Effects of HDL-modifiers on cardiovascular outcomes: a meta-analysis of randomized trials

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#anticholesteremic-agents #cardiovascular-diseases #cholesterol-ester-transfer-proteins #diabetes-mellitus #dietary-supplements

Effects of HDL-modifiers on cardiovascular outcomes: a meta-analysis of randomized trials

Verdoia et al., 2015 | Nutr Metab Cardiovasc Dis | Meta Analysis

Citation

Verdoia M, Schaffer A, ... De Luca G. Effects of HDL-modifiers on cardiovascular outcomes: a meta-analysis of randomized trials. Nutr Metab Cardiovasc Dis. 2015-Jan;25(1):9-23. doi:10.1016/j.numecd.2014.09.003

Abstract

BACKGROUND AND AIM: High density lipoproteins (HDL) have been addressed as a potential strategy for cardiovascular prevention, with great controversies on pharmacological approaches for HDL-elevation. Our aim was to compare HDL-rising treatment with niacin or CETP-inhibitors with optimal medical therapy in cardiovascular outcome. METHODS AND RESULTS: Randomized trials were searched. Primary endpoint was cardiovascular death, secondary were: non fatal myocardial infarction; coronary revascularization; cerebrovascular accidents and safety endpoints. As many as 18 randomized trials, for a total of 69,515 patients, were included. HDL-modifiers did not reduce cardiovascular mortality (2.3%vs3.4%; OR [95%CI] = 0.96 [0.87-1.05], p = 0.37, phet = 0.58), with no benefit from niacin/CETP inhibitors according to patients' risk profile (beta [95%CI] = -0.14 [-0.29 to 0.02], p = 0.09) or the amount of HDL increase (beta [95%CI] = 0.014 [-0.008 to 0.04], p = 0.21). Niacin but not CETP-I reduced myocardial infarction and coronary revascularization, but higher rate of SAE occurred with HDL-modifiers (OR [95%CI] = 1.24 [1.18-1.31], p < 0.00001, phet = 0.02), in particular new onset of diabetes with niacin and worsening of hypertension with CETP-inhibitors. CONCLUSIONS: Niacin and CETP inhibitors do not influence cardiovascular mortality. Significant benefits in MI and coronary revascularization were observed with niacin, despite the higher occurrence of diabetes.

Key Findings

Randomized trials were searched. Primary endpoint was cardiovascular death, secondary were: non fatal myocardial infarction; coronary revascularization; cerebrovascular accidents and safety endpoints. As many as 18 randomized trials, for a total of 69,515 patients, were included. HDL-modifiers did not reduce cardiovascular mortality (2.3%vs3.4%; OR [95%CI] = 0.96 [0.87-1.05], p = 0.37, phet = 0.58), with no benefit from niacin/CETP inhibitors according to patients' risk profile (beta [95%CI] = -

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 69515
Age Range See abstract
Condition hypertension

MeSH Terms

  • Anticholesteremic Agents
  • Cardiovascular Diseases
  • Cholesterol Ester Transfer Proteins
  • Diabetes Mellitus
  • Dietary Supplements
  • Humans
  • Hypertension
  • Myocardial Infarction
  • Niacin
  • Percutaneous Coronary Intervention
  • Randomized Controlled Trials as Topic
  • Risk
  • Stroke

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Comparative Study, Journal Article, Meta-Analysis
  • Vertical: niacin

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09