抗炎治疗与已患有心血管疾病或心血管风险高的患者心肌梗死风险降低相关：一项随机对照试验的系统评价和荟萃分析。
Anti-inflammatory therapies were associated with reduced risk of myocardial infarction in patients with established cardiovascular disease or high cardiovascular risks: A systematic review and meta-analysis of randomized controlled trials.
机构信息
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
出版信息
Atherosclerosis. 2023 Aug;379:117181. doi: 10.1016/j.atherosclerosis.2023.06.972. Epub 2023 Jul 6.
BACKGROUND AND AIMS
We aimed to evaluate the association between anti-inflammatory therapies and the incidence of cardiovascular events in patients with established cardiovascular disease (CVD) or high cardiovascular risks.
METHODS
Literature retrieval was conducted in PubMed, Medline, Embase, the Cochrane Central Register of Controlled Trials and Clinicaltrial.gov website from the inception to December 2022. Randomized controlled trials comparing anti-inflammatory therapies with placebo in patients with established CVD or high cardiovascular risks were included. The results of the meta-analysis were computed as the risk ratio (RR) with 95% confidence interval (CI).
RESULTS
Compared with placebo, anti-inflammatory therapies were associated with decreased incidence of myocardial infarction (MI) (RR = 0.93, 95% CI, 0.88 to 0.98), which was mainly driven by therapies targeting central IL-6 signaling pathway (RR = 0.83, 95% CI, 0.74 to 0.93). IL-1 inhibitors treatment was associated with reduced risks of heart failure (RR = 0.38, 95% CI, 0.18 to 0.80) while lower incidence of stroke was observed in patients with colchicine treatment (RR = 0.47, 95% CI, 0.28 to 0.77). MI events were less frequent in patients over 65 years of age (RR = 0.90, 95% CI, 0.83 to 0.98) or with follow-up duration over 1 year (RR = 0.90, 95% CI, 0.85 to 0.96) when comparing anti-inflammatory therapies with placebo.
CONCLUSIONS
Anti-inflammatory therapies, especially those targeting the central IL-6 signaling pathway, may serve as promising treating strategies to ameliorate the risk of MI. IL-1 inhibitor and colchicine were associated with decreased risks of heart failure and stroke, respectively. MI risk reduction by anti-inflammatory therapies seemed to be more prominent in older patients with long follow-up duration.
背景和目的
我们旨在评估抗炎治疗与已确诊心血管疾病（CVD）或心血管风险较高患者心血管事件发生率之间的关联。
方法
从建库至 2022 年 12 月，我们在 PubMed、Medline、Embase、Cochrane 对照试验中心注册库和 Clinicaltrial.gov 网站上进行文献检索。纳入比较抗炎治疗与安慰剂在已确诊 CVD 或心血管风险较高患者中的疗效的随机对照试验。荟萃分析结果以风险比（RR）及其 95%置信区间（CI）表示。
结果
与安慰剂相比，抗炎治疗与心肌梗死（MI）发生率降低相关（RR=0.93，95%CI，0.88 至 0.98），这主要归因于靶向中枢 IL-6 信号通路的治疗（RR=0.83，95%CI，0.74 至 0.93）。IL-1 抑制剂治疗与心力衰竭风险降低相关（RR=0.38，95%CI，0.18 至 0.80），而秋水仙碱治疗则降低了中风发生率（RR=0.47，95%CI，0.28 至 0.77）。与安慰剂相比，年龄>65 岁（RR=0.90，95%CI，0.83 至 0.98）或随访时间>1 年（RR=0.90，95%CI，0.85 至 0.96）的患者中，抗炎治疗组的 MI 事件发生率更低。
结论
抗炎治疗，尤其是靶向中枢 IL-6 信号通路的治疗，可能是改善 MI 风险的有前途的治疗策略。IL-1 抑制剂和秋水仙碱分别与心力衰竭和中风风险降低相关。抗炎治疗降低 MI 风险的作用在随访时间较长的老年患者中更为显著。
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