Objective To systematically review the effectiveness and safety of Zhibitai vs. atorvastatin in the treatment of hyperlipidemia. Methods Randomized controlled trials (RCTs) about Zhibitai vs. atorvastatin for hyperlipidemia were electronically retrieved in databases of PubMed, CENTRAL (Issue 7, 2010), CBM,CNKI, VIP and WanFang Data from inception to July, 2012. Two reviewers independently screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was conducted using RevMan 5.2 software. Results A total of 4 RCTs involving 519 cases were included. The results of meta-analysis showed, Zhibitai was superior to atorvastatin in reducing TG levels after 8-week treatment (MD= −0.12, 95%CI −0.23 to −0.01, P=0.03) and increasing HDL-C levels after 8-week treatment (MD= −0.16, 95%CI −0.22 to −0.11, P=0.000 01). But there was no significant difference in decreasing TC levels and LDL-C levels after 4-week treatment and 8-week treatment as well as decreasing TG levels after 4-week treatment between the two groups. No obvious adverse reaction occurred in the two groups, but atorvastatin may impair liver function. Conclusion Current evidence with weak strength shows that, Zhibitai is superior to atorvastatin in reducing TG levels, and increasing HDL-C levels after 8 weeks. However, they are alike in other blood-fat index and safety. Due to the limited quantity and quality of the included studies, more high quality RCTs are needed to verify the above conclusion.
Objective To assess the effectiveness and safety of nine lipid-lowing agents in the national essential drug list (2000) and provide evidence for the adjustment and selection of essential drugs. Methods Based on principles of health technology assessment (HTA) and evidence-based medicine, we searched for all published clinical studies about these drugs from the following databases: MEDLINE (1966-2002.8), The Cochrane Library, EMBASE (1974-2002), CBMdisk (1979-2002.8) and VIP (1989-2002.8), the database of National Center for Adverse Drug Reaction(ADR) Monitoring of China and the database of WHO Uppsala drug monitoring center. Included studies were appraised, analyzed and compared for the reduction of triglyceride (TC) or low density lipoprotein (LDL-C), the prevention for the coronary events and the incidence of ADR. Results The results from comparative trials for lipid-lowing agents showed that the equivalent dose of statins for 25% reduction of LDL-C was atorvastatin 10 mg/d, simvastatin 20 mg/d, pravastatin 40mg/d, lovastatin 40 mg/d, cerivastatin 0.3 mg/d and fluvastatin 80 mg/d. It was difficult to compare fenofibrate with gemfibrozil, acipimox with statins or fibrates based on available data. The study on the primary and secondary prevention of cardiovascular events showed that pravastatin and lovastatin were effective in primary prevention, and long-term use could reduce the incidence of cardiovascular disease.Gemfibrozil could reduce the mortality from coronary heart disease (CHD) but the overall mortality was not changed. Pravastatin, simvastatin, atorvastatin, fluvastatin, gemfibrozil and fenofibrate had a confirmed effect in secondary prevention. Data from large-scale clinical trials and the reports from ADR monitoring center of England, America, Canada and Australia suggested that the statins which had rare ADR were safe and tolerated. Rhabdomyolysis was rare but had a serious adverse reaction associated with statins. The rate of fatal rhabdomyolysis related to cerivastatin was the highest among 6 statins. The safety of simvastatin, lovastatin and atorvastatin was lower than cerivastatin but higher than simvastatin and atorvastatin. The number of ADR reports of fenofibrate was fewer than that of gemfibrozil. Conclusions At present, the best evidence focused on pravastatin, simvastatin and lovastatin are widely used and have a confirmed safety and efficacy. Atorvastatin, fluvastatin and fenofibrate still need more data to confirm their effects on coronary heart disease prevention. The drugs which were shown to be inferior or insufficient evidence are cerivastatin, gemfibrozil and acipimox.
