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Interventions to Improve Statin Tolerance and Adherence in Patients at Risk for Cardiovascular Disease : A Systematic Review for the 2020 U.S. Department of Veterans Affairs and U.S. Department of Defense Guidelines for Management of Dyslipidemia.
Reston, JT, Buelt, A, Donahue, MP, Neubauer, B, Vagichev, E, McShea, K
Annals of internal medicine. 2020;(10):806-812
Abstract
BACKGROUND Strategies to improve patients' tolerance of and adherence to statins may enhance the effectiveness of dyslipidemia treatment in those at risk for cardiovascular disease (CVD). PURPOSE To assess the benefits and harms of interventions to improve statin adherence in patients at risk for CVD. DATA SOURCES MEDLINE, EMBASE, PubMed, and the Cochrane Library from December 2013 through May 2019 (English language only). STUDY SELECTION Systematic reviews (SRs), randomized controlled trials (RCTs), and cohort studies that addressed interventions for improving statin tolerance and adherence. DATA EXTRACTION One investigator abstracted data and assessed study quality, and a second investigator checked abstractions and assessments for accuracy. DATA SYNTHESIS One SR, 1 RCT, and 4 cohort studies were included. The SR found that intensified patient care improved adherence and decreased levels of total serum cholesterol and low-density lipoprotein cholesterol (LDL-C) at 6 months or more of follow-up. Compared with statin treatment discontinuation, nondaily statin dosing lowered total cholesterol and LDL-C levels. One large cohort study suggested that more than 90% of patients who discontinued statin treatment could be rechallenged with the same or a different statin and be adherent 1 year after a statin-related adverse event led to discontinuation. Two small cohort studies reported that more than 90% of patients who were previously intolerant to statins and who had low baseline levels of vitamin D were able to adhere to statins 1 year after vitamin D supplementation. LIMITATION This is a qualitative synthesis of new evidence with existing meta-analyses, and studies had several methodological shortcomings. CONCLUSION Although the strength of evidence for most interventions was low or very low, intensified patient care and rechallenge with the same or a different statin (or a lower dose) seem to be favorable options for improving statin adherence. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs.
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Effect of green tea extract on lipid profile in patients with type 2 diabetes mellitus: A systematic review and meta-analysis.
Asbaghi, O, Fouladvand, F, Moradi, S, Ashtary-Larky, D, Choghakhori, R, Abbasnezhad, A
Diabetes & metabolic syndrome. 2020;(4):293-301
Abstract
BACKGROUND Previous studies have indicated controversial results regarding the efficacy of green tea extract (GTE) in improving the lipid profile of type 2 diabetes mellitus (T2DM) patients. We aimed to conduct a systematic review and meta-analysis to pool data from randomized controlled trials (RCTs). METHODS A systematic search was performed in Web of Science, PubMed, and Scopus databases, without any language and time restriction until August 2019, to retrieve the RCTs which examined the effects of GTE on serum concentrations of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglyceride (TG) or total cholesterol (TC) in T2DM patients. Meta-analyses were carried out using a random effects model. I2 index was used to evaluate the heterogeneity. RESULTS Initial search yielded 780 publications. Of these, seven studies were eligible. The supplementary intake of GTE improved lipid profile by reducing serum TG concentrations in patients with T2DM. Meanwhile, subgroup analyses based on duration of interventions (≤8 and > 8 weeks) and intervention dosage (≤800 and > 800 mg/day) showed that the GTE supplementation longer than 8 weeks and in doses >800 mg/day resulted in a significant decrease in serum TG concentrations. Furthermore, intervention longer than 8 weeks with doses lower than 800 mg/day resulted in a significant reduction in serum TC concentrations. CONCLUSION In conclusion, present systematic review and meta-analysis revealed that the supplementary intake of GTE may improve lipid profile by reducing serum concentrations of TG in patients with T2DM. Furthermore, the results of our stratified analyses suggested that long-term GTE intervention may reduce serum concentrations of TG and TC.
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The effect of saffron supplementation on blood glucose and lipid profile: A systematic review and meta-analysis of randomized controlled trials.
