Effects of anti-hypertensive treatment on major cardiovascular events in populations within prehypertensive levels: a systematic review and meta-analysis

2018 ◽  
Vol 32 (2) ◽  
pp. 94-104 ◽  
Author(s):  
Zhongqiu Hong ◽  
Tao Wu ◽  
Shuxian Zhou ◽  
Boshui Huang ◽  
Jingfeng Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Major Cardiovascular Events

scholarly journals Comparative efficacy and safety of statin and fibrate monotherapy: A systematic review and meta-analysis of head-to-head randomized controlled trials

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246480
Author(s):  
Joseph E. Blais ◽  
Gloria Kin Yi Tong ◽  
Swathi Pathadka ◽  
Michael Mok ◽  
Ian C. K. Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Serum Creatinine ◽  
Cardiovascular Events ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Elevated Serum ◽  
Controlled Trials ◽  
Major Cardiovascular Events

Objective To assess whether in adults with dyslipidemia, statins reduce cardiovascular events, mortality, and adverse effects when compared to fibrates. Methods Systematic review and meta-analysis of head-to-head randomized trials of statin and fibrate monotherapy. MEDLINE, EMBASE, Cochrane, WHO International Controlled Trials Registry Platform, and ClinicalTrials.gov were searched through October 30, 2019. Trials that had a follow-up of at least 28 days, and reported mortality or a cardiovascular outcome of interest were eligible for inclusion. Efficacy outcomes were cardiovascular mortality and major cardiovascular events. Safety outcomes included myalgia, serious adverse effects, elevated serum creatinine, and elevated serum alanine aminotransferase. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using the Mantel-Haenszel fixed-effect model, and heterogeneity was assessed using the I2 statistic. Results We included 19 eligible trials that directly compared statin and fibrate monotherapy and reported mortality or a cardiovascular event. Studies had a limited duration of follow-up (range 10 weeks to 2 years). We did not find any evidence of a difference between statins and fibrates for cardiovascular mortality (OR 2.35, 95% CI 0.94–5.86, I2 = 0%; ten studies, n = 2657; low certainty), major cardiovascular events (OR 1.15, 95% CI 0.80–1.65, I2 = 13%; 19 studies, n = 7619; low certainty), and myalgia (OR 1.32, 95% CI 0.95–1.83, I2 = 0%; ten studies, n = 6090; low certainty). Statins had less serious adverse effects (OR 0.57, 95% CI 0.36–0.91, I2 = 0%; nine studies, n = 3749; moderate certainty), less elevations in serum creatinine (OR 0.17, 95% CI 0.08–0.36, I2 = 0%; six studies, n = 2553; high certainty), and more elevations in alanine aminotransferase (OR 1.43, 95% CI 1.03–1.99, I2 = 44%; seven studies, n = 5225; low certainty). Conclusions The eligible randomized trials of statins versus fibrates were designed to assess short-term lipid outcomes, making it difficult to have certainty about the direct comparative effect on cardiovascular outcomes and mortality. With the exception of myalgia, use of a statin appeared to have a lower incidence of adverse effects compared to use of a fibrate.

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