scholarly journals Effect of Uric Acid-Lowering Agents on Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

2021 ◽  
Vol 8 ◽  
Author(s):  
Hongxuan Xu ◽  
Yunqing Liu ◽  
Lingbing Meng ◽  
Li Wang ◽  
Deping Liu
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Uric Acid ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Pooled Analysis ◽  
Controlled Trials ◽  
Heart Failure Patients ◽  
All Cause Mortality ◽  
Randomised Controlled

Background: Elevated serum uric acid (SUA) level is considered an independent predictor of all-cause mortality and the combined endpoint of death or readmission in cardiovascular disease patients. However, the causal relationship between uric acid-lowering therapies (ULTs) and heart failure is still controversial.Design: Meta-analyses were performed to systematically compile available evidence to determine the overall effect of ULTs on heart failure patients.Method: We conducted this systematic review following the PRISMA statement guidelines. Databases were searched to identify randomised controlled trials related to the influence of a ULT intervention in people with heart failure. Data extracted from the included studies were subjected to a meta-analysis to compare the effects of ULTs to a control.Results: Pooled analysis of left ventricular ejection fraction (LEVF) showed an insignificant result towards the ULT group (MD, 1.63%; 95%CI, −1.61 to 4.88; p = 0.32; three studies). Pooled analysis of the 6-Minute Walk Test (6MWT) showed an insignificant result towards the ULT group (MD, 4.59; 95%CI, −12.683 to 22.00; p = 0.61; four studies). Pooled analysis of BNP/NT-pro-BNP led to a nearly statistically significant result towards the ULT group (SMD, −0.30; 95%CI, −0.64 to 0.04; p = 0.08; five studies). Pooled analysis of all-cause mortality and cardiovascular death between ULTs (all XOIs) and placebo did not show a significant difference (RR, 1.26; 95% CI, 0.74 to 2.15, p = 0.39).Conclusion: ULTs did not improve LVEF, BNP/NT-pro-BNP, 6MWT, all-cause mortality, and CV death in heart failure patients. UA may just be a risk marker of heart failure.

scholarly journals The Effects of Modified Simiao Decoction in the Treatment of Gouty Arthritis: A Systematic Review and Meta-Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-12 ◽  
Author(s):  
Ya-Fei Liu ◽  
Ying Huang ◽  
Cai-Yu-Zhu Wen ◽  
Jun-Jun Zhang ◽  
Guo-Lan Xing ◽  
...  
Keyword(s):  
Systematic Review ◽  
Uric Acid ◽  
Adverse Effects ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Gouty Arthritis ◽  
Mean Difference ◽  
Controlled Trials ◽  
Randomised Controlled ◽  
Anti Inflammation

The modified Simiao decoctions (MSD) have been wildly applied in the treatment of gouty arthritis in China. However, the evidence needs to be evaluated by a systematic review and meta-analysis. After filtering, twenty-four randomised, controlled trials (RCTs) comparing the effects of MSD and anti-inflammation medications and/or urate-lowering therapies in patients with gouty arthritis were included. In comparison with anti-inflammation medications, urate-lowering therapies, or coadministration of anti-inflammation medications and urate-lowering therapies, MSD monotherapy significantly lowered serum uric acid (p<0.00001, mean difference = −90.62, and 95% CI [−128.38, −52.86];p<0.00001, mean difference = −91.43, and 95% CI [−122.38, −60.49];p=0.02, mean difference = −40.30, and 95% CI [−74.24, −6.36], resp.). Compared with anti-inflammation medications and/or urate-lowering therapies, MSD monotherapy significantly decreased ESR (p<0.00001; mean difference = −8.11; 95% CI [−12.53, −3.69]) and CRP (p=0.03; mean difference = −3.21; 95% CI [−6.07, −0.36]). Additionally, the adverse effects (AEs) of MSD were fewer (p<0.00001; OR = 0.08; 95% CI [0.05, 0.16]). MSD are effective in the treatment of gouty arthritis through anti-inflammation and lowering urate. However, the efficacy of MSD should be estimated with more RCTs.

scholarly journals Effects of sodium‐glucose cotransporter type 2 inhibitors on cardiovascular, renal, and safety outcomes in patients with cardiovascular disease: a meta‐analysis of randomized controlled trials

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Caiyun Zheng ◽  
Meimei Lin ◽  
Yan Chen ◽  
Haiting Xu ◽  
Lingqun Yan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Sodium Glucose Cotransporter ◽  
All Cause Mortality ◽  
Safety Outcomes ◽  
Randomised Controlled

