Abstract 4264: Salutary Effects of HDL-Cholesterol Raising Therapy on Mitigating Adverse Cardiovascular Clinical Events: A Meta-Analysis of Randomized Controlled Trials
Background: Though epidemiological and observational studies have convincingly demonstrated the association between low levels of high-density lipoprotein (HDL) cholesterol (C) and increased rates of cardiovascular morbidity and mortality, there exists a paucity of clinical trials data to support the benefit of HDL-C raising and its effects on subsequent cardiovascular events. We performed a systemic review and meta-analysis of randomized clinical trials (RCTs) to assess the effect of increase in HDL-C levels and its impact on reduction in adverse clinical outcomes and carotid atherosclerosis (CA) progression.
Methods: We searched Medline, EMBASE, Cochrane Controlled Trials Register. Studies were selected using a priori defined criteria and appraised by the Jadad Score. Risk reduction, weighted means and 95% confidence intervals (CIs) were calculated and pooled using a random-effects model; heterogeneity calculated using Chi-square statistics and standard mean difference (SMD) calculated to assess significance of CA changes.
Results: In 14 RCTs evaluating clinical events, a total of 31,961 patients were randomized to receive either HDL-raising therapy (n=15,707) or placebo (n=16,254) and followed for mean 4.6 years. Using a random effects model, the overall risk reduction was estimated to be 0.797 [0.723– 0.879], p<0.0001 with no heterogeneity among studies. With 6 RCTs evaluating CA progression, the SMD was −0.18 (95% CI −1.97, 1.62).
Conclusions: This meta-analysis demonstrates that HDL-C raising therapies are associated with a significant 16% risk reduction in adverse cardiovascular events and also significant reduction in carotid atherosclerosis.