Lipid-lowering therapies significantly improved flow-mediated dilation (MD 1.70) and reduced pulse wave velocity (MD -0.19) compared to placebo or no treatment.
Meta-Analysis
Do lipid-lowering therapies improve surrogate markers of vascular function and structure (FMD, PWV, AIx, cIMT) compared to placebo or no treatment?
Lipid-lowering therapies significantly improve endothelial function and reduce arterial stiffness, highlighting their beneficial effects on vascular health beyond lipid reduction.
Mean Difference: 1.7 (95% CI 1.4–2)
p-value: p=<0.001
Lipid-lowering therapies (LLTs) reduce cardiovascular disease (CVD) risk, but their effects on parameters related to vascular function and structure remain debated. We systematically reviewed randomized controlled trials (RCTs) published up to January 2026 from PubMed, Web of Science, and Ovid. LLTs were compared with placebo or no treatment. Outcomes included flow-mediated dilation (FMD), pulse wave velocity (PWV), augmentation index (AIx), and carotid intima–media thickness (cIMT). Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Primary analyses were based on post-intervention final values, and leave-one-out sensitivity analyses were performed. Funnel plots and Egger’s regression test were used to assess potential small-study effects when applicable. For FMD, exploratory clinical population subgroup analysis and random-effects meta-regression were conducted to assess potential sources of heterogeneity. 103 RCTs with over ten thousand participants were included. Our meta-analysis demonstrated that LLTs significantly improved FMD (MD: 1.70, 95% CI 1.40–2.00, P < 0.001) and reduced PWV (MD: −0.19, 95% CI −0.38 to −0.01, P = 0.04). Atorvastatin, omega-3 PUFA, fluvastatin, rosuvastatin, pravastatin, simvastatin, niacin and fibrates improved FMD, while alirocumab, ezetimibe and cerivastatin did not. Brachial–ankle PWV decreased significantly (MD: −0.96, 95% CI −1.66 to −0.27, P = 0.006), but not carotid–femoral PWV (except with atorvastatin). No significant effects were observed for cIMT or AIx overall, though rosuvastatin reduced cIMT (MD: −0.04, 95% CI −0.08 to −0.00, P = 0.04). LLTs had beneficial effects on FMD and PWV, with varying efficacy among different drug types. Trial registration : CRD42024583834.
Wang et al. (Sun,) conducted a meta-analysis in Cardiovascular disease risk. Lipid-lowering therapies vs. Placebo or no treatment was evaluated on Flow-mediated dilation (FMD) (MD 1.70, 95% CI 1.40 to 2.00, p=<0.001). Lipid-lowering therapies significantly improved flow-mediated dilation (MD 1.70) and reduced pulse wave velocity (MD -0.19) compared to placebo or no treatment.