Abstract
Background
Statins are the first-line therapy for reducing low-density lipoprotein cholesterol
(LDL-C). However, there are secondary prevention patients who are either intolerant
to maximal statin therapy or do not get adequate effects from a high-intensity statin.
While data exist for the additional LDL-C-lowering effects of ezetimibe, there are
no data on additional LDL-C lowering of bile acid sequestrants when combined with
statin therapy. The purpose of this study was to quantify the LDL-C-lowering effects
of bile acid sequestrants when added to statin therapy.
Methods
Databases (Medline via PubMed, Embase, and the Cochrane Library) were searched for
randomized controlled trials comparing statin therapy to statin therapy with the addition
of bile acid sequestrants. Nine studies were included in the meta-analysis. A meta-regression
was performed to estimate the mean difference in LDL-C between the 2 groups.
Results
Without controlling for other variables, data suggest that combining statin with bile
acid sequestrant increases the percentage change in LDL-C by 16.2 points, on average,
compared with statin use alone.
Conclusion
In patients unable to tolerate an adequate statin dosage, bile acid sequestrants offer
a viable alternative with additional LDL-C-lowering benefit.
Keywords
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Article Info
Publication History
Published online: May 12, 2020
Footnotes
Funding: None.
Conflict of Interest: The authors certify that they all have NO affiliations with, or involvement in, any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or nonfinancial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Authorship: All of the authors had access to the data and a role in writing the manuscript. MA: data collection and primary author; AB: data collection; KZ: statistical analysis; JP: library science; NJS: senior author.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
