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.

Diagnostic prediction model in subjects with low-risk unstable angina pectoris/non-ST segment Elevation Myocardial Infarction.

OBJECTIVE: This study aims to construct a prediction model based on non-invasive examination and cardiovascular risk factors, to predict the presence of coronary artery disease (CAD) and its severity in patients with low-risk unstable angina pectoris (UAP)/Non-ST Segment Elevation Myocardial Infarction (NSTEMI). PATIENTS AND METHODS: This cross-sectional study aimed to assess the association between non-invasive examinations and cardiovascular risk factors in predicting CAD. Model constructed based on non-invasive assessment and cardiovascular risk factors was compared to coronary angiography, the reference standard. RESULTS: This study included 104 patients, comprising 60 men and 44 women, who fulfilled the inclusion criteria. The mean age was 52.3 (6.8) years. Two diagnostic prediction models were constructed after series of analyses. The main model consists of NO, CIMT, history of smoking, and Age-Gender, while the alternative model consists of CIMT, history of smoking, and Age-Gender. The main model has AUC of 74.5% (95% CI: 64.9-84.1), sensitivity of 72.7% (95% CI: 57.2-85.0), specificity 65.0% (95% CI: 51.6 -76.9 for a cut-off point of 74.5. While the alternative model has 69.0% AUC (95% CI: 58.9-79.1), sensitivity of 65.9% (95%: 50.1-79, 5), a specificity of 56.7% (95% CI: 43.2-69.4) for a cut-off point of 69. The main model and the alternative model have similar diagnostic prediction performance based on the ROC comparison test (p = 0.70). CONCLUSIONS: Based on these results, we conclude that NO, CIMT, smoking history, and age-gender have a value of diagnostic validity in subjects with low-risk UAP/NSTEMI.