Triglyceride-lowering therapy for the prevention of cardiovascular events, stroke, and mortality in patients with diabetes: A meta-analysis of randomized controlled trials

Xiu Hong Yang; Qian Ming Tu; Li Li; Yong Ping Guo; Nian Song Wang; Hui Min Jin

doi:10.1016/j.atherosclerosis.2023.117187

Triglyceride-lowering therapy for the prevention of cardiovascular events, stroke, and mortality in patients with diabetes: A meta-analysis of randomized controlled trials

Atherosclerosis. 2023 Jul 13:117187. doi: 10.1016/j.atherosclerosis.2023.117187. Online ahead of print.

Authors

Xiu Hong Yang¹, Qian Ming Tu², Li Li², Yong Ping Guo³, Nian Song Wang⁴, Hui Min Jin⁵

Affiliations

¹ Department of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, 2800 Gong Wei Road, Shanghai, China; Department of Nephrology, Affiliated the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
² Department of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, 2800 Gong Wei Road, Shanghai, China.
³ Department of Nephrology, Affiliated the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China. Electronic address: 18930174132@163.com.
⁴ Department of Nephrology, Affiliated the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, China. Electronic address: wangniansong2012@163.com.
⁵ Department of Nephrology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, 2800 Gong Wei Road, Shanghai, China; Department of Nephrology, The People's Hospital of Wenshan Prefecture, Yunnan Province, China. Electronic address: hmjgli@163.com.

PMID: 37527961
DOI: 10.1016/j.atherosclerosis.2023.117187

Abstract

Background and aims: Triglyceride (TG)-lowering therapy is efficient for the prevention of cardiovascular disease (CVD) in the general population; however, for diabetic individuals, it is more controversial. The purpose of this study was to pool the results from randomized controlled trials (RCTs) to clarify whether the lowering of TG is beneficial for the prevention of CVD events, stroke, and mortality in subjects with diabetes.

Methods: MEDLINE, Web of Science, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register for Controlled Trials were searched to identify the relevant literature. We included randomized controlled trials (RCTs) to assess the association of triglyceride-lowering therapy with the prevention of CVD events, stroke, and mortality in diabetic patients.

Results: Overall, 19 studies were included in this meta-analysis. Compared with the control groups, TG lowering was associated with a decreased risk of CVD events (RR = 0.91, 95% CI 0.87-0.95, p = 0.000) and CVD mortality (RR = 0.93, 95% CI 0.86-1.00, p = 0.047). There was no significant correlation between TG-lowering therapy and the incidence of stroke and all-cause mortality (RR = 0.93, 95% CI 0.86-1.02, p = 0.129 and RR = 0.97, 95% CI 0.93-1.01, p = 0.107, respectively). Subgroup analysis showed that the decreased CVD risk resulting from TG-lowering therapy was independent of age, sex, region, duration of follow-up, degree of TG reduction and glycemic control.

Conclusions: TG-lowering therapy is associated with a reduction in CVD events and cardiovascular-specific mortality, but not in stroke and all-cause mortality. Future large, multicenter RCTs will further confirm these conclusions.

Keywords: All-cause mortality; Cardiovascular disease (CVD); Cardiovascular-specific mortality; Diabetes; Stroke; Triglyceride-lowering therapy.