Objective To assess the effectiveness of statins in treating early diabetic kidney disease (DKD). Methods We searched the Cochrane Central Register of Controlled Trials (Issue 2, 2009), MEDLINE (1991 to August 2009), EMbase (1991 to August 2009), CBMdisc (1991 to August 2009) and CNKI (1994 to August 2009). We also handsearched relevant journals and conference proceedings. Randomized controlled trials (RCTs) in which statins were used to treat patients with early DKD were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of the included studies, and performed meta-analyses by RevMan 4.2 software. Results A total of 281 articles were found and 22 articles inolving 1838 patients were finally included. All these articles were regarded as low quality. We chose the random-effect model to conduct meta-analysis because significant heterogeneities were found among these articles. The results of meta-analysis showed that after treatment with statins, there were significant reductions in urinary albumin excretion rate (UAER) (WMD= –55.77, 95%CI –74.20 to –37.34, Plt;0.000 01), serum creatinine (Scr) (WMD= –4.34, 95%CI –6.74 to –1.94, P=0.000 4), C reactive protein (CRP) (WMD= –1.48, 95%CI – 2.32 to – 0.63, P=0.006), total cholesterol (TC) (WMD= –1.33, 95%CI –1.75 to –0.91, Plt;0.000 01), and triglyceride (TG) (WMD= –0.72, 95%CI-1.17 to -0.27, P=0.002) in group treatment compared with group control. Funnel-plot displayed a symmetrical figure, indicating there was no publication bias. No severe adverse effects were found in these articles except 12 patients with high level of transaminase which were cured after using hepatic protect therapy. Conclusion Currently available evidence shows that with the reduction of TC and TG, statins may decrease UAER and Scr in patients with early DKD and the reduction of CRP may be involved in the mechanism. Statins provide effective renal protection and no severe adverse effects in treating early DKD. However, due to lack of quality in the included studies, more studies of better quality should be conducted
Objective To determine whether statins has some effects on the treatment of cardio-cerebral vascular diseases or hyperlipdemia increases bone mineral density （BMD）. Methods One hundred and sixty-two patients aged over 60 were identified in the outpatient-department of Geriatrics of West China Hospital from Jan. 1998 to Aug. 2003. Seventy cases were exposed to statins with follow-up for 5 years. BMD of the spine, femoral neck, femoral wards triangle and femoral trochanter was measured by dual-energy X-ray absorptiometry. The multiple regression analysis was used to exclude potential confounders, e.g. age, BMI, comorbidity,etc. Results Those elderly patients with a history of taking statins had higher BMD, such as femoral neck with t =-2. 466 （P =0. 015）, femoral wards triangle with t =-2. 483 （P = 0. 014 ）and femoral trochanter with t =-2. 743 （P =0. 007 ）than the control elderly at the end of follow-up. Conclusions It has been found that HMG-CoA reductase inhibitors （statins ） may prevent bone loss in elderly patients by increasing BMD. Further prospective studies of statins are needed to confirm these observatioris.
Objective To evaluate the efficacy of statins pretreatment in patients before percutaneous coronary intervention (PCI). Methods Published literature on relevant randomized controlled trials (RCTs) were retrieved via electronic and handsearch in databases CNKI, CBM, MEDLINE and The Cochrane Library from January 1990 to May 2011. The references of these articles were also retrieved. Two reviewers independently identified articles according to the inclusion and exclusion criteria, extracted the data, assess the quality of the included studies, and then conducted meta-analysis using RevMan 5.0 software. Results A total of 10 trials involving 3 012 patients were included. The results of meta-analyses showed that: during the periprocedural period, the trial group had a lower incidence than the control group (98 of 1 514 cases, incidence 6.5%) in periprocedural myocardial infarction with a significant difference (OR=0.43, 95% CI 0.34 to 0.56, Plt;0.000 01). The composite of death, myocardial infarction, or target vessel revascularization in one month, essentially driven by periprocedural myocardial infarction, was reported 6.8% in the trial group and 15.1% in the control group (OR=0.41, 95% CI 0.32 to 0.53, Plt;0.000 01). Conclusion Current evidence supports the effectiveness of statin pretreatment used to reducing the rate of periprocedural myocardial infarction in patients before receiving PCI.
Objective To determine the effectiveness of statins in reducing C-reactive protein in patients with cerebral infarction and the potency of C-reactive protein as an indicator for preventing cerebrovascular events. Methods We searched PubMed, EMbase, Central Register of Controlled Trials, CBMdisc and CNKI from the date of establishment through August 2008. Bibliographies of the retrieved articles were also checked. Data was extracted and evaluated by two reviewers independently with a designed extraction form. The RevMan 5.0 software was used to carry out meta-analysis. Results Twenty-three randomized trials involving 1946 patients were included. The results of meta-analyses showed the following: statins reduced C-reactive protein compared to the control group (WMD= –5.79, 95%CI –7.32 to –4.26); statins were associated with a reduction of carotid intima-media thickness (IMT) (WMD= –0.21, 95%CI –0.25 to –0.17); atorvastatin greatly reduced C-reactive protein than the simvastatin control group (WMD= –1.78, 95%CI –3.92 to 0.36); statins were associated with a slight improvement in neurological deficit (OR= 2.22, 95%CI 0.94 to 5.21). Conclusion The evidence currently available shows that statins can reduce C-reactive protein and carotid IMT in the patients with cerebral infarction compared to the control group. However, it is not clear whether statins reducing C-reactive protein is correlated to the improvement of neurological deficit and prognosis. Similar trials in future should focus on the relationship between the change of C-reactive protein and clinical outcomes.
