Objective To assess the efficacy and safety of lipid-modifying agents for metabolism syndrome.Methods We searched The Cochrane Library, MEDLINE, EMbase, the China Biological Medicine Database, VIP and CMAC to 2007. We also did some handsearching and additional searching. Randomized controlled trials of lipidmodifying therapy for metabolic syndrome were included. Two reviewers independently extracted data from the eligible studies and evaluated the quality of the included studies. Meta-analyses were performed for the results of homogeneous studies using The Cochrane Collaboration’s RevMan 4.2.9 software. Results A total of 11 studies involving 1 422 patients with metabolic syndrome were included. The results indicated that there was no significant difference in TG between rosuvastatin and atorvastatin. However, rosuvastatin was more effective than atorvastatin on HDL-c improvement. Atorvastatin decreased TG levels greater than simvastatin, but simvastatin was superior to atorvastatin in HDL-c improvement. Two trials comparing fenofibrate with placebo were heterogeneous for some outcomes: one found no significant difference in improvements to HOMA-index, but the other trial indicated that fenofibrate was superior to placebo in improving QUICKI. However, the two trials revealed that fenofibrate favorably affected TG [WMD= – 1.77, 95%CI (– 2.21, – 1.33)] and HDL-c [WMD= 6.62, 95%CI (2.07, 11.17)] compared with placebo. No significant differences among atorvastatin, fenofibrate, alone or in combination, were observed in the proportion of metabolic syndrome reduction [RR=0.99, 95%CI (0.84, 1.16); RR=1.03, 95%CI (0.88, 1.20); RR=1.01, 95%CI (0.87, 1.18)]. Atorvastatin plus fenofibrate was superior to atorvastatin alone in TG and HDL-c improvement. Simvastatin-fenofibrate combination produced greater effectiveness in improving of HDL-c and TG compared with simvastatin alone. The fenofibrateorlistat combination was similar to fenofibrate in reducing metabolic syndrome [RR=1.15, 95%CI (0.68, 1.95)] and TG improvement, but was more effective than fenofibrate in HOMA-index improvement. This review of the clinical trials shows that the majority of lipid-modulating drugs did not have favorable effects on FPG, BP, BMI and WC. Six studies reported side effects, showing that the side effects for lipid-regulating drugs were mild to moderate, and well tolerated.Conclusion Our results suggest that lipid-regulating drugs in general exhibit beneficial effects on TG and HDL-c, but not on blood glucose and central obesity. The therapeutic effects of lipid-regulating drugs on blood pressure and insulin sensitivity are uncertain and have no positive effects on FPG, BMI and WC. There is insufficient evidence in this review to recommend the use of lipid-modifying drugs for metabolic syndrome due to low methodological quality, small ssamplesize and limited number of the trials. More high-quality and large-scale randomized controlled trials are required.
Objectives To assess the efficacy and safety of statins for adult osteoporosis. Methods We electronically searched The Cochrane Library (Issue 4, 2007), MEDLINE (1990 to November 2007), EMBASE (1990 to November 2007), Current Controlled Trials, The National Research Register, CBM (1990 to November 2007), VIP (1990 to November 2007) and CNKI (1990 to November 2007). We also handsearched some related journals and identified randomized controlled trials of statins versus placebo in adults with osteoporosis. Results Two randomized controlled trials were included. We didn’t perform meta-analysis due to heterogeneity. No significant differences were observed in the changes of bone density at the lumbar spine and total hip from baseline between statins and placebo. However, a significant increase in bone density was found in response to simvastatin at the forearm. Biochemical markers of bone metabolism changes from baseline did not differ significantly between statins and placebo groups. Conclusions The evidence currently available does not support the use of statins in the treatment of osteoporosis. Further randomized, double-blind, placebo-controlled trials are needed in order to define the efficacy and acceptability of statins in the treatment of osteoporosis.
ObjectiveTo systematically review the efficacy of statins for contrast induced nephropathy (CIN) prevention in cardiac intervention surgery patients. MethodsWe electronically searched databases including PubMed, Web of Knowledge, The Cochrane Library (Issue 5, 2015), VIP, WanFang Data and CNKI to collect randomized controlled trials (RCTs) about statins for CIN prevention in cardiac intervention surgery patients from inception to May 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 25 RCTs involving 37 353 patients were included, among them, 3 794 were CIN patients. The results of meta-analysis indicated that: compared with the placebo/blank group, the incidence rate of CIN was decreased in the statins group with a significant difference (OR=0.68, 95%CI 0.63 to 0.73, P<0.000 01). ConclusionCurrent evidence shows statins can reduce incidence of CIN in cardiac intervention surgery patients. Due to limited quality and quantity of the included studies, the above conclusions need more high quality studies to verify.
Objective To assess the effectiveness of statins in treating early diabetic kidney disease (DKD). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), MEDLINE (1991 to August 2009), EMbase (1991 to August 2009), CBMdisc (1991 to August 2009) and CNKI (1994 to August 2009). We also handsearched relevant journals and conference proceedings. Randomized controlled trials (RCTs) in which statins were used to treat patients with early DKD were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by RevMan 4.2 software. Results A total of 281 articles were found and 22 articles inolving 1838 patients were finally included. All these articles were regarded as low quality. We chose the random-effect model to conduct meta-analysis because significant heterogeneities were found among these articles. The results of meta-analysis showed that after treatment with statins, there were significant reductions in urinary albumin excretion rate (UAER) (WMD= –55.77, 95%CI –74.20 to –37.34, Plt;0.000 01), serum creatinine (Scr) (WMD= –4.34, 95%CI –6.74 to –1.94, P=0.000 4), C reactive protein (CRP) (WMD= –1.48, 95%CI – 2.32 to – 0.63, P=0.006), total cholesterol (TC) (WMD= –1.33, 95%CI –1.75 to –0.91, Plt;0.000 01), and triglyceride (TG) (WMD= –0.72, 95%CI-1.17 to -0.27, P=0.002) in group treatment compared with group control. Funnel-plot displayed a symmetrical figure, indicating there was no publication bias. No severe adverse effects were found in these articles except 12 patients with high level of transaminase which were cured after using hepatic protect therapy. Conclusion Currently available evidence shows that with the reduction of TC and TG, statins may decrease UAER and Scr in patients with early DKD and the reduction of CRP may be involved in the mechanism. Statins provide effective renal protection and no severe adverse effects in treating early DKD. However, due to lack of quality in the included studies, more studies of better quality should be conducted
ObjectiveTo evaluate the effects and safety of statins in patients with acute respiratory distress syndrome (ARDS). MethodsLiteratures in English and Chinese concerning randomized controlled trials (RCTs) on statins in ARDS patients were retrieved by electronic and manual search. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. ResultsFive RCTs involving 1489 ARDS patients were included, with 709 patients in the statins group and 780 patients in the placebo control group. Compared with the control group, statins did not improve the survival of ARDS patients[risk ratio (RR) 1.01, 95% confidence interval (CI) 0.86 to 1.18, P=0.91), while the improvement of oxygenation[mean difference (MD) 3.92, 95%CI-14.10 to 21.94, P=0.67], ventilator-free days (MD 0.65, 95%CI-0.20 to 1.50, P=0.13) and non-pulmonary organ failure-free days (MD 1.20, 95%CI-1.46 to 3.87, P=0.38) exhibited no differences between the statins group and the control group. However statins were associated with significant elevation of creatine kinase (MD 6.92, 95%CI 5.77 to 8.07, P < 0.000 01). ConclusionThis study demonstrates that statins can not improve outcomes of ARDS patients, and the safety of statins still needs further evaluation.