1.
Effect of high-dose statin versus low-dose statin plus ezetimibe on endothelial function: a meta-analysis of randomized trials.
Ye, Y, Zhao, X, Zhai, G, Guo, L, Tian, Z, Zhang, S
Journal of cardiovascular pharmacology and therapeutics. 2012;(4):357-65
Abstract
BACKGROUND Combining low-dose statin and ezetimibe reduces the low-density lipoprotein cholesterol (LDL-C) similar to high-dose statin. However, whether there is a difference in the effect of these 2 lipid-lowering regimes on endothelial function is still controversial. METHODS We performed a systematic search of databases (MEDLINE [1950 to September 2011], EMBASE [1966 to September 2011]) and references of identified studies. Completely published randomized controlled trials comparing the effect of high-dose statin with low-dose stain plus ezetimibe on endothelial function (flow-mediated dilation [FMD] method) were included in this study. RESULTS Six trials with a total of 213 participants were included in the meta-analysis. The pooled weighted mean difference of FMD did not differ between the 2 lipid-lowering regimes (0.22%; 95% confidence interval [CI]: -0.85%-1.29%, P = .68). Furthermore, no significant reduction in LDL-C and C-reactive protein (CRP) occurred with high-dose statin versus low-dose statin plus ezetimibe (pooled weighted mean differences of LDL-C and CRP were -4.12 mg/dL, 95% CI: -9.54-1.12 mg/dL, P = .12, and -0.02 mg/L, 95% CI: -0.31-0.27 mg/L, P = .89, respectively). CONCLUSIONS Based on the currently available evidence, combining a low-dose statin with ezetimibe may provide similar beneficial effects on endothelial function as high-dose statin.
2.
Effects of statin treatment on cardiac function in patients with chronic heart failure: a meta-analysis of randomized controlled trials.
Zhang, L, Zhang, S, Jiang, H, Sun, A, Zou, Y, Ge, J
Clinical cardiology. 2011;(2):117-23
Abstract
BACKGROUND Whether additional benefit can be achieved with the use of statin treatment in patients with chronic heart failure (CHF) remains undetermined. HYPOTHESIS Statin treatment may be effective in improving cardiac function and ameliorating ventricular remodeling in CHF patients. METHODS The PubMed, MEDLINE, EMBASE, and EBM Reviews databases were searched for randomized controlled trials comparing statin treatment with nonstatin treatment in patients with CHF. Two reviews independently assessed studies and extracted data. Weighted mean differences (WMD) with 95% confidence intervals (CI) were calculated using random effects models. RESULTS Eleven trials with 590 patients were included. Pooled analysis showed that statin treatment was associated with a significant increase in left ventricular ejection fraction (WMD: 3.35%, 95% CI: 0.80 to 5.91%, P = 0.01). The beneficial effects of statin treatment were also demonstrated by the reduction of left ventricular end-diastolic diameter (WMD: -3.77 mm, 95% CI: -6.24 to -1.31 mm, P = 0.003), left ventricular end-systolic diameter (WMD: -3.57 mm, 95% CI: -6.37 to -0.76 mm, P = 0.01), B-type natriuretic peptide (WMD: -83.17 pg/mL, 95% CI: -121.29 to -45.05 pg/mL, P < 0.0001), and New York Heart Association functional class (WMD: -0.30, 95% CI: -0.37 to -0.23, P < 0.00001). Meta-regression showed a statistically significant association between left ventricular ejection fraction improvement and follow-up duration (P = 0.03). CONCLUSIONS The current cumulative evidence suggests that use of statin treatment in CHF patients may result in the improvement of cardiac function and clinical symptoms, as well as the amelioration of left ventricular remodeling.