Effect of statin therapy on plasma apolipoprotein C-III concentrations: a Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background Statins are well established LDL-cholesterol-lowering drugs. Elevated Apo CIII levels are associated with elevated triglyceride-rich particles which are also considered to be a possible risk factor for CVD. Objective The aim of this meta-analysis of randomized placebo-controlled clinical trials was to assess the effect of statins on Apo CIII concentrations. Methods Randomized placebo-controlled trials investigating the impact of statin treatment on cholesterol lowering that include lipoprotein measurement were searched in PubMed-Medline, SCOPUS, Web of Science and Google Scholar databases (up to July 31, 2017). A random-effects model and generic inverse variance method were used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. A weighted random-effects meta-regression was performed to evaluate the impact of potential confounders on Apo CIII concentrations. Results This meta-analysis of data from 6 randomized placebo-controlled clinical trials (10 statin arms) involving 802 subjects showed that statin therapy significantly decreased circulating Apo CIII concentrations (weighted mean difference [WMD]: -2.71, 95% CI: -3.74, -1.68, p<0.001; I2: 73.83%). The effect size was robust in the leave-one-out sensitivity analysis and not driven by any single study. Subgroup analysis showed a reduction of Apo CIII concentrations by atorvastatin (WMD: -4.74, 95% CI: -3.74, -1.68, p=0.002; I2: 84.02%), rosuvastatin (WMD: -2.68, 95% CI: -4.52, -0.84, p=0.004; I2: 0%) and lovastatin (WMD: -1.64, 95% CI: -2.22, -1.07, p<0.001; I2: 0%). Conclusion This meta-analysis suggests that statin treatment significantly reduces plasma Apo CIII levels.