Abstract Background Controlled studies and observational studies have shown that sodium-glucose cotransporter type 2 inhibitors (SGLT-2i) are beneficial for the survival of patients with heart failure (HF). However, it is unclear whether SGLT-2i can provide benefit in patients with other cardiovascular diseases. Here, we conducted a systematic review and meta-analysis to determine the outcomes of cardiovascular, renal, and safety outcomes of SGLT-2i administration in patients with cardiovascular diseases. Methods We searched PubMed, EMBASE, Cochrane Library, Web of Science databases, and ClinicalTrials.gov databases for randomised controlled trials written in English from inception until November 1, 2020. Two reviewers independently identified randomised controlled trials comparing the effects of SGLT-2i in patients with cardiovascular disease with or without diabetes. Primary outcomes were cardiovascular outcomes and renal outcomes. Secondary outcomes were safety outcomes, including adverse endocrine outcomes and adverse infection outcomes. The effects of SGLT-2i were evaluated using RevMan5.3 software. The Cochrane risk of bias tool was used to assess study quality. Results We identified 10 randomised controlled trials (25,108 patients in the SGLT-2i group and 18,574 patients in the placebo group). Meta-analysis revealed that SGLT-2i treatment significantly reduced all-cause mortality, cardiovascular mortality, and hospitalisation for heart failure (HHF) in patients with cardiovascular disease (all-cause mortality relative risk [RR]: 0.86; 95% confidence interval [CI] 0.81–0.91; P < 0.00001; I2 = 0%; cardiovascular mortality RR: 0.85; 95% CI 0.79–0.92; P < 0.0001; I2 = 26%; HHF RR: 0.69; 95% CI 0.64–0.81; P < 0.00001; I2 = 0%). In patients with HF, mortality and HHF after SGLT-2i treatment for HF with reduced ejection fraction were significantly reduced, whereas HF with preserved ejection fraction did not differ compared with placebo treatment. Moreover, SGLT-2i induced a lower incidence of renal damage and myocardial infarction than the placebo group; however, the risk of infection, amputation, volume depletion, and diabetic ketoacidosis was higher. Conclusions SGLT-2i had significant clinical effects on cardiovascular outcomes and significantly influenced acute kidney injury. The effects of SGLT-2i on cardiovascular disease were independent of diabetic status. Sotagliflozin could have advantages over other SGLT-2i in lowering HHF.

scholarly journals 1339 Haemoglobin Threshold for Red Blood Cell Transfusion in Traumatic Brain Injury. A Systematic Review and Meta-Analysis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Anwar ◽  
A Bakhsh ◽  
S Manieanan ◽  
M khan
Keyword(s):  
Systematic Review ◽  
Brain Injury ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Red Blood Cell Transfusion ◽  
Controlled Trials ◽  
All Cause Mortality ◽  
Randomised Controlled

Abstract Background Traumatic Brain Injury (TBI) is a significant and growing worldwide healthcare burden. Minimising brain hypoxia is important in preventing secondary brain injury. Anaemia is common in TBI patients but there is little evidence as to which haemoglobin (Hb) threshold transfusion should be considered in TBI patients. Objective This present systematic review and meta-analysis of randomised controlled trials aims to assess the effect of high verses low red blood cell transfusion thresholds on functional outcomes and quality of life in TBI patients. Method We searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and Web of Science up to June 2020. We also searched clinical trial registers, conference proceedings, and reference lists from previous systematic reviews and included studies. We included randomised studies comparing high verses low Hb threshold for red blood cell transfusion in TBI patients. We assessed the following major outcomes: all-cause mortality, transfusion related adverse events and favourable outcome (Glasgow Outcome Scale, GOS). Results We included 3 RCTs involving 311 participants. Our analysis showed no difference in all-cause mortality (3-6 months) (OR 1.17 (95% CI 0.64 to 2.13)) and no difference in GOS (OR 1.10 (95% CI 0.65 to 1.85)) between transfusing red blood cells at 7g/dL or at 9/10g/dL in moderate to severe TBI. Conclusions There is no difference between a high and a low Hb threshold transfusion policy. However, considering the limitations in current evidence there is a need for future high quality randomised controlled trials.

scholarly journals Effect of Sodium-Glucose Cotransporter Type 2 Inhibitors on Clinical Outcomes in Patients With Cardiovascular Disease: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Author(s):  
Caiyun Zheng ◽  
Meimei Lin ◽  
Yan Chen ◽  
Haiting Xu ◽  
Lingqun Yan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Cardiovascular Mortality ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Volume Depletion ◽  
Sodium Glucose Cotransporter ◽  
All Cause Mortality ◽  
Randomised Controlled

