scholarly journals Better Medications Adherence Lowers Cardiovascular Events, Stroke, and All-Cause Mortality Risk: A Dose-Response Meta-Analysis

2021 ◽  
Vol 8 (11) ◽  
pp. 146
Author(s):  
Mengying Liu ◽  
Guowei Zheng ◽  
Xiting Cao ◽  
Xinyu Chang ◽  
Ningning Zhang ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Dose Response ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Adherence Level ◽  
Cardiovascular Medication ◽  
Cerebrovascular Events ◽  
All Cause Mortality ◽  
Reduced Risk

Aims: We investigated the association between vascular medication adherence, assessed by different methods, and the risk of cardio-cerebrovascular events and all-cause mortality. Methods: A meta-analysis with a systematic search of PubMed, Web of Science, EMBASE, and Cochrane databases from inception date to 21 June 2021 was used to identify relevant studies that had evaluated the association between cardiovascular medication adherence levels and cardiovascular events (CVEs), stroke, and all-cause mortality risks. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects meta-analysis. Restricted cubic splines were used to model the dose-response association. Results: We identified 46 articles in the dose-response meta-analysis. The dose-response analysis indicated that a 20% increment in cardiovascular medication, antihypertensive medication, and lipid-lowering medication adherence level were associated with 9% (RR: 0.91, 95% CI 0.88–0.94), 7% (RR 0.93, 95% CI: 0.84–1.03), and 10% (RR 0.90, 95% CI: 0.88–0.92) lowers risk of CVEs, respectively. The reduced risk of stroke respectively was 16% (RR: 0.84, 95% CI: 0.81–0.87), 17% (RR 0.83, 95% CI: 0.78–0.89), and 13% (RR 0.87, 95% CI: 0.84–0.91). The reduced risk of all-cause mortality respectively was 10% (RR: 0.90, 95% CI: 0.87–0.92), 12% (RR 0.88, 95% CI: 0.82–0.94), and 9% (RR 0.91, 95% CI: 0.89–0.94). Conclusions: A better medication adherence level was associated with a reduced risk of cardio-cerebrovascular events and all-cause mortality.

scholarly journals Cardiovascular events and all-cause mortality in surgically or medically treated primary aldosteronism: A Meta-analysis

2021 ◽  
Vol 22 (1) ◽  
pp. 147032032110037
Author(s):  
Ying Jing ◽  
Kangla Liao ◽  
Ruolin Li ◽  
Shumin Yang ◽  
Ying Song ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Primary Aldosteronism ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Elevated Risk ◽  
Cochrane Library ◽  
Mineralocorticoid Receptor Antagonist ◽  
Primary Endpoints ◽  
All Cause Mortality ◽  
Reduced Risk

Objectives: To compare the effect of surgical or medical treatment on the risk of cardiovascular diseases (CVD) and all-cause mortality in patients with established primary aldosteronism (PA). Methods: We searched PUBMED, MEDLINE and Cochrane Library for the meta-analysis. We included patients who were diagnosed with PA following guideline-supported protocols and received surgery or mineralocorticoid receptor antagonist (MRA)-based medical treatment, and age-sex matched patients with treated essential hypertension (EH). Primary endpoints were CVD incidence and all-cause mortality. Results: Compared with EH, patients with treated PA had a higher risk of CVD [odds ratio (OR) 1.79; 95% confidence interval (CI) 1.39–2.31]. This elevated risk was only observed in patients with medically treated PA [OR 2.11; 95%CI 1.88–2.38] but not in those with surgically treated PA. The risk of all-cause mortality was significantly lower in patients with treated PA [OR 0.86; 95% CI 0.77–0.95] compared to EH. The reduced risk was only observed in patients with surgically treated PA [OR 0.47; 95% CI 0.34–0.66], but not in those with medically treated PA. Conclusions: Patients with medically treated PA have a higher risk of CVD compared to patients with EH. Surgical treatment of PA reduces the risk of CVD and all-cause mortality in patients with PA.

scholarly journals Does Testosterone Therapy Increase Risk of Cardiovascular Events among Men? A Meta-analysis

2018 ◽  
pp. 1-16
Author(s):  
Nader Makki ◽  
Wassef Karrowni
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
Meta Analysis ◽  
Ischemic Heart ◽  
Testosterone Therapy ◽  
Cerebrovascular Events ◽  
All Cause Mortality

