Meta-analysis: statin therapy does not alter the association between low levels of high-density lipoprotein cholesterol and increased cardiovascular risk
| Autor: | Alawi A. Alsheikh-Ali, Richard H. Karas, Haseeb Jafri |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
medicine.medical_specialty
Inverse Association Myocardial Infarction law.invention chemistry.chemical_compound High-density lipoprotein Randomized controlled trial law Risk Factors Diabetes mellitus Internal medicine Internal Medicine medicine Humans Myocardial infarction Risk factor Cholesterol business.industry Cholesterol HDL nutritional and metabolic diseases General Medicine Cholesterol LDL medicine.disease Endocrinology chemistry Cardiovascular Diseases lipids (amino acids peptides and proteins) Hydroxymethylglutaryl-CoA Reductase Inhibitors business Niacin |
| Zdroj: | Annals of internal medicine. 153(12) |
| ISSN: | 1539-3704 |
| Popis: | Low levels of high-density lipoprotein cholesterol (HDL-C) are associated with an increased risk for myocardial infarction (MI). Although statins reduce the risk for MI, most cardiovascular events still occur despite statin treatment.Using meta-analysis of large randomized, controlled trials (RCTs) of statins to determine whether statins alter the relationship between HDL-C level and MI.MEDLINE search to February 2010, ClinicalTrials.gov, and reference lists from eligible studies.English-language RCTs of statin-treated patients versus control participants with 1000 or more person-years of follow-up and reported HDL-C levels and MI.Two independent investigators extracted data from eligible RCTs.Twenty eligible RCTs were identified (543,210 person-years of follow-up and 7838 MIs). After adjustment for on-treatment LDL-C levels, age, hypertension, diabetes, and tobacco use, there was a significant inverse association between HDL-C levels and risk for MI in statin-treated patients and control participants. In Poisson meta-regressions, every 0.26-mmol/L (10-mg/dL) decrease in HDL-C was associated with 7.1 (95% CI, 6.8 to 7.3) and 8.3 (CI, 8.1 to 8.5) more MIs per 1000 person-years in statin-treated patients and control participants, respectively. The inverse association between HDL-C levels and MI did not differ between statin-treated patients and control participants (P= 0.57).The observed associations may be explained by unmeasured confounding and do not imply causality in the relationship between HDL-C level and cardiovascular risk.Statins do not alter the relationship between HDL-C level and cardiovascular risk, such that low levels of HDL-C remain significantly and independently associated with increased risk despite statin treatment. The remaining risk seen in statin-treated patients may be partly explained by low HDL-C levels or other factors associated with low levels of HDL-C.None. |
| Databáze: | OpenAIRE |
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