Cholesteryl ester transfer protein inhibitors in the treatment of dyslipidemia: a systematic review and meta-analysis

PLoS One. 2013 Oct 28;8(10):e77049. doi: 10.1371/journal.pone.0077049. eCollection 2013.

Abstract

Cholesteryl ester transfer protein (CETP) inhibitors are gaining substantial research interest for raising high density lipoprotein cholesterol levels. The aim of the research was to estimate the efficacy and safety of cholesteryl ester transfer protein inhibitors as novel lipid modifying drugs. Systematic searches of English literature for randomized controlled trials (RCT) were collected from MEDLINE, EBASE, CENTRAL and references listed in eligible studies. Two independent authors assessed the search results and only included the double-blind RCTs by using cholesteryl ester transfer protein inhibitors as exclusively or co-administrated with statin therapy irrespective of gender in enrolled adult subjects. Two independent authors extracted the data by using predefined data fields. Of 503 studies identified, 14 studies met the inclusion criteria, and 12 studies were included into the final meta-analysis. Our meta-analysis revealed that CETP inhibitors increased the HDL-c levels (n = 2826, p<0.00001, mean difference (MD) = 20.47, 95% CI [19.80 to 21.15]) and total cholesterol (n = 3423, p = 0.0002, MD = 3.57, 95%CI [1.69 to 5.44] to some extent combined with a reduction in triglyceride (n = 3739, p<0.00001, MD = -10.47, 95% CI [-11.91 to -9.03]) and LDL-c (n = 3159, p<0.00001, MD = -17.12, 95% CI [-18.87 to -15.36]) irrespective of mono-therapy or co-administration with statins. Subgroup analysis suggested that the lipid modifying effects varied according to the four currently available CETP inhibitors. CETP inhibitor therapy did not increase the adverse events when compared with control. However, we observed a slight increase in blood pressure (SBP, n = 2384, p<0.00001, MD = 2.73, 95% CI [2.14 to 3.31], DBP, n = 2384, p<0.00001, MD = 1.16, 95% CI [0.73 to 1.60]) after CETP inhibitor treatment, which were mainly ascribed to the torcetrapib treatment subgroup. CETP inhibitors therapy is associated with significant increase in HDL-c and decrease in triglyceride and LDL-c with satisfactory safety and tolerability in patients with dyslipidemia. However, the side-effect on blood pressure deserves more consideration in future studies.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Amides
  • Anticholesteremic Agents / adverse effects
  • Anticholesteremic Agents / therapeutic use*
  • Benzodiazepines / adverse effects
  • Benzodiazepines / therapeutic use
  • Blood Pressure / drug effects
  • Cholesterol / blood
  • Cholesterol Ester Transfer Proteins / antagonists & inhibitors*
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Drug Therapy, Combination
  • Dyslipidemias / blood
  • Dyslipidemias / drug therapy*
  • Esters
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Oxazolidinones / adverse effects
  • Oxazolidinones / therapeutic use
  • Quinolines / adverse effects
  • Quinolines / therapeutic use
  • Randomized Controlled Trials as Topic
  • Sulfhydryl Compounds / adverse effects
  • Sulfhydryl Compounds / therapeutic use
  • Treatment Outcome
  • Triglycerides / blood

Substances

  • Amides
  • Anticholesteremic Agents
  • CETP protein, human
  • Cholesterol Ester Transfer Proteins
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Esters
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Oxazolidinones
  • Quinolines
  • Sulfhydryl Compounds
  • Triglycerides
  • Benzodiazepines
  • dalcetrapib
  • torcetrapib
  • evacetrapib
  • Cholesterol
  • anacetrapib

Grants and funding

Dr. Zeng's laboratory is supported by grants from the National Natural Science Foundation of China (30925018, 31130029, 81070559, 81100190); National Basic Research Program of China (973 Program, 2008CB517308, 2012CB517801), and Natural Science Foundation Project of CQ CSTC (CSTC, 2009BA5044). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.