The impact of statin-ezetimibe combination therapy versus statin monotherapy on coronary plaque regression in patients with acute coronary syndrome: a meta-analysis.

OBJECTIVE: To investigate the effects of statin monotherapy and statin-ezetimibe combination therapy on coronary plaque regression in acute coronary syndrome patients. METHODS: The systematic review was conducted from July to September 2022 and comprised search on PubMed, ScienceDirect and Cochrane databases to identify studies from January 2010 to July 2022 assessing the effects of statin-ezetimibe combination therapy versus statin monotherapy on coronary plaque regression in patients with acute coronary syndrome. The outcomes of interest were total atheroma volume, plaque volume, and percent atheroma volume assessed by intravascular ultrasound. Meta-analyses were performed on the studies, and mean differences with 95% confidence interval were estimated using Review Manager v5.4. RESULTS: Of the 730 studies identified, 12(1.64%) were shortlisted, and, of them, 5(41.7%) were analysed in detail. There were a total of 557 patients with a mean follow-up of 9 ± 2.43 months. The difference between baseline and follow-up showed significant lowering in total atheroma volume, plaque volume, and percent atheroma volume (p<0.05) in the patients who were receiving statin-ezetimibe combination therapy. CONCLUSIONS: Adding ezetimibe to statin medication was found to be significantly more successful in reducing coronary plaque than statin monotherapy.

New insight of the efficacy trimetazidine in patients with peripheral arterial disease: a meta-analysis.

BACKGROUND: This review aims to examine the impact of trimetazidine on skeletal muscle function in patients suffering from peripheral artery disease (PAD). METHODS: We searched for studies, both experimental and observational research, concerning the comparison of trimetazidine administration to placebo/standard of care in patients with PAD in PubMed, ScienceDirect, and Cochrane. Meta-analyses of the included studies were performed using Review Manager v5.4. Clinical parameters [ankle-brachial index (ABI) and maximum walking distance (MWD)] were analyzed. RESULTS: Three observational studies involving 378 participants with PAD satisfied predefined criteria. There was no substantial difference between the examined groups' on ABI (pre- and post-intervention) (MD = - 0.06 [- 0.19 to 0.07], p = 0.38, I2 = 90%). Meanwhile, MWD improvement was significantly higher (MD = 14.15 [6.05-22.25], p = 0.0006, I2 = 37%) in trimetazidine group than in the control group. CONCLUSIONS: Current evidence from our meta-analysis suggests the beneficial role of trimetazidine's anti-ischemic effect in PAD patients by improving MWD, while it has an insignificant influence on ABI.

Outcomes of optical coherence tomography guided percutaneous coronary intervention against angiography guided in patients with coronary artery disease: A systematic reviews and meta-analyses.

BACKGROUND: Previous studies compared optical coherence tomography (OCT) guided percutaneous coronary intervention (PCI) and angiography-guided was still limited. Therefore, we performed comprehensive meta-analyses to investigate the clinical outcomes of OCT-guided compared with angiography-guided PCI to provide a higher level of evidence. METHODS: A systematic search from electronic databases such as Pubmed, EMBASE, SpringerLink, and Cochrane Library was conducted to obtain original articles comparing OCT and angiography. Major adverse cardiac events (MACE), cardiovascular death, myocardial infarction (MI), stent thrombosis, target vessel revascularization, stenosis area, PCI procedure time, contrast volume, and procedural side effects were the measured outcomes. The primary end-points were MACE and cardiovascular death. RESULTS: Total 11 studies included 5814 patients were analyzed, with 3431 using OCT-guided and 2383 using angiography-guided. Pooled estimates of outcomes, presented as odds ratios (OR) [95% confidence intervals], were generated with random-effect models. Regarding clinical outcomes, OCT-guided PCI showed significantly lower rate of MACE (odds ratio [OR] 0.52, 95% confidence interval [CI] 0.38 to 0.72, p < 0.001), cardiovascular death (OR 0.47, 95% CI 0.33 to 0.67, p < 0.001), and higher contrast volume (OR 1.6, 95% CI 0.81 to 2.39, p < 0.001). OCT-guided has longer PCI procedure time (OR 2.42, 95% CI 1.33 to 4.42, p = 0.004). OCT-guided has no significant difference in lower risk of periprocedural MI (OR 0.59, 95% CI 0.35 to 1.00, p = 0.05), stent thrombosis (OR 0.69, 95% CI 0.2 to 2.43, p = 0.56), target vessel repeat revascularization (OR 0.74, 95% CI 0.47 to 1.14, p = 0.17), stenosis area (OR -0.63, 95% CI -1.5 to 0.25, p = 0.56), and adverse events related to procedures (OR 1.33, 95% CI 0.8 to 2.19, p = 0.27). CONCLUSION: Our meta-analysis demonstrated that OCT-guided PCI is significantly associated with lower MACE, cardiovascular death, and higher contrast volume. It is also associated with a longer duration of PCI. However, it is not associated with MI, stent thrombosis, target vessel revascularization, stenosis area, and adverse events related to procedures.

