Social contact frequency and all-cause mortality: A meta-analysis and meta-regression

Objectives This meta-analysis sought to determine whether surgical ablation improves clinical outcomes and resource utilization compared with no ablation in adult patients with persistent and permanent atrial fibrillation (AF) undergoing cardiac surgery. Methods A comprehensive search was undertaken to identify all randomized (RCT) and nonrandomized (non-RCT) controlled trials of surgical ablation versus no ablation in patients with AF undergoing cardiac surgery up to April 2009. The primary outcome was sinus rhythm. Secondary outcomes included survival and any other reported clinically relevant outcome or indicator of resource utilization. Odds ratios (OR) and weighted mean differences (WMD) and their 95% confidence intervals (95% CI) were analyzed as appropriate using the random effects model. Heterogeneity was measured using the I2 statistic. Meta-regression was performed to explore the relationship between the benefit from surgical AF and duration of follow-up. Results Thirty-three studies met the inclusion criteria (10 RCTs and 23 non-RCTs) for a total of 4647 patients. The number of patients in sinus rhythm was significantly improved at discharge in the surgical AF ablation group versus (68.6%) the surgery alone group (23.0%) in RCTs (OR 10.1, 95% CI 4.5–22.5) and non-RCTs (OR 7.15, 95% CI 3.42–14.95). This effect on sinus rhythm (74.6% vs. 18.4%) remained at follow-up of 1 to 5 years (OR 6.7, 95% CI 2.8–15.7 for RCT, and OR 15.5, 95% CI 6.6–36.7 for non-RCT). The risk of all-cause mortality at 30 days was not different between the groups in RCT (OR 1.20, 95% CI 0.52–3.16) or non-RCT studies (OR 0.99, 95% CI 0.52–1.87). In studies reporting all-cause mortality at 1 year or more (up to 5 years), mortality did not differ in RCT studies (OR 1.21, 95% CI 0.59–2.51) but was significantly reduced in non-RCT studies (OR 0.54, 95% CI 0.31–0.96). Stroke incidence was not reduced significantly; however, in meta-regression, the risk of stroke decreased significantly with longer follow-up. Other clinical outcomes were similar between groups. Operation time was significantly increased with surgical AF ablation; however, overall impact on length of stay was variable. Conclusions In patients with persistent or permanent AF who present for cardiac surgery, the addition of surgical AF ablation led to a significantly higher rate of sinus rhythm in RCT and non-RCT studies compared with cardiac surgery alone, and this effect remains robust over the longer term (1–5 years). Although non-RCT studies suggest the possibility of reduced risk of stroke and death, this remains to be proven in prospective RCTs with adequate power and follow-up.

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Meta-analysis and meta-regression of early aortic valve replacement versus watchful waiting in asymptomatic severe aortic stenosis: a 2020 boost of evidence

European Heart Journal ◽

10.1093/ehjci/ehaa946.1975 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

G Costa ◽

B Oliveiros ◽

L Goncalves ◽

R Teixeira

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Watchful Waiting ◽

Meta Analysis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

All Cause Mortality ◽

Meta Regression

Abstract Background Current guidelines recommend aortic-valve replacement (AVR) as the only effective therapy for severe symptomatic aortic stenosis (AS) patients. Nevertheless, management and timing of intervention in asymptomatic AS remains a controversial topic, with sparse evidence to support the recommendations (level C). Purpose To assess an early-AVR strategy in asymptomatic severe AS, comparing it with a watchful waiting (WW) strategy Methods We systematically searched PubMed, Embase and Cochrane databases, in February 2020, for both interventional or observational studies comparing early-AVR with WW in the treatment of asymptomatic severe AS. Random-effects meta-analysis for early-AVR and WW were performed. Meta-regression was used to assess the influence of study characteristics on the outcome. Results Eight studies were included (seven registry-based or unrandomized studies and one randomized clinical trial) providing a total of 3985 patients, and 1232 pooled all-cause deaths (172 in early-AVR and 1060 in watchful waiting). Meta-analysis showed a significantly lower all-cause mortality for the early-AVR compared with WW group (pooled OR 0.24 [0.17, 0.32], P<0.01) although with a moderate amount of heterogeneity between studies in the magnitude of effect (I2=57%, P=0.02). The early-AVR patients also displayed a lower cardiovascular mortality (pooled OR 0.27 [0.15, 0.48], P<0.01) plus a lower heart failure hospitalization rate (pooled OR 0.27 [0.06, 0.65], P<0.007). No difference in clinical thromboembolic event rate (stroke or myocardial infarction) was noted. The meta-regression for all cause mortality based on possible confounders such as time of follow-up, age, gender, diabetes mellitus, coronary artery disease, left ventricular ejection fraction, and mean peak aortic jet velocity showed that effect sizes reported by the individual studies seem to be independent from the covariates considered (P>0.05). Conclusions Our 2020 pooled data reinforces the previous evidence suggesting the benefit of early-AVR in asymptomatic patients with severe AS. Early AVR vs WW, All-cause death Funding Acknowledgement Type of funding source: None

