Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China; National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China.
Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100007, China.
Pharmacol Res. 2021 Jan;163:105275. doi: 10.1016/j.phrs.2020.105275. Epub 2020 Nov 7.
Studies differ with respect to the effects of statins and their on lipoprotein(a)[Lp(a)] levels. The aim of the present study was to resolve these differences by determining the effect of various types and dosages of statins on Lp(a) levels.
We searched PubMed, Embase and the Cochrane library for randomized controlled trials (RCTs) investigating the efficacy of statins on plasma Lp(a) levels. Study selection, data extraction and risk of bias assessment were conducted independently by four authors. We conducted pairwise meta-analysis and network meta-analysis (NMA). Consistency models were applied to NMA and the ranking probabilities for each treatment's efficacy were calculated. Node-splitting analysis was used to test inconsistency. This study was registered with PROSPERO, number CRD42020167612.
Twenty RCTs with 23,605 participants were included, involving 11 interventions. Most of the included studies presented some risks of bias, especially risks of performance and detection bias. In the pairwise meta-analysis, pooled results showed a small but statistically significant difference between high-intensity rosuvastatin and placebo on Lp(a) levels (MD = 1.81, 95 % CI [0.43, 3.19], P = 0.01). In the NMA, different types and dosages of statins showed no significant effect on the level of Lp(a), and there was no obvious difference between them. Subgroup analysis based on different populations and treatment durations did not provide any statistically significant findings about different statins on Lp(a) levels. Node-splitting analysis showed that no significant inconsistency existed (P > 0.05).
Statins have no clinically significant effect on Lp(a) levels, and there is no significant difference in the effect on Lp(a) levels between different types and dosages of statins. Moderate-intensity pitavastatin tended to have the best effect on reducing Lp(a) levels; nevertheless, it was insignificant. Our findings highlight the necessity for further study of the effect of statins on Lp(a) levels in future studies.
他汀类药物对脂蛋白(a)[Lp(a)]水平的影响存在差异。本研究旨在通过确定不同类型和剂量的他汀类药物对 Lp(a)水平的影响来解决这些差异。
我们在 PubMed、Embase 和 Cochrane 图书馆中搜索了评估他汀类药物对血浆 Lp(a)水平疗效的随机对照试验（RCT）。四位作者独立进行了研究选择、数据提取和偏倚风险评估。我们进行了成对荟萃分析和网络荟萃分析（NMA）。一致性模型应用于 NMA，并计算了每种治疗效果的排名概率。节点分裂分析用于检验不一致性。本研究已在 PROSPERO 注册，编号为 CRD42020167612。
共纳入 20 项 RCT，涉及 23605 名参与者，涉及 11 种干预措施。大多数纳入的研究存在一定的偏倚风险，尤其是实施和检测偏倚风险。在成对荟萃分析中，汇总结果显示高强度瑞舒伐他汀与安慰剂相比，Lp(a)水平的差异较小但具有统计学意义（MD=1.81，95%CI[0.43,3.19]，P=0.01）。在 NMA 中，不同类型和剂量的他汀类药物对 Lp(a)水平没有显著影响，它们之间没有明显差异。基于不同人群和治疗持续时间的亚组分析没有提供关于不同他汀类药物对 Lp(a)水平的任何统计学显著发现。节点分裂分析显示不存在明显的不一致性（P>0.05）。
他汀类药物对 Lp(a)水平没有明显的临床影响，不同类型和剂量的他汀类药物对 Lp(a)水平的影响没有明显差异。中强度匹伐他汀降低 Lp(a)水平的效果可能最好，但无统计学意义。我们的研究结果强调了在未来的研究中进一步研究他汀类药物对 Lp(a)水平影响的必要性。