Abstract BackgroundControlled studies and observational studies have shown that sodium-glucose cotransporter type 2 inhibitors (SGLT-2s) are beneficial to the mortality of patients with heart failure (HF). However, it is unclear whether SGLT-2s can benefit patients with other cardiovascular diseases. Here, we conducted a systematic review and meta-analysis to determine the clinical benefits of SGLT-2s in cardiovascular patients with or without diabetes.MethodsWe searched PubMed, EMBASE, Cochrane Library, Web of Science databases, and ClinicalTrials.gov databases for randomised controlled trials written in English from inception until November 1, 2020. Two reviewers independently identified randomised controlled trials comparing the effects of SGLT-2s in patients with cardiovascular disease with or without diabetes. Primary outcomes were all-cause mortality, cardiovascular mortality, and hospitalisation for heart failure. Secondary outcomes were major adverse events from cardiovascular, metabolic, renal, and infectious diseases. The effects of SGLT-2s were evaluated using RevMan5.3 software. The Cochrane risk of bias tool was used to assess study quality.ResultsWe identified 10 randomised controlled trials (24500 patients in the SGLT-2 group and 17960 patients in the placebo group). Meta-analysis showed that SGLT-2 treatment significantly reduced all-cause mortality, cardiovascular mortality, and hospitalisation for heart failure (HHF) in patients with cardiovascular disease (all-cause mortality relative risk [RR]: 0.86; 95% confidence interval [CI]: 0.80–0.91; P < 0.00001; I2 = 11%; cardiovascular mortality RR: 0.85; 95% CI: 0.79–0.92; P < 0.0001; I2 = 35%; HHF RR: 0.69; 95% CI: 0.64–0.81; P < 0.00001; I2 = 0%). In patients with heart failure, mortality and HHF after SGLT-2 treatment for heart failure with reduced ejection fraction were significantly reduced, whereas heart failure with preserved ejection fraction did not differ compared with placebo treatment. Moreover, SGLT-2s induced a lower incidence of renal damage and myocardial infarction than the placebo group; however, the risk of infection, amputation, volume depletion, and diabetic ketoacidosis was higher. ConclusionsIn this exploratory analysis, SGLT-2s had significant clinical effects in the treatment of patients with cardiovascular disease and had significant benefits in terms of renal function and myocardial infarction, but were associated with increased risk of infection, ketoacidosis, amputation, and volume depletion.

scholarly journals Comparative effectiveness of exercise training program in patients with heart failure: protocol for a systematic review of randomised controlled trials and network meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043160
Author(s):  
Min Gao ◽  
Yangxi Huang ◽  
Qianyi Wang ◽  
Zejuan Gu ◽  
Guozhen Sun
Keyword(s):  
Heart Failure ◽  
Systematic Review ◽  
Comparative Effectiveness ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Exercise Interventions ◽  
Exercise Rehabilitation ◽  
Randomised Controlled

IntroductionHeart failure (HF) is an end-stage of numerous heart diseases including hypertension, coronary heart disease and arrhythmia, in which the heart is unable to perform its circulatory function with sufficient efficiency due to structural or functional dysfunction (systolic or diastolic alterations). Strategies such as exercise rehabilitation may improve cardiac function, exercise capacity and health-related quality of life and reduce anxiety and depression in patients with HF. However, the relative effectiveness as well as the hierarchy of exercise interventions have not been well established, although various exercise options are available. Therefore, this protocol proposes to conduct a network meta-analysis (NMA) aiming to compare the effectiveness of different types of exercise training in patients with HF.Methods and analysisPubMed, Embase and the Cochrane Library will be searched from inception to March 2021 for relevant randomised controlled trials. Other resources, such as Google Scholar and Clinical Trials.gov will also be considered. Studies assessing exercise rehabilitation in patients with HF will be selected. Two independent reviewers will identify eligible trials. The PEDro risk of bias assessment tool will be used to assess the quality of the included studies. Bayesian NMA will be used when possible to determine the comparative effectiveness of the different exercise interventions. The mean ranks and surface will estimate the ranking probabilities for the optimal intervention of various treatments under the cumulative ranking curve. Subgroup, sensitivity and meta-regression will be conducted to explain the included studies’ heterogeneity if possible. We will also use the Grading of Recommendations, Assessment, Development, and Evaluation system to assess the strength of evidence.Ethics and disseminationThis systematic review and NMA will synthesise evidence on the effectiveness of the different exercises in patients with HF. The results will be submitted to a peer-reviewed journal. No ethical approval will be required because the data used for the review will be exclusively extracted from published studies.PROSPERO registration numberCRD42020165870.

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