Efficacy And Safety Of Different Statin Intensity Used In Chinese Patients With Coronary Heart Disease: A Systematic Review And Meta-analysis

Objective: To review the therapeutic efficacy and safety of different intensity statin in the treatment of coronary heart disease(CHD)in the Chinese population in a systematic manner.Methods: A comprehensive literature search was conducted electronically utilizing databases such as PubMed?Web of Science?EMBase?CBM?VIP?CNKI?WanFang Data and the randomized controlled trials(RCTs)that compare the use of statin therapy of different intensities in the Chinese CHD population published prior to August,2017 were considered.References to relevant literature would also be screened by manual retrieval.The eligible literatures were selected according to the inclusion and exclusion criteria,and the data were analyzed by RevMan 5.3 and STATA 14.Results: 18 studies that met inclusion and exclusion criteria were systematically reviewed.The results of Meta analysis demonstrated that:(1)moderate-intensity statin therapy is non-inferior to high-intensity statin therapy in the reduction of stroke(RR=0.67,95%CI:0.41~1.10,P=0.11),however,high-intensity statin is superior in terms reducing nonfatal myocardial infarction(MI)(RR=0.45,95%CI:0.29~0.72,P=0.0008),overall mortality(RR=0.44,95%CI:0.27~0.73,P=0.001),composite endpoint events(RR=0.59,95%CI:0.46~0.76,P<0.0001),heart failure(RR=0.40,95%CI:0.25~0.62,P<0.0001),angina(RR=0.48,95%CI:0.33~0.71,P=0.0002),total cholesterol(TC)levels(MD=0.50,95%CI: 0.35~0.65,P<0.00001)and low density lipoprotein cholesterol(LDL-C)levels(MD=0.38,95%CI: 0.28~0.49,P<0.0001).(2)No significant difference in overall mortality was found between low-intensity and moderate-intensity statin therapy(RR=0.55,95%CI:0.12~2.53,P=0.44).Only one study showed that moderate-intensity statin could reduce nonfatal MI and total cholesterol levels compared to low-intensity statin therapy.(3)No significant difference in adverse reaction was found between high-intensity and moderate-intensity statin therapy(RR=1.30,95%CI:0.92~1.84,P=0.14).None of the studies reported safety in between compare moderate intensity statins with low intensity statins.Conclusion: High-intensity statin therapy use in Chinese CHD patients could potentially decrease the incidences of nonfatal myocardial infarction,death,heart failure,angina,TC levels and LDL-C levels.High-intensity statin therapy,however,does not reduce the risk of stroke and seems to elevate the risk of side effects.However,due to the limited quantity and suboptimal quality of the included studies,the above conclusion is not deemed conclusive and future investigation with higher quality is warranted.