Comparative efficacy of pharmacological agents on reducing the risk of major adverse cardiovascular events in the hypertriglyceridemia population: a network meta-analysis

Abstract

Background Hypertriglyceridemia (HTG) is considered an independent risk factor for major adverse cardiovascular events (MACE). Methods This study analyzed the effects of various agents on MACE risk reduction in HTG (serum triglyceride ≥ 150 mg/dl) populations by performing a network meta-analysis. We performed a frequentist network meta-analysis to conduct direct and indirect comparisons of interventions. PubMed, EMBASE, and the Cochrane library were searched for trials until Jul 6, 2020. Randomized controlled trials that reported MACE associated with agents in entire HTG populations or in subgroups were included. The primary outcome was MACE. Results Of the 2005 articles screened, 21 trials including 56,471 patients were included in the analysis. The network meta-analysis results for MACE risk based on frequency data showed that eicosapentaenoic acid (EPA) (OR: 1.32; 95% CI 1.19–1.46), gemfibrozil (OR: 1.53; 95% CI 1.20–1.95), niacin plus clofibrate (OR: 2.00; 95% CI 1.23–3.25), pravastatin (OR: 1.32; 95% CI 1.15–1.52), simvastatin (OR: 2.38; 95% CI 1.55–3.66), and atorvastatin (OR: 0.55; 95% CI 0.37–0.82) significantly reduced the risk of MACE compared to the control conditions. In the subgroup analysis of HTG patients with triglycerides ≥ 200 mg/dL, bezafibrate (OR: 0.56; 95% CI 0.33–0.94), EPA (OR: 0.72; 95% CI 0.62–0.82), and pravastatin (OR: 1.33; 95% CI 1.01–1.75) significantly reduced the MACE risk. Conclusions Simvastatin had a clear advantage in reducing the risk of MACE in the entire HTG population analyzed in this meta-analysis. EPA, but not omega-3 fatty acid, was considered an effective HTG intervention. Among fibrates, gemfibrozil was most effective, though bezafibrate may significantly reduce the risk of MACE in populations with triglyceride levels of 200–300 mg/dL. Trial registration retrospectively registered in PROSPERO (CRD42020213705).

Network meta‐analyses in psoriasis: overview and critical discussion

“…Network meta-analyses have gained great importance in therapeutic research wherever a large number of CTs on different drugs are to be correlated. [5][6][7][8][9] This is currently particularly true in psoriasis, where a large number of approved drugs means that it is no longer possible to conduct complete clinical research with direct comparisons. Multiple comparisons are therefore used via bridge operators to create a comparable data situation.…”

“…It consists of an evidence‐based set of items in the form of a checklist and a flow diagram 4 . NMAs have been published in different medical fields like cardiovascular diseases and diabetes, 5 pneumology 6 and psychiatry 7 . Also, interventions other than drug treatments were investigated, such as exercise in Alzheimer's disease 8 .…”

The effect of various types and doses of statins on C-reactive protein levels in patients with dyslipidemia or coronary heart disease: A systematic review and network meta-analysis

“…Simvastatin is a lipophilic statin and an inactive prodrug hydrolyzed in the liver to its major active β-hydroxy acid metabolite ( 87 ). Compared with other lipid-lowering agents, simvastatin might be superior in reducing the risk of major adverse cardiovascular events in hypertriglyceridemic patients ( 88 ). Consistent with our findings, Mitra et al supported the notion that lipophilic statins (such as simvastatin) at high-intensity dosage could significantly decrease inflammatory factor TNF-α ( 89 ).…”