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. 2019 Jan 30;18(1):14.
doi: 10.1186/s12933-019-0817-1.

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

Rongzhong Huang  1 , Kerry Mills  2 , Julio Romero  3   4 , Yan Li  5 , Zicheng Hu  6 , Yu Cao  1 , Hua Huang  7 , Yu Xu  8 , Lihong Jiang  9
Affiliations

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

Rongzhong Huang et al. Cardiovasc Diabetol. .

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: Data were taken from 47 studies (15,721 patients; age: 60.2 years [95% confidence interval (CI) 58.8, 61.6]; BMI: 27.2 kg/m2 [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.

Keywords: Atherosclerosis; Cardiovascular; Diabetes; Intima-media thickness; Metabolic disorders.

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Figures

Fig. 1
Fig. 1
A flowchart of the study screening and selection process
Fig. 2
Fig. 2
Network diagram
Fig. 3
Fig. 3
Forest graph showing the outcomes of NMA (relative efficacies of various drug classes in reducing annual mean cIMT)
Fig. 4
Fig. 4
Forest graph showing the outcomes of a parallel NMA comparing the relative efficacies of various drug classes in reducing mean cIMT in the first year of treatment
See this image and copyright information in PMC

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