Low-Density Lipoprotein-Dependent and -Independent Effects of Cholesterol-Lowering Therapies on C-Reactive ProteinA Meta-Analysis
Scott Kinlay, MBBS, PhD, FRACP, FACC*
Veteran's Affairs Boston Healthcare System, West Roxbury Campus, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts
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Figure 1 Average Net Change in CRP (Placebo – Treatment) for Each of the 57 Treatment Groups in 23 RCTs
The treatment and daily dose for drugs is listed next to the year and author. Dotted line indicates the weighted overall random-effects estimate of C-reactive protein (CRP) reduction. A = atorvastatin; C = cerivastatin; Ez = ezetimibe 10 mg/day; FF = fenofibrate; FO = fish oil; L = lovastatin; N = niacin; P = pravastatin; R = rosuvastatin; RCT = randomized controlled trial; S = simvastatin.
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Figure 2 Average Change in CRP by Study Characteristics
Average net change in C-reactive protein (CRP) (placebo – treatment) and 95% confidence intervals show significantly greater CRP reduction for statin or statin-ezitimibe interventions, 80 mg per day statin regimins, and therapies that offered greater low-density lipoprotein (LDL) reduction.
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Figure 3 Funnel Plots to Assess Publication Bias
The dashed line is the fixed-effects estimate of change in CRP across interventions, and the dotted lines are pseudo-95% confidence intervals for the standard error of change in CRP, assuming no heterogeneity between studies. Bias is suspected if the plots are asymmetric (i.e., the point estimates tend to fall to one side of the dashed line). (A) Significant bias in all interventions (Egger p < 0.001). However, stratification by the median change in LDL showed no evidence of bias. (B) LDL >40% (Egger p = 0.5). (C) LDL  40% (Egger p = 0.7). Abbreviations as in Figure 2.
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Figure 4 Plot of Change in CRP by Change in LDL
The plot shows average net change in LDL (placebo – treatment) by the average net change in CRP (placebo – treatment) for the 57 interventions. The size of each circle is proportional to the inverse of the variance of change in CRP, and the dotted line indicates the regression line estimated from the meta-regression analysis. Abbreviations as in Figure 2.
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