Abstract:

Objective To evaluate the safety of clopidogrel in combination with statins for acute coronary syndrome (ACS) under different cytochrome P450 enzyme metabolic pathways by Meta-analysis.Methods A computer retrieval was performed in several databases, as Wanfang Data, Chinese Bio-medicine Database, China National Knowledge Infrastructure, VIP database, Science Citation Index (SCI), Pubmed and Embase. The retrieval period from the library construction to April 2020. After evaluating the quality of these literatures, Meta-analysis was conducted by STATA 14.0 for these data.Results At last, 9 eligible papers included 11, 008 patients; of which, 7, 179 patients taking statins metabolized by CYP3A4 ( Atorvastatin and Simvastatin) and 3, 829 patients taking statins not metabolized by CYP3A4 (Rosuvastatin, Fluvastatin and Pravastatin).Meta-analysis demonstrated that Major Adverse Cardiac Events (MACE) were less frequent statin combined with clopidogrel in non-CYP3A4 metabolism than in CYP3A4 metabolism in Europe and America, with statistically significant difference between the two groups (P<0.05). However, there was no statistically significant difference between the two groups in Asian populations (P>0.05), of which, no statistically significant difference was also found in death, myocardial infarction and stroke (P>0.05).Conclusion A combination of statins non-CYP3A4 metabolite clopidogrel is capable of reducing the risk for MACE in European and American populations, but not in Asian populations.

Key words: acute coronary syndrome, clopidogrel, statin, major adverse cardiac events, CYP3A4, Meta-analysis