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Tea Flavonoids and Risk of Cardiovascular and All-Cause Mortality: A Systematic Review and Meta-Analysis

Proceedings of The Nutrition Society ◽

10.1017/s0029665120001573 ◽

2020 ◽

Vol 79 (OCE2) ◽

Cited By ~ 1

Author(s):

Ding Ding Wang ◽

Aedin Cassidy ◽

Mario G. Ferruzzi ◽

Paul Jacques ◽

Elizabeth Johnson ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Green Tea ◽

Lower Risk ◽

Meta Analysis ◽

Black Tea ◽

Tea Consumption ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Meta Regression

AbstractThere is increasing evidence that both black and green tea are beneficial for prevention of cardiovascular disease (CVD). We conducted a systematic review and meta-analysis evaluating the effects of tea flavonoids on cardiovascular (CVD) and all-cause mortality outcomes.Searches across five databases including PubMed and Embase were conducted through November 2018 to identify randomized controlled trials (RCTs) and prospective cohort studies reporting cardiovascular and all-cause mortality outcomes. Two investigators independently conducted abstract and full-text screenings, data extractions, and risk of bias (ROB) assessments using the Nutrition Evidence Library Bias Assessment Tool (NEL BAT). Mixed-effects dose-response meta-regression and standard random-effects meta-analyses for outcomes with ≥ 4 studies were performed. 0 RCTs and 38 prospective cohort studies were included in the systematic review. NEL BAT scores ranged from 0–15 (0 being the lowest risk). Our linear meta-regression model showed that each cup increase in daily tea consumption (about 280 mg and 338 mg of total flavonoids for black and green tea, respectively) was associated with 3–4% lower risk of CVD mortality (predicted adjusted RR = 0.96; CI 0.93–0.99 for green tea and RR = 0.97; CI 0.94–0.99 for black tea). Furthermore, eachcup increase in daily tea consumption was associated a 2% lower risk of all-cause mortality (predicted adjusted relative risk (RR) = 0.98; 95% CI 0.97–0.99 for black tea and RR = 0.98; CI 0.96–0.99 for green tea, respectively). Two studies reported multivariable Cox regression analysis results for the relationship between black tea intake and risks of all-cause mortality outcomes. The results from these two studies were combined with our linear meta-regression result in a random-effects model meta-analysis and showed that each cup increase in daily black tea consumption was associated with an average of 3% lower risk of all-cause mortality (pooled adjusted RR = 0.97; 95% CI 0.87- 1.00) with large heterogeneity (I2 = 81.4%; p = 0.005). Current evidence indicates that increased tea consumption may reduce cardiovascular and all-cause mortality in a dose-response manner. This systematic review was registered on PROSPERO.

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724 Cardiovascular morbidity and mortality related to non-alcoholic fatty liver disease: a systematic review and meta-analysis of prospective studies

European Heart Journal Supplements ◽

10.1093/eurheartj/suab136 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Giandomenico Bisaccia ◽

Fabrizio Ricci ◽

Eugenia Melchiorre ◽

Claudio Tana ◽

Giulia Renda ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Fatty Liver Disease ◽