Importance: There has been increasing interest in use of testosterone therapy (TT) beyond patients with hypogonadism to include younger men without documented hormone measurements for the purpose of improving libido, sexual function, bone density, and body mass. However, there is no conclusive data about safety of TT due to lack of adequately powered randomized clinical trials (RCTs) specifically designed for this purpose. Objective: To examine the overall risk of cardiovascular events associated with TT via meta-analysis of published randomized and observational studies. Data Sources: We searched MEDLINE, EMBASE, CINAHL, the Cochrane Controlled Trials Register and the National Institute of Health Clinical Trials.gov database from 1966 to 2014. Study Selection: Out of the initial 2,800 studies identified, we obtained a total of 34 studies for detailed analysis after applying our inclusion/exclusion criteria. Two reviewers used eligibility criteria to assess all titles, abstracts, and full texts and resolved disagreements by discussion. Data Extraction and Synthesis: One reviewer did data abstractions and quality assessments, which were confirmed by a second reviewer. Data were then collected and analyzed using random and fixed effect model, as appropriate. Risk estimates were extracted as adjusted hazard ratios (HRs) from included studies. Main Outcome and Measures: Association of TT with cardiovascular events as a primary endpoint and association of TT with ischemic heart disease, all-cause mortality and cerebrovascular events as secondary endpoints. Results: TT was associated with increased incidence of cardiovascular events (adjusted hazard ratio (HR) = 1.41, 95% CI = 1.19-1.67, p = 0.0004), all-cause mortality (adjusted HR = 1.29, 95% CI = 1.03-1.62, p = 0.02), and ischemic heart disease (adjusted HR=1.51, 95% CI = 1.05-2.18, p = 0.02) but there was no clear association with cerebrovascular events (adjusted HR=0.91, 95% CI = 0.66-1.25, p=0.54).  Subgroup analyses of our primary endpoint by study type (randomized versus observational studies) did not change our results (adjusted HR=1.40, 95% CI = 1.05-1.87, p = 0.02 and adjusted HR=1.54, 95% CI = 1.09-2.17, p = 0.01 respectively). Additional analysis using meta-regression and sensitivity analyses to account for factors such as history of prior CV events, indication for TT and duration of follow up did not change our results. However, we did notice lack of association between CV events and Intramuscular testosterone. Conclusions and Relevance: TT may be associated with an increased risk of all-cause mortality, cardiovascular events, and ischemic heart disease. These findings support the need for an adequately powered randomized study.  

scholarly journals Association Between Circulating Proprotein Convertase Subtilisin/Kexin Type 9 and Major Adverse Cardiovascular Events, Stroke, and All-Cause Mortality: Systemic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yimo Zhou ◽  
Weiqi Chen ◽  
Meng Lu ◽  
Yongjun Wang
Keyword(s):  
Dose Response ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
Systemic Review ◽  
Cochrane Library ◽  
Major Adverse Cardiovascular Events ◽  
Proprotein Convertase ◽  
Standard Deviation Increase ◽  
Increased Risk ◽  
All Cause Mortality

Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9), a pivotal protein in low-density lipoprotein cholesterol metabolism, has been validated to be an established target for cardiovascular (CV) risk reduction. Nevertheless, prospective studies concerning the associations between circulating PCSK9 and the risk of CV events and mortality have yielded, so far, inconsistent results. Herein, we conducted a meta-analysis to evaluate the association systemically.Methods: Pertinent studies were identified from PubMed, EMBASE, and Cochrane Library database through July 2020. Longitudinal studies investigating the value of circulating PCSK9 for predicting major adverse cardiovascular events (MACEs) or stroke or all-cause mortally with risk estimates and 95% confidence intervals (CI) were included in the analyses. Dose-response meta-analysis was also applied to evaluate circulating PCSK9 and risk of MACEs in this study.Results: A total of 22 eligible cohorts comprising 28,319 participants from 20 eligible articles were finally included in the study. The pooled relative risk (RR) of MACEs for one standard deviation increase in baseline PCSK9 was 1.120 (95% CI, 1.056–1.189). When categorizing subjects into tertiles, the pooled RR for the highest tertile of baseline PCSK9 was 1.252 (95% CI, 1.104–1.420) compared with the lowest category. This positive association between PCSK9 level and risk of MACEs persisted in sensitivity and most of the subgroup analyses. Twelve studies were included in dose-response meta-analysis, and a linear association between PCSK9 concentration and risk of MACEs was observed (x2 test for non-linearity = 0.31, P non-linearity = 0.575). No significant correlation was found either on stroke or all-cause mortality.Conclusion: This meta-analysis added further evidence that high circulating PCSK9 concentration significantly associated with increased risk of MACEs, and a linear dose-response association was observed. However, available data did not suggest significant association either on stroke or all-cause mortality. Additional well-designed studies are warranted to further investigate the correlations between PCSK9 concentration and stroke and mortality.

scholarly journals Influence of Statin Therapy on the Incidence of Cardiovascular Events, Cancer, and All-Cause Mortality in People Living With HIV: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Yanping Li ◽  
Zhandi Wang ◽  
Haimei Xia ◽  
Ju Zhang
Keyword(s):  
Cohort Studies ◽  
Statin Therapy ◽  
Cardiovascular Events ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
All Cause Mortality ◽  
Living With Hiv ◽  
Risk Of Cancer ◽  
Reduced Risk ◽  
Statin Use

