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Efficacia e sicurezza nella terapia di combinazione con statine e acidi grassi omega-3 vs monoterapia con statine in pazienti con dislipidemia: revisione sistematica e metanalisi

Recentemente, diversi studi clinici hanno dimostrato che la terapia combinata con statine e acidi grassi omega-3 migliora i profili lipidici e previene gli eventi cardiovascolari. Tuttavia, i risultati degli studi che hanno confrontato l'efficacia della monoterapia con statine rispetto alla terapia combinata con omega-3 non sono stati ancora integrati nel processo decisionale clinico. Inoltre, la sicurezza delle terapie combinate rimane controversa. Secondo questa revisione sistematica e una metanalisi, la terapia di associazione permette una maggiore riduzione del rapporto colesterolo totale/colesterolo HDL; d'altra parte, essa è associata a un significativo aumento del numero di eventi avversi gastrointestinali, ma non di eventi avversi totali. Gli autori suggeriscono che la terapia di combinazione migliora il profilo lipidico, ad eccezione del colesterolo LDL, rispetto alla monoterapia con statine. Tuttavia, deve essere raccomandata cautamente, tenendo conto dell'importanza clinica del colesterolo LDL e dei problemi di sicurezza associati all’uso concomitante dei due trattamenti.

Comparison of efficacy and safety of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia: A systematic review and meta-analysis

Choi HD, Chae SM

Medicine (Baltimore). 2018;97:e13593

OBJECTIVE: Dyslipidemia is a major risk factor for the development of cardiovascular disease. Both statins and omega-3 fatty acids demonstrate beneficial effects on lipid concentrations. The goal was to evaluate the safety and efficacy of combination therapy with statins and omega-3 fatty acids.
METHODS: We performed a systematic review and meta-analysis of published data to compare the safety and efficacy of combination therapy with statins and omega-3 fatty acids versus statin monotherapy in patients with dyslipidemia. Six articles were assessed in the present meta-analysis (quantitative assessment) and qualitative assessment.
RESULTS: In terms of efficacy, the combination treatment afforded a significantly greater reduction in total cholesterol/high-density lipoprotein cholesterol than statin alone did [standard difference in means = -0.215; 95% confidence interval (CI) -0.359--0.071]. However, there was no significant difference in low-density lipoprotein (LDL) cholesterol between the 2 groups. Qualitative assessment of other lipid parameters was performed. Combination therapy with statins and omega-3 fatty acids was generally more effective on lipid concentration than statin monotherapy. In terms of safety, there were no significant differences in total adverse events between the 2 groups. Gastrointestinal adverse events were found to be significantly increased in patients receiving combination therapy using the fixed-effects model (relative risk = 0.547; 95% CI 0.368-0.812).
CONCLUSIONS: We suggest that combination therapy with statins and omega-3 fatty acids enhances lipid profile, except LDL cholesterol, compared with statin monotherapy. Nevertheless, statin and omega-3 fatty acid combination should be cautiously recommended, taking into account the clinical importance of LDL cholesterol and safety issues associated with their concomitant use.

Medicine (Baltimore). 2018;97:e13593