Effect of phytosterols in the treatment of hypercholesterolemia in adults – systematic review with meta-analysis / Efeitos dos fitoesteróis no tratamento da hipercolesterolemia em adultos – revisão sistemática com metanálise

Increased plasma total cholesterol (TC) and LDL-cholesterol (low-density lipoprotein) are considered risk factors for coronary disease. Phytosterols are among the dietary options for decreasing serum concentrations of TC and LDL-c by up to 15%.To evaluate the scientific evidence on the use of phytosterols in the treatment of hypercholesterolemia in adults.A systematic meta-analysis of the Medline, Embase, Web of Service, VHL, PUBMED, Scopus, Cochrane Library and LILACS databases was performed between November and December 2016. The PICO strategy was used. Inclusion criteria were randomized clinical trials with adults of both sexes using phytosterols longer than 4 weeks intervention. Exclusion criteria were animal and in vitro studies, humans less than 18 years old and individuals with other diseases (cancer, metabolic syndromes, diabetes mellitus, hypertension, renal disease, liver diseases). The risk of bias was assessed by two reviewers. The primary outcomes investigated were TC and LDL-cholesterol. Statistical analyses were conducted using the RevMan 5.3. The standardized effect size was used to estimate the standardized mean difference and 95% CI of TC and LDL-c.Twenty-seven randomized controlled trials were included in this systematic review and 26 studies in the meta-analysis of TC and LDL-cholesterol. The meta-analyzes showed an association with the reduction in plasma TC (-2.54 [-3.04; -2.03]) and LDL-c (-2.8 [-2.63; -1.53]) after intervention with the vegetable esters.The consumption of 1.5 to 2.0 g/day of phytosterols promotes reduction of TC and LDL-c in hypercholesterolemic individuals, regardless of the way they are consumed.

Download Full-text

Effect of a Ketogenic Diet on the Nutritional Parameters of Obese Patients: A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu13092946 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2946

Author(s):

Miguel Ángel López-Espinoza ◽

Salvador Chacón-Moscoso ◽

Susana Sanduvete-Chaves ◽

María José Ortega-Maureira ◽

Tamara Barrientos-Bravo

Keyword(s):

Systematic Review ◽

Ketogenic Diet ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Cochrane Library ◽

Nutritional Parameters ◽

Balanced Diet ◽

Comparison Results

The effect of a ketogenic diet (KD) on biochemical parameters and nutritional status has been the subject of debate over the years, as several randomized clinical trials (RCTs) obtained different results. Method: A systematic review and random-effects meta-analysis of RCTs comparing KD with a balanced diet was performed by means of a search of PubMed, Cochrane Library, Scopus, and Web of Science. Trials where the method for measuring the response variables was unclear, those that considered pathologies other than chronic non-communicable diseases and those with participants receiving pharmacological treatment for obesity were excluded from the comparison. Results: Of the studies included in the meta-analysis, no statistically significant standardized mean differences were observed for body mass index (BMI) (d = −0.457, p = 0.359), total cholesterol, COL-T (d = 0.230, p = 0.591), high-density lipoprotein, HDL (d = −0.028, p = 0.934), low-density lipoprotein, LDL (d = 0.528, p = 0.173), or triglycerides, TG (d = −0.283, p = 0.222), with high values of heterogeneity. The percentage of women included in the studies is a significant moderating variable in terms of BMI ratio (z = −6.68, p < 0.001) and TG (z = −2.27, p = 0.023). Conclusion: A KD shows no more benefits on nutritional parameters than a balanced diet, and adverse effects of being on the diet are sometimes reported.

Download Full-text

Potential Biomarkers for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

International Journal of Molecular Sciences ◽

10.3390/ijms23020602 ◽

2022 ◽

Vol 23 (2) ◽

pp. 602

Author(s):

Ka Young Kim ◽

Ki Young Shin ◽

Keun-A Chang

Keyword(s):

Systematic Review ◽

Uric Acid ◽

Cognitive Impairment ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Cochrane Library ◽

