The effects of bile acid sequestrants on lipid profile and blood glucose concentrations: A systematic review and meta-analysis of randomized controlled trials.

AIM: To undertake a systematic review and meta-analysis of prospective clinical studies to determine the effect of bile acid sequestrants (BAS) on lipid profile and blood glucose concentrations.

METHOD: PubMed-Medline, Web of Science, Cochrane Database and Google Scholar databases were searched (up until August 2016) to identify prospective studies evaluating the impact of BASs on the cardio-metabolic profile. Random effects model meta-analysis was used for quantitative data synthesis. Sensitivity analysis was conducted using the leave-one-out method. Heterogeneity was quantitatively assessed using the I(2) index. Systematic review registration: CRD42016035973.

RESULTS: From a total of 769 entries identified, 15 studies were included in the final analysis. The meta-analysis indicated a significant reduction in fasting serum triglyceride concentrations following treatment with BASs (weighted mean difference [WMD] 0.54mg/dL, 95% CI 0.43 to 0.65, heterogeneity p=0.021; I(2) 54.2%, n=11 studies). The WMDs for total serum cholesterol (TC) was -1.18mg/dL (95% CI -1.30 to -1.06, heterogeneity p=0012; I(2) 63.1%, n=11 studies), 0.126mg/dL (95% CI 0.02 to 0.22, heterogeneity p=0.231; I(2) 43.2%, n=11 studies) for HDL-cholesterol, and -0.24mg/dL (95% CI -0.35 to -0.14, heterogeneity p=0.562; I(2) 23.1%, n=10 studies) for LDL-cholesterol, and -2.10mg/dL (95% CI -2.84 to -1.36, heterogeneity p=0.200; I(2) 42.6%, n=11 studies) fasting blood glucose (FBG) and -0.83% (95% CI -1.08 to -0.57, heterogeneity p=0.856; I(2) 20.9%, n=11 studies) for HbA1c. These findings were robust in sensitivity analyses.

CONCLUSIONS: This meta-analysis suggests that therapy with BAS significantly improves HDL-C, LDL-C, and glycemic markers including fasting blood glucose, HbA1c levels, while deteriorating triglyceride levels.