Efficacy of Ezetimibe/Simvastatin (10/10 mg) versus High Dose Statin in Dyslipidemia Patients: A Meta-Analysis of Randomized Controlled Trials

2020 ◽  
Author(s):  
Gaoming YANG ◽  
Dengfeng HAN ◽  
Jianhua MA ◽  
Xiaoning ZHANG
Keyword(s):  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Controlled Trials ◽  
High Dose ◽  
Randomized Controlled ◽  
Statin Monotherapy ◽  
Hs Crp

Background: The monotherapies of statin and ezetimibe had not successfully achieved their objectives in the management of lipid levels of dyslipidemia patients. We aimed to compare the effects of combined low-dose simvastatin and ezetimibe versus high-dose statin on the lipid-lowering treatment of dyslipidemia patients. Methods: We searched five databases published before May 2018, namely PubMed, EMBASE, Cochrane, Web of Science, and Clinicaltrials.gov. Completely published randomized controlled trials (RCTs) comparing the effect of high-dose statin (S) with ezetimibe/simvastatin (10/10 mg; E/S) on the management of dyslipidemia patients were included. Results: A total of ten RCTs met the inclusion criteria, including 1,624 patients (E/S:691, S:933). Six outcomes underwent pooled analysis, including weighted mean difference (WMD) from baseline in total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), high sensitivity C-reactive protein (hs-CRP), triglyceride (TG), and non-high-density lipoprotein cholesterol (nonHDL-C). No significant gap was found between high-dose statin and ezetimibe/simvastatin (10/10 mg) in LDL-C (-1.55; 95% confidence interval [CI]:-4.42~1.31, P=0 .29), HDL-C (1.05; 95%CI:-0.21~2.3, P=0 .1), TG (4.03; 95%CI:-4.53~12.58, P=0.36), and hs-CRP (0.14; 95%CI:-0.50~0.78, P=0.67). However, there was significant difference found between the two lipid-lowering treatments in TC (-0.45; 95%CI:-9.07~-0.83, P=0.02) and non-HDL-C (-4.97; 95%CI -8.46~-1.49, P=0.005). Conclusion: Ezetimibe co-administered with simvastatin (10 mg) and high-dose statin monotherapy may show similar effects in reducing LDL-C, TG, and hs-CRP levels and in increasing HDL-C levels. However, the results suggest that there was greater TC and non-HDL-C lowering through high-dose statin monotherapy as compared with ezetimibe/simvastatin co-administration.

Effects of fibrates on C-reactive protein concentrations: a meta-analysis of randomized controlled trials

2012 ◽  
Vol 50 (2) ◽  
Author(s):  
Yongchen Hao ◽  
Huan Zhang ◽  
Xueli Yang ◽  
Lu Wang ◽  
Dongfeng Gu
Keyword(s):  
High Density Lipoprotein ◽  
Randomized Controlled Trials ◽  
High Density Lipoprotein Cholesterol ◽  
Meta Analysis ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Controlled Trials ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Randomized Controlled

AbstractThe effects of fibrates on C-reactive protein (CRP) are controversial. This meta-analysis was conducted to synthesize the available clinical trial evidence and summarize the effects of fibrates on CRP concentrations. In addition, this study assessed the relationship between changes in CRP and lipid measures.A systematic search was conducted of randomized controlled trials on the effects of fibrates on CRP concentrations in the PubMed, Embase and Cochrane Library Database up to January 2011. A meta-analysis was performed using a random effect model. Meta-regression analysis was employed to assess the relationships between average change in CRP and lipid profiles.Sixteen randomized controlled trials were included in the meta-analysis. Compared with placebo, treatment with fibrates significantly decreased CRP concentrations (weighted mean difference –0.47 mg/L, 95% confidence interval –0.93 to –0.01 mg/L, p=0.046). Fibrates significantly reduced CRP concentrations in trials with a higher baseline CRP concentrations (≥3 mg/L). There was a significant correlation between change in CRP and change in high-density lipoprotein cholesterol (regression coefficient or slope=–2.03, 95% CI –3.20 to –0.87, p=0.001).Fibrates can reduce CRP concentrations and change in CRP was correlated with change in high-density lipoprotein cholesterol but not with triglyceride. These findings suggest that patients with dyslipidemia could benefit from fibrates treatment by CRP lowering and this benefit is associated with lipid profile improving.

