Non-statin interventions in the prevention of cardiovascular events: Sex-based meta-analysis

To explore the sex-specific association of non-statin classes of drugs in reducing cardiovascular outcomes.

Published data search up to November 2019 reporting primary outcomes that approximate with major vascular events (MVEs) after treatment with non-statin group of drugs was performed. The primary outcome was the sex-specific association with MVEs. Random-effects meta-analysis was performed to estimate relative risk (RR) of the individual classes of therapies.

Seven Randomized Clinical Trials (RCTs) including 122,164 patients were included in our analysis. Four studies compared the Triglyceride (TG)-lowering group of drugs with placebo and 3 studies compared low-density lipoprotein cholesterol (LDL-c) lowering drugs with placebo. Overall, with non-statin drugs, there was no difference in the risk reduction of cardiovascular (CV) events between men (RR 0.86; 95% CI 0.79-0.94, p-value <0.001) and women (RR 0.88; 95% CI 0.83-0.93, p-value 0.91). However, TG targeting interventions showed no cardiovascular outcome benefits in men (RR 0.85; 95% CI 0.71-1.02, p-value <0.001) while no significant benefit was seen in women (RR 0.87; 95% CI 0.77-0.98, p value = 0.85). No such difference existed in non-statin LDL-c lowering group of drugs in between men (RR 0.88; 95% CI 0.81-0.94, p value = 0.18) and women (RR 0.88; 95% CI 0.82-0.94, p value = 0.46). However, lowering of TG was only associated with a higher risk reduction of CV events (RR 0.86; 95% CI 0.77-0.95, p value = 0.03) in the entire study population.

Non-statin group of drugs was effective in reducing adverse CV outcomes for both sexes. Lowering TG was associated with higher risk reduction in CV events in general.