%0 Journal Article
%T Effects of high
%A A Michael Lincoff
%A Edo Kaluski
%A Hammad Rahman
%A Haris Riaz
%A Nishant P Shah
%A Safi U Khan
%A Steven E Nissen
%J European Journal of Preventive Cardiology
%@ 2047-4881
%D 2019
%R 10.1177/2047487318816495
%X The effects of increasing high-density lipoprotein cholesterol on cardiovascular outcomes remain uncertain. We conducted a meta-analysis to investigate the effects of high-density lipoprotein cholesterol modifiers (niacin, fibrates and cholesteryl ester transfer protein inhibitors) on cardiovascular outcomes. Thirty-one randomized controlled trials (154,601 patients) with a follow-up of 6 months or more and a sample size of 100 or more patients were selected using MEDLINE, EMBASE and CENTRAL database (inception January 2018). High-density lipoprotein cholesterol modifiers had no statistically significant effect on cardiovascular mortality in terms of relative risk (RR) (RR 0.94, 95% confidence interval (CI) 0.89每1.00, Pˋ=ˋ0.05, I2ˋ=ˋ13%) or absolute risk (risk difference ˋ0.0001, 95% CI ˋ0.0014, 0.0011, Pˋ=ˋ0.84, I2ˋ=ˋ28%). High-density lipoprotein cholesterol modifiers reduced the RR of myocardial infarction (RR 0.87, 95% CI 0.82每0.93, Pˋ<ˋ0.001, I2ˋ=ˋ37%). This significant effect was derived by the use of fibrates (RR 0.80, 95% CI 0.73每0.87, Pˋ<ˋ0.001, I2ˋ=ˋ22%) and meta-regression analysis showed that this benefit was consistent with an absolute reduction in low-density lipoprotein cholesterol. High-density lipoprotein cholesterol modifiers had no effect on stroke (RR 1.00, 95% CI 0.93每1.09, Pˋ=ˋ0.94, I2ˋ=ˋ25%) or all-cause mortality (RR 1.02, 95% CI 0.97每1.08, Pˋ=ˋ0.48, I2ˋ=ˋ49%). Meta-regression analyses failed to demonstrate a significant association of pharmacologically increased high-density lipoprotein cholesterol with key endpoints. In studies with background statin therapy, high-density lipoprotein cholesterol modifiers had no statistically significant impact on cardiovascular mortality, myocardial infarction, stroke or all-cause mortality (Pˋ>ˋ0.05). The use of high-density lipoprotein cholesterol modifying treatments had no significant effect on cardiovascular mortality, stroke or all-cause mortality. The beneficial effect on myocardial infarction was lost when drugs were used with statin therapy
%K Niacin
%K fibrates
%K CETP inhibitors
%K meta-analysis
%U https://journals.sagepub.com/doi/full/10.1177/2047487318816495