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 I2 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] 0.54 mg/dL, 95% CI 0.43 to 0.65, heterogeneity p = 0.021; I2 54.2%, n = 11 studies). The WMDs for total serum cholesterol (TC) was −1.18 mg/dL (95% CI −1.30 to −1.06, heterogeneity p = 0012; I2 63.1%, n = 11 studies), 0.126 mg/dL (95% CI 0.02 to 0.22, heterogeneity p = 0.231; I2 43.2%, n = 11 studies) for HDL-cholesterol, and −0.24 mg/dL (95% CI −0.35 to −0.14, heterogeneity p = 0.562; I2 23.1%, n = 10 studies) for LDL-cholesterol, and −2.10 mg/dL (95% CI −2.84 to −1.36, heterogeneity p = 0.200; I2 42.6%, n = 11 studies) fasting blood glucose (FBG) and −0.83% (95% CI −1.08 to −0.57, heterogeneity p = 0.856; I2 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.