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Published on: September 19, 2016
Anti-inflammatory therapies to prevent cardiovascular events: systematic review and network meta-analysis of
Kevin E Boczar1,2,3,4, Alexander L Pearson1, Ramtin Hakimjavadi1
1Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada.
Insights
Anti-inflammatory drugs like colchicine and corticosteroids significantly reduce major adverse cardiac events (MACE) in patients with coronary artery disease (CAD). This review compares their effectiveness in acute coronary syndromes (ACS) and stable CAD, offering insights into cardiovascular event reduction strategies.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Cardiovascular (CV) events remain a leading cause of mortality.
- Anti-inflammatory therapies are being explored as a novel strategy for CV event reduction.
- Patients with coronary artery disease (CAD), including acute coronary syndromes (ACS) and stable CAD, are a key focus for these investigations.
Purpose of the Study:
- To systematically review and compare the relative effectiveness of various anti-inflammatory medications.
- To assess the impact of these therapies on reducing CV events in patients with known CAD.
- To differentiate effectiveness in patients with ACS versus stable CAD.
Main Methods:
- A systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs) involving anti-inflammatory treatments in CAD patients.
- Extensive database searches (Medline, Embase, Cochrane, etc.) and clinical trial registries were conducted.
- Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB2) tool.
Main Results:
- The analysis included 41 studies with data from 29,487 patients (ACS) and 41,791 patients (stable CAD).
- In ACS patients, non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine showed significant reductions in major adverse cardiac events (MACE).
- In stable CAD patients, corticosteroids and colchicine were associated with significant MACE reduction.
Conclusions:
- Colchicine demonstrated effectiveness in reducing MACE for both ACS and stable CAD patients.
- NSAIDs showed potential in ACS, but evidence was limited and predominantly indirect.
- Corticosteroids were effective in stable CAD, though findings relied partly on indirect comparisons.
Background:
Anti-inflammatory therapies have been increasingly investigated for the reduction of cardiovascular (CV) events. The objective of this paper was to summarize and compare the relative effectiveness of anti-inflammatory medications for the reduction of CV events in patients with known coronary artery disease (CAD), either acute coronary syndromes (ACS) or stable CAD.
Methods:
Systematic review and network meta-analysis of randomised controlled trials (RCTs) that included at least one anti-inflammatory treatment and involved patients with CAD. Databases searched: Medline, Embase, Cochrane Central Register of Controlled Trials, clinical trial registry websites, Europe PMC, and conference abstracts. Bayesian network meta-analysis was performed to calculate risk estimates using fixed-effects analyses in patients with ACS and stable CAD. Risk of bias assessments were performed using the Cochrane Risk of Bias 2 (RoB2) tool.
Results:
17,021 studies were screened; 41 met inclusion criteria. 29,487 patients were included in the ACS network and 41,791 in the stable CAD network. In the ACS network analysis, both non-steroidal anti-inflammatory drugs [OR: 0.30, 95% Credible Limits (CrI): 0.11-0.74] and colchicine (OR: 0.77, CrI: 0.62-0.95) were associated with a significant reduction in major adverse cardiac events (MACE) compared to control. In the stable CAD analysis, both corticosteroids (OR: 0.44, 95% CrI: 0.26-0.72) and colchicine (OR: 0.65, CrI: 0.54-0.77) were associated with a significant reduction in MACE compared to control.
Conclusions:
In patients with ACS, colchicine was associated with a reduction in MACE, while observed associations for NSAIDs were derived from sparse and predominantly indirect evidence. In patients with stable CAD, colchicine and corticosteroids were associated with a reduction in MACE, although these findings were informed largely by indirect comparisons.
Systematic Review Registration:
Identifier CRD42022303289.
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