SYSTEMATIC REVIEW article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
Anti-inflammatory therapies to prevent cardiovascular events: systematic review and network meta-analysis of randomised controlled trials
Kevin Emery Boczar 1,2
Alexander L. Pearson 1
Ramtin Hakimjavadi 1
Sheojung Shin 1
Saba Shahab 1
Aishwarya Geejo 1
Sarah M. Visintini 1,3
Christopher A. Fehlmann 2,4
Kathryn Bezzina 5,6
Rob S. B. Beanlands 1
George A. Wells 1,2
1. University of Ottawa Heart Institute, Ottawa, Canada
2. University of Ottawa School of Epidemiology and Public Health, Ottawa, Canada
3. University of Ottawa Berkman Library, Ottawa, Canada
4. The Ottawa Hospital Research Institute, Ottawa, Canada
5. University of Pennsylvania Department of Medicine, Philadelphia, United States
6. Elisabeth Bruyere Hospital, Ottawa, Canada
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Background Anti-inflammatory therapies have been increasingly investigated for the reduction of cardiovascular (CV) events. The objective of this paper was to summarize and compare the relative effectiveness of anti-inflammatory medications for the reduction of CV events in patients with known coronary artery disease (CAD), either acute coronary syndromes (ACS) or stable CAD. Methods Systematic review and network meta-analysis of randomised controlled trials (RCTs) that included at least one anti-inflammatory treatment and involved patients with CAD. Databases searched: Medline, Embase, Cochrane Central Register of Controlled Trials, clinical trial registry websites, Europe PMC, and conference abstracts. Bayesian network meta-analysis was performed to calculate risk estimates using fixed-effects analyses in patients with ACS and stable CAD. Risk of bias assessments were performed using the Cochrane Risk of Bias 2 (RoB2) tool. Results 17,021 studies were screened; 41 met inclusion criteria. 29,487 patients were included in the ACS network and 41,791 in the stable CAD network. In the ACS network analysis, both non-steroidal anti-inflammatory drugs (OR: 0.30, 95% Credible Limits [CrI]: 0.11-0.74) and colchicine (OR: 0.77, CrI: 0.62-0.95) were associated with a significant reduction in major adverse cardiac events (MACE) compared to control. In the stable CAD analysis, both corticosteroids (OR: 0.44, 95% CrI: 0.26-0.72) and colchicine (OR: 0.65, CrI: 0.54-0.77) were associated with a significant reduction in MACE compared to control. Conclusions In patients with ACS, colchicine was associated with a reduction in MACE, while observed associations for NSAIDs were derived from sparse and predominantly indirect evidence. In patients with stable CAD, colchicine and corticosteroids were associated with a reduction in MACE, although these findings were informed largely by indirect comparisons.
Summary
Keywords
Acute Coronary Syndrome, anti-inflammatory, Coronary Artery Disease, Network meta-analyses, Therapeutics
Received
02 October 2025
Accepted
27 January 2026
Copyright
© 2026 Boczar, Pearson, Hakimjavadi, Shin, Shahab, Geejo, Visintini, Fehlmann, Bezzina, Beanlands and Wells. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ramtin Hakimjavadi
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.