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Meta-analysis and trial sequential analysis of ezetimibe for coronary atherosclerotic plaque compositions

Bofeng Chai1, Youlu Shen2, Yuhong Li2

  • 1Graduate School of Qinghai University, Xining, China.

Frontiers in Pharmacology
|April 13, 2023
PubMed

Insights

Ezetimibe significantly reduced fibro-fatty plaque (FFP) volume in patients with coronary artery disease. However, further research is needed to confirm its efficacy on fibrous plaque (FP) and necrotic core (NC) volumes.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Medical Imaging

Background:

  • Atherosclerotic cardiovascular disease (ASCVD) is characterized by lipid aggregation, inflammation, fibrous cap formation, and plaque disruption.
  • Ezetimibe is known for lowering blood lipids, but its specific effects on atherosclerotic plaque composition require further investigation.

Purpose of the Study:

  • To systematically evaluate the efficacy of ezetimibe in altering coronary atherosclerotic plaque compositions.
  • To determine the impact of ezetimibe on specific plaque components, including fibro-fatty plaque (FFP), fibrous plaque (FP), necrotic core (NC), and dense calcification (DC).

Main Methods:

  • Systematic literature search of PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) up to January 22, 2023.
  • Meta-analysis and trial sequential analysis (TSA) were conducted using Stata 14.0 and TSA 0.9.5.10 Beta software.
  • Included four RCTs involving 349 coronary artery disease patients.

Main Results:

  • Meta-analysis revealed a significant reduction in fibro-fatty plaque (FFP) volume with ezetimibe treatment (WMD = -2.90, p = 0.003).
  • No statistically significant differences were observed in the reduction of fibrous plaque (FP) volume (p = 0.15), necrotic core (NC) volume (p = 0.35), or dense calcification (DC) volume (p = 0.62).
  • Trial sequential analysis (TSA) indicated that additional studies are necessary to confirm ezetimibe's effects on FP and NC.

Conclusions:

  • Ezetimibe effectively decreases fibro-fatty plaque (FFP) volume in coronary atherosclerotic plaques.
  • Ezetimibe demonstrated no statistically significant impact on fibrous plaque (FP), necrotic core (NC), or dense calcification (DC) volumes.
  • Further research is warranted to definitively establish the efficacy of ezetimibe for FP and NC based on TSA findings.

Keywords:
compositionscoronary atherosclerotic plaquesezetimibemeta-analysistrial sequential analysis

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