Objective To assess the effectiveness of xuezhikang for treating diabetic kidney disease. Methods We searched the Cochrane Central Register of Controlled Trials (Issue 3, 2008), MEDLINE (1980 to September 2008), EMbase (1980 to September 2008), CBMdisc (1990 to September 2008), and CNKI (1994 to September 2008). We also hand searched relevant journals and conference proceedings. Randomized controlled trials (RCTs) in which xuezhikang was used to treat diabetic kidney disease were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of included studies, and performed metaanalyses by using The Cochrane Collaboration’s RevMan 4.2 software. Results Nine RCTs were included. Meta-analyses showed that xuezhikang was superior to routine treatment in decreasing 24-hour urinary protein (WMD –0.87, 95%CI –1.34 to –0.41), microalbuminuria (WMD –115.39, 95%CI –127.63 to –103.15), and urinary albumin excretion rate (WMD – 65.46, 95%CI –68.87 to –62.12); but xuezhikang had similar effects in reducing serum creatinine compared with routine treatment (WMD –5.42, 95%CI –11.06 to 0.21). Moreover, xuezhikang was more effective in regulating blood lipids, including TC (WMD –1.71, 95%CI –2.39 to –1.03), TG (WMD –0.96, 95%CI –1.46 to –0.46), LDL-C (WMD –1.01, 95%CI –1.64 to –0.38), and HDL-C (WMD 0.22, 95%CI 0.09 to 0.36). Xuezhikang was not superior to routine treatment in improving fasting blood sugar (WMD -0.01, 95%CI -0.49 to 0.47), but was more effective in improving 2 h-BS (WMD –1.10, 95%CI –1.35 to –0.85) and HbA1c (WMD –0.41, 95%CI –0.56 to –0.27). No significant adverse effects or allergic reactions were reported. Conclusions The evidence currently available shows that xuezhikang may decrease 24-hour urinary protein, microalbuminuria, serum creatinine, regulate blood lipids, and adjust blood glucose. Due to a high risk of selection bias and detection bias in the included studies, the evidence is insufficient to determine the effect of xuezhikang. Further large-scale trials are required to define the role of xuezhikang in the treatment of diabetic kidney disease.
The present study was designed to elucidate the role of apoE polymorphism in the lithogenesis of cholecystolithiasis and to explore the hereditary pathogenesis of the disease. Polymerase Chain Reaction (PRC) was used as researching apoE phenotypes and allele frequencies in patients with gallstones (n=87) and in controls (n=50), and the fasting serum lipids of subjects were also measured. The characteristics of lipid variants were analysed among the patients with different apoE phenotypes. The results showed that the levels of TG (1.43mmol/L), VLDL-C(0.68mmol/L) in E2/3 patients were greatly higher than those in E2/3 controls (1.06mmol/L, Ｐ＜0.05 and 0.48mmol/L, Ｐ＜0.05), and LDL-C (1.41mmol/L) was markably lower in E2/3 patients than that in controls (2.04mmol/L, Ｐ＜0.05). The levels of serum lipids decreased significantly in E3/3 patients with HDL-C (0.89mmol/L), HDL2-C (0.49mmol/L), HDL3-C (0.39mmol/L), and compared with those in E3/3 controls (1.28mmol/L Ｐ＜0.05, 0.73mmol/L Ｐ＜0.001 and 0.55mmol/L Ｐ＜0.001). In E3/4 patients there were only slight changes of VLDL-C, LDL-C level. The results suggest that the average level of serum lipids in the same apoE phenotype patients with gallstones is higher than that in controls, and the different apoE phenotypes patients with gallstones have different characteristics of dyslipidemia. ε2 allele is probably one of the dangerous factor in the lithogenesis of cholecystolithiasis.
Objective To observe the serum lipid level of patients with branch retinal vein occlusion (BRVO). Methods A total of 71 BRVO patients (BRVO group) were enrolled in this study. The patients included 31 males and 40 females, with an average age of (52.75plusmn;10.2) years. All the patients were examined for visual acuity, slit lamp ophthalmoscopy combine with preset lens, fundus color photography and fundus fluorescein angiography (FFA) examination. Seventy-two age and sex matched normal subjects were enrolled in this study as control group. The subjects included 32 males and 40 females, with an average age of (53.10plusmn;9.5) years. The BRVO and control group were divided into four subgroup which including age with ＜40 years, 40-49 years, 50-59 years and ge;60 years. The plasma cholesterol and triglyceride level of BRVO group, control group, and age subgroups of BRVO and control group were comparatively analyzed. Results The average plasma cholesterol levels were (4.529plusmn;0.100) and (4.274plusmn;0.106) mmol/L in BRVO and control group, respectively. There was no difference between two groups (t=-1.738，P＞0.05). The average triglyceride levels were (1.500plusmn;0.129) and (1.319plusmn;0.095) mmol/L in BRVO and control group, respectively. There was no difference between two groups (t=-1.135，P＞0.05). There was no difference of average plasma cholesterol (t=-1.755, 1.850, -1.892, -0.507) and triglyceride (t=0.846, -0.074, -1.288, -1.887) level in age subgroups of BRVO and control subgroup (P＞0.05). Conclusion There is no significant difference of serum lipid level between BRVO patients and controls.
