Safety and efficacy of anti-inflammatory therapy in patients with coronary artery disease: a systematic review and meta-analysis

Abstract

Background: The inflammation hypothesis of atherosclerosis has been put forward for 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 by searching PubMed, EMBASE, web of science, and Cochrane Library database. The primary outcome was a composite outcome of cardiovascular death, myocardial infarction (MI), or stroke. The secondary outcomes included individual 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 60,782 patients with CAD was included. Compared with patients receiving placebo, anti-inflammatory therapy significantly reduced the incidence of the primary outcome in patients with CAD (RR 0.93, 0.89-0.98, P = 0.007). 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 0.94, 0.86-1.02, P = 0.14), all-cause death (RR 1.00, 0.94-1.07, P = 0.98) and stroke (RR 0.96, 0.85-1.09, P = 0.51) between two groups.

Conclusions: Anti-inflammatory therapy can reduce the incidence of the primary outcome in patients with CAD, especially the risk of MI and coronary revascularization. However, anti-inflammatory therapy increases the risk of infection. (Registered by PROSPERO, CRD 420212291032).

Keywords: Anti-inflammatory therapy; Coronary artery disease; Meta-analysis.

Fig. 1

Flow diagram of literature search

Fig. 2

Comparison of the primary outcome between anti-inflammatory therapy and placebo groups

Fig. 3

Comparison of the secondary outcomes between anti-inflammatory therapy and placebo groups

Fig. 4

The safety outcomes between anti-inflammatory therapy and placebo groups

Fig. 5

Subgroup analysis of anti-inflammatory therapy in patients with ACS and CCS.ACS, acute coronary syndrome; CCS, chronical coronary syndrome

Fig. 6

Subgroup analysis of targeting the central IL-6 inflammatory signaling pathway drugs and PLA₂ inhibitors