Blood Proteins ◽

Post Stroke

Stroke is a primary debilitating disease in adults, occurring in 15 million individuals each year and causing high mortality and disability rates. The latest estimate revealed that stroke is currently the second leading cause of death worldwide. Post-stroke cognitive impairment (PSCI), one of the major complications after stroke, is frequently underdiagnosed. However, stroke has been reported to increase the risk of cognitive impairment by at least five to eight times. In recent decades, peripheral blood molecular biomarkers for stroke have emerged as diagnostic, prognostic, and therapeutic targets. In this study, we aimed to evaluate some blood-derived proteins for stroke, especially related to brain damage and cognitive impairments, by conducting a systematic review and meta-analysis and discussing the possibility of these proteins as biomarkers for PSCI. Articles published before 26 July 2021 were searched in PubMed, Embase, the Web of Science, and the Cochrane Library to identify all relevant studies reporting blood biomarkers in patients with stroke. Among 1820 articles, 40 were finally identified for this study. We meta-analyzed eight peripheral biomarker candidates: homocysteine (Hcy), high-density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglyceride (TG), uric acid, and glycated hemoglobin (HbA1c). The Hcy, CRP, TC, and LDL-C levels were significantly higher in patients with PSCI than in the non-PSCI group; however, the HDL-C, TG, uric acid, and HbA1c levels were not different between the two groups. Based on our findings, we suggest the Hcy, CRP, TC, and LDL-C as possible biomarkers in patients with post-stroke cognitive impairment. Thus, certain blood proteins could be suggested as effective biomarkers for PSCI.

Download Full-text

Effect of Cashew Nut on Lipid Profile: A Systematic Review and Meta-Analysis

Complementary Medicine Research ◽

10.1159/000506348 ◽

2020 ◽

Vol 27 (5) ◽

pp. 348-356 ◽

Cited By ~ 2

Author(s):

Mojgan Morvaridzadeh ◽

Mahdi Sepidarkish ◽

Farnaz Farsi ◽

Abolfazl Akbari ◽

Roghayeh Mostafai ◽

...

Keyword(s):

Systematic Review ◽

Lipid Profile ◽

Fixed Effects ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Density Lipoprotein ◽

Cochrane Library ◽

Analysis Model ◽

Beneficial Effects ◽

Cashew Nut

Introduction: Nuts are one of the dietary components which appear to have beneficial effects on cardiovascular disease biomarkers. Studies demonstrate beneficial effects of cashews on serum lipids concentration, but results in the literature remain inconclusive. We conducted a review to examine the effects of cashew nut supplementation on serum lipid profile. Methods: Two reviewers independently searched PubMed, Web of Science, Cochrane Library, Scopus, and EMBASE electronic databases from inception until June 2019 without language limitation. Random- and fixed-effects models were used to calculate 95% confidence intervals (CI) for studies. Results: Six randomized clinical trials comprising 531 participants were included in this systematic review. Three studies were included in the meta-analysis model. There were no significant changes for total cholesterol (TC) (standardized mean difference [SMD]: –0.02, 95% CI: –0.32, 0.28), triglycerides (TG) (SMD: –0.01, 95% CI: –0.22, 0.20), high-density lipoprotein (HDL) cholesterol (SMD: 0.09, 95% CI: –0.16, 0.34), or low-density lipoprotein (LDL) cholesterol (SMD: –0.18, 95% CI: –0.75, 0.39). Conclusion: The results of this analysis demonstrate that treatment with cashew nut supplementation alone did not significantly change serum levels of LDL, HDL, TC, or TG.

Download Full-text

Systematic Review and Meta-analysis of Randomised Controlled Trials Testing the Effects of Proanthocyanidins Supplementation on Lipid Profile

10.21203/rs.3.rs-1052042/v1 ◽

2021 ◽

Author(s):

Jingyi Ren ◽

Yiting Sun ◽

Jiaqi An ◽

Fengge Chen ◽

Bowen Yin ◽

...

