{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:21:57Z","timestamp":1790803317978,"version":"4.1.0"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T00:00:00Z","timestamp":1675728000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The efficacy of lipid-lowering therapies (LLT) amongst different ethnicities and regions remains unclear. We aimed to assess cardiovascular event reductions associated with LLT according to ethnicity and region in previously published randomized clinical trials (RCTs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Medline, EMBASE, and Cochrane CENTRAL were searched for RCTs of statins, ezetimibe, or proprotein convertase subtilisin\/kexin type 9 inhibitors comparing intensive vs. less-intensive low-density lipoprotein cholesterol (LDL-C) lowering. The primary endpoint was major adverse cardiovascular events (MACE) defined as the composite of cardiovascular mortality, myocardial infarction, stroke, and revascularization. Random-effects meta-analysis was used to pool risk ratios (RRs) with 95% confidence intervals (CI) adjusted per mmol\/L reduction in LDL-C. Fifty-three trials with 329 897 participants were included. Amongst participants, 39.5% were from Europe, 16.0% from North America, 9.0% from Japan, 2.8% from Australasia, 1.8% from South America, 1.1% from Asia, 0.6% from South Africa, and 29.2% were unspecified. Amongst trials reporting ethnicities, there were 60.3% White, 20.2% Japanese, 9.4% Asian, 5.5% Black, and 4.7% Latin American. There was reduction in MACE with LLT in regions including Australasia (RR 0.75, 95% CI 0.67\u20130.85), North America (RR 0.75, 95% CI 0.69\u20130.83), Europe (RR 0.78, 95% CI 0.71\u20130.86), and Japan (RR 0.73, 95% CI 0.63\u20130.85) and in Black ethnicity (RR 0.55, 95% CI 0.37\u20130.82). Head-to-head comparisons between regions and ethnicities revealed no significant differences in MACE reduction.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Despite under-representation in clinical trials, regional and ethnic minority groups such as Australasia and Blacks appear to derive at least as much cardiovascular benefit from LLT.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwad030","type":"journal-article","created":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T19:31:49Z","timestamp":1675798309000},"page":"1120-1131","source":"Crossref","is-referenced-by-count":9,"title":["Under-representation of ethnic and regional minorities in lipid-lowering randomized clinical trials: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5007-6888","authenticated-orcid":false,"given":"Sonia","family":"Sawant","sequence":"first","affiliation":[{"name":"Cardiology Department, Royal Prince Alfred Hospital , 50-60 Missenden Road , Australia"},{"name":"School of Public Health, Imperial College London , Exhibition Road, South Kensington, London SW7 2BX , UK"},{"name":"Sydney Medical School, The University of Sydney , Parramatta Road, Camperdown NSW 2050 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8197-5090","authenticated-orcid":false,"given":"Nelson","family":"Wang","sequence":"additional","affiliation":[{"name":"Cardiology Department, Royal Prince Alfred Hospital , 50-60 Missenden Road , Australia"},{"name":"Sydney Medical School, The University of Sydney , Parramatta Road, Camperdown NSW 2050 , Australia"},{"name":"The George Institute for Global Health, University of New South Wales , King Street, Newtown NSW 2042 , Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"key":"2023082118594717400_zwad030-B1","first-page":"e9349","article-title":"Global epidemiology of ischemic heart disease: results from the global burden of disease study","volume":"12","author":"Khan","year":"2020","journal-title":"Cureus"},{"key":"2023082118594717400_zwad030-B2","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/S2213-8587(19)30388-2","article-title":"Intensive LDL cholesterol-lowering treatment beyond current recommendations for the prevention of major vascular events: a systematic review and meta-analysis of randomised trials including 327\u2008037 participants","volume":"8","author":"Wang","year":"2020","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2023082118594717400_zwad030-B3","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1016\/S0140-6736(14)61368-4","article-title":"Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174\u2008000 participants in 27 randomised trials","volume":"385","year":"2015","journal-title":"Lancet"},{"key":"2023082118594717400_zwad030-B4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.5551\/jat.RV16004","article-title":"Racial differences in the cholesterol-lowering effect of statin","volume":"24","author":"Naito","year":"2017","journal-title":"J Atheroscler Thromb"},{"key":"2023082118594717400_zwad030-B5","doi-asserted-by":"crossref","first-page":"3071","DOI":"10.1016\/j.ijcard.2013.04.091","article-title":"Do the lipid responses to rosuvastatin and atorvastatin differ between Chinese and Caucasians? 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