Abstract
Background and purpose
The contribution of modifying non-low-density lipoprotein cholesterol (LDL-C) levels
to reduce stroke risk remains uncertain. The aim of this study was to investigate
the association between treatment-induced change in plasma triglyceride levels and
risk of stroke and progression of carotid intima-media thickness (CIMT).
Methods
We performed a systematic review and meta-regression analyses of randomized controlled
trials of lipid-modifying treatments selected from a PubMed search on literature published
from 1966 to 2008.
Results
We identified 64 randomized controlled trials (active groups, n = 96,807; control groups, n = 98,681) that tested lipid-modifying drugs and reported triglyceride levels and stroke
outcome. Extracting data from placebo groups, we found a statistically significant
association between baseline triglyceride levels and stroke risk (adjusted relative
risk [RR], 1.05 per 10-mg/dL increase; 95% CI, 1.03–1.07). Except for a trend in fibrate
and niacin trials, there was no evidence of any relationship between degree of triglyceride
change and stroke incidence. In multivariable meta-regression analysis including baseline
and change in LDL-C, only change in LDL-C was associated with log risk ratio of all
strokes (RR reduction, 4.5% per 10-mg/dL reduction; 95% CI, 1.7–7.2; P = .003). Similarly, taking into account 26 randomized controlled trials reporting CIMT
outcome, LDL-C reduction was associated with reduced CIMT progression (−3.0 μm/y per 10-mg/dL reduction; 95% CI, −5.5 to −0.4; P = .03).
Conclusions
In view of the limitations of meta-regression analysis and CIMT measures as surrogate
endpoints in lipid-lowering drugs trials, additional studies are needed to more precisely
quantify the detrimental effect of triglyceride levels on stroke risk and to establish
the efficacy of triglyceride-lowering therapy in addition to LDL-C reduction.
Keywords
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Article info
Publication history
Published online: May 11, 2010
Accepted:
February 8,
2010
Received in revised form:
January 27,
2010
Received:
November 27,
2009
Identification
Copyright
© 2010 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
