Background: The aim of this study was to compare and summarize the lipid-altering effects of combination therapy with ezetimibe and statins (E/S) and a double dose of statin (D/S) monotherapy on patients with hypercholesterolemia. Methods: We conducted search on 2 medical databases, PubMed and EMBASE to identify all relevant studies. A meta-analysis was performed to clarify the efficacy in the two groups. Only double-blind Randomized controlled study (RCTs) of efficacy evaluation in the two groups with ezetimibe and statins and a double dose of statin in participants with hypercholesterolemia that examined low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high-density lipoprotein (HDL) were included. Two reviewers extracted data from all primary studies independently. The primary data were the level of LDL-C, TC and HDL-C concentrations at the end point and are expressed as mean and standard deviation (SD). Results: A total of 11 double-blind, active or placebo-controlled studies with 1926 hypercholesterolemia adults randomized to ezetimibe 10 mg added to ongoing statins (N = 994) or statin titration (doubling) (N = 932) were pooled for the global meta-analysis. The effect size between treatment groups within individual studies was assessed by weighted mean difference (MD) using a random-or fixed-effect model. The result showed that the participants in E/S group get obvious lower LDL-C [MD =-13.14 mg/dL, 95%CI (−16.83,-9.44), p = 0.00001] and TC concentration [MD =-23.79 mg/dL, 95%CI (−38.65,-8.93), p = 0.002] from baseline to follow-up, comparing to the D/ S group. Besides, no significant between-group differences were observed for concentrations of HDL-C [MD = 0.46 mg/dL, 95%CI (− 1.14, 2.06), p = 0.57]. According to subgroup analysis, the combination of ezetimibe and atorvastatin (10 mg) [MD =-16.98 mg/dL, p < 0 .0001] or simvastatin (20 mg) [MD =-17.35 mg/dL, p < 0 .0001] showed stronger ability of reducing LDL-C than combination of ezetimibe and rosuvastatin (10 mg) [MD =-9.29 mg/dL, p = 0.05]. The efficacy of short-term (endpoint time between 6 to 16 week) and long-term (52 week) treatment in the LDL-C between two groups did not show significant differences. Besides, only participants from Asia treated with combination therapy were associated with a significant lower LDL-C concentration [MD =-14.7 mg/dL, p < 0 .0001].
SummaryComparison of the prognostic value of red cell distribution width (RDW) and N-terminal pro B-type natriuretic peptide (NT-proBNP) for short-term clinical outcomes in acute heart failure (AHF) patients has not been fully investigated.A total of 128 patients with AHF were enrolled and followed for 3 months. Primary endpoints were cardiovascular (CV) events, defi ned as cardiac death and/or readmission for HF. Baseline RDW and NT-proBNP were measured at admission.The 30-day and 90-day CV event rates were 16.4% and 35.9%, respectively. NT-proBNP was higher in people with cardiovascular events at both time points, while RDW was signifi cantly higher only at the 90-day time point. The area under the ROC curve of RDW (area under the ROC curve = 0.695) for the prediction of CV events was higher than that of NT-proBNP (area under the ROC curve = 0.610) at the 90-day time point, but lower at the 30-day time point. Cox hazard analysis revealed RDW and NT-proBNP were independent predictive factors of a 90-day CV event (RDW, hazard ratio, 4.610, 95% confi dence interval 1.935-10.981, P = 0.001; NT-proBNP, hazard ratio, 3.661, 95% confi dence interval 1.125-11.907, P = 0.031). Kaplan-Meier survival analysis revealed that patients with an RDW level > 14.5% and NT-proBNP > 1471.5 pg/mL were at highest risk for a CV event (P < 0.001).RDW and NT-proBNP are strong independent predictors of 90-day cardiovascular events in patients hospitalized with AHF. RDW can add prognostic value to NT-proBNP for predicting early cardiovascular events. (Int Heart J 2014; 55: 58-64) Key words: Marker, Prognosis A cute heart failure (AHF) has been defi ned as new-onset or gradual or rapidly worsening heart failure signs and symptoms requiring urgent therapy. 1) It is the leading cause of hospitalization in adults over 65 years.2) AHF may result from new onset of ventricular dysfunction or, more typically, exacerbation of chronic heart failure symptoms. 3)Recognizing such higher risk patients, however, may be challenging. Although numerous parameters indicate the prognosis of heart failure, most are costly to evaluate and are assessed only in research.4) Red cell distribution width (RDW) is a measure of the variability in size of circulating erythrocytes. 5)This parameter is a widely investigated and routine laboratory value reported as a component of complete blood count.A previous study has shown RDW can be a significant independent predictor of all-cause mortality and hospital readmission for patients with chronic heart failure (CHF).6) It was also found to be an independent and addictive predictor of early mortality in patients with acute dyspnea. 7) Higher levels of RDW correlate to poorer survival in stroke, 8) myocardial infarction 9) and pulmonary hypertension. 10) However, little is known about the prognostic value of RDW in the short-term outcome in acute heart failure. Accordingly, in order to determine the prognostic utility of RDW in short-term adverse outcome in patients with AHF, we conducted a prospective study to compare RDW ...
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