Clinical Question: Does therapy aim...

Clinical Question: Does therapy aimed at raising the horizontal of high-density lipoprotein (HDL) cholesterol provide a benefit in patients with heart disease?

Setting: Outpatient (any)

cogitation Design: Meta-analysis (randomized controlled trials)

Synopsis: The authors of this meta-analysis identified 83 randomized controll trials enrolling more than 21000 patients that evaluated the part of HDL-cholesterol-raising therapy with fibrates so as gemfibrozil, clofibrate, fenofibrate, or bezafibrate. The authors searched alone MEDLINE and focused only onward English-language journals. Unpublished data, review article citations, and other databases were not searched, all of which are now standard practice in metaanalysis. As a follow the authors may have missed studies that did not indicate a benefit to treatment. All randomized studies lasting at least three weeks were included.

greatest in number of the studies lasted at least eight month and almost all of the results data were from studies enrolling patients with preexisting coronary heart disease or prototype 2 diabetes. The authors combined all fibrates into united group. On average, treatment of men with a fibrate or niacin decreased the total cholesterol flush by approximately 10 percent, increased the HDL cholesterol flat by 10 to 16 percent and reduc triglyceride horizontals by 20 to 36 percent Fibrates, in general, decreased the likelihood of a major coronary marked occurrence over four years (number urgencyed to treat [NNT] = 33; 95 percent confidence interval [CI], 20 to 100) and the risk of coronary death (NNT = 100; 95 percent CI, naught to 100). Cardiovascular deaths and deaths from any cause were not affected by way of treatment. The authors did not make notes on the homogeneity of their data.

Bottom Line: In men with pre-existing heart disease, medicine therapy with fibrates aimed at increasing HDL cholesterol plains decreases the likelihood of a major coronary occurrence and decreases the risk of coronary death. Despite being studied in many at-risk men fibrate therapy has not been shown to decrease the number of overall deaths or cardiovascular deaths. Research evaluating the benefit of therapies aimed at lowering the flats of low-density lipoprotein (LDL) cholesterol and increasing the evens of HDL cholesterol is povertyed Until then, physicians should focus upon lowering LDL cholesterol levels, because that is where the greater benefit is evident. (Level of Evidence: 1a-)

thought Reference: Birjmohun RS, et al. Efficacy and safety of high-density lipoprotein cholesterol-increasing compounds: a meta-analysis of randomized controll trials. J Am Coll Cardiol January 18 2005;45:185-97 Used with permission from Shaughnessy A. Raising HDL cholesterol slightly beneficial. Accessed online March 31 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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