Effect of Raloxifene Treatment on Apolipoproteins and Lipoprotein(a) Concentrations in Postmenopausal Women: A Meta-Analysis of Randomized Controlled Trials

IF 3.2 4区医学 Q2 PHARMACOLOGY & PHARMACY

Clinical therapeutics Pub Date : 2024-10-01 DOI:10.1016/j.clinthera.2024.07.008

Xinyi Liao , Jian Deng , Lei Du , Benjamin Hernández-Wolters , Kousalya Prabahar , Hamed Kord-Varkaneh

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引用次数: 0

Abstract

Background and Aim

Although various randomized controlled trials (RCTs) have evaluated the effect of raloxifene on apolipoproteins and lipoprotein(a) concentrations in postmenopausal women, the results have been inconsistent and inconclusive. Therefore, we conducted this meta-analysis of RCTs to investigate the effect of raloxifene administration on apolipoproteins and lipoprotein(a) [Lp(a)] concentrations in postmenopausal women.

Methods

Two independent researchers systematically searched the scientific literature (including PubMed/Medline, Scopus, Web of Science, and EMBASE) for English-language randomized controlled trials (RCTs) published up to June 2024. We included RCTs reporting the impact of raloxifene on apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB), and Lp(a) levels in postmenopausal women. The primary outcome of interest was change in Lp(a), and the secondary outcomes were changes in ApoA-I and ApoB.

Findings

The present meta-analysis incorporated 12 publications with 14 RCT arms. The comprehensive outcomes derived from the random-effects model revealed a statistically significant increase in ApoA-I (WMD: 6.06 mg/dL, 95% CI: 4.38, 7.75, P < 0.001) and decrease in ApoB concentrations (WMD: -8.48 mg/dL, 95% CI: -10.60, -6.36, P < 0.001) and Lp(a) (WMD: -3.02 mg/dL, 95% CI: -4.83, -1.21, P < 0.001) following the administration of raloxifene in postmenopausal women. In the subgroup analyses, the increase in ApoA-I and the decrease in ApoB and Lp(a) levels were greater in RCTs with a mean participant age of ≥60 years and a duration of ≤12 weeks.

Implications

The current meta-analysis of RCTs demonstrates that treatment with raloxifene reduces ApoB and Lp(a) levels while increasing ApoA-I levels in postmenopausal women. Since these effects on lipid components are associated with a reduced risk of cardiovascular disease (CVD), raloxifene could be a suitable therapy for postmenopausal women who are at an increased risk of CVD and have other medical indications for raloxifene administration.

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雷洛昔芬治疗对绝经后妇女载脂蛋白和脂蛋白（a）浓度的影响：随机对照试验的元分析》。

背景和目的：尽管各种随机对照试验（RCT）评估了雷洛昔芬对绝经后妇女脂蛋白和脂蛋白（a）浓度的影响，但结果并不一致，也没有定论。因此，我们对研究性临床试验进行了荟萃分析，研究服用雷洛昔芬对绝经后妇女脂蛋白和脂蛋白（a）[Lp（a）]浓度的影响：两名独立研究人员系统检索了截至 2024 年 6 月发表的英文随机对照试验 (RCT)，包括 PubMed/Medline、Scopus、Web of Science 和 EMBASE 等科学文献。我们纳入了报告雷洛昔芬对绝经后女性载脂蛋白 A-I (ApoA-I)、载脂蛋白 B (ApoB) 和脂蛋白 (a) 水平影响的 RCT。主要研究结果是脂蛋白（a）的变化，次要研究结果是载脂蛋白 A-I 和载脂蛋白 B 的变化：本荟萃分析纳入了 12 篇文献，共 14 项 RCT 研究。随机效应模型得出的综合结果显示，载脂蛋白 A-I 有显著的统计学增长（WMD：6.06 mg/dL，95% CI：4.38, 7.75，P <0.001），载脂蛋白 B 浓度下降（WMD：-8.48毫克/分升，95% CI：-10.60，-6.36，P＜0.001）和脂蛋白（a）（WMD：-3.02毫克/分升，95% CI：-4.83，-1.21，P＜0.001）。在亚组分析中，参与者平均年龄≥60岁、持续时间≤12周的研究结果表明，载脂蛋白A-I水平的升高和载脂蛋白B及脂蛋白（a）水平的降低幅度更大：目前的研究性试验荟萃分析表明，使用雷洛昔芬治疗可降低绝经后妇女的载脂蛋白B和脂蛋白（a）水平，同时提高载脂蛋白A-I水平。由于对脂质成分的这些影响与心血管疾病（CVD）风险的降低有关，因此对于心血管疾病风险增加且有其他服用雷洛昔芬适应症的绝经后妇女来说，雷洛昔芬可能是一种合适的疗法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical therapeutics 医学-药学

CiteScore

6.00

自引率

3.10%

发文量

154

审稿时长

9 weeks

期刊介绍： Clinical Therapeutics provides peer-reviewed, rapid publication of recent developments in drug and other therapies as well as in diagnostics, pharmacoeconomics, health policy, treatment outcomes, and innovations in drug and biologics research. In addition Clinical Therapeutics features updates on specific topics collated by expert Topic Editors. Clinical Therapeutics is read by a large international audience of scientists and clinicians in a variety of research, academic, and clinical practice settings. Articles are indexed by all major biomedical abstracting databases.