Objective To evaluate the effects of pseudo-ginseng Tongshu capsule on changes of bloodstream, blood plasma lipid and Fibrin of patients with Brain Infarction. Methods The patients with Brain Infarction were randomly selected, among whom 120 received pseudo-ginseng Tongshu capsule for 3 month and 86 received the routine therapy. Before and after the treatment, change of bloodstream, blood plasma lipid and Fibrin were tested. Results A total of 120 patients were included in the treatment group and 86 in the control group. In the 3rd month, the level of total cholesterol (TC) and Fibrinogen was decreased significantly in the patients with Brain Infarction (Plt;0.05). Conclusion The level of blood plasma lipid and Fibrinogen is decreased significantly in the patients with Brain Infarction who accept pseudoginseng Tongshu capsule.
Objective To assess the efficacy and safety of lipid-modifying agents for metabolism syndrome.Methods We searched The Cochrane Library, MEDLINE, EMbase, the China Biological Medicine Database, VIP and CMAC to 2007. We also did some handsearching and additional searching. Randomized controlled trials of lipidmodifying therapy for metabolic syndrome were included. Two reviewers independently extracted data from the eligible studies and evaluated the quality of the included studies. Meta-analyses were performed for the results of homogeneous studies using The Cochrane Collaboration’s RevMan 4.2.9 software. Results A total of 11 studies involving 1 422 patients with metabolic syndrome were included. The results indicated that there was no significant difference in TG between rosuvastatin and atorvastatin. However, rosuvastatin was more effective than atorvastatin on HDL-c improvement. Atorvastatin decreased TG levels greater than simvastatin, but simvastatin was superior to atorvastatin in HDL-c improvement. Two trials comparing fenofibrate with placebo were heterogeneous for some outcomes: one found no significant difference in improvements to HOMA-index, but the other trial indicated that fenofibrate was superior to placebo in improving QUICKI. However, the two trials revealed that fenofibrate favorably affected TG [WMD= – 1.77, 95%CI (– 2.21, – 1.33)] and HDL-c [WMD= 6.62, 95%CI (2.07, 11.17)] compared with placebo. No significant differences among atorvastatin, fenofibrate, alone or in combination, were observed in the proportion of metabolic syndrome reduction [RR=0.99, 95%CI (0.84, 1.16); RR=1.03, 95%CI (0.88, 1.20); RR=1.01, 95%CI (0.87, 1.18)]. Atorvastatin plus fenofibrate was superior to atorvastatin alone in TG and HDL-c improvement. Simvastatin-fenofibrate combination produced greater effectiveness in improving of HDL-c and TG compared with simvastatin alone. The fenofibrateorlistat combination was similar to fenofibrate in reducing metabolic syndrome [RR=1.15, 95%CI (0.68, 1.95)] and TG improvement, but was more effective than fenofibrate in HOMA-index improvement. This review of the clinical trials shows that the majority of lipid-modulating drugs did not have favorable effects on FPG, BP, BMI and WC. Six studies reported side effects, showing that the side effects for lipid-regulating drugs were mild to moderate, and well tolerated.Conclusion Our results suggest that lipid-regulating drugs in general exhibit beneficial effects on TG and HDL-c, but not on blood glucose and central obesity. The therapeutic effects of lipid-regulating drugs on blood pressure and insulin sensitivity are uncertain and have no positive effects on FPG, BMI and WC. There is insufficient evidence in this review to recommend the use of lipid-modifying drugs for metabolic syndrome due to low methodological quality, small ssamplesize and limited number of the trials. More high-quality and large-scale randomized controlled trials are required.
