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Understanding treatment-subgroup effect in primary and secondary prevention of cardiovascular disease: An exploration using meta-analyses of individual patient data
VD. Torres Roldan, OJ. Ponce, M. Urtecho, GF. Torres, T. Belluzzo, V. Montori, C. Liu, F. Barrera, A. Diaz, L. Prokop, G. Guyatt, VM. Montori
Language English Country United States
Document type Journal Article, Meta-Analysis, Systematic Review
NLK
ProQuest Central
from 2003-01-01 to 2 months ago
Nursing & Allied Health Database (ProQuest)
from 2003-01-01 to 2 months ago
Health & Medicine (ProQuest)
from 2003-01-01 to 2 months ago
Health Management Database (ProQuest)
from 2003-01-01 to 2 months ago
Public Health Database (ProQuest)
from 2003-01-01 to 2 months ago
- MeSH
- Cardiovascular Diseases prevention & control MeSH
- Humans MeSH
- Primary Prevention methods standards MeSH
- Secondary Prevention methods standards MeSH
- Practice Guidelines as Topic * MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Systematic Review MeSH
BACKGROUND AND OBJECTIVE: Recommendations for preventing cardiovascular (CV) disease are currently separated into primary and secondary prevention. We hypothesize that relative effects of interventions for CV prevention are not different across primary and secondary prevention cohorts. Our aim was to test for differences in relative effects on CV events in common preventive CV interventions across primary and secondary prevention cohorts. METHODS AND RESULTS: A systematic search was performed to identify individual patient data (IPD) meta-analyses that included both primary and secondary prevention populations. Eligibility assessment, data extraction, and risk of bias assessment were conducted independently and in duplicate. We extracted relative risks (RR) with 95% confidence intervals (95% CI) of the interventions over patient-important outcomes and estimated the ratio of RR for primary and secondary prevention populations. We identified five eligible IPDs representing 524,570 participants. Quality assessment resulted in overall low-to-moderate methodological quality. We found no subgroup effect across prevention categories in any of the outcomes assessed. CONCLUSION: In the absence of significant treatment-subgroup interactions between primary and secondary CV prevention cohorts for common preventive interventions, clinical practice guidelines could offer recommendations tailored to individual estimates of CV risk without regard to membership to primary and secondary prevention cohorts. This would require the development of reliable ASCVD risk estimators that apply across both cohorts.
Department of Library Public Services Mayo Clinic Rochester MN USA
Internal Medicine Jablonec nad Nisou Hospital Jablonec nad Nisou Czech Republic
Knowledge and Evaluation Research Unit Mayo Clinic Rochester MN USA
McMaster University Hamilton Ontario Canada
School of Medicine Cayetano Heredia Peruvian University Lima Peru
References provided by Crossref.org
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- $a BACKGROUND AND OBJECTIVE: Recommendations for preventing cardiovascular (CV) disease are currently separated into primary and secondary prevention. We hypothesize that relative effects of interventions for CV prevention are not different across primary and secondary prevention cohorts. Our aim was to test for differences in relative effects on CV events in common preventive CV interventions across primary and secondary prevention cohorts. METHODS AND RESULTS: A systematic search was performed to identify individual patient data (IPD) meta-analyses that included both primary and secondary prevention populations. Eligibility assessment, data extraction, and risk of bias assessment were conducted independently and in duplicate. We extracted relative risks (RR) with 95% confidence intervals (95% CI) of the interventions over patient-important outcomes and estimated the ratio of RR for primary and secondary prevention populations. We identified five eligible IPDs representing 524,570 participants. Quality assessment resulted in overall low-to-moderate methodological quality. We found no subgroup effect across prevention categories in any of the outcomes assessed. CONCLUSION: In the absence of significant treatment-subgroup interactions between primary and secondary CV prevention cohorts for common preventive interventions, clinical practice guidelines could offer recommendations tailored to individual estimates of CV risk without regard to membership to primary and secondary prevention cohorts. This would require the development of reliable ASCVD risk estimators that apply across both cohorts.
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