SynthesisAmerican journal of cardiovascular drugs : drugs, devices, and other interventions2024

Benefits and Risks of Antihyperlipidemic Medication in Adults with Different Low-Density Lipoprotein Cholesterol Based on the Number Needed to Treat.

Hong-Fei Wang, Yu-Cheng Mao, Su-Fen Qi, Xin-Yi Xu, Zi-Yan Zhang, Chang Geng, Kai Song, Qing-Bao Tian

Abstract readMeta-AnalysisSystematic Review
PubMed Publisher
In one paragraph

Synthesis in American journal of cardiovascular drugs : drugs, devices, and other interventions, 2024. The graph read 4 numbers from its abstract, feeding 4 cells of the map: it supports the treatment in 1, favours the comparator in 3. Cited by 1 paper.

4numbers the graph read from it
4cells of the map it votes in
1citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
24101 · no effect
Injection-site reactionsPCSK9 inhibitors vs Control (implied)favours the comparator · ascvd, dyslipidemiafeeds one cell of the map
number needed to treat 41.026.0 to 80.0
Notably, the safety outcomes of statins and ezetimibe did not reach statistical significance, while the incidence of injection-site reactions with PCSK9 inhibitors was statistically significant [number needed to treat to harm (NNTH) 41, 95% CI 80-26].
MACEEzetimibe vs Control (implied)favours the comparator · ascvd, dyslipidemiafeeds one cell of the map
number needed to treat 18.011.0 to 41.0
Ezetimibe and PCSK9 inhibitors also were effective in reducing MACE (NNTB 18, 95% CI 11-41, and NNTB 18, 95% CI 16-24).
MACEStatins vs Control (implied), in individuals with baseline LDL-C values of 100 mg/dL or higherfavours the comparator · ascvd, dyslipidemiafeeds one cell of the map
number needed to treat 31.025.0 to 37.0
Statins exhibited a significant reduction in MACE [number needed to treat to benefit (NNTB) 31, 95% confidence interval (CI) 25-37], but this effect was observed only in individuals with baseline LDL-C values of 100 mg/dL or higher.
MACEPCSK9 inhibitors vs Control (implied)favours the comparator · ascvd, dyslipidemiafeeds one cell of the map
number needed to treat 18.016.0 to 24.0
Ezetimibe and PCSK9 inhibitors also were effective in reducing MACE (NNTB 18, 95% CI 11-41, and NNTB 18, 95% CI 16-24).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

Other lipid agents×cardiovascular events

ContradictsOpen on the map →What to test next →

10 readable studies in this cell: 5 favour the treatment, 5 find no difference, 0 favour the comparator.

Belief with this paper
0.80established · 4 families support, 1 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT0020287818,144 enrolled · 2005
HR 0.940.89 to 0.99
NCT0061899526 enrolled · 2007
Geometric least-squares mean ratio 0.940.77 to 1.14

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

PCSK9 inhibitors×adverse events & safety

SupportsOpen on the map →What to test next →

5 readable studies in this cell: 3 favour the treatment, 2 find no difference, 0 favour the comparator.

Belief with this paper
0.00contested · 0 families support, 4 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT0176463327,564 enrolled · 2013
HR 0.850.79 to 0.92
NCT0166340218,924 enrolled · 2012
HR 0.850.78 to 0.93
NCT04873934400 enrolled · 2021
OR 0.760.43 to 1.35

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

PCSK9 inhibitors×cardiovascular events

ContradictsOpen on the map →What to test next →

10 readable studies in this cell: 8 favour the treatment, 2 find no difference, 0 favour the comparator.

Belief with this paper
1.00established · 6 families support, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT0176463327,564 enrolled · 2013
HR 0.850.79 to 0.92
NCT0166340218,924 enrolled · 2012
HR 0.850.78 to 0.93
NCT0387240112,301 enrolled · 2019
HR 0.750.65 to 0.86

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

Statins×cardiovascular events

ContradictsOpen on the map →What to test next →

30 readable studies in this cell: 18 favour the treatment, 11 find no difference, 1 favour the comparator.

Belief with this paper
0.86replicated · 12 families support, 2 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
HR 0.710.56 to 0.90
NCT023442907,769 enrolled · 2015
HR 0.640.48 to 0.84
HR 1.781.00 to 3.17
NCT03944512102 enrolled · 2019
RR 0.670.37 to 1.19

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Therapeutic Management of LDL-C: Efficacy and Economic Impact Assessment.Journal of cardiovascular development and disease · 2025
    Review
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

8 authors.

Hong-Fei WangDepartment of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China.
Yu-Cheng MaoDepartment of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China.
Su-Fen QiDepartment of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China.
Xin-Yi XuPostdoctoral Research Station in Basic Medicine, Hebei Medical University, Shijiazhuang, China.
Zi-Yan ZhangDepartment of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China.
Chang GengDepartment of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China.
Kai SongDepartment of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China.
Qing-Bao TianDepartment of Epidemiology and Statistics, School of Public Health, Hebei Medical University, Shijiazhuang, China. tqb1980@hebmu.edu.cn.

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

purposeThe objective of this investigation is to examine the benefits and potential risks of these drugs in individuals by varying baseline low-density lipoprotein cholesterol (LDL-C) values, utilizing the concept of the number needed to treat (NNT).

methodsWe extensively searched electronic databases, such as PubMed, EMBASE, Cochrane, and Web of Science, up to 6 August 2023. Baseline LDL-C values were stratified into four categories: < 100, 100-129, 130-159, and ≥ 160 mg/dL. Risk ratios (RRs) and NNT values were computed.

resultsThis analysis incorporated data from 46 randomized controlled trials (RCTs), encompassing a total of 237,870 participants. The meta-regression analysis demonstrated an incremental diminishing risk of major adverse cardiovascular events (MACE) with increasing baseline LDL-C values. Statins exhibited a significant reduction in MACE [number needed to treat to benefit (NNTB) 31, 95% confidence interval (CI) 25-37], but this effect was observed only in individuals with baseline LDL-C values of 100 mg/dL or higher. Ezetimibe and PCSK9 inhibitors also were effective in reducing MACE (NNTB 18, 95% CI 11-41, and NNTB 18, 95% CI 16-24). Notably, the safety outcomes of statins and ezetimibe did not reach statistical significance, while the incidence of injection-site reactions with PCSK9 inhibitors was statistically significant [number needed to treat to harm (NNTH) 41, 95% CI 80-26].

conclusionStatins, ezetimibe, and PCSK9 inhibitors demonstrated a substantial capacity to reduce MACE, particularly among individuals whose baseline LDL-C values were relatively higher. The NNT visually demonstrates the gradient between baseline LDL-C and cardiovascular disease (CVD) risk. SYSTEMATIC REVIEW REGISTRATION: Registration: PROSPERO identifier number: CRD42023458630.

Indexed as

Cardiovascular DiseasesCholesterol, LDLAdultAnticholesteremic AgentsEzetimibeHumansHydroxymethylglutaryl-CoA Reductase InhibitorsHypolipidemic AgentsNumbers Needed To TreatPCSK9 InhibitorsRandomized Controlled Trials as TopicRisk AssessmentAnticholesteremic AgentsCholesterol, LDLEzetimibeHydroxymethylglutaryl-CoA Reductase InhibitorsHypolipidemic AgentsPCSK9 Inhibitors

Identifiers

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.