Key result
Increasing HDL levels via pharmacological therapies beyond optimal lipid-lowering therapy did not significantly reduce all-cause mortality (OR 1.07) in patients with established cardiovascular disease.
Why the study?
Do HDL-raising drugs reduce all-cause mortality and cardiovascular events in patients with established coronary artery disease on optimal LDL lowering therapy?
Systematic Review (n=26,858)
Do HDL-raising drugs reduce all-cause mortality and cardiovascular events in patients with established coronary artery disease on optimal LDL lowering therapy?
Pharmacological elevation of HDL-C beyond optimal LDL lowering does not reduce mortality or cardiovascular events in secondary prevention.
Answers are grounded in this paper and cite their sources.
No CV benefit from HDL-raising drugs in CAD; leaves open whether HDL function-targeted therapies warrant RCTs.
BACKGROUND: Substantial residual cardiovascular risk remains after optimal LDL lowering in patients of established coronary artery disease. A number of therapeutic agents that raise HDL-C have been tested in clinical trials to cover this risk. However, the results of clinical trials are conflicting. OBJECTIVES: To determine whether raising HDL-C with pharmacologic therapies translates into beneficial cardiovascular outcomes and to find out if this change was proportional to the percentage change in HDL levels. METHODS: Electronic and printed sources were searched up to August, 2013 for randomised controlled trials (RCTs) using at least one of the HDL raising therapies for secondary prevention of adverse cardiovascular events over optimal LDL levels. Data from eligible studies were pooled for the following outcomes: all cause mortality, cardiovascular disease mortality, hospitalization for unstable angina, non-fatal myocardial infarction, coronary revascularization and ischemic stroke. Mantel Haensnzel fixed effect model was used preferentially. Meta-regression was done to see the correlation of change in HDL levels and cardiovascular outcomes. Pooled odds ratios with 95% confidence interval (CI) were calculated. RESULTS: A total of 12 RCTs including 26,858 patients with follow up period ranging from 1 year to 6.2 years were included in the analysis. Pooled analysis showed no significant difference in all-cause mortality between the treatment and control group (Pooled OR 1.07; 95% CI 0.98-1.16, p = 0.15). No significant difference was found between the groups for any of the secondary outcomes. Similarly no correlation was seen between percentage change in HDL and adverse cardiovascular outcomes on meta-regression analysis. CONCLUSION: Increasing HDL levels via pharmacological manipulation beyond optimal lipid lowering therapy for secondary prevention is not beneficial.
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Kaur et al. (2014) conducted a systematic review in Established cardiovascular disease (secondary prevention) (n=26,858). HDL-raising drugs (niacin, fibrates, CETP inhibitors) vs. Standard lipid lowering therapy / placebo was evaluated on All-cause mortality (OR 1.07, 95% CI 0.98-1.16, p=0.15). Increasing HDL levels via pharmacological therapies beyond optimal lipid-lowering therapy did not significantly reduce all-cause mortality (OR 1.07) in patients with established cardiovascular disease.
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