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

• Main Authors: Liu D, Li X, Zhang Y, Kwong JSW, Li L, Xu C, Li Q, Sun X, Tian H, Li S
• Format: Article
• Language: English
• Published: Dove Medical Press 2018-06-01
• Series: Drug Design, Development and Therapy
• Subjects: Chloroquine; hydroxychloroquine; antimalarials; cardiovascular disease; systematic review
• Online Access: https://www.dovepress.com/chloroquine-and-hydroxychloroquine-are-associated-with-reduced-cardiov-peer-reviewed-article-DDDT

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 ClinicalTrials.gov 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