title: Triglyceride-lowering therapies reduce cardiovascular disease event risk in subjects with hypertriglyceridemia.
abstract: Cardiovascular outcomes trials of fibrates, niacin, or omega-3 fatty acids alone, or added to a statin, have not consistently demonstrated reduced risk, but larger, statistically significant clinical benefits have been reported in subgroups with elevated triglycerides (TG) and/or elevated TG plus low high-density lipoprotein cholesterol (HDL-C).
  
  
  
  To perform a meta-analysis of the effects of therapies targeting TG and TG-rich lipoprotein cholesterol on cardiovascular disease event risk in subjects with elevated TG or elevated TG paired with low HDL-C.
  
  
  
  Publications were identified using PubMed, the Cochrane Central Register of Controlled Trials, clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, and Internet Stroke Center. Random-effects meta-analysis models were used to generate summary relative risk estimates and 95% confidence intervals. Heterogeneity was assessed by χ(2) and I(2) statistics, and the impact of each trial was assessed in one study-removed sensitivity analyses.
  
  
  
  Six trials of fibrates, 2 of niacin, 1 of fibrate + niacin, and 1 of omega-3 eicosapentaenoic acid ethyl esters were identified. For the prespecified primary cardiovascular disease or coronary heart disease end point used in each trial, the summary relative risk estimate (95% confidence interval) for subjects with elevated TG was 0.82 (0.73-0.91), p-heterogeneity = 0.13, I(2) = 36.2, and for subjects with elevated TG and low-HDL-C, it was 0.71 (0.63-0.81), p-heterogeneity = 0.52, I(2) = 0.0. There was no evidence of publication bias, and the results remained statistically significant when each individual trial was removed.
  
  
  
  Drugs that substantially, but not exclusively, lower TG and TG-rich lipoprotein cholesterol may have cardiovascular benefits in individuals with elevated TG, particularly if accompanied by low HDL-C.
authors: Midwest Center for Metabolic and Cardiovascular Research/MB Clinical Research, Glen Ellyn, IL, USA. Electronic address: kevin.maki@mxns.com.
authors: Kevin C
authors: KC
authors: Maki
authors: Duke University School of Medicine, Durham, NC, USA.
authors: John R
authors: JR
authors: Guyton
authors: University of Miami Miller School of Medicine, Miami, FL, USA.
authors: Carl E
authors: CE
authors: Orringer
authors: Griffith and Flinders University Schools of Medicine, Queensland and South Australia, Australia.
authors: Ian
authors: I
authors: Hamilton-Craig
authors: EpidStat Institute, Ann Arbor, MI, USA.
authors: Dominik D
authors: DD
authors: Alexander
authors: AstraZeneca Pharmaceuticals, Wilmington, DE, USA.
authors: Michael H
authors: MH
authors: Davidson
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications*; D006801:Humans; D015228:Hypertriglyceridemia / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism; D000960:Hypolipidemic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D012306:Risk; D014280:Triglycerides / Q000378:metabolism*
chemical_list: D000960:Hypolipidemic Agents; D014280:Triglycerides
keywords: Cardiovascular disease; Cardiovascular events; Fibrates; Hypertriglyceridemia; Lipid-altering drug therapy; Niacin; Omega-3 fatty acids; Triglyceride-lowering therapy