Keyword(s):

Systematic Review ◽

Lipid Profile ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Pooled Analysis ◽

Lipoprotein Cholesterol ◽

Cochrane Library ◽

Randomised Controlled

Abstract Background: The studies that assessed proanthocyanidins (PCs) supplementation on lipid profile revealed contradictory results. The objective of this meta-analysis was to investigate the influence of PCs supplementation on lipid profile.Methods: Six databases (Pubmed, Web of Science, Cochrane Library, Scopus, EMBASE, and Google Scholar) were searched to identify for published relevant studies up to June 9, 2021. The weighted mean difference (WMD) and the corresponding standard deviations (SD) of the total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were calculated to estimate the pooled effect. Results: A total of 1411 articles were identified through database searching, of which, seven studies were included in the meta-analysis. Pooled analysis suggested that PCs supplementation effectively affected the level of HDL-C (WMD: 2.716, 95% CI: 0.269, 5.163, p = 0.030), but had no significant effect on TC (WMD: -0.201, 95% CI: -6.443, 6.041, p=0.950), LDL-C (WMD: -3.000, 95% CI: -8.254, 2.254, p = 0.263), and TG (WMD: -8.874, 95% CI: -21.009, 3.260, p =0.152). In the subgroup analyses, a significant enhance in HDL-C in people with a shorter intervention duration (duration < 12 weeks) or people with a higher BMI (BMI ≥ 24 kg/m2). Conclusion: The present systematic review and meta-analysis suggest that PCs supplementation had no effects on TC, LDL-C or TG, whereas it may contribute to a change on HDL-C. Additional high-quality studies are needed to confirm this result.

Download Full-text

Effect of Stains on LDL Reduction and Liver Safety: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2018/7092414 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Xiao Liang ◽

Qin He ◽

Qinghua Zhao

Keyword(s):

Systematic Review ◽

Liver Injury ◽

Statin Therapy ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Cochrane Library ◽

Random Effects Models ◽

Liver Safety ◽

Study Characteristics

Background and Aim. Statin is a class of medications used to decrease low-density lipoprotein cholesterol level to prevent cardiovascular disease. However, the risk of hepatic damage caused by statin therapy is still controversial. We conducted a systematic review and meta-analysis summarizing the existing evidence of the effect of statin therapy on incidence of liver injury to clarify whether statin therapy could lead to liver function test abnormalities.Methods. We searched the Cochrane Library, PubMed, and Embase database for the relevant studies update till Jan. 2017 regarding statin therapy and liver injury. Two researchers screened the literature independently by the selection and exclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled using random effects models, and subgroup analyses were performed by study characteristics. This meta-analysis was performed by STATA 13.1 software.Results. Analyses were based on 74,078 individuals from 16 studies. The summary OR of statin therapy was 1.18 (95% CI: 1.01–1.39,p=0.04;I2=0.0%) for liver injury. Subgroup analysis indicated that fluvastatin increased the risk of liver injury significantly (OR, 3.50; 95% CI: 1.07–11.53,p=0.039;I2=0.0%) and dose over 40 mg/daily had an unfavorable effect on the liver damage (OR, 3.62; 95% CI: 1.52–8.65,p=0.004;I2=0.0%). The sensitivity analysis indicated that the results were robust.Conclusion. Our findings confirm that statin therapy substantially increases the risk of liver injury, especially using fluvastatin over 40 mg/d.

Download Full-text

Effect of Photodynamic Therapy on Microorganisms Responsible for Dental Caries: A Systematic Review and Meta-Analysis

International Journal of Molecular Sciences ◽

10.3390/ijms20143585 ◽

2019 ◽

Vol 20 (14) ◽

pp. 3585 ◽

Cited By ~ 12

Author(s):

Analú Barros de Oliveira ◽

Túlio Morandin Ferrisse ◽

Raquel Souza Marques ◽

Sarah Raquel de Annunzio ◽

Fernanda Lourenção Brighenti ◽

...

Keyword(s):

Systematic Review ◽

Photodynamic Therapy ◽

Dental Caries ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Research Question ◽

Microbial Reduction ◽

Cochrane Library ◽

Study Protocols

The aim of this study was to perform a systematic review of the literature followed by a meta-analysis about the efficacy of photodynamic therapy (PDT) on the microorganisms responsible for dental caries. The research question and the keywords were constructed according to the PICO strategy. The article search was done in Embase, Lilacs, Scielo, Medline, Scopus, Cochrane Library, Web of Science, Science Direct, and Pubmed databases. Randomized clinical trials and in vitro studies were selected in the review. The study was conducted according the PRISMA guideline for systematic review. A total of 34 articles were included in the qualitative analysis and four articles were divided into two subgroups to perform the meta-analysis. Few studies have achieved an effective microbial reduction in microorganisms associated with the pathogenesis of dental caries. The results highlight that there is no consensus about the study protocols for PDT against cariogenic microorganisms, although the results showed the PDT could be a good alternative for the treatment of dental caries.

