title: Systematic review and meta-analysis deciphering the impact of fibrates on paraoxonase-1 status.
abstract: OBJECTIVE
  A significant residual cardiovascular risk is consistently observed in patients treated with statins. A combined treatment with fibrates reduces cardiovascular events in very high-risk patients. Because this is apparently unconnected to an improvement in lipid-related outcomes we hypothesized that the cardioprotective effects of fibrates might be associated with an improvement in paraoxonase-1 (PON1) status.
  
  
  METHODS
  The search for existing evidence, using the Medline, Scopus and Cochrane databases, was systematic and followed the PRISMA statement without restrictions on publication date. We excluded non-clinical and observational studies and we extracted data on baseline and post-treatment values of serum PON1 activity and other measurements of PON1 status.
  
  
  RESULTS
  Nine studies (including 12 treatment arms) in patients with hyperlipidemia, diabetes or metabolic syndrome treated with fibrates, alone or in combination with statins, were included to synthesize results. A meta-analysis of the data using a random-effects model revealed a significant increase in serum PON1 activity following fibrate therapy (WMD: 15.64U/L, 95% CI: 6.94, 24.34, p<0.001), an effect that was robust and not sensitive to any particular study. Subgroup analysis indicated differences in the effect size among types of fibrates and that PON1 alterations were associated with high-density lipoprotein cholesterol changes following fibrate therapy.
  
  
  CONCLUSIONS
  Results indicate a significant PON1-enhancing effect of fibrates. Whether this effect is associated with a clinical benefit, although likely, remains to be further investigated.
authors.affiliation: Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Research Centre, School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Sahebkar
authors.affiliation: Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Campus of International Excellence Southern Catalonia, Carrer Sant Llorenç 21, 43201 Reus, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Hernández-Aguilera
authors.affiliation: Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Campus of International Excellence Southern Catalonia, Carrer Sant Llorenç 21, 43201 Reus, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Abelló
authors.affiliation: Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Campus of International Excellence Southern Catalonia, Carrer Sant Llorenç 21, 43201 Reus, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Sancho
authors.affiliation: Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Campus of International Excellence Southern Catalonia, Carrer Sant Llorenç 21, 43201 Reus, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Camps
authors.affiliation: Unitat de Recerca Biomèdica, Hospital Universitari Sant Joan, Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Campus of International Excellence Southern Catalonia, Carrer Sant Llorenç 21, 43201 Reus, Spain. Electronic address: jorge.joven@urv.cat.
authors.forename: Jorge
authors.initials: J
authors.lastname: Joven
mesh_terms: D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D043303:Aryldialkylphosphatase / Q000097:blood* / Q000737:chemistry; D002318:Cardiovascular Diseases / Q000201:enzymology / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000201:enzymology / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D058065:Diabetic Cardiomyopathies / Q000201:enzymology / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004359:Drug Therapy, Combination / Q000009:adverse effects; D058607:Fibric Acids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D024821:Metabolic Syndrome / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D012307:Risk Factors; D015854:Up-Regulation / Q000187:drug effects*
chemical_list: D000924:Anticholesteremic Agents; D058607:Fibric Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D043303:Aryldialkylphosphatase; C468406:PON1 protein, human
keywords: Cardiovascular risk; HDL; Hypertriglyceridemia; Lipoprotein metabolism; Oxidation