Statins in adult patients with carotid artery disease: A protocol for a systematic review and network meta-analysis

Abstract

Introduction: Atherosclerosis is now widely recognized as a multifactorial disease with outcomes that arise from complex factors such as plaque components, blood fow, and infammation. Te locations most frequently afected by carotid atherosclerosis are the proximal internal carotid artery (ie, the origin) and the common carotid artery bifurcation. Terefore, the objective of the current study is to conduct a systematic review with network meta-analysis to compare the efects of statins classes on carotid disease (CD) patients. Methods and analysis: Randomized clinical trials (RCTs) and observational studies published in English up to 31 December 2018, and which include direct and/or indirect evidence, will be included. Studies will be retrieved by searching four electronic databases and cross-referencing. Dual selection and abstraction of data will occur. Te primary outcome will all-cause mortality, new event of acute myocardial infarction, stroke (hemorrhagic and ischemic), hospitalization for acute coronary syndrome and urgent revascularization procedures and cardiovascular mortality. Secondary outcomes will be assessment of Carotid artery intima-media thickness (IMT); atherosclerotic plaque, fow-mediated dilatation (FMD); pulse wave velocity (PWV), brachial-ankle pulse wave velocity (bc), ankle-brachial pressure index (ABI), carotid atherosclerosis and carotid plaque. Network meta-analysis will be performed using multivariate random-efects meta-regression models. Te surface under the cumulative ranking curve will be used to provide a hierarchy of statins that reduce cardiovascular mortality in CD patients. A revised version of the Cochrane Risk of Bias tool (RoB 2.0) will be used to assess the risk of bias in eligible RCTs. Results will be synthesized and analyzed using network meta-analysis (NMA). Overall strength of the evidence and publication bias will be evaluated.