Meta Analysis ◽

Alcoholic Fatty Liver ◽

Increased Risk ◽

All Cause Mortality ◽

Meta Regression ◽

Meta Regression Analysis ◽

Alcoholic Fatty Liver Disease

Abstract Aims Whether non-alcoholic fatty liver disease (NAFLD) is a risk factor for cardiovascular (CV) events is still debated. Currently available evidence derives from non-homogeneous studies yielding conflicting results. We set out to assess the relationship between NAFLD and CV morbidity and mortality by pooling results of previous studies. Methods We performed a systematic review and meta-analysis of prospective observational studies published from 1966 through 2021 reporting summary-level outcome data in subjects with and without NAFLD. Adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for all-cause mortality, CV mortality, myocardial infarction (MI), stroke, major adverse cerebrocardiovascular events (MACCE) and atrial fibrillation (AF) were pooled through inverse variance random-effect meta-analysis to compute the summary effect size. We performed post hoc subgroup analysis stratified by geographical region and univariate mixed-effect model meta-regression analysis to address statistical heterogeneity. Results We identified a total of 29 studies pooling an overall population of 5 626 573 middle-aged individuals (mean age 56 ± 8; male sex 53%; NAFLD 5.8%, n = 326 389). Mean follow-up was 10 ± 6 years. Compared with control population, presence of NAFLD was associated with similar risk of all-cause death (RR 1.17; 95% CI 0.89–1.52) and CV death (RR 0.84; 95% CI 0.64–1.10). When analysed by geographic location, pooled estimates of RR (95% CI) for all-cause death were 1.57 (1.00–2.48) for Western countries, and 0.81 (0.52–1.1.26) for Eastern countries (test for subgroup difference, P = 0.04). Meta-regression analysis showed a stronger relationship between NAFLD and all-cause mortality proportional to increasing body mass index (P = 0.048). NAFLD was associated with increased risk of myocardial infarction (RR 1.35; 95% CI 1.09–1.68), stroke (RR 1.20; 95% CI 1.06–1.35), MACCE (RR 2.09; 95% CI 1.57–2.78), and atrial fibrillation (RR 1.37; 95% CI 1.05–1.78). Conclusion NAFLD portends excess all-cause mortality but only in Western countries. CV mortality was similar in NAFLD and non-NAFLD groups. NAFLD is associated with increased risk of incident MI, stroke, MACCE, and AF.

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Prognostic significance of cardiac amyloidosis in patients with aortic stenosis: a systematic review and meta-analysis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.364 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

F Ricci ◽

L Ceriello ◽

MY Khanji ◽

G Dangas ◽

C Bucciarelli Ducci ◽

...

Keyword(s):

Systematic Review ◽

Regression Analysis ◽

Aortic Stenosis ◽

Elderly Patients ◽

Cardiac Amyloidosis ◽

Meta Analysis ◽

Prognostic Significance ◽

All Cause Mortality ◽

Meta Regression ◽

Meta Regression Analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Cardiac amyloidosis (CA) has been increasingly recognized in elderly patients with aortic stenosis (AS), but with uncertain prognostic significance. Objectives We performed a systematic review and meta-analysis to clarify whether concurrent CA portends excess mortality in patients with aortic stenosis AS. Methods Our systematic review of the literature published through June 2020, sought observational studies reporting summary-level outcome data of all-cause mortality in AS patients with or without concurrent CA. Pooled estimate of Mantel-Haenszel odds ratio (OR) and 95% confidence intervals (CIs) for all-cause death was assessed as the primary endpoint. We performed subgroup analysis stratified by severity of left ventricular hypertrophy (LVH) and study-level meta-regression analysis to explore the effect of covariates on summary effect size and to address statistical heterogeneity. Results We identified 4 studies including 609 AS patients (9% AS-CA; 69% men; age, 84 ± 5 years). The average follow-up was 20 ± 5 months. Compared with lone AS, AS-CA was associated with 2-fold increase in all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2 = 62%). When analysed according to LVH severity, pooled ORs (95% CI) for all-cause mortality were 1.29 (0.65-2.22) for mild LVH (≤16 mm), and 4.81 (2.19-10.56) for moderate/severe LVH (>16 mm). Meta-regression analysis confirmed a stronger relationship proportional to the degree of LVH, regardless of age and aortic valve replacement, explaining between-study heterogeneity variance. Conclusions CA heralds significantly higher risk of all-cause death in elderly patients with AS. Severity of LVH appears to be a major prognostic determinant in patients with dual AS-CA pathology. Abstract Figure.

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Tea Flavonoids and Risk of Cardiovascular and All-Cause Mortality: A Systematic Review and Meta-Analysis (P06-126-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz031.p06-126-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Taylor Wallace ◽

Aedin Cassidy ◽

Mei Chung ◽

Mario Ferruzzi ◽

Paul Jacques ◽

...

