Comparative effectiveness of statins and exercise in high-risk individuals: systematic review and network meta-analysis.

Background And Aims: Arterial stiffness (AS) predicts cardiovascular disease (CVD) risk and relates to multiple factors. But the best interventions for AS in high-risk CVD groups are unknown. This review focuses on how different interventions affect AS and related indicators.

Methods: We searched MEDLINE (PubMed), Embase, Cochrane Library, EBSCO, and Web of Science for relevant studies. Inclusion criteria: (1) randomized controlled trials (RCT); (2) participants with CVD risk factors as per American College of Sports Medicine (ACSM) guidelines; (3) interventions including Whole-Body Vibration (WBV), statins (STA), interval training (INT), aerobic exercise (AE), resistance exercise (RT), and combined exercise (CT); (4) control groups with usual care or placebo; (5) outcomes of pulse wave velocity (PWV), systolic blood pressure (SBP), and diastolic blood pressure (DBP); (6) studies in English. Data were analyzed using a random effects network meta-analysis and assessed for bias using the Cochrane tool.

Results: This meta-analysis of 58 studies ( = 2,931) found all long-term interventions (STA, WBV, CT, RT, AE, INT) significantly reduced PWV ( < 0.001). WBV, INT, and AE notably lowered both SBP and DBP ( < 0.001). hSTA showed optimal PWV reduction (SUCRA=92.0), while WBV showed highest efficacy for SBP (SUCRA=94.0) and DBP (SUCRA=77.3).

Conclusions: For CVD high-risk populations, high doses of statins (hSTA) optimally reduces AS; WBV is the top non-drug AS intervention, while INT best improves both AS and BP short-term. Combined, these interventions significantly enhance outcomes.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=564538, PROSPERO CRD42024564538.