Key result
Simvastatin demonstrated a clear advantage in reducing the risk of major adverse cardiovascular events compared to control conditions in patients with hypertriglyceridemia.
Why the study?
Hypertriglyceridemia is considered an independent risk factor for MACE, but the comparative effects of various pharmacological agents on MACE reduction remained to be established.
Do various pharmacological agents reduce the risk of MACE in patients with hypertriglyceridemia?
Meta-Analysis (n=56,471)
Do various pharmacological agents reduce the risk of MACE in patients with hypertriglyceridemia?
In patients with hypertriglyceridemia, simvastatin, EPA, and gemfibrozil are effective in reducing MACE, with bezafibrate showing benefit in those with triglycerides 200-300 mg/dL.
Answers are grounded in this paper and cite their sources.
Supports EPA, gemfibrozil, and select statins for MACE reduction in hypertriglyceridemia; extends RCT evidence via network meta-analysis.
BACKGROUND: Hypertriglyceridemia (HTG) is considered an independent risk factor for major adverse cardiovascular events (MACE). METHODS: This study analyzed the effects of various agents on MACE risk reduction in HTG (serum triglyceride ≥ 150 mg/dl) populations by performing a network meta-analysis. We performed a frequentist network meta-analysis to conduct direct and indirect comparisons of interventions. PubMed, EMBASE, and the Cochrane library were searched for trials until Jul 6, 2020. Randomized controlled trials that reported MACE associated with agents in entire HTG populations or in subgroups were included. The primary outcome was MACE. RESULTS: Of the 2005 articles screened, 21 trials including 56,471 patients were included in the analysis. The network meta-analysis results for MACE risk based on frequency data showed that eicosapentaenoic acid (EPA) (OR: 1.32; 95% CI 1.19-1.46), gemfibrozil (OR: 1.53; 95% CI 1.20-1.95), niacin plus clofibrate (OR: 2.00; 95% CI 1.23-3.25), pravastatin (OR: 1.32; 95% CI 1.15-1.52), simvastatin (OR: 2.38; 95% CI 1.55-3.66), and atorvastatin (OR: 0.55; 95% CI 0.37-0.82) significantly reduced the risk of MACE compared to the control conditions. In the subgroup analysis of HTG patients with triglycerides ≥ 200 mg/dL, bezafibrate (OR: 0.56; 95% CI 0.33-0.94), EPA (OR: 0.72; 95% CI 0.62-0.82), and pravastatin (OR: 1.33; 95% CI 1.01-1.75) significantly reduced the MACE risk. CONCLUSIONS: Simvastatin had a clear advantage in reducing the risk of MACE in the entire HTG population analyzed in this meta-analysis. EPA, but not omega-3 fatty acid, was considered an effective HTG intervention. Among fibrates, gemfibrozil was most effective, though bezafibrate may significantly reduce the risk of MACE in populations with triglyceride levels of 200-300 mg/dL. Trial registration retrospectively registered in PROSPERO (CRD42020213705).
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Qi et al. (2021) conducted a meta-analysis in Hypertriglyceridemia (n=56,471). Pharmacological agents (e.g., simvastatin, EPA, gemfibrozil) vs. Control was evaluated on Major adverse cardiovascular events (MACE) (OR 2.38, 95% CI 1.55-3.66). Simvastatin demonstrated a clear advantage in reducing the risk of major adverse cardiovascular events compared to control conditions in patients with hypertriglyceridemia.
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