Association of lowering apolipoprotein B with cardiovascular outcomes across various lipid-lowering therapies: Systematic review and meta-analysis of trials
Khan SU, Khan MU, Valavoor S, Khan MS, Okunrintemi V, Mamas MA, Leucker TM, Blaha MJ, Michos ED
European journal of preventive cardiology · 52 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
- Universidad u hospital
- Johns Hopkins University
- Gobierno
- National Institute of General Medical Sciences
- Gobierno
- NIGMS NIH HHS
- Subvenciones
- National Institute of General Medical Sciences (U54-GM-104942)
Según 3 financiadores declarados.
Publicación
- Publicado
- 2019-09-02 · Eur J Prev Cardiol · vol. 27 · número 12 · págs. 1255–1268
- Editorial
- Oxford University Press
- Citado
- 66 citas · más que el 71% de estudios similares · 1.1× el promedio de su campo
- Referencias
- 67 trabajos
- Acceso
- Lectura gratuita
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cholesterol and Lipid Metabolism · Diabetes, Cardiovascular Risks, and Lipoproteins
- Palabras clave
- apolipoprotein B, LDL receptor, statins, ezetimibe, PCSK9 inhibitors, bile acid sequestrants, CETP inhibitors, fibrates, nicotinic acid, omega-3 fatty acids, lipid-lowering therapy, major adverse cardiovascular events, all-cause mortality, cardiovascular mortality
- MeSH
- humans, cardiovascular diseases, apolipoproteins b, prognosis, risk factors, hypolipidemic agents, biomarkers
9 autores
- Safi Ullah Khan🇺🇸 · autor de correspondenciaWest Virginia University
- Muhammad U. Khan🇺🇸West Virginia University; John H. Stroger, Jr. Hospital of Cook County
- Shahul Valavoor🇺🇸West Virginia University
- Muhammad Shahzeb Khan🇺🇸West Virginia University; John H. Stroger, Jr. Hospital of Cook County
- Victor Okunrintemi🇺🇸East Carolina University
- Mamas A. Mamas🇬🇧Royal Stoke University Hospital; Keele University
- Thorsten Martin Leucker🇺🇸Johns Hopkins University; Johns Hopkins Medicine
- Michael Joseph Blaha🇺🇸Johns Hopkins University; Johns Hopkins Medicine
- Erin D. Michos🇺🇸Johns Hopkins University; Johns Hopkins Medicine
Resumen
El texto original del estudio, en el idioma en que se publicó.
Aims
The effect of therapeutic lowering of apolipoprotein B (apoB) on mortality and major adverse cardiovascular events is uncertain. It is also unclear whether these potential effects vary by different lipid-lowering strategies.
Methods
A total of 29 randomized controlled trials were selected using PubMed, Cochrane Library and EMBASE through 2018. We selected trials of therapies which ultimately clear apolipoprotein B particles by upregulating low-density lipoprotein receptor (LDL-R) expression (statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, bile acid sequestrants) or therapies which reduce apolipoprotein B independent of LDL-R (cholesteryl ester transfer protein inhibitor, fibrates, niacin, omega-3 fatty acids) with sample size of ≥1000 patients and follow-up of ≥1 year. The meta-regression and meta-analyses were constructed using a random effects model.
Results
In 332,912 patients, meta-regression analyses showed relative risks of 0.95 for all-cause mortality (95% confidence interval 0.92-0.99) and 0.93 (0.88-0.98) for cardiovascular mortality for every 10 mg/dL decrease in apolipoprotein B by all interventions combined. Reduction in all-cause mortality was limited to statins (0.92 (0.86-0.98)). For MACE, the relative risk per 10 mg/dL reduction in apolipoprotein B was 0.93 (0.90-0.97) for all therapies combined, with both statin (0.88 (0.83-0.93)) and non-statin therapies (0.96 (0.94-0.99)). which clear apolipoprotein B by upregulating LDL-R showing significant reductions; whereas interventions which lower apolipoprotein B independent of LDL-R did not demonstrate this effect (1.02 (0.81-1.30)).
Conclusion
While both statin and established non-statin therapies (PCSK9 inhibitor and ezetimibe) reduced cardiovascular risk per decrease in apolipoprotein B, interventions which reduce apolipoprotein B independently of LDL-R were not associated with cardiovascular benefit.
Resumen vía Europe PMC. Los derechos de autor siguen siendo de los autores o la editorial.
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