Background: Possible influences of statin therapy on the risk of cardiovascular events, cancer, and all-cause mortality in people living with HIV (PLWH) remain unclear. We performed a meta-analysis to systematically evaluate the efficacy of statin in PLWH.Methods: Relevant cohort studies were retrieved via a search of the Medline, the Embase, and the Web of Science databases until June 14, 2021. The data were combined with a random-effects model by incorporating the between-study heterogeneity.Results: A total of 12 multivariate cohort studies with 162,252 participants were eligible for the meta-analysis and 36,253 (22.3%) of them were statin users. Pooled results showed that statin use was independently related to a reduced mortality risk in PLWH [adjusted risk ratio (RR): 0.56, 95% CI: 0.44 to 0.72, p < 0.001, I2 = 41%]. In addition, results of the meta-analysis showed that statin use was not significantly associated with a reduced risk of cardiovascular events in PLWH compared to the statin non-users (RR: 1.14, 95% CI: 0.80 to 1.63, p = 0.48, I2 = 42%). However, statin use was significantly related to a reduced risk of cancer in PLWH (RR: 0.73, 95% CI: 0.58 to 0.93, p = 0.009, I2 = 49%). Sensitivity analyses by excluding one study at a time showed consistent results. No significant publication biases were observed.Conclusion: Statin use is associated with reduced all-cause mortality in PLWH. In addition, statin use is related to a reduced risk of cancer, although the risk of cardiovascular events seems not significantly affected.

scholarly journals Lipid profile and prognosis in patients with coronary heart disease: a meta-analysis of prospective cohort studies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xiangmei Zhao ◽  
Dongying Wang ◽  
Lijie Qin
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cohort Studies ◽  
Lipid Profile ◽  
Prospective Cohort ◽  
Cardiac Death ◽  
Meta Analysis ◽  
Prospective Cohort Studies ◽  
All Cause Mortality ◽  
Reduced Risk

Abstract Background This meta-analysis based on prospective cohort studies aimed to evaluate the associations of lipid profiles with the risk of major adverse cardiovascular outcomes in patients with coronary heart disease (CHD). Methods The PubMed, Embase, and Cochrane Library electronic databases were systematically searched for prospective cohort study published through December 2019, and the pooled results were calculated using the random-effects model. Results Twenty-one studies with a total of 76,221 patients with CHD met the inclusion criteria. The per standard deviation (SD) increase in triglyceride was associated with a reduced risk of major adverse cardiovascular events (MACE). Furthermore, the per SD increase in high-density lipoprotein cholesterol (HDL-C) was associated with a reduced risk of cardiac death, whereas patients with lower HDL-C were associated with an increased risk of MACE, all-cause mortality, and cardiac death. Finally, the risk of MACE was significantly increased in patients with CHD with high lipoprotein(a) levels. Conclusions The results of this study suggested that lipid profile variables could predict major cardiovascular outcomes and all-cause mortality in patients with CHD.

scholarly journals Incidence, risk factors and prognostic effect of imaging right ventricular involvement in patients with COVID-19: a dose–response analysis protocol for systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049866
Author(s):  
Chenghui Zhou ◽  
Baohui Lou ◽  
Hui Li ◽  
Xin Wang ◽  
Hushan Ao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Right Ventricular ◽  
Dose Response ◽  
Meta Analysis ◽  
Adult Patients ◽  
Sensitivity Analyses ◽  
Prognostic Effect ◽  
All Cause Mortality ◽  
Incidence Risk

IntroductionEmerging evidence has shown that COVID-19 infection may result in right ventricular (RV) disturbance and be associated with adverse clinical outcomes. The aim of this meta-analysis is to summarise the incidence, risk factors and the prognostic effect of imaging RV involvement in adult patients with COVID-19.MethodsA systematical search will be performed in PubMed, EMBase, ISI Knowledge via Web of Science and preprint databases (MedRxiv and BioRxiv) (until October 2021) to identify all cohort studies in adult patients with COVID-19. The primary outcome will be the incidence of RV involvement (dysfunction and/or dilation) assessed by echocardiography, CT or MRI. Secondary outcomes will include the risk factors for RV involvement and their association with all-cause mortality during hospitalisation. Additional outcomes will include the RV global or free wall longitudinal strain (RV-GLS or RV-FWLS), tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and RV diameter. Univariable or multivariable meta-regression and subgroup analyses will be performed for the study design and patient characteristics (especially acute or chronic pulmonary embolism and pulmonary hypertension). Sensitivity analyses will be used to assess the robustness of our results by removing each included study at one time to obtain and evaluate the remaining overall estimates of RV involvement incidence and related risk factors, association with all-cause mortality, and other RV parameters (RV-GLS or RV-FWLS, TAPSE, S’, FAC and RV diameter). Both linear and cubic spline regression models will be used to explore the dose–response relationship between different categories (>2) of RV involvement and the risk of mortality (OR or HR).Ethics and disseminationThere was no need for ethics approval for the systematic review protocol according to the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital. This meta-analysis will be disseminated through a peer-reviewed journal for publication.PROSPERO registration numberCRD42021231689.

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