Cardiovascular Risk of HDL: Niacin, Fibrates & CETP Inhibitors

Research Paper Title

Effect of Cardiovascular Risk of the High Density Lipoprotein Targeted Drug Therapies Niacin, Fibrates, and CETP Inhibitors: Meta-analysis of Randomised Controlled Trials including 117 411 Patients.

Study Question

Do treatments to increase the level of high density lipoprotein (HDL) deliver the cardiovascular event reduction that might be expected from the strong relation seen in observational studies?

Summary Answer

In randomised controlled trials neither niacin, fibrates, nor cholesteryl ester transfer protein (CETP) inhibitors were found to reduce all cause morality, coronary heart disease mortality, myocardial infarction, or stroke in people treated with statins, despite HDL levels being significantly increased. In people not receiving statins, niacin was found to significantly reduce the risk of stroke and non-fatal myocardial infarction, whereas fibrates reduced the risk of non-fatal myocardial infarction.

What is Known and What this Paper Adds

In observational studies, higher levels of HDL are associated with better cardiovascular outcomes. Three available classes of agent aim to increase HDL levels: nicain, fibrates, and CETP inhibitors. In trials where patients were receiving statin treatment, none of the three classes of agent has so far been found to improve cardiovascular outcomes.

Reference

Keee, D., Price, C., Shun-Shin, M.J. & Francis, D.P. (2014) Effect of Cardiovascular Risk of the High Density Lipoprotein Targeted Drug Therapies Niacin, Fibrates, and CETP Inhibitors: Meta-analysis of Randomised Controlled Trials including 117 411 Patients. BMJ 2014;349:g4379.

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