Effectiveness of endurance exercise training in patients with coronary artery disease: A meta-analysis of randomised controlled trials

Aims. Acetylsalicylic acid (ASA) is widely used for the prevention of atherothrombotic events in patients with chronic coronary artery disease (CAD) and peripheral artery disease (PAD), but the risk of vascular events remains high. We aimed at identifying randomised controlled trials (RCTs) on antithrombotic treatments in patients with chronic CAD or PAD. Methods. Searches were conducted on MEDLINE, EMBASE, and CENTRAL on March 1st, 2018. This systematic review (SR) uses a narrative synthesis to summarize the evidence for the efficacy and safety of antiplatelet and anticoagulant therapies in the population of both chronic CAD or PAD patients. Results. Four RCTs from 27 publications were included. Study groups included 15,603 to 27,395 patients. ASA alone was the most extensively studied (n=3); other studies included rivaroxaban with or without ASA (n=1), vorapaxar alone (n=1), and clopidogrel with (n=1) or without ASA (n=1). Clopidogrel alone and clopidogrel plus ASA compared to ASA presented similar efficacy with comparable safety profile. Rivaroxaban plus ASA significantly reduced the risk of the composite of cardiovascular death, myocardial infarction, and stroke compared to ASA alone, although major bleeding with rivaroxaban plus ASA increased. Conclusion. There is limited and heterogeneous evidence on the prevention of atherothrombotic events in patients with chronic CAD or PAD. Clopidogrel alone and clopidogrel plus ASA did not demonstrate superiority over ASA alone. A combination of rivaroxaban plus ASA may offer significant additional benefit in reducing cardiovascular outcomes, yet it may increase the risk of bleeding, compared to ASA alone.

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GW24-e1838 Efficacy of folic acid supplementation alone on endothelial function and plasma homocysteine concentration in coronary artery disease: a meta-analysis of randomised controlled trials

Heart ◽

10.1136/heartjnl-2013-304613.432 ◽

2013 ◽

Vol 99 (Suppl 3) ◽

pp. A157.1-A157

Author(s):

Yi Xin ◽

Li Xiao Yan ◽

Jiang Xue Jun

Keyword(s):

Coronary Artery Disease ◽

Folic Acid ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Folic Acid Supplementation ◽

Plasma Homocysteine ◽

Controlled Trials ◽

Homocysteine Concentration ◽

Artery Disease ◽

Randomised Controlled

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Systematic review and network meta-analysis of randomised controlled trials of interventions for depressive symptoms in patients with coronary artery disease

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.184 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

F Doyle ◽

KE Freedland ◽

RM Carney ◽

P De Jonge ◽

C Dickens ◽

...

Keyword(s):

Coronary Artery Disease ◽

Depressive Symptoms ◽

Coronary Artery ◽

Meta Analysis ◽

Dropout Rate ◽

Evidence Base ◽

Controlled Trials ◽

Depression Treatments ◽

Artery Disease ◽

Randomised Controlled

Abstract Funding Acknowledgements Type of funding sources: None. Objective Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy. Methods We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8-weeks post-treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random effects network meta-analysis synthesized the evidence. GRADE was used to assess evidence quality. Results Thirty-three RCTs (7240 participants) provided analysable data. All treatments were equally acceptable. At 8-weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26-weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. GRADE ratings ranged from very low to low. Conclusions All treatments were equally acceptable, while antidepressants appeared to have the most robust evidence base for post-CAD depression. The evidence base was limited and biased; conclusions based on this literature should be drawn cautiously and considered to be tentative. Rigorous, multi-arm intervention trials, including trials of combination therapies and exercise, are urgently needed.

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