The Effect of Sulodexide on the Incidence of Cardiovascular Outcomes in Patients With Vascular Disorders

Background and Objectives: Among patients with macrovascular and microvascular disease, we investigated the association between sulodexide and cardiovascular (CV) outcomes and adverse events. Methods: We conducted a meta-analysis of randomized control trials (RCTs) reporting CV outcomes and adverse events in patients with vascular disease receiving sulodexide for any indication versus control. The following outcomes were investigated: any CV event, myocardial infarction, CV death, bleeding events and gastrointestinal symptoms. Results: Twelve studies with a total of 8,436 patients were included. Sulodexide resulted in a significant reduction in CV events (OR 0.51 [95% confidence interval 0.41-0.73]; p<0.0001) and CV death (OR 0.63 [CI 0.48-0.81]; p = 0.0004). This effect was mainly related to a lower risk of CV events (OR 0.55, CI 0.41-0.73) and CV death (OR 0.60, CI 0.45-0.79) in the macrovascular disease arm. Similarly, patients with macrovascular disease on sulodexide had significantly lower rates of myocardial infarction (OR 0.68 CI 0.50-0.94; p = 0.02) compared to control. The effects of sulodexide were nonsignificant among patients with microvascular disease in terms of overall CV event, myocardial infarction and mortality reduction. The risk of bleeding and gastrointestinal adverse events was not significantly different between sulodexide and control. Conclusion: Sulodexide has a beneficial effect among patients with macrovascular disease in terms of reducing the risk for MI, overall CV mortality and CV events. Larger RCTs are needed to corroborate these findings. Keywords: Sulodexide, microvascular disease, macrovascular disease, cardiovascular outcomes