Anti-inflammatory Therapies in Patients with Established Cardiovascular Disease or High Cardiovascular Risks

Background: 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 July 2022. Randomized controlled trials compared 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 odds ratio (OR) with 95% confidence interval (CI). Results: Compared with placebo, anti-inflammatory therapies were associated with decreased incidence of myocardial infarction (MI) (OR=0.93, 95%CI, 0.87 to 0.98), which was mainly driven by therapies targeting central IL-6 signaling pathway (OR=0.84, 95%CI, 0.76 to 0.94). IL-1 inhibitors treatment was associated with reduced risks of heart failure (OR=0.32, 95%CI, 0.14 to 0.76) while lower incidence of stroke was observed in patients with colchicine treatment (OR=0.46, 95%CI, 0.28 to 0.77). MI events were less frequent in patients over 65 years old (OR=0.90, 95%CI, 0.82 to 0.98) or with follow-up duration over 1 year (OR=0.90, 95%CI, 0.84 to 0.96)when comparing anti-inflammatory therapies with placebo. Conclusion: Anti-inflammatory therapies, especially those targeting central IL-6 signaling pathway may serve as promising treating strategies to ameliorate the risk of MI. Meanwhile, IL-1 inhibitor and colchicine were associated with decreased risks of heart failure and stroke respectively. MI risk reductions by anti-inflammatory therapies seem to be more prominent in patients who were elderly and with long follow-up duration. Disclosure C.Lin: None. Z.Li: None. X.Cai: None. L.Ji: Other Relationship; Eli Lilly and Company, Novo Nordisk, Merck & Co., Inc., Bayer Inc., Sanofi-Aventis U.S., Roche Pharmaceuticals, MSD Life Science Foundation, AstraZeneca, Boehringer Ingelheim Inc., Abbott, Metronics. Funding National Natural Science Foundation of China (81970698, 81970708); Beijing Natural Science Foundation (7202216)