A Meta Analysis Of Combined Lipid-lowering For Mixed Dyslipidemia

Background:With the increase in incidence of type2diabetes and metabolic syndrome, the incidence of coronary heart disease and cerebrovascular stroke rises. Diabetes and insulin resistance prone to abnormal lipid metabolism, which usually presents as mixed dyslipidemia, especially the atherogenic dyslipidemia characterized by high TG with low HDL-C has been proved to be the important factors for residual vascular risk. How to further reduce residual vascular risk? Fenofibrate has been the combined drug with statins for diabetic patients because of the safty and benefit for microvascular and macrovascular.Many trials about combined lipid-lowering have been completed, but as the limited number of cases, we still don’t have enough evidence of statins-fibrate combined therapy for mixed hyperlipidemia.Purpose:To evaluate the change of the primary parameters(LDL-C, TC, HDL-C), the secondary parameters(TG, ApoB, non-HD1-C) and the side effect for mixed hyperlipidemia patients treated by statins-fenofibrate combined therapy.Methods:We search the random contral trials about statins-fenofibrate combined therapy from1980to2012in the medline database and the Cochrane Library. According to the criteria and the cochrane Bias risk tool, we determine the final RCTs and extract the data about the primary indicators,the secondary indicators and the incidence of side effect. We use the Revman5.1.6sofrware to finish the meta-analysis. Results:The meta-analysis includes11RCTs which are divided into three subgroups: Rosuvastatin-fenofibrate(4Rcts), Simvastatin-fenofibrate(4Rcts), atorvastatin-fenofibrate(3Rcts),all of them have been evaluated by the cochrane bias risk tool.The result show that:For LDL-C, simvastatin-fenofibrate therapy is better than simvastatin alone (MD,-4.68%;95%CI (-7.63,-1.73), P=0.002), but the other subgroups don’t have statistical differences.For TC, simvastatin and rosuvasatin subgroup have positive results, but atorvastatin-fenofibrate is negative. For HDL-C,all subgroups have positive results.combination therapy with fenofibrate has greater decrease inTG, non-HDL-C and ApoB compared to statins alone. About side effect,there is no statistical differences between combination therapy and statins alone,such as muscle related side effect of rosuvastatin (RR,1.13;95%CI0.69-1.85; P=0.61) and live related side effect of rosuvasatin (RR,1.66;95%CI,0.60-4.54; P=0.33)Conclusion:Statins-fenofibrate combined therapy has significantly greater decrease than statins alone on TG, non-HDL-C and ApoB, but for the primary indicator LDL-C and TC, the result is still different between three subgroups. We need more research to definite it. About the safety, combination therapy don’t elevate the incidence of side effect.