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Effectiveness comparison of atorvastatin vs. rosuvastatin in reducing CRP level in acute coronary syndrome: A systematic review and meta-analysis

Abstract

Background: Acute coronary syndrome (ACS) is a group of various clinical symptoms, including acute myocardial ischemia. When administered for coronary artery instability, one of the targets for statins is to reduce inflammation factor-like c-reactive protein (CRP). Increased levels of CRP are related to ischemic heart disease. Therefore, a meta-analysis was assessed to compare atorvastatin vs. rosuvastatin as the most effective for reducing CRP of a patient with acute coronary syndrome

Methods: We searched PubMed and Cochrane databases until October 23th 2020. Search terms included acute coronary syndrome, C-reactive protein or CRP, rosuvastatin, atorvastatin, randomized, random, and randomization. We excluded study populations with acute kidney injury/dyslipidemia/metabolic syndrome. All analyses in our study were carried out using Review Manager version 5.3 (RevMan Cochrane, London, UK).

Result: We have found four eligible studies (487 patients) were included. Funnel plots and p-Egger were inspected to assess publication bias. The pooled analysis demonstrated the benefit of atorvastatin or rosuvastatin over therapy for all studies. The result shown (WMD: 2.41; P=0.06; 95% CI: -0.07 – 4.90) on the forest plot.

Conclusion: Our meta-analysis clarifies that atorvastatin, compared to rosuvastatin, or vice versa, is not statistically significant in reducing CRP in acute coronary syndrome patients.

