Non-statin interventions in the prevention of cardiovascular events: Sex-based meta-analysis

Prog Cardiovasc Dis. 2020 May-Jun;63(3):228-232. doi: 10.1016/j.pcad.2020.03.012. Epub 2020 Mar 26.


Objective: To explore the sex-specific association of non-statin classes of drugs in reducing cardiovascular outcomes.

Methods: Published data search up to November 2019 reporting primary outcomes that approximate with major vascular events (MVEs) after treatment with non-statin group of drugs was performed. The primary outcome was the sex-specific association with MVEs. Random-effects meta-analysis was performed to estimate relative risk (RR) of the individual classes of therapies.

Results: Seven Randomized Clinical Trials (RCTs) including 122,164 patients were included in our analysis. Four studies compared the Triglyceride (TG)-lowering group of drugs with placebo and 3 studies compared low-density lipoprotein cholesterol (LDL-c) lowering drugs with placebo. Overall, with non-statin drugs, there was no difference in the risk reduction of cardiovascular (CV) events between men (RR 0.86; 95% CI 0.79-0.94, p-value <0.001) and women (RR 0.88; 95% CI 0.83-0.93, p-value 0.91). However, TG targeting interventions showed no cardiovascular outcome benefits in men (RR 0.85; 95% CI 0.71-1.02, p-value <0.001) while no significant benefit was seen in women (RR 0.87; 95% CI 0.77-0.98, p value = 0.85). No such difference existed in non-statin LDL-c lowering group of drugs in between men (RR 0.88; 95% CI 0.81-0.94, p value = 0.18) and women (RR 0.88; 95% CI 0.82-0.94, p value = 0.46). However, lowering of TG was only associated with a higher risk reduction of CV events (RR 0.86; 95% CI 0.77-0.95, p value = 0.03) in the entire study population.

Conclusion: Non-statin group of drugs was effective in reducing adverse CV outcomes for both sexes. Lowering TG was associated with higher risk reduction in CV events in general.

Keywords: Cardiovascular outcomes; Non-statins; Sex-based difference.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Aged
  • Biomarkers / blood
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / prevention & control*
  • Dyslipidemias / blood
  • Dyslipidemias / drug therapy*
  • Dyslipidemias / epidemiology
  • Female
  • Humans
  • Hypolipidemic Agents / adverse effects
  • Hypolipidemic Agents / therapeutic use*
  • Lipids / blood*
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Sex Factors
  • Treatment Outcome


  • Biomarkers
  • Hypolipidemic Agents
  • Lipids