Systematic review and meta-analysis of methotrexate use and risk of cardiovascular disease.
Systematic review and meta-analysis of methotrexate use and risk of cardiovascular disease.
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DOI：
10.1016/j.amjcard.2011.06.054
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发表时间：
2011-11-01
影响因子：
2.8
通讯作者：
Mozaffarian, Dariush
中科院分区：
文献类型：
--
作者：
Micha, Renata;Imamura, Fumiaki;von Ballmoos, Moritz Wyler;Solomon, Daniel H.;Hernan, Miguel A.;Ridker, Paul M.;Mozaffarian, Dariush
炎症可预测心血管疾病（CVD）事件的风险，但直接靶向炎症的药物与CVD风险的关系尚未建立。甲氨蝶呤是一种缓解疾病的抗风湿药物，广泛用于治疗慢性炎症性疾病。我们对甲氨蝶呤与心血管疾病发生的关系进行了系统回顾和荟萃分析。如果队列、病例对照研究或随机试验报告了甲氨蝶呤与CVD风险之间的相关性，则将其纳入。独立裁定入选/排除，所有数据一式两份提取。采用逆方差加权荟萃分析计算合并效应。在识别的694篇出版物中，10项在类风湿性关节炎、银屑病或多发性关节炎患者中进行甲氨蝶呤给药的观察性研究符合入选标准。甲氨蝶呤与总CVD风险降低21%（n=10项研究，95%CI =0.73-0.87，p<0.001）和心肌梗死风险降低18%（n=5，95%CI =0.71-0.96，p=0.01）相关，没有证据表明研究间存在统计学异质性（分别为p=0.30，p=0.33）。在预先设定的异质性来源中，在调整基础疾病严重程度（RR=0.64，95% CI=0.43-0.96，p<0.01）和其他合并用药（RR=0.73，95% CI=0.63-0.84，p<0.001）的研究中观察到更强的相关性。发表偏倚可能很明显（漏斗图，Begg检验，p=0.06）;然而，排除具有极端风险估计的研究并没有改变结果（RR=0.81，95% CI=0.74-0.89）。总之，在慢性炎症患者中，甲氨蝶呤的使用与较低的CVD风险相关。这些发现表明，直接治疗炎症可能会降低CVD风险。
Inflammation predicts risk of cardiovascular disease (CVD) events, but the relation of drugs that directly target inflammation with CVD risk is not established. Methotrexate is a disease-modifying anti-rheumatic drug broadly used for treatment of chronic inflammatory disorders. We performed a systematic review and meta-analysis of evidence for relationships of methotrexate with CVD occurrence. Cohorts, case-control studies or randomized trials were included if they reported an association between methotrexate and CVD risk. Inclusions/exclusions were independently adjudicated, and all data were extracted in duplicate. Pooled effects were calculated using inverse-variance-weighted meta-analysis. Of 694 identified publications, 10 observational studies, in which methotrexate was administered among patients with rheumatoid arthritis, psoriasis, or polyarthritis met inclusion criteria. Methotrexate was associated with 21% lower risk of total CVD (n=10 studies, 95% CI=0.73-0.87, p<0.001), and 18% lower risk of myocardial infarction (n=5, 95% CI=0.71-0.96, p=0.01), without evidence for statistical between-study heterogeneity (p=0.30, p=0.33, respectively). Among prespecified sources of heterogeneity explored, stronger associations were observed in studies that adjusted for underlying disease severity (RR=0.64, 95% CI=0.43-0.96, p<0.01), and for other concomitant medication (RR=0.73, 95% CI=0.63-0.84, p<0.001). Publication bias was potentially evident (funnel plot, Begg’s test, p=0.06); excluding studies with extreme risk estimates did not, however, alter results (RR=0.81, 95% CI=0.74-0.89). In conclusion, methotrexate use is associated with lower risk of CVD among patients with chronic inflammation. These findings suggest that a direct treatment of inflammation may reduce CVD risk.
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影响因子：
37.8
作者：
Micha R;Wallace SK;Mozaffarian D
通讯作者：
Mozaffarian D
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
5.1
作者：
Hirshberg, B;Muszkat, M;Rubinow, A
通讯作者：
Rubinow, A
DOI：
10.1002/art.23935
发表时间：
2008-08-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Nadareishvili, Zurab;Michaud, Kaleb;Wolfe, Frederick
通讯作者：
Wolfe, Frederick
DOI：
10.1002/art.22094
发表时间：
2006-08-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Suissa, Samy;Bernatsky, Sasha;Hudson, Marie
通讯作者：
Hudson, Marie