title: Effect of HDL-raising drugs on cardiovascular outcomes: a systematic review and meta-regression.
abstract: BACKGROUND
  Substantial residual cardiovascular risk remains after optimal LDL lowering in patients of established coronary artery disease. A number of therapeutic agents that raise HDL-C have been tested in clinical trials to cover this risk. However, the results of clinical trials are conflicting.
  
  
  OBJECTIVE
  To determine whether raising HDL-C with pharmacologic therapies translates into beneficial cardiovascular outcomes and to find out if this change was proportional to the percentage change in HDL levels.
  
  
  METHODS
  Electronic and printed sources were searched up to August, 2013 for randomised controlled trials (RCTs) using at least one of the HDL raising therapies for secondary prevention of adverse cardiovascular events over optimal LDL levels. Data from eligible studies were pooled for the following outcomes: all cause mortality, cardiovascular disease mortality, hospitalization for unstable angina, non-fatal myocardial infarction, coronary revascularization and ischemic stroke. Mantel Haensnzel fixed effect model was used preferentially. Meta-regression was done to see the correlation of change in HDL levels and cardiovascular outcomes. Pooled odds ratios with 95% confidence interval (CI) were calculated.
  
  
  RESULTS
  A total of 12 RCTs including 26,858 patients with follow up period ranging from 1 year to 6.2 years were included in the analysis. Pooled analysis showed no significant difference in all-cause mortality between the treatment and control group (Pooled OR 1.07; 95% CI 0.98-1.16, p = 0.15). No significant difference was found between the groups for any of the secondary outcomes. Similarly no correlation was seen between percentage change in HDL and adverse cardiovascular outcomes on meta-regression analysis.
  
  
  CONCLUSIONS
  Increasing HDL levels via pharmacological manipulation beyond optimal lipid lowering therapy for secondary prevention is not beneficial.
authors.affiliation: Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Navjot
authors.initials: N
authors.lastname: Kaur
authors.affiliation: Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Avaneesh
authors.initials: A
authors.lastname: Pandey
authors.affiliation: Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Harish
authors.initials: H
authors.lastname: Negi
authors.affiliation: Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Nusrat
authors.initials: N
authors.lastname: Shafiq
authors.affiliation: Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Srinivas
authors.initials: S
authors.lastname: Reddy
authors.affiliation: ICMR- Advanced centre for evidence based child health, Advance Paediatric Centre, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Harpreet
authors.initials: H
authors.lastname: Kaur
authors.affiliation: Dr. Tulsi Das Library, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Neelima
authors.initials: N
authors.lastname: Chadha
authors.affiliation: Department of Pharmacology, Post Graduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Samir
authors.initials: S
authors.lastname: Malhotra
mesh_terms: D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality; D016022:Case-Control Studies; D008076:Cholesterol, HDL / Q000378:metabolism*; D023381:Endpoint Determination; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016017:Odds Ratio; D017594:Publication Bias; D016896:Treatment Outcome
chemical_list: D008076:Cholesterol, HDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
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