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Cholesteryl Ester Transfer Protein Inhibitors and Cardiovascular Outcomes: A Systematic Review and Meta-Analysis of

Hossein Taheri1,2, Kristian B Filion1,2,3, Sarah B Windle1

  • 1Center for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital/McGill University, Montreal, Québec, Canada.

Cardiology
|March 16, 2020
PubMed

Insights

Cholesteryl ester transfer protein (CETP) inhibitors do not increase cardiovascular risk or mortality. While showing a trend towards reducing heart attacks and cardiovascular deaths, the clinical significance of these findings is modest.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Clinical Trials

Background:

  • Cholesteryl ester transfer protein (CETP) inhibitors raise high-density lipoprotein cholesterol (HDL-c).
  • The effect of CETP inhibitors on cardiovascular outcomes remains unclear.
  • This review assesses their impact on lipid profiles, cardiovascular events, and mortality.

Purpose of the Study:

  • To systematically review the effects of CETP inhibitors on cardiovascular outcomes.
  • To evaluate their impact on serum lipid profiles and all-cause mortality.
  • To determine the safety and efficacy of CETP inhibitors in clinical trials.

Main Methods:

  • Systematic review of 11 placebo-controlled randomized controlled trials (RCTs).
  • Included trials investigated dalcetrapib, anacetrapib, evacetrapib, or TA-8995.
  • Data were pooled using random-effects models to assess major adverse cardiovascular events (MACE) and mortality.

Main Results:

  • Anacetrapib and evacetrapib significantly increased HDL-c and decreased LDL-c, unlike dalcetrapib.
  • CETP inhibitors as a class were not associated with an increased risk of MACE (RR: 0.97; 95% CI: 0.91-1.04).
  • A trend towards reduced nonfatal myocardial infarction (MI) and cardiovascular death was observed but did not reach statistical significance.

Conclusions:

  • CETP inhibitors are not linked to increased MACE or all-cause mortality.
  • A modest, statistically non-significant trend suggests potential reductions in nonfatal MI and cardiovascular death.
  • The clinical importance of these potential benefits requires further investigation.
Abstract

Keywords:
Cardiovascular eventsCholesteryl ester transfer protein inhibitorsHigh-density lipoproteinsLow-density lipoproteinsMeta-analysisSystematic review

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