Key result
Anti-inflammatory therapy significantly reduced the incidence of the composite primary outcome of cardiovascular death, myocardial infarction, and stroke (RR 0.93) compared to no anti-inflammatory therapy in patients with coronary artery disease.
Why the study?
Although animal experiments suggest anti-inflammatory therapy inhibits atherosclerosis, its efficacy in patients with coronary artery disease remains controversial.
Does anti-inflammatory therapy reduce the composite outcome of cardiovascular death, MI, and stroke in patients with coronary artery disease?
Meta-Analysis (n=61,065)
Does anti-inflammatory therapy reduce the composite outcome of cardiovascular death, MI, and stroke in patients with coronary artery disease?
Anti-inflammatory therapy, particularly agents targeting the IL-6 pathway, significantly reduces the risk of major adverse cardiovascular events in patients with coronary artery disease.
Anti-inflammatory therapy merits consideration in CAD; confirms benefit on hard endpoints in pooled trial data.
Background The inflammation hypothesis of atherosclerosis has been put forward more than 20 years. Although many animal experiments have suggested that anti-inflammatory therapy can inhibit the atherosclerotic process, the efficacy of anti-inflammatory therapy for patients with coronary artery disease (CAD) is still controversial. Therefore, this study aims to evaluate the safety and efficacy of anti-inflammatory drugs in patients with CAD. Method We conducted this systematic review and meta-analysis of randomized controlled trials about the safety and efficacy of anti-inflammatory therapy in patients with CAD. The relevant randomized controlled trials were included by searching PubMed, EMBASE, web of science and Cochrane Library database. The primary outcome was the composite outcome of cardiovascular death, myocardial infarction (MI), and stroke. The secondary outcomes included MI, coronary revascularization, cardiovascular death, all-cause death and stroke. The relative risk (RR) and 95% confidence intervals (CI) for outcome events were calculated by the fixed effects model, and trial sequential analysis was applied to assess the results. Result A total of ten randomized controlled trials and 61065 patients with CAD was included (32227 patients receiving the anti-inflammatory therapy, 28937 patients without receiving the anti-inflammatory therapy). Compared with patients without receiving the anti-inflammatory therapy, the anti-inflammatory therapy significantly reduced the incidence of the primary outcome in patients with CAD (RR 0.93, 0.89-0.98, P =0.006). In addition, the anti-inflammatory therapy can also reduce the risk of MI (RR 0.90, 0.84-0.96, P =0.002) and coronary revascularization (RR 0.74, 0.66-0.84, P < 0.00001) remarkably. However, there was no significant difference in the incidence of cardiovascular death (RR 0.93, 0.85-1.02, P =0.12), all-cause death (RR 1.00, 0.93-1.06, P =0.88) and stroke (RR 0.94, 0.83-1.07, P =0.36) between two groups. Conclusions The anti-inflammatory therapy can reduce the incidence of primary outcome in patients with CAD, especially the risk of MI and coronary revascularization (Registered by PROSPERO, CRD 42020220315).
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Niu et al. (2021) conducted a meta-analysis in Coronary Artery Disease (n=61,065). Anti-inflammatory therapy vs. No anti-inflammatory therapy was evaluated on Composite outcome of cardiovascular death, myocardial infarction (MI), and stroke (RR 0.93, 95% CI 0.89-0.98, p=0.006). Anti-inflammatory therapy significantly reduced the incidence of the composite primary outcome of cardiovascular death, myocardial infarction, and stroke (RR 0.93) compared to no anti-inflammatory therapy in patients with coronary artery disease.
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