Lipid management in the prevention of stroke: a meta-analysis of fibrates for stroke prevention

Abstract

BackgroundFibrates has been extensively used to improve plasma lipid levels and prevent adverse cardiovascular outcomes. However, the effect of fibrates on stroke is unclear at the present time. We therefore carried out a comprehensive systematic review and meta-analysis to evaluate the effects of fibrates on stroke.MethodsWe systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings to identify studies for our analysis. We included randomized placebo controlled trials which reported the effects of fibrates on stroke. Relative risk (RR) was used to measure the effect of fibrates on the risk of stroke under random effect model. The analysis was further stratified by factors that could affect the treatment effects.ResultsOverall, fibrate therapy was not associated with a significant reduction on the risk of stroke (RR, 1.02, 95% CI, 0.90 to 1.16, P = 0.78). In the subgroup analyses, we observed that gemfibrozil therapy showed a beneficial effect on stroke (RR, 0.72, 95% CI, 0.53 to 0.98, P = 0.04). Similarly, fibrate therapy comparing to placebo had no effect on the incidence of fatal stroke. Subgroup analysis suggested that fibrate therapy showed an effect on fatal stroke when the Jadad score more than 3 (RR, 0.41, 95% CI, 0.17 to 1.00, P = 0.049). Furthermore, a sensitivity analysis indicated that fibrate therapy may play a role in fatal stroke (RR, 0.49, 95% CI, 0.26 to 0.93, P = 0.03) for patients with previous diabetes, cardiovascular disease or stroke.ConclusionsOur study indicated that fibrate therapy might play an important role in reducing the risk of fatal stroke in patients with previous diabetes, cardiovascular disease or stroke. However, it did not have an effect on the incidence of stroke.

Guidelines for the Primary Prevention of Stroke

“…320 Overall, fibrate therapy was not associated with a significant reduction on the risk of stroke (RR, 1.02; 95% CI, 0.90–1.16; P =0.78). However, a subgroup analysis suggested that fibrate therapy reduced fatal stroke (RR, 0.49; 95% CI, 0.26–0.93; P =0.03) in patients with diabetes mellitus, CVD, or stroke.…”

Effect of calcium or vitamin D supplementation on vascular outcomes: A meta-analysis of randomized controlled trials

“…The reason for this could be that atherosclerotic vascular disease is also a risk factor for stroke; furthermore, different baseline patient characteristics and low incidence of stroke may contribute to broad confidence intervals. Finally, the association between calcium or vitamin D supplementation and incident stroke may be reduced or balanced by several residual confounding factors, such as lipid level [37], blood pressure [38], glucose level [39], and homocysteine level [40].…”

Glucose uptake heterogeneity of the leg muscles is similar between patients with multiple sclerosis and healthy controls during walking

“…The PDDS has been validated and shows a high correlation to the Expanded Disability Status Scale (EDSS) [15, 16, 17, 18, 19]. Leg spasticity was graded using the MASS.…”