The Effects of Statins on Cardiovascular and Inflammatory Biomarkers in Primary Prevention: A Systematic Review and Meta-Analysis

William B He; Hiu T K Ko; Andrea J Curtis; Sophia Zoungas; Robyn L Woods; Andrew Tonkin; Johannes T Neumann; Simon L Turner; Ingrid Hopper

doi:10.1016/j.hlc.2023.04.300

The Effects of Statins on Cardiovascular and Inflammatory Biomarkers in Primary Prevention: A Systematic Review and Meta-Analysis

Heart Lung Circ. 2023 Aug;32(8):938-948. doi: 10.1016/j.hlc.2023.04.300. Epub 2023 Jun 7.

Authors

William B He¹, Hiu T K Ko², Andrea J Curtis², Sophia Zoungas², Robyn L Woods², Andrew Tonkin³, Johannes T Neumann⁴, Simon L Turner², Ingrid Hopper⁵

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Alfred Health, Melbourne, Vic, Australia. Electronic address: W.He@Alfred.org.au.
² School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
³ School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, Austin and Repatriation Medical Centre, Melbourne, Vic, Australia.
⁴ School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
⁵ School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of General Medicine, Alfred Health, Melbourne, Vic, Australia.

PMID: 37291001
DOI: 10.1016/j.hlc.2023.04.300

Abstract

Background: Statins are well-established for their treatment of cardiovascular disease (CVD) due to their cholesterol-lowering effects and potential anti-inflammatory properties. Although previous systematic reviews demonstrate that statins reduce inflammatory biomarkers in the secondary prevention of CVD, none examine their effects on cardiac and inflammatory biomarkers in a primary prevention setting.

Methods: We conducted a systematic review and meta-analysis to examine the effects of statins on cardiovascular and inflammatory biomarkers among individuals without established CVD. The biomarkers included are: cardiac troponin, N-terminal pro B-type natriuretic peptide (NT-proBNP), C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), soluble vascular cell adhesion molecule (sVCAM), soluble intercellular adhesion molecule (sICAM), soluble E-selectin (sE-selectin) and endothelin-1 (ET-1). A literature search was performed through Ovid MEDLINE, Embase and CINAHL Plus for randomised controlled trials (RCTs) published up to June 2021.

Results: Overall, 35 RCTs with 26,521 participants were included in our meta-analysis. Data was pooled using random effects models presented as standardised mean differences (SMD) with 95% confidence intervals (CI). Combining 36 effect sizes from 29 RCTs, statin use resulted in a significant reduction in CRP levels (SMD -0.61; 95% CI -0.91, -0.32; P<0.001). This reduction was observed for both hydrophilic (SMD -0.39; 95% CI -0.62, -0.16; P<0.001) and lipophilic statins (SMD -0.65; 95% CI -1.01, -0.29; P<0.001). There were no significant changes in serum concentrations of cardiac troponin, NT-proBNP, TNF-α, IL-6, sVCAM, sICAM, sE-selectin and ET-1.

Conclusion: This meta-analysis demonstrates that statin use reduces serum CRP levels in a primary prevention setting for CVD, with no clear effect on the other eight biomarkers studied.

Keywords: Cardiac biomarkers; Cardiovascular disease; Cytokines; Primary prevention; Statins; Troponin.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Biomarkers
Cardiovascular Diseases* / prevention & control
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / therapeutic use
Interleukin-6
Troponin
Tumor Necrosis Factor-alpha

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Interleukin-6
Tumor Necrosis Factor-alpha
Biomarkers
Troponin