Download Full-text

Effect of sofosbuvir-based DAAs on changes in lower-density lipoprotein in HCV patients: a systematic review and meta-analysis

BMC Infectious Diseases ◽

10.1186/s12879-021-06657-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ying-Wen Wang ◽

Wei-Ping Lee ◽

Yi-Hsiang Huang ◽

Ming-Chih Hou ◽

Keng-Hsin Lan

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Numerical Data ◽

Risk Of Bias ◽

Post Treatment ◽

Cochrane Library ◽

End Of Treatment ◽

Direct Acting

Abstract Background Previous studies reported worsened lipid profiles in patients infected with hepatitis C virus (HCV) during direct-acting antivirals (DAAs) treatment. This study aimed to investigate the effect of sofosbuvir (SOF)-based DAAs on changes in low-density lipoprotein (LDL) in HCV patients. Methods A systematic review of articles published before 31 May 2021 was conducted by searching MEDLINE, Cochrane Library, EMBASE, and CINAHL Plus. Eligible studies were those comparing SOF-based DAAs and non-SOF DAAs for HCV patients and providing numerical data for changes in LDL. Risk of Bias in Non-randomized Studies- of Interventions was used for assessing risk of bias, and meta-analysis was performed for changes in LDL. Results Six studies comprising 1248 patients were included, 848 patients treated with SOF-based DAAs and 400 patients with non-SOF DAAs vs. SOF-based DAAs group had significantly greater increases in LDL from baseline to week 4 than non-SOF DAAs group (P = 0.001). However, changes in LDL from baseline to the end of treatment (P = 0.060), to post-treatment week 12 (P = 0.263), and to post-treatment week 24 (P = 0.319) did not significantly differ between the two groups. Further comparison of SOF/ledipasvir with asunaprevir/daclatasvir revealed a similar trend in changes in LDL. Conclusions For HCV patients, SOF-based DAA regimens were associated with rapid and significant increases in LDL during the initial 4 weeks of treatment, and the changes did not sustain after the end of treatment. Potential mechanism might be related to the phosphoramidate side chain of SOF.

Download Full-text

The neurological level of spinal cord injury and cardiovascular risk factors: a systematic review and meta-analysis

Spinal Cord ◽

10.1038/s41393-021-00678-6 ◽

2021 ◽

Author(s):

Peter Francis Raguindin ◽

Gion Fränkl ◽

Oche Adam Itodo ◽

Alessandro Bertolo ◽

Ramona Maria Zeh ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Blood Pressure ◽

Spinal Cord ◽

Cardiovascular Risk ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Low Density ◽

Cord Injury

Abstract Study design Systematic review and meta-analysis. Objective To determine the difference in cardiovascular risk factors (blood pressure, lipid profile, and markers of glucose metabolism and inflammation) according to the neurological level of spinal cord injury (SCI). Methods We searched 5 electronic databases from inception until July 4, 2020. Data were extracted by two independent reviewers using a pre-defined data collection form. The pooled effect estimate was computed using random-effects models, and heterogeneity was calculated using I2 statistic and chi-squared test (CRD42020166162). Results We screened 4863 abstracts, of which 47 studies with 3878 participants (3280 males, 526 females, 72 sex unknown) were included in the meta-analysis. Compared to paraplegia, individuals with tetraplegia had lower systolic and diastolic blood pressure (unadjusted weighted mean difference, −14.5 mmHg, 95% CI −19.2, −9.9; −7.0 mmHg 95% CI −9.2, −4.8, respectively), lower triglycerides (−10.9 mg/dL, 95% CI −19.7, −2.1), total cholesterol (−9.9 mg/dL, 95% CI −14.5, −5.4), high-density lipoprotein (−1.7 mg/dL, 95% CI −3.3, −0.2) and low-density lipoprotein (−5.8 mg/dL, 95% CI −9.0, −2.5). Comparing individuals with high- vs. low-thoracic SCI, persons with higher injury had lower systolic and diastolic blood pressure (−10.3 mmHg, 95% CI −13.4, −7.1; −5.3 mmHg 95% CI −7.5, −3.2, respectively), while no differences were found for low-density lipoprotein, serum glucose, insulin, and inflammation markers. High heterogeneity was partially explained by age, prevalent cardiovascular diseases and medication use, body mass index, sample size, and quality of studies. Conclusion In SCI individuals, the level of injury may be an additional non-modifiable cardiovascular risk factor. Future well-designed longitudinal studies with sufficient follow-up and providing sex-stratified analyses should confirm our findings and explore the role of SCI level in cardiovascular health and overall prognosis and survival.

