The Efficacy and Safety of Different Anti-inflammatory Drugs for the Treatment of Coronary Heart Disease:a Systematic Review
Objective:To systematically evaluate the efficacy and safety of different anti-inflammatory drugs for the treatment of coronary heart disease,in order to further clarify the optimal targets of anti-inflammatory treatment of coronary heart disease.Methods:Randomized controlled trials of anti-inflammatory drugs for coronary heart disease were searched from MedLine,the Cochrane Library,EMbase,Web of Science and other databases.RevMan 5.3 software were used for Meta-analysis.Results:A total of 18 literatures were included,including 65 892 patients.The results of Meta-analysis showed that anti-inflammatory therapy patients occurred a low risk of major adverse cardiovascular events(MACE)(RR=0.87,95％Cl 0.79-0.96,P=0.005),the subgroup analysis showed that interleukin(IL)1 antagonist(RR=0.87,95％Cl 0.79-0.95,P=0.002)and colchicine reduced the risk of MACE(RR=0.61,95％Cl 0.48-0.79,P=0.000 1).Anti-inflammatory drugs showed no effect on all-cause mortality.There was no statistically significant difference in the incidence of hospitalization due to heart failure between the two groups(RR=0.95,95％Cl 0.83-1.10,P＞0.05).Subgroup analysis showed that IL-1 antagonists reduced the incidence of hospitalization due to heart failure in coronary heart disease patients(RR=0.12,95％Cl 0.02-0.94,P=0.04).In terms of adverse reactions,methotrexate increased the risk of infection(RR=1.13,95％Cl 1.03-1.24,P=0.01)and gastrointestinal adverse reactions(RR=1.23,95％CI 1.07-1.43,P＜0.05).Conclusion:The current evidence showed that anti-inflammatory therapy could reduce the incidence of MACE in patients with coronary heart disease,and the nucleotide-binding oligomeric domain-like receptor protein 3(NLRP3)/IL-1/IL-6 inflammatory pathway might be one of the ideal therapeutic targets.
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