Comparative effects of lipid lowering, hypoglycemic, antihypertensive and antiplatelet medications on carotid artery intima-media thickness progression: a network meta-analysis

Cardiovascular Diabetology

Rongzhong Huang¹  Yu Cao¹  Lihong Jiang¹  Yan Li²  Zicheng Hu³  Hua Huang⁴  Julio Romero⁵  Kerry Mills⁶  Yu Xu⁷ 

[1] Department of Cardiothoracic Surgery, The First People’s Hospital of Yunnan Province;Department of Geriatrics, The First People’s Hospital of Yunnan Province;Department of Neurology, Institute of Surgery Research, Daping Hospital, Third Military Medical University;Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University;Department of Software Engineering and Artificial Intelligence, University of Canberra;Health Research Institute, University of Canberra;Statistical Laboratory, Chuangxu Institute of Life Science;

关键词: Atherosclerosis;    Intima-media thickness;    Metabolic disorders;    Cardiovascular;    Diabetes;   

DOI  :  10.1186/s12933-019-0817-1

来源: DOAJ

【 摘 要 】

Abstract Background Carotid artery intima-media thickness (cIMT) progression is a surrogate marker of atherosclerosis with a high predictive value for future CVD risk. This study evaluates the comparative efficacies of lipid lowering, hypoglycemic, antihypertensive and antiplatelet medications on cIMT progression. Methods We conducted a network meta-analysis (NMA) to evaluate the relative efficacies of several drug classes in modifying cIMT progression. After a literature search in several electronic databases, studies were selected by following predetermined eligibility criteria. An inverse variance-heterogeneity model was used for NMA. Sensitivity analyses were performed to check the reliability of the overall NMA, and transitivity analyses were performed to examine the effects of modifiers on the NMA outcomes. Results Data were taken from 47 studies (15,721 patients; age: 60.2 years [95% confidence interval (CI) 58.8, 61.6]; BMI: 27.2 kg/m2 [95% CI 26.4, 28.0]; and gender: 58.3% males [95% CI 48.3, 68.3]). Treatment duration was 25.8 months [95% CI 22.9, 28.7]. Of the 13 drug classes in the network, treatment with phosphodiesterase III inhibitors was the most effective in retarding annual mean cIMT against network placebo (weighted mean difference (WMD) − 0.059 mm [95% CI − 0.099, − 0.020) followed by the calcium channel blockers (WMD − 0.055 mm [95% CI − 0.099, 0.001]) and platelet adenosine diphosphate inhibitors (WMD − 0.033 mm [95% CI − 0.058, 0.008]). These 3 drug classes also attained the same positions when the NMA was conducted by using first-year changes in mean cIMT. In transitivity analyses, longer treatment duration, higher body mass index (BMI), and a higher baseline cIMT were found to be independently associated with a lesser reduction in annual mean cIMT. However, in a multivariate analysis with these 3 modifiers, none of these factors was significantly associated with annual change in mean cIMT. In the placebo group, age was inversely associated with annual change in mean cIMT independently. Conclusion Phosphodiesterase III inhibitors and calcium channel blockers are found more effective than other drug classes in retarding cIMT progression. Age, BMI, and baseline cIMT may have some impact on these outcomes.

【 授权许可】

Unknown