Effect of the Renin-Angiotensin System Inhibitors on Inflammatory Markers: A Systematic Review and Meta-analysis of Randomized Controlled Trials |
| |
| Institution: | 1. Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt;2. Zagazig University Hospitals, Zagazig, El-Sharkia, Egypt;3. Department of Preventive Cardiology and Lipidology, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland;4. Department of Cardiology and Adult Congenital Heart Diseases, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland;5. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School–The University of Queensland School of Medicine, New Orleans, Louisiana;6. Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland;1. Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, MN;2. Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN;3. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;4. Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN;5. Center for Clinical and Translational Science;6. Department of Orthopedic Surgery (H.M.K.), Mayo Clinic, Rochester, MN;1. Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;3. Sealy Center on Aging and Department of Internal Medicine, University of Texas Medical Branch, Galveston;1. Providence Medical Research Center, Providence Health Care, University of Washington, Spokane and Seattle;2. David Geffen School of Medicine at University of California, Los Angeles;1. Department of Neurologic Surgery, Mayo Clinic, Rochester MN;2. Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester MN;3. Department of Otolaryngology–Head and Neck Surgery, Mayo Clinic, Rochester MN;4. Department of Radiation Oncology, Mayo Clinic, Rochester MN;5. Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN;1. Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN;2. Advisor to residents and Consultant in Cardiovascular Medicine, Mayo Clinic, Rochester, MN |
| |
| Abstract: | ObjectiveTo synthesize more conclusive evidence on the anti-inflammatory effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs).MethodsPubMed, Scopus, and Embase were searched from inception until March 1, 2021. We included randomized controlled trials (RCTs) that assessed the effect of ACEIs or ARBs, compared with placebo, on any of the following markers: C-reactive protein (CRP), interleukin 6 (IL-6), or tumor necrosis factor α (TNF-α). Mean changes in the levels of these markers were pooled as a weighted mean difference (WMD) with a 95% CI.ResultsThirty-two RCTs (n=3489 patients) were included in the final analysis. Overall pooled analysis suggested that ACEIs significantly reduced plasma levels of CRP (WMD, ?0.54 95% CI, ?0.88 to ?0.21]; P=.002; I2=96%), IL-6 (WMD, ?0.84 95% CI, ?1.03 to ?0.64]; P<.001; I2=0%), and TNF-α (WMD, ?12.75 95% CI, ?17.20 to ?8.29]; P<.001; I2=99%). Moreover, ARBs showed a significant reduction only in IL-6 (WMD, ?1.34 95% CI, ?2.65 to ?0.04]; P=.04; I2=85%) and did not significantly affect CRP (P=.15) or TNF-α (P=.97) levels. The lowering effect of ACEIs on CRP levels remained significant with enalapril (P=.006) and perindopril (P=.01) as well as with a treatment duration of less than 24 weeks (WMD, -0.67 95% CI, ?1.07 to -0.27]; P=.001; I2=94%) and in patients with coronary artery disease (WMD, ?0.75 95% CI, ?1.17 to ?0.33]; P<.001; I2=96%).ConclusionBased on this meta-analysis, ACEIs showed a beneficial lowering effect on CRP, IL-6, and TNF-α, whereas ARBs were effective as a class in reduction of IL-6 only. |
| |
| Keywords: | ACEI"} {"#name":"keyword" "$":{"id":"kwrd0015"} "$$":[{"#name":"text" "_":"angiotensin-converting enzyme inhibitor AngII"} {"#name":"keyword" "$":{"id":"kwrd0025"} "$$":[{"#name":"text" "_":"angiotensin II ARB"} {"#name":"keyword" "$":{"id":"kwrd0035"} "$$":[{"#name":"text" "_":"angiotensin receptor blocker CAD"} {"#name":"keyword" "$":{"id":"kwrd0045"} "$$":[{"#name":"text" "_":"coronary artery disease CRP"} {"#name":"keyword" "$":{"id":"kwrd0055"} "$$":[{"#name":"text" "_":"C-reactive protein CVD"} {"#name":"keyword" "$":{"id":"kwrd0065"} "$$":[{"#name":"text" "_":"cardiovascular disease IL-6"} {"#name":"keyword" "$":{"id":"kwrd0075"} "$$":[{"#name":"text" "_":"interleukin 6 RAAS"} {"#name":"keyword" "$":{"id":"kwrd0085"} "$$":[{"#name":"text" "_":"renin-angiotensin-aldosterone system RCT"} {"#name":"keyword" "$":{"id":"kwrd0095"} "$$":[{"#name":"text" "_":"randomized controlled trial T2DM"} {"#name":"keyword" "$":{"id":"kwrd0105"} "$$":[{"#name":"text" "_":"type 2 diabetes mellitus TNF-α"} {"#name":"keyword" "$":{"id":"kwrd0115"} "$$":[{"#name":"text" "_":"tumor necrosis factor α WMD"} {"#name":"keyword" "$":{"id":"kwrd0125"} "$$":[{"#name":"text" "_":"weighted mean difference |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
