Abstract
BackgroundFibrates has been extensively used to improve plasma lipid levels and prevent adverse cardiovascular outcomes. However, the effect of fibrates on stroke is unclear at the present time. We therefore carried out a comprehensive systematic review and meta-analysis to evaluate the effects of fibrates on stroke.MethodsWe systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings to identify studies for our analysis. We included randomized placebo controlled trials which reported the effects of fibrates on stroke. Relative risk (RR) was used to measure the effect of fibrates on the risk of stroke under random effect model. The analysis was further stratified by factors that could affect the treatment effects.ResultsOverall, fibrate therapy was not associated with a significant reduction on the risk of stroke (RR, 1.02, 95% CI, 0.90 to 1.16, P = 0.78). In the subgroup analyses, we observed that gemfibrozil therapy showed a beneficial effect on stroke (RR, 0.72, 95% CI, 0.53 to 0.98, P = 0.04). Similarly, fibrate therapy comparing to placebo had no effect on the incidence of fatal stroke. Subgroup analysis suggested that fibrate therapy showed an effect on fatal stroke when the Jadad score more than 3 (RR, 0.41, 95% CI, 0.17 to 1.00, P = 0.049). Furthermore, a sensitivity analysis indicated that fibrate therapy may play a role in fatal stroke (RR, 0.49, 95% CI, 0.26 to 0.93, P = 0.03) for patients with previous diabetes, cardiovascular disease or stroke.ConclusionsOur study indicated that fibrate therapy might play an important role in reducing the risk of fatal stroke in patients with previous diabetes, cardiovascular disease or stroke. However, it did not have an effect on the incidence of stroke.
Highlights
Fibrates has been extensively used to improve plasma lipid levels and prevent adverse cardiovascular outcomes
Among the 88 trials retrieved for detailed assessment, 78 trials were excluded for lack of data on stroke, polytherapy in either treatment group or control group, or reporting the same population
The results of our study indicated that fibrate therapy has no effect on the incidence of stroke, and fatal stroke
Summary
Fibrates has been extensively used to improve plasma lipid levels and prevent adverse cardiovascular outcomes. Over the past few decades, a series of studies have shown a strong correlation between hypertriglyceridemia and cardiovascular disease. Those studies indicated that elevated triglyceride levels as a risk factor of coronary artery disease. Reduction of the Recently, a meta-analysis [5] revealed that statins could effectively achieve target cholesterol goals and reduce the risk of stroke. Fibrates has been clearly shown to be effective in elevating HDL cholesterol, lowering triglyceride concentrations, reducing LDL cholesterol and chylomicron remnants [9]. Inconsistent clinical results have been reported [8,10], and the efficacy of fibrates lowering triglyceride levels in reducing the risk of stroke has not been confirmed by randomized trials
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