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Chloroquine and hydroxychloroquine are associated with reduced cardiovascular risk: a systematic review and meta-analysis

Authors Liu D, Li X, Zhang Y, Kwong JSW, Li L, Zhang Y, Xu C, Li Q, Sun X, Tian H, Li S

Received 3 March 2018

Accepted for publication 13 April 2018

Published 11 June 2018 Volume 2018:12 Pages 1685—1695


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Manfred Ogris

Dan Liu,1,* Xiaodan Li,2,* Yonggang Zhang,3 Joey Sum-Wing Kwong,4,5 Ling Li,6 Yiyi Zhang,1 Chang Xu,6 Qianrui Li,1 Xin Sun,6 Haoming Tian,1 Sheyu Li1,7

1Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China; 2Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, China; 3Center for Stem Cell Research and Application, Institute of Blood Transfusion, Chinese Academy of Medical Sciences & Peking Union Medical College, Chengdu 610052, China; 4Jockey Club School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong; 5Department of Clinical Epidemiology and Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan; 6Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China; 7Division of Molecular & Clinical Medicine, Ninewells Hospital, University of Dundee, Dundee, Scotland, UK

*These two authors contributed equally to this work

Background and aims: Chloroquine (CQ) and hydroxychloroquine (HCQ) are widely used in patients with rheumatic diseases, but their effects on the cardiovascular system remain unclear. We aimed to assess whether CQ/HCQ could reduce the risk of cardiovascular disease (CVD).
Materials and methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, and the for studies investigating the association between CQ/HCQ and the risk of CVD from inception to 20 December 2017. We carried out the quality assessment using the Newcastle-Ottawa Quality Assessment Scale (NOS). Random-effects model was used to pool the risk estimates relative ratio (RR), hazard ratio (HR) or odds ratio (OR) with 95% confidence interval (CI) for the outcomes.
Results: A total of 19 studies (7 case-control studies, 12 cohort studies, and no clinical trials) involving 19,679 participants were included in the meta-analysis. Pooled results for HRs or RRs showed that CQ/HCQ was associated with a significantly reduced risk of CVD (pooled RR 0.72, 95% CI 0.56–0.94, p=0.013). Results based on ORs showed a similar tendency towards a reduced risk of CVD with CQ/HCQ (pooled OR 0.41, 95% CI 0.25–0.69, p=0.001).
Conclusion: Our results suggested that CQ/HCQ was associated with a reduced risk of CVD in patients with rheumatic diseases. Randomized trials are needed to confirm the potential of CQ/HCQ in cardiovascular prevention in patients with and without rheumatic diseases.

Keywords: chloroquine, hydroxychloroquine, antimalarials, cardiovascular disease, atherosclerosis, drug repurpose and rheumatic diseases, systematic review

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