Preventive cardiologyMeta-Analysis of Comparison of Effectiveness of Lowering Apolipoprotein B Versus Low-Density Lipoprotein Cholesterol and Nonhigh-Density Lipoprotein Cholesterol for Cardiovascular Risk Reduction in Randomized Trials
Section snippets
Methods
Articles were identified by a literature search of the MEDLINE database (1966 to December 1, 2010), English-language journals, a manual search of the authors' reference files, and reference lists of original articles, reviews, and meta-analyses using methods previously described4 to identify randomized controlled trials. Two abstractors independently extracted information using a standardized protocol and reporting form. Disagreements were resolved by consensus. For inclusion in meta-analyses,
Results
Analysis included 25 trials (n = 131,134). For statin trials, 12 met inclusion criteria (n = 101,957); all used statins as monotherapy and 7 were placebo controlled (Table 1) (LaRosa JC, Personal communication, 2010).6, 7, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 For fibrate trials, 4 met inclusion criteria (n = 12,908) and all used a fibrate as monotherapy compared to placebo: 1 used gemfibrozil (n = 2,531), 2 used fenofibrate (n = 10,213), and 1
Discussion
In clinical trials of different lipid-modifying treatments including surgery, magnitude of apoB decrease was associated with magnitude of decrease in coronary heart disease and total cardiovascular disease events, although there was no association with stroke risk decrease. For all types of treatment combined, each 10-mg/dl decrease in apoB was associated with a 9% decrease in coronary heart disease risk and a 6% decrease in major cardiovascular disease risk. In the statin trials a 10-mg/dl
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Dr. Robinson has received research grants from the Institution from Amgen, Thousand Oaks, California, Daiichi-Sankyo, Parsippany, New Jersey, Esperion, Plymouth, Michigan, GlaxoSmithKline, Pittsburgh, Pennsylvania, and Merck & Co., West Point, Pennsylvania. Dr. Jacobson has served as a consultant for Abbott, Abbott Park, Illinois, Amarin, Groton, Connecticut, AstraZeneca, Wilmington, Delaware, GlaxoSmithKline, Merck & Co., and Pfizer, New York, New York.