Low-density lipoprotein-dependent and independent effects of statins on prevention of major coronary events: Meta-regression of randomized placebo-controlled trials

Abstract Background: Compositional abnormalities in lipoproteins and cardiovascular risk factors play an important role in the progression of diabetic peripheral neuropathy (DPN). This systematic review aimed to estimate the predicting value of low-density lipoprotein (LDL) and systolic blood pressure (SBP) level in type-2 diabetes mellitus (T2DM) patients with and without peripheral neuropathy. We also tried to determine whether LDL and SBP are associated with an increased collision risk of DPN. Materials and Methods: A systematic search was conducted for eligible publications which explored the LDL and SBP level in T2DM patients with and without peripheral neuropathy. The quality of the included studies was assessed by the QUADAS-2 tool. The standardized mean difference (SMD) with 95% CI of LDL and SBP level were pooled to assess the correlation between LDL and SBP level with DPN. We performed random effects meta-regression analyses to investigate factors associated with an increased collision risk of DPN. Results: There was a significant association between LDL and SBP with poor prognosis of DPN in those included studies (I2 = 88.1% and I2 = 84.9%, respectively, Both P < 0.001). European T2DM patients have higher serum level of LDL in compare with the European DPN patients (SMD = 0.16, 95 % CI: -0.06 - 0.38; P < 0.001). SBP level was associated with a 2.6 fold reduce in non-DPN patients of T2DM (SMD = -2.63, 95% CI: -4.00 - -1.27, P < 0.001). Furthermore, the results of the case-control study design model are more precise to show the accuracy of SBP in Asian T2DM patients. Old age European T2DM patients have significantly low collision risk in the last 30 years for diabetes drivers that indicates that LDL and SBP levels could be a promising vulnerability biomarker for early detection and effective intervention of DPN in real-life clinical practice of individuals with T2DM. Conclusion: Our finding supports the LDL and SBP status could be a promising prognostic biomarker for early detection and effective intervention of DPN in real-life clinical practice of individuals with T2DM.

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Hit or miss: the new cholesterol targets

BMJ evidence-based medicine ◽

10.1136/bmjebm-2020-111413 ◽

2020 ◽

pp. bmjebm-2020-111413

Author(s):

Robert DuBroff ◽

Aseem Malhotra ◽

Michel de Lorgeril

Keyword(s):

Cardiovascular Risk ◽

High Risk ◽

Randomised Controlled Trials ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Controlled Trials ◽

Low Density ◽

Low Density Lipoprotein Cholesterol ◽

Randomised Controlled

Drug treatment to reduce cholesterol to new target levels is now recommended in four moderate- to high-risk patient populations: patients who have already sustained a cardiovascular event, adult diabetic patients, individuals with low density lipoprotein cholesterol levels ≥190 mg/dL and individuals with an estimated 10-year cardiovascular risk ≥7.5%. Achieving these cholesterol target levels did not confer any additional benefit in a systematic review of 35 randomised controlled trials. Recommending cholesterol lowering treatment based on estimated cardiovascular risk fails to identify many high-risk patients and may lead to unnecessary treatment of low-risk individuals. The negative results of numerous cholesterol lowering randomised controlled trials call into question the validity of using low density lipoprotein cholesterol as a surrogate target for the prevention of cardiovascular disease.

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