References

  1. World Health Organization. Cardiovascular diseases [Internet]. WHO. 2015 [cited 24 October 2020] Available from:http://www.who.int/topics/cardiovascular_diseases/en/.
  2. Eisen A, Giugliano RP, Braunwald E. Updates on acute coronary syndrome: a review. Cardiology. 2016;1(6):718-30.
  3. Amsterdam, Wenger, Brindis, Casey, et al. 2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 130(25): e344–e426.
  4. Ownbey M, Suffoletto B, Firsch A, et al. Prevalence and interventional outcomes of patients with resolution of ST-segment elevation between prehospital and in-hospital ECG. Prehosp Emerg Care. 2014;18(2): 174-9.
  5. Thomas MR, Lip GY. Novel risk markers and risk assessments for cardiovascular disease. Circ Res. 2017;120(1):133-49.
  6. Gimenez MR, et al. Sex-specific chest pain characteristics in the early diagnosis of acute myocardial infarction. Intern Med. 2014; 174(2): 241-249.
  7. Marchio P, Guerra-Ojeda S, Vila JM, Aldasoro M, Victor VM, Mauricio MD. Targeting early atherosclerosis: A focus on oxidative stress and inflammation. Oxid Med Cell Longev. 2019; 20:1-31.
  8. Geovanini GR, Libby P. Atherosclerosis and inflammation: overview and updates. Clin Sci. 2018;132(12):1243-52.
  9. Moriya J. Critical roles of inflammation in atherosclerosis. J Cardiol. 2019;73(1):22-7.
  10. Kasikara C, Doran AC, Cai B, Tabas I. The role of non-resolving inflammation in atherosclerosis. J Clin Invest. 2018;128(7):2713-23.
  11. Mourouzis K, Oikonomou E, Siasos G, Tsalamadris S, Vogiatzi G, Antonopoulos A, et al. Pro-inflammatory Cytokines in Acute Coronary Syndromes. Curr Pharm Design. 2020;26.
  12. Kristono GA, Holley AS, Lakshman P, Brunton-O'Sullivan MM, Harding SA, Larsen PD. Association between inflammatory cytokines and long-term adverse outcomes in acute coronary syndromes: A systematic review. Heliyon. 2020;6(4):e03704.
  13. Kaur A, Mackin ST, Schlosser K, Wong FL, Elharram M, Delles C, Stewart DJ, Dayan N, Landry T, Pilote L. Systematic review of microRNA biomarkers in acute coronary syndrome and stable coronary artery disease. Cardiovasc Res. 2020;116(6):1113-24.
  14. Danesh J, Wheeler JG, Hirschfield GM, Eda S, Eiriksdottir G, Rumley A, et al. C?reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004; 350:1387?97.
  15. He LP, Tang XY, Ling WH, Chen WQ, Chen YM: Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies. Heart. 2010; 96:339-46.
  16. Shrivastava AK, Singh HV, Raizada A, Singh SK: C-reactive protein, inflammation and coronary heart disease. Egypt Heart J. 2015; 67:89-97.
  17. Blaum C, Brunner FJ, Kröger F, Braetz J, Lorenz T, Goßling A, et al. Modifiable lifestyle risk factors and C-reactive protein in patients with coronary artery disease: Implications for an anti-inflammatory treatment target population. Eur J Prev Cardiol. 2019;1-9.
  18. Kalyoncuoglu M, Durmus G. Relationship between C-reactive protein-to-albumin ratio and the extent of coronary artery disease in patients with non-ST-elevated myocardial infarction. Coronary Artery Dis. 2020;31(2):130-6.
  19. Arima H, Kubo M, Yonemoto K, Doi Y, Ninomiya T, Tanizaki Y, Hata J, Matsumura K, Iida M, Kiyohara Y. High-sensitivity C-reactive protein and coronary heart disease in a general population of Japanese: the Hisayama study. Arteriosclerosis, thrombosis, and vascular biology. 2008;28(7):1385-91.
  20. Soinio M, Marniemi J, Laakso M, Lehto S, Rönnemaa T. High-sensitivity C-reactive protein and coronary heart disease mortality in patients with type 2 diabetes: a 7-year follow-up study. Diabetes care. 2006;29(2):329-33.
  21. Zhuang Q, Shen C, Chen Y, Zhao X, Wei P, Sun J, Ji Y, Chen X, Yang S. Association of high sensitive C-reactive protein with coronary heart disease: a Mendelian randomization study. BMC medical genetics. 2019;20(1):170.
  22. Koenig W: High-sensitivity C-reactive protein and atherosclerotic disease: from improved risk prediction to risk-guided therapy. Int J Cardiol. 2013, 168:5126-34.
  23. Dong Y, Wang X, Zhang L, Chen Z, Zheng C, Wang J, Kang Y, Shao L, Tian Y, Wang Z. High-sensitivity C reactive protein and risk of cardiovascular disease in China-CVD study. J Epidemiol Community Health. 2019;73(2):188-92.
  24. Sane R, Amin G, Dongre S, Mandole R. Effect of ischemic reversal program on high-Sensitivity C-reactive protein in patients of coronary heart disease: An observational study. Journal of Indian College of Cardiology. 2019;9(3):119.
  25. Nordenskjöld AM, Baron T, Eggers KM, Jernberg T, Lindahl B: Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery (MINOCA) disease. Int J Cardiol. 2018; 261:18-2
  26. Bäck M, Yurdagul A, Tabas I, Öörni K, Kovanen PT. Inflammation and its resolution in atherosclerosis: mediators and therapeutic opportunities. Nat Rev Cardiol. 2019;16(7):389-406.
  27. Nguyen MT, Fernando S, Schwarz N, Tan J, Bursill CA, Psaltis PJ. Inflammation as a therapeutic target in atherosclerosis. Journal of clinical medicine. 2019;8(8):1109.
  28. Kumar B, Shah MA, Kumar R, Kumar J, Memon A. Comparison of Atorvastatin and Rosuvastatin in Reduction of Inflammatory Biomarkers in Patients with Acute Coronary Syndrome. Cureus. 2019;11(6): e4898.
  29. Aydin MU, Aygul N, Altunkeser BB, Unlu A, Taner A. Comparative effects of high-dose atorvastatin versus moderate-dose rosuvastatin on lipid parameters, oxidized-LDL and inflammatory markers in ST elevation myocardial infarction. Atherosclerosis. 2015;239(2):439-43.
  30. Zhang L, Zhang S, Yu Y, Jiang H, Ge J: Efficacy and safety of rosuvastatin vs. atorvastatin in lowering LDL cholesterol: A meta-analysis of trials with East Asian populations. Herz. 2018:1-9.
  31. Khurana S, Gupta S, Bhalla H, Nandwani S, Gupta V. Comparison of anti-inflammatory effect of atorvastatin with rosuvastatin in patients of acute coronary syndrome. Journal of pharmacology & pharmacotherapeutics. 2015;6(3):130.
  32. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration. 2011. Available at: www.cochrane-handbook.org.
  33. George M, Joseph L, Chacko BK, Jose J. A comparative study on the effect of HMG-CoA reductase inhibitors on C-reactive protein in patients with acute coronary syndrome. World J Pharm Res. 2017; 6:1852-63.
  34. Anagnostis P, Adamidou F, Slavakis A, et al.: Comparative effect of atorvastatin and rosuvastatin on 25-hydroxy-vitamin D levels in non-diabetic patients with dyslipidaemia: a prospective randomized open-label pilot study. Open Cardiovasc Med J. 2014; 8:55-60.
  35. Betteridge DJ, Gibson JM, Sager PT: Comparison of effectiveness of rosuvastatin versus atorvastatin on the achievement of combined C-reactive protein (< 2 mg/L) and low-density lipoprotein cholesterol (< 70 mg/dl) targets in patients with type 2 diabetes mellitus (from the ANDROMEDA study). Am J Cardiol. 2007; 100:1245-8.
  36. Ridker PM, Danielson E, Fonseca FA, et al. rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med. 2008; 359:2195-207.
  37. Qian C, Wei B, Ding J, Wu H, Cai X, Li B, Wang Y: Meta-analysis comparing the effects of rosuvastatin versus atorvastatin on regression of coronary atherosclerotic plaques. Am J Cardiol. 2015; 116:1521-6.

How to Cite

Pratiwi, I. G. A. I. H., & Putra, A. A. G. W. (2022). Effectiveness comparison of atorvastatin vs. rosuvastatin in reducing CRP level in acute coronary syndrome: A systematic review and meta-analysis. Intisari Sains Medis, 13(1), 121–126. https://doi.org/10.15562/ism.v13i1.1267

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I Gusti Ayu Inten Heny Pratiwi
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Pubmed
ISM Journal


Anak Agung Gde Waisampayana Putra
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Pubmed
ISM Journal