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Effects of HDL-modifiers on cardiovascular outcomes: a meta-analysis of randomized trials

M Verdoia1, A Schaffer1, H Suryapranata2

  • 1Division of Cardiology, Azienda Ospedaliera-Universitaria "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.

Nutrition, Metabolism, and Cardiovascular Diseases : NMCD
|December 3, 2014
PubMed

Insights

Pharmacological approaches to increase high-density lipoprotein (HDL) cholesterol, such as niacin and CETP inhibitors, did not reduce cardiovascular mortality. Niacin showed benefits for myocardial infarction and revascularization but increased diabetes risk.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • High-density lipoproteins (HDL) are explored for cardiovascular disease prevention.
  • Pharmacological strategies to elevate HDL, including niacin and CETP inhibitors, have shown controversial results.
  • Optimal medical therapy is the current standard for cardiovascular risk management.

Purpose of the Study:

  • To compare the efficacy of HDL-raising treatments (niacin, CETP inhibitors) versus optimal medical therapy in cardiovascular outcomes.
  • To evaluate the impact of these interventions on cardiovascular mortality, myocardial infarction, revascularization, and safety endpoints.

Main Methods:

  • Systematic search of randomized controlled trials.
  • Inclusion of 18 trials with a total of 69,515 patients.
  • Analysis of primary endpoint (cardiovascular death) and secondary endpoints (MI, revascularization, stroke, safety).

Main Results:

  • HDL-modifying therapies did not significantly reduce cardiovascular mortality (OR 0.96 [0.87-1.05]).
  • Niacin, but not CETP inhibitors, reduced myocardial infarction and coronary revascularization.
  • HDL-modifiers were associated with a higher rate of serious adverse events (SAE), including new-onset diabetes with niacin and worsened hypertension with CETP inhibitors.

Conclusions:

  • Niacin and CETP inhibitors do not impact overall cardiovascular mortality.
  • Niacin demonstrated significant benefits in reducing myocardial infarction and coronary revascularization.
  • The increased risk of diabetes with niacin and hypertension with CETP inhibitors are important safety considerations.
Abstract

Keywords:
CETP-inhibitorsCardiovascular mortalityHDL cholesterolNiacin

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