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

Abstract

Background and aimsChloroquine (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 methodsWe 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.ResultsA 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).ConclusionOur 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.

Chloroquine and hydroxychloroquine in the treatment of COVID-19 with or without diabetes: A systematic search and a narrative review with a special reference to India and other developing countries

“…Although there are sporadic case reports of chloroquineinduced cardiomyopathy and reversible heart failure in the literature, many studies and large meta-analysis conducted in patients with rheumatoid arthritis pointed to a reduced cardiovascular risk with both these compounds [40]. Nevertheless, since both the drug has potential to prolog QTc, a baseline ECG should be done in patients with established cardiovascular disease.…”

Challenges and cares to promote rational use of chloroquine and hydroxychloroquine in the management of coronavirus disease 2019 (COVID-19) pandemic: a timely review

“…Within lysosomes, HCQ is protonated and accumulates, inhibiting the action of lysosomal phospholipases, resulting in vacuolization of cardiac and skeletal muscle cells (Yogasundaram et al 2014). Liu et al (2018) performed a meta-analysis to investigate the effects of using CQ and HCQ in 16,679 (pooled) patients with rheumatic diseases, but their effects on the cardiomyopathy and neuromyopathy were not confirmed. Chatre et al (2018) examined cardiac complications attributed to CQ and HCQ in a systematic review of the literature and noted that CQ-or HCQ-related cardiac disorders were rare but severe adverse events occurred after long-term administration.…”

Hydroxychloroquine and QT prolongation: reassuring data in approved indications

“…Together with the comforting safety data for HCQ in rheumatic conditions, metabolic and cardiovascular benefits have been associated with its use in these approved indications [ 7 ]. Wide emphasis on the rare cardiac effects might induce unnecessary anxiety in patients taking HCQ at recommended doses for rheumatic conditions, in which good-quality evidence suggests reduced risk of cardiovascular disease [ 8 , 9 ]. Conversely, there is a known risk of flare related to HCQ withdrawal in patients with these approved indications.…”