Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117,411 patients
Keene D, Price C, Shun-Shin MJ, Francis DP
BMJ (Clinical research ed.) · 339 citas
Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación independiente
- Gobierno
- National Institute for Health and Care Research
- Organización sin fines de lucro
- British Heart Foundation
- Gobierno
- National Institute for Health Research (NIHR)
- Subvenciones
- National Institute for Health and Care Research (ACF-2013-21-004); British Heart Foundation (FS/14/27/30752); National Institute for Health and Care Research (ACF-2011-21-003); British Heart Foundation (FS/10/38/28268)
Según 3 financiadores declarados.
Publicación
- Publicado
- 2014-07-18 · BMJ · vol. 349 · número jul18 2 · pág. g4379
- Citado
- 511 citas · más que el 100% de estudios similares · 11.3× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 60 trabajos
- Acceso
- Acceso abierto (revista híbrida) · CC-BY-NC
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cholesterol and Lipid Metabolism · Paraoxonase enzyme and polymorphisms
- Palabras clave
- HDL cholesterol, nicotinic acid, fibrates, CETP inhibitors, cardiovascular risk, all-cause mortality, coronary heart disease mortality, myocardial infarction, stroke, statins, cardiovascular drug therapy, lipid-lowering therapy, subgroup analysis, meta-analysis of randomised trials
- MeSH
- humans, coronary disease, myocardial infarction, amides, esters, sulfhydryl compounds, niacin, oxazolidinones, quinolines, lipoproteins, hdl, anticholesteremic agents, hydroxymethylglutaryl-coa reductase inhibitors, cholesterol ester transfer proteins, randomized controlled trials as topic, stroke, fibric acids
4 autores
- Daniel Keene🇬🇧 · autor de correspondenciaImperial College London
- C. Price🇬🇧Imperial College London
- Matthew James Shun-Shin🇬🇧Imperial College London
- Dárrel P. Francis🇬🇧Imperial College London
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objective
To investigate the effects on cardiovascular outcomes of drug interventions that increase high density lipoprotein levels.
Design
Meta-analysis.
Studies reviewed
Therapeutic benefit of niacin, fibrates, and cholesteryl ester transfer protein (CETP) inhibitors on cardiovascular events (all cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke).
Results
117,411 patients were randomised in a total of 39 trials. All interventions increased the levels of high density lipoprotein cholesterol. No significant effect was seen on all cause mortality for niacin (odds ratio 1.03, 95% confidence interval 0.92 to 1.15, P=0.59), fibrates (0.98, 0.89 to 1.08, P=0.66), or CETP inhibitors (1.16, 0.93 to 1.44, P=0.19); on coronary heart disease mortality for niacin (0.93, 0.76 to 1.12, P=0.44), fibrates (0.92, 0.81 to 1.04, P=0.19), or CETP inhibitors (1.00, 0.80 to 1.24, P=0.99); or on stroke outcomes for niacin (0.96, 0.75 to 1.22, P=0.72), fibrates (1.01, 0.90 to 1.13, P=0.84), or CETP inhibitors (1.14, 0.90 to 1.45, P=0.29). In studies with patients not receiving statins (before the statin era), niacin was associated with a significant reduction in non-fatal myocardial infarction (0.69, 0.56 to 0.85, P=0.0004). However, in studies where statins were already being taken, niacin showed no significant effect (0.96, 0.85 to 1.09, P=0.52). A significant difference was seen between these subgroups (P=0.007). A similar trend relating to non-fatal myocardial infarction was seen with fibrates: without statin treatment (0.78, 0.71 to 0.86, P<0.001) and with all or some patients taking statins (0.83, 0.69 to 1.01, P=0.07); P=0.58 for difference.
Conclusions
Neither niacin, fibrates, nor CETP inhibitors, three highly effective agents for increasing high density lipoprotein levels, reduced all cause mortality, coronary heart disease mortality, myocardial infarction, or stroke in patients treated with statins. Although observational studies might suggest a simplistic hypothesis for high density lipoprotein cholesterol, that increasing the levels pharmacologically would generally reduce cardiovascular events, in the current era of widespread use of statins in dyslipidaemia, substantial trials of these three agents do not support this concept.
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