Title:A Systematic Review and Meta-Analysis of Controlled Trials on the Effects of Statin and Fibrate Therapies on Plasma Homocysteine Levels
Volume: 23
Issue: 39
Author(s): Amirhossein Sahebkar, Matteo Pirro, Željko Reiner, Arrigo Cicero, Gianna Ferretti, Mario Simental-Mendía and Luis E. Simental-Mendía
Affiliation:
关键词:
动脉粥样硬化,血脂异常,高同型半胱氨酸血症,他汀类药物,非诺贝特,荟萃分析。
摘要: Background: Plasma homocysteine is an independent non-traditional risk factor for atherosclerotic
cardiovascular disease. The impact of statin therapy on plasma homocysteine is not conclusive.
Objective: To evaluate the effect of statin therapy on plasma homocysteine concentrations in a
systematic review and meta-analysis of controlled clinical trials.
The secondary aim was to assess the comparative effect of statins versus fibrates on plasma homocysteine
levels in head-to-head trials.
Method: PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases were searched
(from the first reports to March 07, 2016) to identify controlled trials evaluating the impact of statins on
plasma homocysteine concentrations. A systematic assessment of bias in the included studies was performed
using the Cochrane criteria. A random-effects model and generic inverse variance method were
used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method.
Random-effects meta-regression was performed using unrestricted maximum likelihood method to
evaluate the impact of potential moderators.
Results: Meta-analysis of data from 7 studies did not suggest a significant alteration in plasma homocysteine
concentrations following treatment with statins compared with the control group (WMD: -0.59
μmol/L, 95% CI: -1.66, 0.48, p=0.279; I2=52.53%). However, meta-analysis of 9 studies suggested a
significantly greater reduction of plasma homocysteine concentrations with statins compared with fenofibrate
(WMD: -4.81 μmol/L, 95% CI: -5.39, -4.23, p<0.001; I2=0%). Results of both analyses were
robust in the sensitivity analysis.
Conclusion: Statin therapy is not associated with a significant alteration of plasma homocysteine levels,
while fenofibrate increases the homocysteine levels when compared with statins.