Abstract TP198: Combined Diet and Aerobic Exercise Reduces non-HDL-C in Adults: A Meta-Analysis of Randomized Controlled Trials

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
George A Kelley ◽  
Kristi S Kelley
Keyword(s):  
High Density Lipoprotein ◽  
Aerobic Exercise ◽  
Randomized Controlled Trials ◽  
High Density Lipoprotein Cholesterol ◽  
Statistical Significance ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Controlled Trials ◽  
Randomized Controlled

BACKGROUND AND PURPOSE: Non-high-density lipoprotein cholesterol (non-HDL-C) is associated with an increased risk for cerebrovascular disease. However, the effects of three community-deliverable lifestyle interventions [diet (D), aerobic exercise (E), or both (DE)] on non-HDL-C in adults are not known. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap. METHODS: A priori study eligibility included randomized controlled trials >4 weeks that included a D, E, DE and control (C) group in adults >18 years of age in which data for total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) were available for calculating non-HDL-C. Studies were retrieved by searching nine electronic databases, cross-referencing and expert review. Dual data selection and extraction were conducted. A mixed effects model was employed whereby a random-effects approach was used to combine effect size (ES) results within each subgroup while a fixed-effect approach was used to compare subgroups (Q b ). Heterogeneity was examined using the Q and I 2 statistics and 95% confidence intervals (CI) were also calculated. Statistical significance was set at p < 0.05 while a trend for statistical significance was set between p >0.05 to < 0.10. RESULTS: Overall, a statistically significant exercise minus control group decrease in non-HDL-C was found for DE (7 ESs, 389 participants, mean, -11.1 mg/dl, 95% CI, -21.7 to -0.6, p =0.04, Q=2.4, p =0.88, I 2 =0%), a trend for the D group (7 ESs, 402 participants, mean, -8.5 mg/dl, 95% CI, -18.6 to 1.6, p =0.10, Q=0.76, p =0.99, I 2 =0%) and no change for the E group (7 ESs, 387 participants, mean, 3.0 mg/dl, 95% CI, -7.1 to 13.1, p =0.56, Q=0.78, p =0.99, I 2 =0%). Relative changes were -6.5%, -5.6%, and 0.8% respectively, for DE, D and E groups. Overall, no statistically significant between-group differences were found (Q b = 4.1, p = 0.12). There was a trend for decreases in non-HDL-C to be greater in the DE versus E group (Q b = 3.6, p = 0.06) with no statistically significant differences between D and E (Q b = 2.5, p = 0.12) or DE and D (Q b = 0.1, p = 0.72) groups. CONCLUSIONS: Combined DE reduces non-HDL-C in adults.

Triglyceride to high density lipoprotein cholesterol ratio, total cholesterol to high density lipoprotein cholesterol ratio and low ankle brachial index in an elderly population

VASA ◽  
2014 ◽  
Vol 43 (3) ◽  
pp. 189-197 ◽  
Author(s):  
Yiqiang Zhan ◽  
Jinming Yu ◽  
Rongjing Ding ◽  
Yihong Sun ◽  
Dayi Hu
Keyword(s):  
High Density Lipoprotein ◽  
Total Cholesterol ◽  
High Density Lipoprotein Cholesterol ◽  
Ankle Brachial Index ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Cholesterol Ratio ◽  
Potential Biomarker

