The effect of statin on major adverse cardiovascular events and mortality in patients with rheumatoid arthritis - a systematic review and meta-analysis

OBJECTIVE

The aim of this systematic review and meta-analysis is to assess the effect of statin on major adverse cardiovascular events (MACE) and mortality in patients with RA.

MATERIALS AND METHODS

A systematic literature search was performed using PubMed, Scopus, Embase, and Clinicaltrials.gov for studies investigating the effect of statin on MACE and mortality in RA patients up until 6 February 2022. The primary outcome was MACE, which can be defined as nonfatal myocardial infarction (MI), nonfatal presumed ischemic stroke, transient ischemic attack, any coronary or non-coronary revascularization, or cardiovascular death. The pooled effect estimated was reported as hazard ratio (HR).

RESULTS

There were 40,307 patients from a total of six studies, comprising of one double-blind placebo controlled randomized controlled trial, four propensity-score matched cohorts, and one observational study included in this meta-analysis. The rate of MACE was lower in RA patients receiving statin [OR 0.67 (95%CI 0.51, 0.89), p=0.005; I2: 21.0%, p=0.29] (Figure 2). Sensitivity analysis using fixed-effect model showed that MACE was lower in the statin group [OR 0.73 (95%CI 0.62, 0.87), p<0.0051 I2: 21.0%, p=0.29]. Mortality was lower in RA patients receiving statin [OR 0.73 (95%CI 0.62, 0.88), p<0.001; I2: 29.0%, p=0.25] (Figure 3). Sensitivity analysis using fixed-effect model showed that mortality was lower in the statin group [OR 0.75 (95%CI 0.66, 0.85), p<0.001 I2: 29.0%, p=0.25].

CONCLUSIONS

This systematic review and meta-analysis showed that statin was associated with reduction of MACE and mortality in patients with RA.

Body mass index and outcome in patients with COVID-19: A dose-response meta-analysis

Background

There is mounting evidence related to the association between obesity and severity of COVID-19. However, the direct relationship of the increase in the severe COVID-19 risk factors, with an increase in body mass index (BMI), has not yet been evaluated.

Aim

This meta-analysis aims to evaluate the dose–response relationship between body mass index (BMI) and poor outcome in patients with COVID-19.

Methods

A systematic literature search was conducted using PubMed, Europe PMC, ProQuest, and the Cochrane Central Database. The primary outcome was composite poor outcome composed of mortality and severity. The secondary outcomes were mortality and severity.

Results

A total of 34,390 patients from 12 studies were included in this meta-analysis. The meta-analysis demonstrated that obesity was associated with composite poor outcome (OR 1.73 [1.40, 2.14], P < 0.001; I²: 55.6%), mortality (OR 1.55 [1.16, 2.06], P = 0.003; I²: 74.4%), and severity (OR 1.90 [1.45, 2.48], P < 0.001; I²: 5.2%) in patients with COVID-19. A pooled analysis of highest BMI versus reference BMI indicate that a higher BMI in the patients was associated with composite poor outcome (aOR 3.02 [1.82, 5.00], P < 0.001; I²: 59.8%), mortality (aOR 2.85 [1.17, 6.92], P = 0.002; I²: 79.7%), and severity (aOR 3.08 [1.78, 5.33], P < 0.001; I²: 11.7%). The dose–response meta-analysis showed an increased risk of composite poor outcome by aOR of 1.052 [1.028, 1.077], P < 0.001 for every 5 kg/m² increase in BMI (P_{non-linearity} < 0.001). The curve became steeper with increasing BMI.

Conclusion

Dose–response meta-analysis demonstrated that increased BMI was associated with increased poor outcome in patients with COVID-19.