Imperial College London
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Dr Daniel Keene MBChB, MSc (Distinction), MRCP, PhD

Faculty of Medicine, National Heart & Lung Institute

Clinical Senior Lecturer in Cardiology (Clinical)
 
 
 
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Contact

 

d.keene

 
 
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Location

 

Block B Hammersmith HospitalHammersmith Campus

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Summary

 

Publications

Citation

BibTex format

@article{Keene:2014:10.1136/bmj.g4379,
author = {Keene, D and Price, C and Shun-Shin, MJ and Francis, DP},
doi = {10.1136/bmj.g4379},
journal = {BMJ: British Medical Journal},
title = {Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117 411 patients},
url = {http://dx.doi.org/10.1136/bmj.g4379},
volume = {349},
year = {2014}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Objective To investigate the effects on cardiovascular outcomes of drug interventions that increase high density lipoprotein levels.Design Meta-analysis.Studies reviewed Therapeutic benefit of niacin, fibrates, and cholesteryl ester transfer protein (CETP) inhibitors on cardiovascular events (all cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke).Results 117 411 patients were randomised in a total of 39 trials. All interventions increased the levels of high density lipoprotein cholesterol. No significant effect was seen on all cause mortality for niacin (odds ratio 1.03, 95% confidence interval 0.92 to 1.15, P=0.59), fibrates (0.98, 0.89 to 1.08, P=0.66), or CETP inhibitors (1.16, 0.93 to 1.44, P=0.19); on coronary heart disease mortality for niacin (0.93, 0.76 to 1.12, P=0.44), fibrates (0.92, 0.81 to 1.04, P=0.19), or CETP inhibitors (1.00, 0.80 to 1.24, P=0.99); or on stroke outcomes for niacin (0.96, 0.75 to 1.22, P=0.72), fibrates (1.01, 0.90 to 1.13, P=0.84), or CETP inhibitors (1.14, 0.90 to 1.45, P=0.29). In studies with patients not receiving statins (before the statin era), niacin was associated with a significant reduction in non-fatal myocardial infarction (0.69, 0.56 to 0.85, P=0.0004). However, in studies where statins were already being taken, niacin showed no significant effect (0.96, 0.85 to 1.09, P=0.52). A significant difference was seen between these subgroups (P=0.007). A similar trend relating to non-fatal myocardial infarction was seen with fibrates: without statin treatment (0.78, 0.71 to 0.86, P<0.001) and with all or some patients taking statins (0.83, 0.69 to 1.01, P=0.07); P=0.58 for difference.Conclusions Neither niacin, fibrates, nor CETP inhibitors, three highly effective agents for increasing high density lipoprotein levels, reduced all cause mortality, coronary heart disease mortality, myocardial infarction, or stroke in patients treated with statins. Although observational studi
AU  - Keene,D
AU  - Price,C
AU  - Shun-Shin,MJ
AU  - Francis,DP
DO  - 10.1136/bmj.g4379
PY  - 2014///
SN  - 0959-535X
TI  - Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin, fibrates, and CETP inhibitors: meta-analysis of randomised controlled trials including 117 411 patients
T2  - BMJ: British Medical Journal
UR  - http://dx.doi.org/10.1136/bmj.g4379
UR  - http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000339326500001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
UR  - https://www.bmj.com/content/349/bmj.g4379
UR  - http://hdl.handle.net/10044/1/18838
VL  - 349
ER  -
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