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Meta-Analysis
. 2020 Jul 13;20(1):334.
doi: 10.1186/s12872-020-01567-1.

Efficacy of more intensive lipid-lowering therapy on cardiovascular diseases: a systematic review and meta-analysis

Hsin-Yin Hsu  1   2 , Chien-Ju Lin  3 , Yu-Shan Lee  1 , Ting-Hui Wu  1 , Kuo-Liong Chien  4   5
Affiliations
Meta-Analysis

Efficacy of more intensive lipid-lowering therapy on cardiovascular diseases: a systematic review and meta-analysis

Hsin-Yin Hsu et al. BMC Cardiovasc Disord. .

Abstract

Background: Cardiovascular disease is the leading cause of morbidity and mortality with incidence rates of 5-10 per 1000 person-years, according to primary prevention studies. To control hyperlipidemia-a major risk factor of cardiovascular disease-initiation of lipid-lowering therapy with therapeutic lifestyle modification or lipid-lowering agent is recommended. Few systematic reviews and meta-analyses are available on lipid-lowering therapy for the primary prevention of cardiovascular diseases. In addition, the operational definitions of intensive lipid-lowering therapies are heterogeneous. The aim of our study was to investigate whether intensive lipid-lowering therapies reduce greater cardiovascular disease risks in primary prevention settings.

Methods: MEDLINE, EMBASE, and Cochrane Library databases were searched from inception to March 2019 for randomized controlled trials. We used random effects model for overall pooled risk ratio (RR) estimation with cardiovascular events of interest and all-cause mortality rate for the intensive lipid-lowering group using the standard lipid-lowering group as the reference. The Cochrane Risk of Bias Tool was used for quality assessment.

Results: A total of 18 randomized controlled trials were included. The risk reductions in cardiovascular outcomes and all-cause mortality associated with more intensive vs. standard lipid-lowering therapy across all trials were 24 and 10%, respectively (RR 0.76, 95% confidence interval 0.68-0.85; RR 0.90, 95% confidence interval 0.83-0.97); however, the risk reduction varied by baseline LDL-C level in the trial. A greater risk reduction was noted with higher LDL-C level. Intensive lipid-lowering for coronary heart disease protection was more pronounced in the non-diabetic populations than in the diabetic populations.

Conclusions: More intensive LDL-C lowering was associated with a greater reduction in risk of total and cardiovascular mortality in trials of patients with higher baseline LDL-C levels than less intensive LDL-C lowering. Intensive lipid-lowering was associated with a significant risk reduction of coronary heart disease and must be considered even in the non-diabetic populations.

Keywords: All-cause mortality; Cardiovascular outcome; Intensive lipid-lowering; Primary prevention.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA study selection flow diagram. CDSR, Cochrane Database of Systematic Reviews; CENTRAL, Cochrane Central Register of Controlled Trials
Fig. 2
Fig. 2
Forest plot of pooled RR of coronary events
Fig. 3
Fig. 3
Forest plot of subgroup analyses of coronary event risks according to baseline LDL-C levels
Fig. 4
Fig. 4
Meta-regression analyses of coronary event risk according to diabetes proportions
See this image and copyright information in PMC

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