Download Full-text

Sulforaphane ameliorates lipid profile in rodents: an updated systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-87367-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kaili Du ◽

Yuxin Fan ◽

Dan Li

Keyword(s):

Systematic Review ◽

Weight Control ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Low Density Lipoprotein ◽

Disease Model ◽

Density Lipoprotein ◽

Liver Weight ◽

Lipoprotein Cholesterol ◽

Alcoholic Fatty Liver

AbstractSulforaphane (SFN), a naturally-occurring isothiocyanate enriched in cabbage and broccoli, has been provided as food supplements to improve weight management and reduce lipid levels. However, its effects on serum lipid profiles are contradictory. In this review, a meta-analysis and systematic review of SFN on lipid reduction and weight control is assessed with mice and rats fed on high-fat diet. The effects of SFN supplementation were evaluated by weighted mean difference (WMD) in body weight (BW), liver weight (LW) and also by its effect on serum lipids. A random-effects model was applied to estimate the overall summary effect. SFN reduced BW (WMD: − 2.76 g, 95% CI: − 4.19, − 1.34) and LW (WMD: − 0.93 g, 95% CI: − 1.63, − 0.23) significantly in our ten trials. Its effects on serum total cholesterol (TC) (WMD: − 15.62 mg/dL, 95% CI: − 24.07, − 7.18), low-density lipoprotein cholesterol (LDL-C) (WMD: − 8.35 mg/dL, 95% CI: − 15.47, − 1.24) and triglyceride (TG) (WMD: − 40.85 mg/dL, 95% CI: − 67.46, − 14.24) were significant except for high-density lipoprotein cholesterol (HDL-C) component (WMD: 1.05 mg/dL, 95% CI: − 3.44, 5.54). However, species, disease model, duration, SFN dosage as well as route of administration did not explain the heterogeneity among studies. In summary, these findings provide new insights concerning preclinical strategies for treating diseases including obesity, diabetes, hypertension, non-alcoholic fatty liver disease as well as cardiovascular disease with SFN supplements.

Download Full-text

Dyslipidaemia

The ESC Handbook on Cardiovascular Pharmacotherapy ◽

10.1093/med/9780198759935.003.0002 ◽

2019 ◽

pp. 33-48

Author(s):

Heinz Drexel

Keyword(s):

Cardiovascular Disease ◽

Randomized Clinical Trials ◽

Ldl Cholesterol ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Epidemiological Studies ◽

Residual Risk ◽

Atherosclerotic Cardiovascular Disease ◽

Cholesterol Levels

Lipid metabolism has gained cardiological interest only after statins were demonstrated to reduce cardiovascular disease in secondary and primary prevention. Therefore, this chapter first introduces the physiological and atherogenic properties of lipoproteins, before focusing on interventions. Both the efficacy and safety of statins have been proven in numerous randomized clinical trials. Because there is a considerable residual risk in statin-treated patients, additional approaches have been investigated. The focus is now on further reductions in low-density lipoprotein (LDL) cholesterol levels. First, high-intensity statin regimens were shown to reduce residual risk. Subsequently, ezetimibe was demonstrated, for the first time, to have a beneficial effect as a non-statin lipid intervention. More recently, inhibitors of the enzyme PCSK9 have demonstrated a very high efficacy in reducing LDL cholesterol levels. Although the causality of LDL for atherosclerotic cardiovascular disease has been proven in epidemiological studies, including Mendelian randomization studies, as well as interventional trials, adherence to statins and other therapies is far from optimal. In contrast, interventions to increase high-density lipoprotein (HDL) cholesterol levels could not proven to have further benefits when combined with statins.

Download Full-text