Assistant Professor University of Ottawa University of Ottawa Heart Instute Ottawa, Ontario, Canada
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 AND RESULTS: 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 random effects analyses in patients with ACS and stable CAD. Risk of bias assessments were performed using the Cochrane Risk of Bias 2 (RoB2) tool. 15,627 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: 0.71, CrI: 0.58-0.88) were associated with a significant reduction in major adverse cardiac events (MACE) compared to control (Figure 1). 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 (Figure 2).
Conclusion: In patients with ACS, NSAIDs and colchicine were associated with a reduction in MACE. In patients with stable CAD, both colchicine and corticosteroids were associated with a reduction in MACE.
