January 30, 2019Cardiovascular DiabetologyOpen Access

Comparative effects of lipid lowering, hypoglycemic, antihypertensive and antiplatelet medications on carotid artery intima-media thickness progression: a network meta-analysis

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Why the study?

Carotid artery intima-media thickness progression is a surrogate marker of atherosclerosis with high predictive value for future CVD risk, motivating an evaluation of the comparative efficacies of multiple medication classes.

Do lipid lowering, hypoglycemic, antihypertensive, and antiplatelet medications reduce carotid artery intima-media thickness progression compared to placebo or each other?

Structured PICO

Do lipid lowering, hypoglycemic, antihypertensive, and antiplatelet medications reduce carotid artery intima-media thickness progression compared to placebo or each other?

Population

Patients evaluated for carotid artery intima-media thickness (cIMT) progression, 58.3% males.

Intervention

13 drug classes including lipid lowering, hypoglycemic, antihypertensive and antiplatelet medications (e.g., phosphodiesterase III inhibitors, calcium channel blockers) administered for a mean duration of 25.8 months.

Comparator

Network placebo and other drug classes.

Outcome

Annual mean cIMT progression.surrogate

In a network meta-analysis of 13 drug classes, phosphodiesterase III inhibitors and calcium channel blockers were the most effective in retarding carotid artery intima-media thickness progression.

Implication

PDE III inhibitors and CCBs most effectively slow cIMT progression; extends comparative RCT evidence to guide drug selection in high-risk patients.

Abstract

BACKGROUND: Carotid artery intima-media thickness (cIMT) progression is a surrogate marker of atherosclerosis with a high predictive value for future CVD risk. This study evaluates the comparative efficacies of lipid lowering, hypoglycemic, antihypertensive and antiplatelet medications on cIMT progression. METHODS: We conducted a network meta-analysis (NMA) to evaluate the relative efficacies of several drug classes in modifying cIMT progression. After a literature search in several electronic databases, studies were selected by following predetermined eligibility criteria. An inverse variance-heterogeneity model was used for NMA. Sensitivity analyses were performed to check the reliability of the overall NMA, and transitivity analyses were performed to examine the effects of modifiers on the NMA outcomes. RESULTS: [95% CI 26.4, 28.0]; and gender: 58.3% males [95% CI 48.3, 68.3]). Treatment duration was 25.8 months [95% CI 22.9, 28.7]. Of the 13 drug classes in the network, treatment with phosphodiesterase III inhibitors was the most effective in retarding annual mean cIMT against network placebo (weighted mean difference (WMD) - 0.059 mm [95% CI - 0.099, - 0.020) followed by the calcium channel blockers (WMD - 0.055 mm [95% CI - 0.099, 0.001]) and platelet adenosine diphosphate inhibitors (WMD - 0.033 mm [95% CI - 0.058, 0.008]). These 3 drug classes also attained the same positions when the NMA was conducted by using first-year changes in mean cIMT. In transitivity analyses, longer treatment duration, higher body mass index (BMI), and a higher baseline cIMT were found to be independently associated with a lesser reduction in annual mean cIMT. However, in a multivariate analysis with these 3 modifiers, none of these factors was significantly associated with annual change in mean cIMT. In the placebo group, age was inversely associated with annual change in mean cIMT independently. CONCLUSION: Phosphodiesterase III inhibitors and calcium channel blockers are found more effective than other drug classes in retarding cIMT progression. Age, BMI, and baseline cIMT may have some impact on these outcomes.