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Background <p>Lipid-lowering therapies (LLTs) reduce cardiovascular disease (CVD) risk, but their effects on parameters related to vascular function and structure remain debated.</p> Methods <p>We systematically reviewed randomized controlled trials (RCTs) published up to January 2026 from PubMed, Web of Science, and Ovid. LLTs were compared with placebo or no treatment. Outcomes included flow-mediated dilation (FMD), pulse wave velocity (PWV), augmentation index (AIx), and carotid intima–media thickness (cIMT). Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Primary analyses were based on post-intervention final values, and leave-one-out sensitivity analyses were performed. Funnel plots and Egger’s regression test were used to assess potential small-study effects when applicable. For FMD, exploratory clinical population subgroup analysis and random-effects meta-regression were conducted to assess potential sources of heterogeneity.</p> Results <p>103 RCTs with over ten thousand participants were included. Our meta-analysis demonstrated that LLTs significantly improved FMD (MD: 1.70, 95% CI 1.40–2.00,&#xa0;<i>P</i> &lt; 0.001) and reduced PWV (MD: −0.19, 95% CI −0.38 to −0.01,&#xa0;<i>P</i> = 0.04). Atorvastatin, omega-3 PUFA, fluvastatin, rosuvastatin, pravastatin, simvastatin, niacin and fibrates improved FMD, while alirocumab, ezetimibe and cerivastatin did not. Brachial–ankle PWV decreased significantly (MD: −0.96, 95% CI −1.66 to −0.27,&#xa0;<i>P</i> = 0.006), but not carotid–femoral PWV (except with atorvastatin). No significant effects were observed for cIMT or AIx overall, though rosuvastatin reduced cIMT (MD: −0.04, 95% CI −0.08 to −0.00,&#xa0;<i>P</i> = 0.04).</p> Conclusions <p>LLTs had beneficial effects on FMD and PWV, with varying efficacy among different drug types.</p> <p><i>Trial registration</i>: CRD42024583834.</p>

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Effects of lipid-lowering therapies on vascular parameters: a systematic review and meta-analysis of randomized controlled trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月14日

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  • Jiamin Wang,
  • Ruobing Yu,
  • Ling Kong,
  • Hao Nie,
  • Lei Ruan,
  • Yucong Zhang

摘要

Background

Lipid-lowering therapies (LLTs) reduce cardiovascular disease (CVD) risk, but their effects on parameters related to vascular function and structure remain debated.

Methods

We systematically reviewed randomized controlled trials (RCTs) published up to January 2026 from PubMed, Web of Science, and Ovid. LLTs were compared with placebo or no treatment. Outcomes included flow-mediated dilation (FMD), pulse wave velocity (PWV), augmentation index (AIx), and carotid intima–media thickness (cIMT). Mean differences (MDs) with 95% confidence intervals (CIs) were pooled using random-effects models. Primary analyses were based on post-intervention final values, and leave-one-out sensitivity analyses were performed. Funnel plots and Egger’s regression test were used to assess potential small-study effects when applicable. For FMD, exploratory clinical population subgroup analysis and random-effects meta-regression were conducted to assess potential sources of heterogeneity.

Results

103 RCTs with over ten thousand participants were included. Our meta-analysis demonstrated that LLTs significantly improved FMD (MD: 1.70, 95% CI 1.40–2.00, P < 0.001) and reduced PWV (MD: −0.19, 95% CI −0.38 to −0.01, P = 0.04). Atorvastatin, omega-3 PUFA, fluvastatin, rosuvastatin, pravastatin, simvastatin, niacin and fibrates improved FMD, while alirocumab, ezetimibe and cerivastatin did not. Brachial–ankle PWV decreased significantly (MD: −0.96, 95% CI −1.66 to −0.27, P = 0.006), but not carotid–femoral PWV (except with atorvastatin). No significant effects were observed for cIMT or AIx overall, though rosuvastatin reduced cIMT (MD: −0.04, 95% CI −0.08 to −0.00, P = 0.04).

Conclusions

LLTs had beneficial effects on FMD and PWV, with varying efficacy among different drug types.

Trial registration: CRD42024583834.