Keyword(s):

Systematic Review ◽

Cohort Studies ◽

Green Tea ◽

Lower Risk ◽

Meta Analysis ◽

Black Tea ◽

Tea Consumption ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Meta Regression

Abstract Objectives To conduct a systematic review and meta-analysis evaluating the effects of tea flavonoids on cardiovascular (CVD) and all-cause mortality outcomes. Methods Searches across five databases including PubMed and Embase were conducted through November 2018 to identify randomized controlled trials (RCTs) and prospective cohort studies reporting cardiovascular and all-cause mortality outcomes. Two investigators independently conducted abstract and full-text screenings, data extractions, and risk of bias (ROB) assessments using the Nutrition Evidence Library Bias Assessment Tool (NEL BAT). Mixed-effects dose-response meta-regression and standard random-effects meta-analyses for outcomes with ≥4 studies were performed. Results 0 RCTs and 38 prospective cohort studies were included in the systematic review. NEL BAT scores ranged from 0–15 (0 being the lowest risk). Our linear meta-regression model showed that each cup increase in daily tea consumption (about 280 mg and 338 mg of total flavonoids for black and green tea, respectively) was associated with 3–4% lower risk of CVD mortality (predicted adjusted RR = 0.96; CI 0.93–0.99 for green tea and RR = 0.97; CI 0.94–0.99 for black tea). Furthermore, each cup increase in daily tea consumption was associated a 2% lower risk of all-cause mortality (predicted adjusted relative risk (RR) = 0.98; 95% CI 0.97–0.99 for black tea and RR = 0.98; CI 0.96–0.99 for green tea, respectively). Two studies reported multivariable Cox regression analysis results for the relationship between black tea intake and risks of all-cause mortality outcomes. The results from these two studies were combined with our linear meta-regression result in a random-effects model meta-analysis and showed that each cup increase in daily black tea consumption was associated with an average of 3% lower risk of all-cause mortality (pooled adjusted RR = 0.97; 95% CI 0.87–1.00) with large heterogeneity (I2 = 81.4%; p = 0.005). Conclusions Current evidence indicates that increased tea consumption may reduce CVD and all-cause mortality in a dose-response manner. This systematic review was registered on PROSPERO. Funding Sources Funding for this study was provided through an unrestricted educational grant from Unilever. The funding body had no influence on the study design; the collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the paper for publication.

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Association of Obesity with COVID-19 Severity and Mortality: A Systemic Review and Meta-Regression

10.1101/2021.05.08.21256845 ◽

2021 ◽

Author(s):

Romil Singh ◽

Sawai Singh Rathore ◽

Hira Khan ◽

Smruti Karale ◽

Abhishek Bhurwal ◽

...

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Cardiovascular Diseases ◽

Meta Analysis ◽

Invasive Mechanical Ventilation ◽

Female Gender ◽

All Cause Mortality ◽

Meta Regression ◽

High Bmi

Objective: To estimate the association of obesity with severity (defined as use of invasive mechanical ventilation or intensive care unit admission) and all-cause mortality in coronavirus disease 2019 (COVID-19) patients. Patients and Methods: A systematic search was conducted from inception of COVID-19 pandemic through January 31st, 2021 for full-length articles focusing on the association of increased BMI/ Obesity and outcome in COVID-19 patients with help of various databases including Medline (PubMed), Embase, Science Web, and Cochrane Central Controlled Trials Registry. Preprint servers such as BioRxiv, MedRxiv, ChemRxiv, and SSRN were also scanned. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were used for study selection and data extraction. The severity in hospitalized COVID-19 patients, such as requirement of invasive mechanical ventilation and intensive care unit admission with high BMI/ Obesity was the chief outcome. While all-cause mortality in COVID-19 hospitalized patients with high BMI/ Obesity was the secondary outcome. Results: A total of 576,784 patients from 100 studies were included in this meta-analysis. Being obese was associated with increased risk of severe disease (RR=1.46, 95% CI 1.34-1.60, p<0.001, I2 = 92 %). Similarly, high mortality was observed in obese patients with COVID-19 disease (RR=1.12, 95% CI 1.06-1.19, p<0.001, I2 = 88%). In a multivariate meta-regression on severity outcome, the covariate of female gender, pulmonary disease, diabetes, older age, cardiovascular diseases, and hypertension was found to be significant and explained R2= 50% of the between-study heterogeneity for severity. Similarly, for mortality outcome, covariate of female gender, proportion of pulmonary disease, diabetes, hypertension, and cardiovascular diseases were significant, these covariates collectively explained R2=53% of the between-study variability for mortality. Conclusions: Our findings suggest that obesity is significantly associated with increased severity and higher mortality among COVID-19 patients. Therefore, the inclusion of obesity or its surrogate body mass index in prognostic scores and streamlining the management strategy and treatment guidelines to account for the impact of obesity in patient care management is recommended.

