Comparative effectiveness of statins on non-high density lipoprotein cholesterol in people with diabetes and at risk of cardiovascular disease: systematic review and network meta-analysis

Abstract

ObjectiveTo compare the efficacy of different statin treatments by intensity on levels of non-high density lipoprotein cholesterol (non-HDL-C) for the prevention of cardiovascular disease in people with diabetes.DesignSystematic review and network meta-analysis.Data sourcesMedline, Cochrane Central Register of Controlled Trials, and Embase from inception to 1 December 2021.Review methodsRandomised controlled trials comparing different types and intensities of statins, including placebo, in adults with type 1 or type 2 diabetes mellitus were included. The primary outcome was changes in levels of non-HDL-C, calculated from measures of total cholesterol and HDL-C. Secondary outcomes were changes in levels of low density lipoprotein cholesterol (LDL-C) and total cholesterol, three point major cardiovascular events (non-fatal stroke, non-fatal myocardial infarction, and death related to cardiovascular disease), and discontinuations because of adverse events. A bayesian network meta-analysis of statin intensity (low, moderate, or high) with random effects evaluated the treatment effect on non-HDL-C by mean differences and 95% credible intervals. Subgroup analysis of patients at greater risk of major cardiovascular events was compared with patients at low or moderate risk. The confidence in network meta-analysis (CINeMA) framework was applied to determine the certainty of evidence.ResultsIn 42 randomised controlled trials involving 20 193 adults, 11 698 were included in the meta-analysis. Compared with placebo, the greatest reductions in levels of non-HDL-C were seen with rosuvastatin at high (−2.31 mmol/L, 95% credible interval −3.39 to −1.21) and moderate (−2.27, −3.00 to −1.49) intensities, and simvastatin (−2.26, −2.99 to −1.51) and atorvastatin (−2.20, −2.69 to −1.70) at high intensity. Atorvastatin and simvastatin at any intensity and pravastatin at low intensity were also effective in reducing levels of non-HDL-C. In 4670 patients at greater risk of a major cardiovascular events, atorvastatin at high intensity showed the largest reduction in levels of non-HDL-C (−1.98, −4.16 to 0.26, surface under the cumulative ranking curve 64%). Simvastatin (−1.93, −2.63 to −1.21) and rosuvastatin (−1.76, −2.37 to −1.15) at high intensity were the most effective treatment options for reducing LDL-C. Significant reductions in non-fatal myocardial infarction were found for atorvastatin at moderate intensity compared with placebo (relative risk=0.57, confidence interval 0.43 to 0.76, n=4 studies). No significant differences were found for discontinuations, non-fatal stroke, and cardiovascular deaths.ConclusionsThis network meta-analysis indicated that rosuvastatin, at moderate and high intensity doses, and simvastatin and atorvastatin, at high intensity doses, were most effective at moderately reducing levels of non-HDL-C in patients with diabetes. Given the potential improvement in accuracy in predicting cardiovascular disease when reduction in levels of non-HDL-C is used as the primary target, these findings provide guidance on which statin types and intensities are most effective by reducing non-HDL-C in patients with diabetes.Systematic review registrationPROSPERO CRD42021258819.

Adjunctive therapy with lipid-lowering agents in COVID-19: a systematic review and meta-analysis of randomized controlled trials

“…The results of five trials assessing the effectiveness of statins in COVID-19 have been reported so far. Statins are the first line of treatment for dyslipidemia and their effectiveness in improving lipid profile has been well-proven in the past [ 33 ]. In addition to their lipid-lowering effects, previous studies found statins to be potentially beneficial in preventing and treating infections [ 34 ].…”

Association between statin use during hospitalisation and mortality in patients with intracerebral haemorrhage: a propensity score-matched cohort study

“…The effectiveness of statins in the primary and secondary prevention of ischaemic cardio-cerebrovascular diseases has also been well proved 4 5. Many studies have demonstrated that statin can reduce primary and secondary cardiovascular events 6–10. Several studies have also demonstrated that there was an association between statin use and reduced mortality in patients with ICH 11–13.…”

“…4 5 Many studies have demonstrated that statin can reduce primary and secondary cardiovascular events. [6][7][8][9][10] Several studies have also demonstrated that there was an association between statin use and reduced mortality in patients with ICH. [11][12][13] However, others reported that this relationship did not exist.…”

The Non-High-Density Lipoprotein Cholesterol to High-Density Lipoprotein Cholesterol Ratio (NHHR) as a Predictor of All-Cause and Cardiovascular Mortality in US Adults with Diabetes or Prediabetes: NHANES 1998-2018

“…Dyslipidemia in diabetes patients is characterized by increased levels of non-high-density lipoprotein cholesterol (non-HDL-C), including low-density lipoprotein cholesterol (LDL-C), intermediate-density lipoprotein, and very low-density lipoprotein remnants, all of which contribute to the development of atherosclerosis [10,11]. In recent years, the clinical value of non-HDL-C has gained widespread attention and recognition.…”