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.

The role of pentoxifylline in preventing contrast-induced nephropathy in coronary angiography/intervention - systematic review, meta-analysis, and meta-regression of randomized controlled trials

OBJECTIVE

This systematic review and meta-analysis aimed to synthesize the latest evidence on pentoxifylline effect on the contrast-induced nephropathy (CIN) and whether the quality evidence is sufficient to make a definite conclusion MATERIALS AND METHODS: We performed a systematic literature search on topics that assesses pentoxifylline and CIN in coronary angiography/intervention up until 01 April 2021 using PubMed, Scopus, Embase, and hand-sampling. Primary outcome was CIN defined as ≥0.5 mg/dL or 25% rise in the SCr 48 h after procedure.

RESULTS

There were a total of 1142 subjects from 6 studies. There was no difference between pentoxifylline and control group in terms of serum creatinine at baseline (p=0.46) and after the procedure (p=0.33). The incidence of CIN was 51/571 (8.9%) in the pentoxifylline group and 61/571 (10.7%) in the control group. Pentoxifylline was not significantly associated with increase or decrease in the risk of CIN (RR 0.84 [0.59, 1.19], p=0.32; I2: 0%, p=0.89). Subgroup analysis for elective studies showed a non-significant result (RR 0.77 [0.47, 1.27], p=0.31; I2: 0%). Meta-regression analysis showed that the association between pentoxifylline and mortality was not affected by age (p=0.994), gender (reference: male, p=0.562), hypertension (p=0.336), diabetes (p=0.536), baseline serum creatinine (p=0.344), contrast used (p=0.431), and CIN incidence (p=0.521). GRADE Approach showed a low certainty of evidence for the effect estimate of pentoxifylline on CIN.

CONCLUSIONS

Our meta-analysis showed that pentoxifylline was not associated with the risk of CIN with low certainty of evidence. Hence, larger, multicentre, double-blind randomized controlled trials are required.

Greater mitral valve area in obese patients with rheumatic heart disease: a new evidence of obesity paradox ?

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

 The existence of obesity paradox’s been proposed this past decade, suggesting obese individuals may have survival benefit when there"s acute cardiovascular decompensation or congestive heart failure. Adiponectin, a residual protein from fat, has a cardioprotective role against inflammation.

PURPOSE : In this study, we look at mitral valve stenosis (MS), an inflammatory result of rheumatic heart disease (RHD), to determine the relationship between BMI (body mass index) and degree of MS.

METHODS

 A cross-sectional study was conducted over 463 medical records from RHD patients at a Heart Service Installation. Anthropometric and echocardiography results were taken and analysed statistically. Mitral valve area (MVA) was calculated using planimetry method and classified based on EAE/ASE guideline.

RESULTS

 Based on BMI criteria (WHO Asia Pacific), the underweight, normal, overweight, and obese percentage of all patients are 16.8%, 46.7%, 15.1%, and 21.4% respectively. Most patients have normal BMI in all stenosis degree. Categorically, the relationship between BMI and MS degree is insignificant (p &gt; 0.05). Meanwhile, the median of MVA in the obese group shows the greatest (1.0 vs 0.79, 0.86, and 0.90 ; p value &lt;0.05). A post-hoc analysis carried out and shows significant difference among MVA value in underweight to obese patients (p &lt; 0.05) and also in normal to obese patients (p &lt; 0.05)

CONCLUSION

 Significant relationship of MVA value in RHD patients according to BMI is noted with greater median of MVA in obese group. This may provide evidence of the obesity paradox in RHD patients with mitral stenosis. Abstract Table 1  Abstract Table 2

The effect of extracorporeal shockwave myocardial revascularization therapy to myocardial perfusion and function in indicated CABG-stable angina pectoris patients: case series

OBJECTIVE

Many studies have found a beneficial effect of Extracorporeal Shockwave Myocardial Revascularization (ESMR) therapy for refractory angina patients. However, clinical studies ESMR therapy for indicated coronary artery bypass grafting (CABG)-stable angina pectoris (SAP) patients are limited.

