The effect of statin therapy in combination with ezetimibe on circulating C-reactive protein levels: a systematic review and meta-analysis of randomized controlled trials

Background

Previous studies have reported that statin or ezetimibe therapy has an anti-inflammatory effect. However, the results of individual studies on the effect of statin therapy in combination with ezetimibe on C-reactive protein (CRP) and high-sensitivity CRP (hs-CRP) levels have not been clear. Therefore, the present systematic review and meta-analysis were conducted on randomized clinical trials (RCTs) to evaluate the effect of statin therapy in combination with ezetimibe on CRP and hs-CRP levels.

Methods

A literature search was carried out on the MEDLINE, SciVerse Scopus, and Clarivate Analytics Web of Science databases up to February 2022 to find eligible studies. The pooled effect sizes were considered for weighted mean difference (WMD) and 95% confidence intervals (CI) for CRP and hs-CRP, and it was also determined as standardized weighted mean difference (SMD) for overall CRP. For all variables, a random-effects model was used.

Results

Of the 57 studies included in the systematic review, 53 were used for meta-analysis. Statin therapy in combination with ezetimibe significantly reduced the serum levels of hs-CRP (WMD ??0.2 mg/l; 95% CI ??0.4, ??0.1, P???0.001) and overall CRP (SMD ??0.16 mg/l; 95% CI ??0.2, ??0.07, P???0.001). Nevertheless, CRP levels were not significantly changed by combination therapy. A significant association was observed between the serum low-density lipoprotein cholesterol (LDL-C) changes and hs-CRP levels, which can justify the source of heterogeneity.

Conclusions

The current study showed that statin therapy in combination with ezetimibe could be effective in reducing the levels of hs-CRP and overall CRP.

Graphical abstract

     

Pseudarthrosen und komplikationsbehaftete Verläufe nach Mittelhandfrakturen

Trauma und Berufskrankheit - Frakturen der Mittelhandknochen verlaufen nicht selten komplikationsbehaftet und zeigen einen durch Delayed Union oder Pseudarthrosenbildung verzögerten...     

Efficacy of an electric toothbrush on plaque control compared to two manual toothbrushes

Objectives: This study aimed to compare an electric toothbrush with two manual toothbrushes, in their relative efficacy to control plaque. Design: Randomised clinical trial. Setting: Kerman Dental School, Iran. Participants: Forty‐five volunteer dental students were randomly assigned to one of three groups. All subjects received a baseline plaque assessment using O’Leary plaque index, and then a prophylaxis to achieve the plaque index of zero. Subjects were trained to brush twice daily, with their assigned device and return after 1 week and then after 2 weeks for plaque assessment. Chi‐squared and ANOVA were mainly used. Main outcome measure: Plaque assessment using O’Leary plaque index. Results: Although Jordan toothbrush consistently resulted in lower plaque indices compared to both manual toothbrushes, those differences were not statistically significant, F(2, 42) = 2.45, P = 0.10. Plaque reduction from week 1 to week 2 was significant in Jordan Power group (60%, from 13.46 to 5.44, P = 0.010) and Panbehriz Classic group (53%, from 20.92 to 9.91, P = 0.007). Conclusion: The results of this study shows no evidence of statistically significant difference in respect to plaque control, between Jordan Power electric toothbrush and either of Oral‐B Advantage or Panbehriz Classic manual brushes in a group of dental students after 2 weeks.     

Relationship between tooth shade value and skin color: an observational study

STATEMENT OF PROBLEM: There is limited scientific information on the relationship between tooth shade and skin color. This lack of knowledge may impact the ability of the prosthodontist to select artificial teeth that complement the facial complexion of the patient. PURPOSE: This observational study explored the possibility of a relationship between tooth shade and skin color. MATERIALS AND METHODS:A total of 119 individuals aged 18 to 80 years participated in this observational study. Two investigators calibrated for examining tooth shade performed all examinations. A Vita-Lumin shade guide was used to examine either the maxillary right or left central incisor, one of which had to be restoration- and caries-free for study inclusion. Tooth shades were divided into 4 categories according to value, and skin tones were divided into 4 categories (fair, fair/medium, medium, and dark) with the use of L'Oreal True Illusion compact makeup shades as a guide. Categorical modeling with chi-square analysis and Fisher's exact tests was used to analyze the data (alpha=.05). RESULTS: No interaction among age, skin color, and tooth shade or gender, skin color, and tooth shade was found; however, age was associated with tooth shade (P<.001). Older persons were more likely to have teeth with lower values (darker). Among those aged 60 and older, 85% had teeth in the medium and low range values compared with 17% of those younger than 31. Significant tooth shade differences were discovered among patients with different skin colors (P<.05). Among those with low values (darker teeth), 50% were of fair complexion and 17% were of dark complexion (P<.001). CONCLUSION: Within the limitations of this study, tooth shade value and skin color were inversely related. Older adults were more likely to have darker teeth (lower value).