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A Threshold of Objectively-Assessed Daily Sedentary Time for All-cause Mortality in Older Adults: A Meta-Regression of Prospective Cohort Studies

Journal of Clinical Medicine ◽

10.3390/jcm8040564 ◽

2019 ◽

Vol 8 (4) ◽

pp. 564 ◽

Cited By ~ 9

Author(s):

Ku ◽

Steptoe ◽

Liao ◽

Hsueh ◽

Chen

Keyword(s):

Older Adults ◽

Dose Response ◽

Sedentary Time ◽

Meta Analysis ◽

Response Relationship ◽

Dose Response Relationship ◽

Mortality Risks ◽

Prospective Cohort Studies ◽

All Cause Mortality ◽

Meta Regression

Background: This meta-analysis aimed to estimate the shape of the dose-response association between objectively-assessed daily sedentary time (ST) and all-cause mortality, and to explore whether there is a threshold of ST above which there is an increase in mortality risk in older adults. Methods: Searches for prospective cohort studies providing effect estimates of daily ST (exposure) on all-cause mortality (outcome) were undertaken in five databases up to 31 March 2019. A random-effects meta-regression model was conducted to quantify the dose-response relationship between daily ST and all-cause mortality. Sensitivity analyses were also performed to test the stability of the results. Results: Our analysis of pooled data from 11 eligible studies did not reveal a consistent shape of association between ST and mortality. After excluding three studies with potential confounding bias, there was a log-linear dose-response relationship between daily ST and all-cause mortality. Overall, higher amounts of time spent in sedentary behaviors were associated with elevated mortality risks in older adults. Visual assessments of dose-response relationships based on meta-regression analyses indicated that increased mortality risks became significant when total ST exceeded approximately 9 h/day. Conclusions: Based on a limited number of studies, this meta-analysis provides a starting point for considering a cut-off of daily sedentary time, suggesting older adults spend less time in daily sitting.

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One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression

Journal of Interventional Cardiology ◽

10.1155/2019/8947204 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Raymundo A. Quintana ◽

Dominique J. Monlezun ◽

Adrian DaSilva-DeAbreu ◽

Uday G. Sandhu ◽

Derick Okwan-Duodu ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Meta Analysis ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Baseline Characteristics ◽

Meta Regression ◽

One Year

Objective. To assess 1-year mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS). Background. Clinical trials have proven the beneficial effect of TAVR on mortality in patients with tricuspid AS. Individuals with bicuspid AS were excluded from these trials. Methods. A meta-analysis using literature search from the Cochrane, PubMed, ClinicalTrials, SCOPUS, and EMBASE databases was conducted to determine the effect of TAVR on 1-year mortality in patients with bicuspid AS. Short-term outcomes that could potentially impact one-year mortality were analyzed. Results. After evaluating 380 potential articles, 5 observational studies were selected. A total of 3890 patients treated with TAVR were included: 721 had bicuspid and 3,169 had tricuspid AS. No statistically significant difference between the baseline characteristics of the two groups of patients was seen outside of mean aortic gradient. Our primary endpoint of one-year all-cause mortality revealed 85 deaths in 719 patients (11.82%) with bicuspid AS compared to 467 deaths in 3100 patients (15.06%) with tricuspid AS, with no difference between both groups [relative risk (RR) 1.03; 95% CI 0.70-1.51]. Patients with bicuspid AS were associated with a decrease in device success (RR 0.62; 95% CI 0.45-0.84) and an increase in moderate-to-severe prosthetic valve regurgitation (RR 1.55; 95% CI 1.07-2.22) after TAVR compared to patients with tricuspid AS. The effect of meta-regression coefficients on one-year all-cause mortality was not statistically significant for any patient baseline characteristics. Conclusion. When comparing TAVR procedure in tricuspid AS versus bicuspid AS, there was no difference noted in one-year all-cause mortality.

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Association of lowering apolipoprotein B with cardiovascular outcomes across various lipid-lowering therapies: Systematic review and meta-analysis of trials

European Journal of Preventive Cardiology ◽

10.1177/2047487319871733 ◽

2019 ◽

Vol 27 (12) ◽

pp. 1255-1268 ◽

Cited By ~ 4

Author(s):

Safi U Khan ◽

Muhammad U Khan ◽

Shahul Valavoor ◽

Muhammad Shahzeb Khan ◽

Victor Okunrintemi ◽

...

Keyword(s):

Apolipoprotein B ◽

Meta Analysis ◽

Density Lipoprotein ◽

Lipid Lowering ◽

Cochrane Library ◽

Major Adverse Cardiovascular Events ◽

Omega 3 ◽

Pcsk9 Inhibitors ◽

All Cause Mortality ◽

Meta Regression

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.

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