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Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk.
J Am Coll Cardiol. 2009 Jan 27; 53(4):316-22.JACC

Abstract

OBJECTIVES

To determine the relationship between non-high-density lipoprotein cholesterol (HDL-C) lowering and coronary heart disease (CHD) risk reduction for various lipid-modifying therapies.

BACKGROUND

Non-HDL-C is the second lipid target of therapy after low-density lipoprotein cholesterol (LDL-C).

METHODS

Randomized placebo or active-controlled trials were evaluated. The effect of mean non-HDL-C reduction on the relative risk of nonfatal myocardial infarction and CHD death was estimated using Bayesian random-effects meta-analysis models adjusted for study duration. Cochrane's Q was used to test for heterogeneity.

RESULTS

Inclusion criteria were met by 14 statin (n = 100,827), 7 fibrate (n = 21,647), and 6 niacin (n = 4,445) trials, and 1 trial each of a bile acid sequestrant (n = 3,806), diet (n = 458), and ileal bypass surgery (n = 838). For statins, each 1% decrease in non-HDL-C resulted in an estimated 4.5-year CHD relative risk of 0.99 (95% Bayesian confidence interval: 0.98 to 1.00). The fibrate model did not differ from the statin model (Bayes factor K = 0.49) with no evidence of heterogeneity. The niacin model was moderately different from the statin model (K = 7.43), with heterogeneity among the trials (Q = 11.8, 5 df; p = 0.038). The only niacin monotherapy trial (n = 3,908) had a 1:1 relationship between non-HDL-C and risk reduction. No consistent relationships were apparent for the 5 small trials of niacin in combination. The 95% confidence intervals for the single trials of diet, bile acid sequestrants, and surgery also included the 1:1 relationship.

CONCLUSIONS

Non-HDL-C is an important target of therapy for CHD prevention. Most lipid-modifying drugs used as monotherapy have an approximately 1:1 relationship between percent non-HDL-C lowering and CHD reduction.

Authors+Show Affiliations

Lipid Research Clinic, University of Iowa, Iowa City, IA 52242, USA. jennifer-g-robinson@uiowa.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

19161879

Citation

Robinson, Jennifer G., et al. "Meta-analysis of the Relationship Between Non-high-density Lipoprotein Cholesterol Reduction and Coronary Heart Disease Risk." Journal of the American College of Cardiology, vol. 53, no. 4, 2009, pp. 316-22.
Robinson JG, Wang S, Smith BJ, et al. Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk. J Am Coll Cardiol. 2009;53(4):316-22.
Robinson, J. G., Wang, S., Smith, B. J., & Jacobson, T. A. (2009). Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk. Journal of the American College of Cardiology, 53(4), 316-22. https://doi.org/10.1016/j.jacc.2008.10.024
Robinson JG, et al. Meta-analysis of the Relationship Between Non-high-density Lipoprotein Cholesterol Reduction and Coronary Heart Disease Risk. J Am Coll Cardiol. 2009 Jan 27;53(4):316-22. PubMed PMID: 19161879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis of the relationship between non-high-density lipoprotein cholesterol reduction and coronary heart disease risk. AU - Robinson,Jennifer G, AU - Wang,Songfeng, AU - Smith,Brian J, AU - Jacobson,Terry A, PY - 2008/06/16/received PY - 2008/10/06/revised PY - 2008/10/07/accepted PY - 2009/1/24/entrez PY - 2009/1/24/pubmed PY - 2009/2/27/medline SP - 316 EP - 22 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 53 IS - 4 N2 - OBJECTIVES: To determine the relationship between non-high-density lipoprotein cholesterol (HDL-C) lowering and coronary heart disease (CHD) risk reduction for various lipid-modifying therapies. BACKGROUND: Non-HDL-C is the second lipid target of therapy after low-density lipoprotein cholesterol (LDL-C). METHODS: Randomized placebo or active-controlled trials were evaluated. The effect of mean non-HDL-C reduction on the relative risk of nonfatal myocardial infarction and CHD death was estimated using Bayesian random-effects meta-analysis models adjusted for study duration. Cochrane's Q was used to test for heterogeneity. RESULTS: Inclusion criteria were met by 14 statin (n = 100,827), 7 fibrate (n = 21,647), and 6 niacin (n = 4,445) trials, and 1 trial each of a bile acid sequestrant (n = 3,806), diet (n = 458), and ileal bypass surgery (n = 838). For statins, each 1% decrease in non-HDL-C resulted in an estimated 4.5-year CHD relative risk of 0.99 (95% Bayesian confidence interval: 0.98 to 1.00). The fibrate model did not differ from the statin model (Bayes factor K = 0.49) with no evidence of heterogeneity. The niacin model was moderately different from the statin model (K = 7.43), with heterogeneity among the trials (Q = 11.8, 5 df; p = 0.038). The only niacin monotherapy trial (n = 3,908) had a 1:1 relationship between non-HDL-C and risk reduction. No consistent relationships were apparent for the 5 small trials of niacin in combination. The 95% confidence intervals for the single trials of diet, bile acid sequestrants, and surgery also included the 1:1 relationship. CONCLUSIONS: Non-HDL-C is an important target of therapy for CHD prevention. Most lipid-modifying drugs used as monotherapy have an approximately 1:1 relationship between percent non-HDL-C lowering and CHD reduction. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/19161879/Meta_analysis_of_the_relationship_between_non_high_density_lipoprotein_cholesterol_reduction_and_coronary_heart_disease_risk_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)03619-X DB - PRIME DP - Unbound Medicine ER -