Asbaghi, O, Soltani, S, Norouzi, N, Milajerdi, A, Choobkar, S, Asemi, Z
Complementary therapies in medicine. 2019;:102158
Abstract
BACKGROUND Despite several studies about the effects of saffron supplementation on serum concentrations of lipid and glucose profiles, no systematic study had summarized the findings. Therefore, we conduct current study to systematically summarize findings from studies about the effect of saffron supplementation on serum levels of glucose and lipid profiles and to do a meta-analysis, if possible. METHODS A systematic literature search was conducted for clinical trials published in PubMed, SCOPUS, EMBASE, Cochrane's Library and ISI Web of Science from the beginning to 22 February 2019. All randomized clinical trials on the effect of saffron supplementation on serum concentrations of lipid and glucose profiles were included. RESULTS In overall, six studies were included in the current study. Pooled analysis of six studies for the effect of saffron on serum TG, TC and FBG concentrations and of five studies for LDL and HDL, showed a significant reduction in TG (WMD: -8.93 mg/dl; 95% CI: -16.49 to -1.37, P = 0.02) and TC levels (WMD: -5.72 mg/dl; 95% CI: -11.10 to -0.34, P = 0.03), a significant increase in HDL levels (WMD: 2.7 mg/dl; 95% CI: 0.22 to 5.18, P = 0.03), and no significant effect on LDL (WMD: -2.30 mg/dl; 95% CI: -11.73 to 7.13, P = 0.63) and FBG levels (WMD: -5.30 mg/dl; 95% CI: -14.20 to 3.60, P = 0.51). CONCLUSION We found a significant reduction in serum concentrations of TC and TG and a significant increase in serum levels of HDL following supplementation with saffron. Saffron supplementation had no significant influence on serum FPG and LDL concentrations.
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Effects of probiotic supplementation on the regulation of blood lipid levels in overweight or obese subjects: a meta-analysis.
Yan, S, Tian, Z, Li, M, Li, B, Cui, W
Food & function. 2019;(3):1747-1759
Abstract
BACKGROUND Obesity is a risk factor for many deadly diseases. Meanwhile, the prevalence of obesity has been continuously increasing in many countries. Probiotics are defined as live microorganisms that confer health benefits on hosts. Probiotic supplementation could reduce body weight, body mass index (BMI) and fat percentage. However, it is unclear whether supplementation with probiotics is beneficial to lower blood lipid levels for obese or overweight people. METHODS In this study, a comprehensive search across multiple databases was performed to identify studies that focused on the effects of probiotics on blood lipid levels in overweight or obese subjects. The meta-analysis included studies that compared the variations in blood lipid (total cholesterol (TC), low density lipoprotein (LDL), high density lipoprotein (HDL) and triglyceride (TG)) concentrations between overweight and obese subjects who were supplemented with probiotics versus the controls who were not supplemented with probiotics. RESULTS Our findings indicated that probiotic supplementation in obese or overweight people was associated with significantly larger reductions in TC and LDL levels compared to a lack of probiotic supplementation in the control subjects. However, there was no significant difference in the variations between HDL and TG concentrations. CONCLUSION Probiotic supplementation reduced TC and LDL concentrations in obese or overweight people. Additional data from large clinical trials are required to confirm the efficacy and safety of probiotics in the regulation of blood lipid levels in obese or overweight people.
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Effects of products designed to modulate the gut microbiota on hyperlipidaemia.
Deng, X, Ma, J, Song, M, Jin, Y, Ji, C, Ge, W, Guo, C
European journal of nutrition. 2019;(7):2713-2729
Abstract
PURPOSE Fatalities due to heart and cerebrovascular diseases caused by uncontrolled hyperlipidaemia increase every year; on the other hand, lipid-lowering drugs are known to cause side effects. The gut microbiota has been thoroughly investigated by researchers and consumers, because they have unique functional properties and littler side effects. However, the effects of the gut microbiota remain controversial. We conducted a meta-analysis to assess the effects of products designed to modulate the gut microbiota on various hyperlipidaemias. METHODS We systematically searched PubMed, Embase, Cochrane Library (Central), and Web of Science for randomized controlled trials (published before June 2017, and those only in English) to compare treatment (products designed to modulate the gut microbiota) versus placebo. Our main endpoints were total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) in serum. We assessed pooled data using a fixed effects model. RESULTS Of 1337 identified studies, 21 were eligible and included in our analysis (n = 1436 participants). The combined estimate of effect size for the impact of products designed to modulate the gut microbiota on serum TC (WMD - 11.07 mg/dL, 95% CI - 13.72 to - 8.43, p < 0.001), LDL-C (WMD - 10.96 mg/dL, 95% CI - 13.37 to - 8.56, p < 0.001), and HDL-C (WMD 0.72 mg/dL, 95% CI 0.06-1.38, p = 0.032) were statistically significant, while no significant effect was found on TG concentrations (WMD - 0.56 mg/dL, 95% CI - 5.59 to 4.47, p = 0.828). Subgroup analysis showed parallel trials, probiotics, and long-term intervention had better effects on lowering blood lipid levels. CONCLUSION Products designed to modulate the gut microbiota results in changes of the plasma lipid concentrations and these changes may protect against cardiovascular disease.