A Meta-Analysis of Essential Trace Elements in Patients with Coronary Heart Disease

Meta-analysis of Essential Trace Elements in CHD
Vol. 19 No. 1 : 2024 (1-24)

Megat Kamaruddin PSN Megat Kamaruddin PSN
Mohammed Nawi A Mohammed Nawi A
Ja’afar MH Ja’afar MH
Abd Malek AM Abd Malek AM
Yaman MN Yaman MN

Abstract
There is growing evidence that presence of essential trace elements that pose risk for coronary heart disease (CHD) patients. A meta-analysis was conducted on the levels of trace elements Copper (Cu), Zinc (Zn), Iron (Fe), Manganese (Mn), Cobalt (Co) and Chromium (Cr) in CHD patients. Eligible articles from the databases of Web of Science, Scopus, PubMed, EBSCOHost and Ovid were searched based on PRISMA guidelines. English articles published between 2011 to 2021 were included and analysed by descriptive statistics and RevMan 5.4. Quality assessment was assessed with Newcastle-Ottawa scale. There were six studies selected with 322 participants’ data. Trace elements Cu (SMD=-0.13, 95%CI=[-0.99, 0.73], I2=92%, p=0.77), Zn (SMD=-0.38, 95%CI=[-0.81, 0.06], I2=71%, p=0.09), Fe (SMD=0.47, 95%CI=[-1.19, 2.13], I2=97%, p=0.58) and Mn (SMD=0.11, 95%CI=[-0.11, 0.33], I2=0%, p=0.33) levels were not significant. Sensitivity analysis revealed significant Cu level among patients with CHD (SMD=-0.54, 95%CI=[-0.85, -0.22], I2=0%, p=0.0008) and Fe level among the controls (SMD=1.41, 95%CI=[0.08, 2.73], I2=95%, p=0.04). Whereas Co and Cr levels varied according to dietary and smoking behaviours. Overall quality assessment was medium-to-high quality. Elements Cu was found significant in CHD patients and Fe was found significant among the controls, while other findings were inconclusive.
Keywords : Coronary heart disease, essential trace elements, meta-analysis,
Abstrak
Terdapat bukti yang semakin meningkat bahawa kehadiran unsur surih penting yang menimbulkan risiko untuk pesakit penyakit jantung koronari (CHD). Meta-analisis telah dijalankan ke atas tahap unsur surih Kuprum (Cu), Zink (Zn), Besi (Fe), Mangan (Mn), Kobalt (Co) dan Kromium (Cr) dalam pesakit CHD. Artikel yang sesuai daripada pangkalan data Web of Science, Scopus, PubMed, EBSCOHost dan Ovid telah dicari berdasarkan garis panduan PRISMA. Artikel Bahasa Inggeris yang diterbitkan antara 2011 hingga 2021 disertakan dan dianalisis dengan statistik deskriptif dan RevMan 5.4. Penilaian kualiti dinilai dengan skala Newcastle-Ottawa. Terdapat enam kajian telah dipilih dengan 322 data peserta. Unsur surih Cu (SMD=-0.13, 95%CI=[-0.99, 0.73], I2=92%, p=0.77), Zn (SMD=-0.38, 95%CI=[-0.81, 0.06], I2= 71%, p=0.09), Fe (SMD=0.47, 95%CI=[-1.19, 2.13], I2=97%, p=0.58) dan Mn (SMD=0.11, 95%CI=[-0.11, 0.33 ], I2=0%, p=0.33) menunjukkan tahap tidak signifikan. Analisis sensitiviti mendedahkan tahap Cu yang ketara dalam kalangan pesakit dengan CHD (SMD=-0.54, 95%CI=[-0.85, -0.22], I2=0%, p=0.0008) dan tahap Fe antara kawalan (SMD=1.41, 95% CI=[0.08, 2.73], I2=95%, p=0.04). Dapatan kajian juga menunjukkan paras elemen-elemen surih Co dan Cr berbeza-beza mengikut tingkah laku pemakanan dan tabiat merokok. Penilaian kualiti  secara keseluruhan menunjukkan kadar kualiti yang sederhana tinggi. Dari analisis yang telah dijalankan, elemen surih Cu didapati signifikan pada pesakit jantung koronari dan elemen surih Fe didapati signifikan di kalangan kajian kawalan, manakala penemuan lain tidak menunjukkan hasil kajian yang muktamad. 
Kata Kunci : Meta-analisis, penyakit jantung koronari, unsur surih penting,

Correspondance Address
Mohamad Nurman Yaman, Department of Medical Education, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia. Tel: +603-9145 9433 Email: mdnurman@ppukm.ukm.edu.my