Reduction of C-reactive protein, low-density lipoprotein cholesterol, and its relationship with cardiovascular events of different lipid-lowering therapies: A systematic review and meta-analysis of randomized controlled trials.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 36123891 · doi:10.1097/MD.0000000000030563
What was done
Systematic review and meta-analysis of randomized controlled trials (RCTs) searched in MEDLINE, EMBASE, and Cochrane CENTRAL up to September 1, 2021. Included studies evaluated statins, ezetimibe, or PCSK9 monoclonal antibodies (PCSK9-mAbs) versus placebo with a treatment duration of at least 4 weeks and reported changes in LDL-C and CRP. The authors calculated weighted mean differences (WMD) with 95% confidence intervals (CIs), conducted meta-regression between CRP and LDL-C changes, and compared drug classes on cardiovascular outcomes.
What was found
Compared with placebo: - Statins significantly lowered LDL-C (WMD -47.94 mg/dL, 95% CI -51.21 to -44.67) and CRP (WMD -0.67 mg/L, 95% CI -0.90 to -0.45). - Ezetimibe significantly lowered LDL-C (WMD -22.84 mg/dL, 95% CI -26.76 to -18.92) and CRP (WMD -0.64 mg/L, 95% CI -1.07 to -0.21). - PCSK9-mAbs significantly reduced LDL-C (WMD -54.24 mg/dL, 95% CI -59.77 to -48.70), but CRP reduction was not statistically significant (numerical data omitted in abstract). Meta-regression found no significant association between change in CRP level and change in LDL-C level. Subgroup comparisons showed PCSK9-mAbs lowered LDL-C more than statins or ezetimibe, while risks of cardiovascular death, myocardial infarction, and stroke showed no significant differences between drug classes (numerical risks not reported in abstract).
Why it matters
This review shows that while statins and ezetimibe lower both LDL-C and CRP, PCSK9-mAbs lower LDL-C without a significant effect on CRP. It suggests cardiovascular event reductions are comparable between traditional lipid-lowering strategies and PCSK9-mAbs despite differences in inflammatory marker reduction.
Limits
The abstract does not state the number of included studies or total sample size. Specific numerical risk estimates and confidence intervals are omitted for cardiovascular outcomes and for CRP changes under PCSK9-mAb treatment. Information on baseline cardiovascular risk, study duration, background therapy, and heterogeneity is absent from the abstract.
Cited by
- supports Statins reduce C-reactive protein levels by roughly 17%.