Objective To assess the efficacy and safety of Xuezhikang capsule (XZK) for hyperlipidemia. Methods MEDIINE，EMBASE, Cochrane Central Register of Controlled Trials(CCTR), Cochrane Metabolic and Endocrine Disorders Group data bank, and Chinese Biomedical Database(CBM), China Hospital Knowledge Database(CHKD) were searched，and the published/unpublished information was handsearched (updated to Dec., 2005) to identify randomized controlled trials (RCTs) or quasi-RCT of XZK versus statins or other lipid lowering drugs in treating hyperlipidemia patients. The quality evaluation, data extraction and analysis were conducted by the method recommended in Cochrane Reviewer’s Handbook 4.2.2. Data were analyzed using Review Manager (Version 4.2). Results Eleven trials (conducted in China) were identified, including 1 073 patients with hyperlipidemia met the inclusion criteria. All the included RCTs were graded as B or C. ① The effect of XZK in reducing TC: There were no significant differences between XZK and statins ( WMD 0.06, 95%CI-0.09 to 0.20 and RR1.02, 95%CI 0.93 to 1.12), XZK and fibrates (WMD 0.05, 95%CI -0.22 to 0.31) and XZK and probucol(WMD 0.42, 95%CI -0.01 to 0.85). XZK was superior to hexanicit (WMD 0.96, 95%CI 0.73 to 1.18). ② The effect of XZK in reducing TG: XZK had the same effect as statins (WMD 0.02, 95%CI -0.10 to 0.14 and RR 1.17, 95%CI 0.92 to 1.49) and hexanicit (WMD 0.28, 95%CI -0.17 to 0.73 ).Meanwhile, XZK was superior to probucol (WMD 0.71, 95%CI 0.22 to 1.20), but it was not as good as fibrates (WMD -0.81, 95%CI -1.40 to -0.23). ③ The effect of XZK in increasing HDL-C：XZK had the same effect as that of statins (WMD -0.03, 95%CI -0.10 to 0.04 and RR 1.03, 95% CI 0.80 to 1.33). The effect of XZK was better than that of hexanicit (WMD 0.15, 95%CI 0.01 to 0.29). XZK had the same effect of fibrates (WMD 0.03, 95%CI -0.08 to 0.15) and probucol (WMD 0.04, 95%CI -0.16 to 0.24). ④ The effect of XZK in reducing LDL-C：The effects of XZK and statins were the same (WMD -0.23, 95%CI -0.61 to 0.15 and RR 1.15, 95%CI 0.75 to 1.77). The effect of XZK was better than that of hexanicit (WMD 0.53, 95%CI 0.16 to 0.90). Meanwhile, XZK had the same effect as those of fibrates (WMD 0.19, 95%CI -0.12 to 0.50) and probucol (WMD 0.35, 95%CI -0.03 to 0.73). ⑤ The adverse reactions of XZK were mainly the gastrointestinal tract reaction, while liver function abnormality and myalgia were scarcely found. Conclusion Xuezhikang capsule have the same effects as those of statins in reducing the levels of TC, TG, LDL-C and raising HDL-C in patients with hyperlipidemia. No obvious adverse reactions are found during the short-term treatment. But further confirmation with clinical randomized controlled trials of high quality, large sample and long-term follow-up is needed.
目的 探讨成都地区中老年人群的腰高比值（WHtR）与血压、血脂、血糖的关系。 方法 2007年5月间在成都市地中老年人群（688人）中用统一编制的调查表记录被调查者的血压、血脂、血糖、WHtR等指标，并用相关统计学数据进行分析。 结果 ① 成都地区中老年人群WHtR≥0.5的高血压、高血脂、高血糖的发病率明显高于对照组（P＜0.05），且有统计学意义。② 年龄、收缩压、舒张压、甘油三酯和血糖水平，WHtR≥0.5组明显高于WHtR＜0.5组，而WHtR≥0.5组高密度脂蛋白水平低于WHtR＜0.5组，且组间差异均有统计学意义。③ logistic 回归分析表明WHtR与年龄、收缩压、舒张压、甘油三酯、空腹血糖水平呈正相关，与高密度脂蛋白水平呈负相关。 结论 成都地区中老年人群WHtR与血压、血脂及血糖关系密切，可能可以通过改善血压、血脂、空腹血糖等指标来减少WHtR，中老年人群要加强对 WHtR 的自我管理, 尽可能将心血管疾病危险因素降到最低。