Background: The associations of triglyceride (TG) to high-density lipoprotein cholesterol ratio (HDL‑C) and total cholesterol (TC) to HDL‑C ratio and low ankle brachial index (ABI) were seldom investigated. Patients and methods: A population based cross-sectional survey was conducted and 2982 participants 60 years and over were recruited. TG, TC, HDL‑C, and low-density lipoprotein cholesterol (LDL-C) were assessed in all participants. Low ABI was defined as ABI ≤ 0.9 in either leg. Multiple logistic regression models were applied to study the association between TG/HDL‑C ratio, TC/HDL‑C ratio and low ABI. Results: The TG/HDL‑C ratios for those with ABI > 0.9 and ABI ≤ 0.9 were 1.28 ± 1.20 and 1.48 ± 1.13 (P < 0.0001), while the TC/HDL‑C ratios were 3.96 ± 1.09 and 4.32 ± 1.15 (P < 0.0001), respectively. After adjusting for age, gender, body mass index, obesity, current drinking, physical activity, hypertension, diabetes, lipid-lowering drugs, and cardiovascular disease history, the odds ratios (ORs) with 95 % confidence intervals (CIs) of low ABI for TG/HDL‑C ratio and TC/HDL‑C ratio were 1.10 (0.96, 1.26) and 1.34 (1.14, 1.59) in non-smokers. When TC was further adjusted, the ORs (95 % CIs) were 1.40 (0.79, 2.52) and 1.53 (1.21, 1.93) for TG/HDL‑C ratio and TC/HDL‑C ratio, respectively. Non-linear relationships were detected between TG/HDL‑C ratio and TC/HDL‑C ratio and low ABI in both smokers and non-smokers. Conclusions: TC/HDL‑C ratio was significantly associated with low ABI in non-smokers and the association was independent of TC, TG, HDL‑C, and LDL-C. TC/HDL‑C might be considered as a potential biomarker for early peripheral arterial disease screening.

scholarly journals Patterns and trends of potentially inappropriate high-density lipoprotein cholesterol testing in Australian adults at high risk of cardiovascular disease from 2008 to 2014: analysis of linked individual patient data from the Australian Medicare Benefits Schedule and Pharmaceutical Benefits Scheme

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019041 ◽  
Author(s):  
Farshid Hajati ◽  
Evan Atlantis ◽  
Katy J L Bell ◽  
Federico Girosi
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
National Guidelines ◽  
Pharmaceutical Benefits Scheme

ObjectivesWe examine the extent to which the adult Australian population on lipid-lowering medications receives the level of high-density lipoprotein cholesterol (HDL-C) testing recommended by national guidelines.DataWe analysed records from 7 years (2008–2014) of the 10% publicly available sample of deidentified, individual level, linked Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) electronic databases of Australia.MethodsThe PBS data were used to identify individuals on stable prescriptions of lipid-lowering treatment. The MBS data were used to estimate the annual frequency of HDL-C testing. We developed a methodology to address the issue of ‘episode coning’ in the MBS data, which causes an undercounting of pathology tests. We used a published figure on the proportion of unreported HDL-C tests to correct for the undercounting and estimate the probability that an HDL-C test was performed. We judged appropriateness of testing frequency by comparing the HDL-C testing rate to guidelines’ recommendations of annual testing for people at high risk for cardiovascular disease.ResultsWe estimated that approximately 49% of the population on stable lipid-lowering treatment did not receive any HDL-C test in a given year. We also found that approximately 19% of the same population received two or more HDL-C tests within the year. These levels of underutilisation and overutilisation have been changing at an average rate of 2% and −4% a year, respectively, since 2009. The yearly expenditure associated with test overutilisation was approximately $A4.3 million during the study period, while the cost averted because of test underutilisation was approximately $A11.3 million a year.ConclusionsWe found that approximately half of Australians on stable lipid-lowering treatment may be having fewer HDL-C testing than recommended by national guidelines, while nearly one-fifth are having more tests than recommended.

Reduction of high density lipoprotein cholesterol and apolipoprotein a-i concentrations by a lipid-lowering diet

1980 ◽  
Vol 35 (1) ◽  
pp. 21-27 ◽  
Author(s):  
Bengt Vessby ◽  
Jonas Boberg ◽  
Inga-Britt Gustafsson ◽  
Brita Karlström ◽  
Hans Lithell ◽  
...  
Keyword(s):  
High Density Lipoprotein ◽  
High Density Lipoprotein Cholesterol ◽  
Density Lipoprotein ◽  
High Density ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Apolipoprotein A
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