical endpoint of the HDL-C and Apo-A1 quintile subgroups.At the same time,the hazard ratios(HRs)and 95% confidence interval(95% CI)for each additional standard amount(SD)of HDL-C and Apo-A1 were calculated.Establish a forest map to analyze the adjusted HRs and 95% CI for gender,age,smoking,body mass index,diabetes,and systolic blood pressure for coronary heart disease risk.Result According to the search strategy that has been developed,after the literature is included and the standard screening is excluded,13 articles are finally included.Thirteen clinical RCT studies that met the exclusion criteria included: 4S,AFCAPS-TexCAPS,LIPID,CARDS,TNT,IDEAL,SPARCL,JUPITER,SHARP,IMPROVE-IT,FOURIER,SPIRE-2,ODYSSEY-OUTCOMES.A total of 156,677 participants were enrolled in 13 clinical RCT studies,of which 73,339 were randomized to the statin treatment group.The HR of the quintiles in the statin-treated patients with HDL-C was 1.00,0.85,0.81,0.76,and 0.69,respectively.The linear analysis was P < 0.001.For each SD increase,the cardiovascular risk reduced by 0.82,P < 0.001.The HR of each quintile subgroup of Apo-A1 was 1.00,0.81,0.71,0.68,and 0.49,respectively.The linear analysis was P < 0.001.For each SD increase,the cardiovascular risk reduced by 0.71,P < 0.001.The HR of the HDL-C variable quintile subgroup was 1.00,0.89,0.94,0.96,0.96 for the cardiovascular events,and P=0.8 for the linear analysis.For each SD increase,the cardiovascular risk reduced by 0.96,P=0.4.The HR of the Apo-A1 variable quintile in the cardiovascular events was 1.00,0.89,0.93,0.92,and 0.86,respectively,and the linear analysis was P < 0.001.For each SD increase,the cardiovascular risk reduced by 0.96,P < 0.001.Subgroup analysis of gender,BMI,smoking,diabetes,coronary heart disease,intensive statin therapy,basal LDL-C,and basal triglyceride levels showed that each clinical feature had no risk of adjusting HDL-C,Apo-A1,and major cardiovascular events.Statistical significance(P>0.78).Conclusion In statin-treated patients,HDL-C and Apo A-1 levels are negatively correlated with the risk of major cardiovascular events.In addition,the higher the level of Apo A-1,the lower the cardiovascular risk.The results of this study support the further exploration of the role of Apo A-1 in the prevention of cardiovascular events. |
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