PATIENTS AND METHODS

Four indicated CABG-SAP patients CCS class I-III reviewed in this study. All patients refuse to CABG procedure. Data of myocardial perfusion and function from medical records were collected.

RESULTS

After ESMR therapy, summed rest score was improved in patient 1 from 14 to 8, Patient 2 from 10 to 5, and Patient 3 from 6 to 4. Summed stress score was improved in patient 1 from 31 to 19. Left ventricular ejection fraction was improved in patient 1 at rest from 59 to 67% and stress from 39 to 57%. The global longitudinal strain was improved in patient 1 from -16 to -20.9 and Patient 3 from -14.8 to -18.2. Diastolic dysfunction severity was improved in patient 2 and patient 3 from grade 2 to grade 1.

CONCLUSIONS

In our case series, ESMR therapy for indicated CABG-SAP patients might improve myocardial perfusion and function, especially for patients with a high ischemic burden.

The association between serum prealbumin and poor outcome in COVID-19 - Systematic review and meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to evaluate the association between the prealbumin and severity and mortality in COVID-19.

MATERIALS AND METHODS

We performed a systematic literature search from PubMed, Embase, and Scopus databases up until 2 February 2021. The primary outcome was the poor outcome, a composite of mortality and severity. Severe COVID-19 was defined as COVID-19 that fulfill the criteria for severe pneumonia or patients with acute respiratory distress syndrome/disease progression/need for intensive care unit or mechanical ventilation. The effect estimates were a mean difference between patients with and without a poor outcome in mg/dL and odds ratio (OR) per 1 mg/dL decrease in prealbumin level. The effect estimates were reported with their 95% confidence interval (95% CI).

RESULTS

Nine studies comprising of 2104 patients were included in this systematic review and meta-analysis. Patients with poor outcome have lower prealbumin level (mean difference -71.48 mg/dL [95% CI -93.74, -49.22], p<0.001; I2: 85.9%). Every 1 mg/dL decrease in prealbumin level was associated with 1% increase in poor outcome (OR 0.992 [0.987, 0.997], p=0.004, I2: 81.7%). Meta-regression analysis showed that the association between the prealbumin level and poor outcome varies with gender (male) (coefficient: 3.50, R2: 100%, p<0.001), but not age, diabetes, hypertension, and chronic kidney disease.

CONCLUSIONS

Low serum prealbumin was associated with poor outcomes in patients with COVID-19.

Glucose-6-phosphate dehydrogenase deficiency in neonates

OBJECTIVE

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an inherited deficiency that may be the cause of neonatal hyperbilirubinemia, as has been found in several countries and among widely different ethnic groups, especially in Mediterranean region. Our aim was to study the prevalence of G6PD deficiency in relation to neonatal jaundice.

METHODS

From March 1998 to April 2001 we studied 705 clinically icteric neonates who were admitted to Al-Zahra and Beheshti hospitals, two teaching hospitals in Isfahan, Iran. Laboratory investigations included determination of direct and indirect serum bilirubin concentrations, blood group typing, direct coomb's test, hemoglobin, blood smear, reticulocyte count and G6PD level.

RESULTS

In only 53 (7.5%) of cases G6PD deficiency was diagnosed. In all G6PD deficient neonates no evidence of other factors known to cause hyperbilirubinemia were detected. The sex distribution was 13 (24.5%) females and 40 (75.5%) males in the G6PD deficient group. The mean bilirubin level in G6PD deficient and G6PD normal groups were 22.26 +/- 8.36 and 18.14 +/- 3.85 mg/dl, respectively (p=0.001). Phototherapy was required in G6PD deficient and other icteric neonates with duration of 3.76 +/- 1.93 and 3.13 +/- 2.14 days, respectively (p=0.045). Twenty-seven of the 53 (50.9%) G6PD deficient infants required exchange transfusion. None of them developed kernicterus.

CONCLUSIONS

Since the prevalence of severe hyperbilirubinemia among our neonates was relatively high and about half of them required exchange transfusion, early detection of this enzymopathy regardless of sex and close surveillance of the affected newborns may be important in reducing the risk of severe hyperbilirubinemia and exchange transfusion.