The effects of statin therapy on aneurysm size, growth rate, and matrix metalloproteinases-9 levels in patients with aortic aneurysm: a systematic review and meta-analysis.

BACKGROUND: Aortic aneurysm enlargement over time causes rupture, which frequently results in death. The family of proteases known as matrix metalloproteinases (MMP) is assumed to be proteolytic activity involved in the growth of aortic aneurysms. Statins are pleiotropic lipid-lowering medications with anti-inflammatory action. Statins can lower aneurysmal enlargement and MMP secretion, according to a number of studies, however the evidence is still up for debate. The purpose of this study is to assess how statins affect aortic aneurysm patient's aneurysm diameter size, growth rate, and MMP-9 levels. METHODS: From January 2000 to December 2022, electronic journal searches in PubMed, ScienceDirect, and Cochrane were conducted to discover papers evaluating the effects of statin treatment in patients with aortic aneurysm. Aneurysm diameter size, growth rate, and MMP-9 levels were the outcomes we were looking for. Meta-analyses were run on the included studies, and mean differences (MD) and 95% CIs were calculated with Review Manager v5.4. RESULTS: Our analysis includes a total of ten research. Statin medication substantially reduced aneurysm diameter size by 0.30 mm (P = 0.04; MD - 0.30; 95% CI - 0.58 to - 0.01) and growth rate by 0.34 mm/year (P < 0.00001; MD - 0.34; 95% CI - 0.40 to - 0.29) compared to placebo. There was no significant change in MMP-9 concentrations between individuals with aortic aneurysm who took a statin and those who did not. CONCLUSION: Overall, this meta-analysis demonstrates that statin medication is considerably helpful in reducing aneurysm diameter size and aneurysmal growth rate in individuals with aortic aneurysm.

The effect of progesteron for expression delta (δ) opioid receptor spinal cord through peripheral nerve injury.

BACKGROUND: Neuropathic pain is a major problem to date because of its high prevalence and lack of effective treatment. Neuropathic pain processes can be influenced by many factors and at various levels of the nervous system, including progesterone and the opioid system. The various mechanisms of the effect of progesterone on pain are still controversial, while the effect of progesterone on the activation of the opioid system also needs to be proven. This study aimed to determine the effect of progesterone on pain through the modulation mechanism of the opioid system. METHODS: This research is a completely randomized experimental study using male wistar rats aged around three months at the Experimental Animal Laboratory, Department of Medical Biochemistry, Faculty of Medicine, Airlangga University. RESULTS: The result was analyzed by using statistical analysis of two independent samples (t-test). The t value was obtained at 6.880, p = 0.000 (p < 0.05). CONCLUSION: It was shown that there was a significant difference in the delta (δ) opioid receptor expression between the control group and the progesterone group, which indicated that progesterone causes an increase in the delta (δ) opioid receptor expression in the spinal cord.

CYP2C19 polymorphism and coronary in-stent restenosis: A systematic review and meta-analysis.

Background: In-stent restenosis (ISR) remains a major drawback in coronary stenting. The association between the CYP2C19 loss of function (LOF) gene and the prevalence of ISR after coronary stenting remains controversial. Previous studies have produced conflicting results and have been limited by their small population sizes. We conducted this systematic review and meta-analysis to determine the association between the presence of the CYP2C19 LOF gene and the prevalence of ISR. Methods: A systematic online database search was performed until April 2021. The primary outcome was ISR and assessed using OR with 95% CI. Publication bias was assessed using the Newcastle Ottawa Scale. I 2 was applied to examine heterogeneities among the studies. Results: A total of 284 patients (four non-randomized controlled trial studies) were included in this study. Two hundred and six patients had wild-type genotypes, while 78 patients had the LOF genotype. Among the 78 patients with the LOF gene, 40 patients had an ISR. Meanwhile, of the 206 patients with a wild-type gene, 69 patients had an ISR. The LOF gene was associated with a higher risk of ISR (OR 95% CI = 2.84 [1.54-5.24], p = 0.0008). A major limitation in our study was the small number of previous studies and small sample sizes. Conclusions: Patients with LOF genes, regardless of the allele variation, treated with clopidogrel, had a higher risk of developing ISR after coronary stenting.