Zhang Wan-Tong, Wang Xu-Jie, Xue Chun-Miao, Ji Xin-Yu, Pan Lin, Weng Wei-Liang, Li Qiu-Yan, Hua Guo-Dong, Zhu Bao-Chen
Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
Front Pharmacol. 2021 Nov 11;12:771804. doi: 10.3389/fphar.2021.771804. eCollection 2021.
Multiple studies have revealed that idiopathic pulmonary fibrosis (IPF) patients are more at risk for cardiovascular diseases and that many IPF patients receive cardiovascular medications like statins, angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), and anticoagulants. Existing studies have reported divergent findings on the link between cardiovascular medications and fibrotic disease processes. The aim of this study is to synthesize the evidence on the efficacy of cardiovascular medications in IPF. We searched studies reporting the effect of cardiovascular medications on IPF in the PubMed, Embase, Web of Science, Cochrane Library, and two Chinese databases (China National Knowledge Infrastructure database and China Wanfang database). We calculated survival data, forced vital capacity (FVC) decline, and IPF-related mortality to assess the efficacy of cardiovascular medications in IPF. We also estimated statistical heterogeneity by using I and Cochran Q tests, and publication bias was evaluated by risk of bias tools ROBINS-I. A total of 12 studies were included in the analysis. The included studies had moderate-to-serious risk of bias. Statin use was associated with a reduction in mortality (hazard ratio (HR), 0.89; 95% CI 0.83-0.97). Meta-analysis did not demonstrate any significant relationship between statin use and the FVC decline (HR, 0.86; 95% CI 0.73-1.02), ACEI/ARB use, and survival data (HR, 0.92; 95% CI 0.73-1.15) as well as anticoagulant use and survival data (HR, 1.16; 95% CI 0.62-2.19). Our study suggested that there is a consistent relationship between statin therapy and survival data in IPF population. However, there is currently insufficient evidence to conclude the effect of ACEI, ARB, and anticoagulant therapy on IPF population especially to the disease-related outcomes in IPF.
多项研究表明，特发性肺纤维化（IPF）患者患心血管疾病的风险更高，许多IPF患者会服用心血管药物，如他汀类药物、血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体阻滞剂（ARB）和抗凝剂。现有研究报告了心血管药物与纤维化疾病进程之间的不同结果。本研究的目的是综合关于心血管药物在IPF中疗效的证据。我们在PubMed、Embase、科学网、Cochrane图书馆以及两个中文数据库（中国知网数据库和中国万方数据库）中搜索了报告心血管药物对IPF影响的研究。我们计算生存数据、用力肺活量（FVC）下降情况以及IPF相关死亡率，以评估心血管药物在IPF中的疗效。我们还使用I检验和Cochran Q检验估计统计异质性，并通过偏倚风险工具ROBINS-I评估发表偏倚。共有12项研究纳入分析。纳入的研究存在中度至严重的偏倚风险。使用他汀类药物与死亡率降低相关（风险比（HR），0.89；95%置信区间0.83 - 0.97）。荟萃分析未显示使用他汀类药物与FVC下降（HR，0.86；95%置信区间0.73 - 1.02）、使用ACEI/ARB以及生存数据（HR，0.92；95%置信区间0.73 - 1.15）之间存在任何显著关系，也未显示使用抗凝剂与生存数据（HR，1.16；95%置信区间0.62 - 2.19）之间存在显著关系。我们的研究表明，在IPF人群中，他汀类药物治疗与生存数据之间存在一致的关系。然而，目前尚无足够证据得出ACEI、ARB和抗凝剂治疗对IPF人群的影响，尤其是对IPF疾病相关结局的影响。
