Clinical benefit from pharmacological elevation of high-density lipoprotein cholesterol: meta-regression analysis

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#cholesterol-ester-transfer-proteins #cholesterol-hdl #coronary-disease #fibric-acids #humans

Clinical benefit from pharmacological elevation of high-density lipoprotein cholesterol: meta-regression analysis

Hourcade-Potelleret et al., 2015 | Heart | Meta Analysis

Citation

Hourcade-Potelleret F, Laporte S, ... Mismetti P. Clinical benefit from pharmacological elevation of high-density lipoprotein cholesterol: meta-regression analysis. Heart. 2015-Jun;101(11):847-53. doi:10.1136/heartjnl-2014-306691

Abstract

CONTEXT: Epidemiological evidence that the risk of coronary heart disease is inversely associated with the level of high-density lipoprotein cholesterol (HDL-C) has motivated several phase III programmes with cholesteryl ester transfer protein (CETP) inhibitors. OBJECTIVES: To assess alternative methods to predict clinical response of CETP inhibitors. METHODS: Meta-regression analysis on raising HDL-C drugs (statins, fibrates, niacin) in randomised controlled trials. RESULTS: 51 trials in secondary prevention with a total of 167,311 patients for a follow-up >1 year where HDL-C was measured at baseline and during treatment. The meta-regression analysis showed no significant association between change in HDL-C (treatment vs comparator) and log risk ratio (RR) of clinical endpoint (non-fatal myocardial infarction or cardiac death). CETP inhibitors data are consistent with this finding (RR: 1.03; P5-P95: 0.99-1.21). A prespecified sensitivity analysis by drug class suggested that the strength of relationship might differ between pharmacological groups. A significant association for both statins (p<0.02, log RR=-0.169-0.0499HDL-C change, R(2)=0.21) and niacin (p=0.02, log RR=1.07-0.185HDL-C change, R(2)=0.61) but not fibrates (p=0.18, log RR=-0.367+0.077*HDL-C change, R(2)=0.40) was shown. However, the association was no longer detectable after adjustment for low-density lipoprotein cholesterol for statins or exclusion of open trials for niacin. CONCLUSIONS: Meta-regression suggested that CETP inhibitors might not influence coronary risk. The relation between change in HDL-C level and clinical endpoint may be drug dependent, which limits the use of HDL-C as a surrogate marker of coronary events. Other markers of HDL function may be more relevant.

Key Findings

51 trials in secondary prevention with a total of 167,311 patients for a follow-up >1 year where HDL-C was measured at baseline and during treatment. The meta-regression analysis showed no significant association between change in HDL-C (treatment vs comparator) and log risk ratio (RR) of clinical endpoint (non-fatal myocardial infarction or cardiac death). CETP inhibitors data are consistent with this finding (RR: 1.03; P5-P95: 0.99-1.21). A prespecified sensitivity analysis by drug class sugge

Outcomes Measured

  • Requires manual extraction

Population

Field Value
Population See abstract
Sample Size 167311
Age Range See abstract
Condition See abstract

MeSH Terms

  • Cholesterol Ester Transfer Proteins
  • Cholesterol, HDL
  • Coronary Disease
  • Fibric Acids
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Niacin
  • Randomized Controlled Trials as Topic
  • Regression Analysis
  • Secondary Prevention
  • Treatment Outcome

Evidence Classification

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

Provenance

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