Objective To assess the clinical efficacy of statins for preventing stroke recurrence. Methods We searched The Cochrane Library, PubMed, EMbase, CBM, CSJD, and CJFD for randomized controlled trials on the use of statin drugs to prevent stroke recurrence (up to May 10, 2008), and manually searched key Chinese magazines in the related fields. Two reviewers extracted data independently using a designed extraction form. The quality of included trials was evaluated according to the Cochrane handbook 4.12. RevMan 5.0 software was used for data analysis. Results Six randomized controlled trials involving 9,675 patients were identified. The results of meta-analysis showed that there was no statistical difference in stroke recurrence rate (RR=0.94, 95%CI 0.84 to 1.04, P=0.21) and fatal stroke occurrence (RR=0.77, 95%CI 0.48 to 1.25, P=0.30) between statins and placebo groups, but a significant difference was found between the two groups in transient ischemic attack occurrence (RR=0.80, 95%CI 0.69 to 0.92, P=0.002). Conclusion Current evidence indicates that statin drugs have no superiority to prevent stroke recurrence and fatal stroke occurrence, but can prevent transient ischemic attack.
Objectives To assess the efficacy and safety of statins for adult osteoporosis. Methods We electronically searched The Cochrane Library (Issue 4, 2007), MEDLINE (1990 to November 2007), EMBASE (1990 to November 2007), Current Controlled Trials, The National Research Register, CBM (1990 to November 2007), VIP (1990 to November 2007) and CNKI (1990 to November 2007). We also handsearched some related journals and identified randomized controlled trials of statins versus placebo in adults with osteoporosis. Results Two randomized controlled trials were included. We didn’t perform meta-analysis due to heterogeneity. No significant differences were observed in the changes of bone density at the lumbar spine and total hip from baseline between statins and placebo. However, a significant increase in bone density was found in response to simvastatin at the forearm. Biochemical markers of bone metabolism changes from baseline did not differ significantly between statins and placebo groups. Conclusions The evidence currently available does not support the use of statins in the treatment of osteoporosis. Further randomized, double-blind, placebo-controlled trials are needed in order to define the efficacy and acceptability of statins in the treatment of osteoporosis.
ObjectiveTo evaluate the effects and safety of statins in patients with acute respiratory distress syndrome (ARDS). MethodsLiteratures in English and Chinese concerning randomized controlled trials (RCTs) on statins in ARDS patients were retrieved by electronic and manual search. All related data were extracted. Meta-analysis was conducted using the statistical software RevMan 5.3 on the basis of strict quality evaluation. ResultsFive RCTs involving 1489 ARDS patients were included, with 709 patients in the statins group and 780 patients in the placebo control group. Compared with the control group, statins did not improve the survival of ARDS patients[risk ratio (RR) 1.01, 95% confidence interval (CI) 0.86 to 1.18, P=0.91), while the improvement of oxygenation[mean difference (MD) 3.92, 95%CI-14.10 to 21.94, P=0.67], ventilator-free days (MD 0.65, 95%CI-0.20 to 1.50, P=0.13) and non-pulmonary organ failure-free days (MD 1.20, 95%CI-1.46 to 3.87, P=0.38) exhibited no differences between the statins group and the control group. However statins were associated with significant elevation of creatine kinase (MD 6.92, 95%CI 5.77 to 8.07, P < 0.000 01). ConclusionThis study demonstrates that statins can not improve outcomes of ARDS patients, and the safety of statins still needs further evaluation.
ObjectiveTo evaluate the effect of statins on amino-terminal brain natriuretic peptide (NT-proBNP), grade of New York Heart Association (NYHA), and ejection fraction (EF) in patients with chronic heart failure (CHF) using marginal structural model. MethodsA total of 297 patients with CHF from two medical centers in Shanxi province were sequentially enrolled from January 2018 to December 2020. The medical records were collected. Confounding factors were analyzed by t-test, Chi-square test and logistic regression. The random forest algorithm was used to estimate the weight of inverse probability. The marginal structural model was applied to evaluate the effects of statins. ResultsUsing logistic regression to exclude the influence of baseline confounders, the results showed that statins had no significant effect on the level of NT-proBNP in patients with CHF. The marginal structural model which excluded the influence of baseline confounders, time-dependent confounders and treatment conversion factors showed that statins significantly reduced NT-proBNP (OR=0.699, 95%CI 0.528 to 0.926, P=0.012). Statins had no significant effects on NYHA and EF. ConclusionStatins can effectively reduce the level of NT-proBNP in patients with CHF.