| cardiovascular disease | ||||
| DISEASE | INTERVENTION | COMPARISON | RESULTS | |
| N Engl J Med. 2018 Jun 13. doi: 10.1056/NEJMoa1800389. [Epub ahead of print] | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients |
The Use of
Mediterranean diet supplemented with extra-virgin olive oil, or with mixed nuts As Prevention, Primary |
Is better Than
simple advice to reduce dietary fat |
To reduce cardiovascular events (myocardial infarction, stroke, or cardiovascular death): medit. diet plus olive oil 3.8% VS medit. diet plus nuts 3.4% VS control group 4.4% | |
| N Engl J Med. 2019 01 24;380(4):347-357 | Randomized Controlled Trial, Multicenter Study | |||
| IN diabetes mellitus, type 2, patients with cardiovascular disease or at risk of |
The Use of
renal sodium-glucose cotransporter inhibitor, gliflozins, dapagliflozin, on top or in substitution of previous antidiabetes Tt As Treatment, Chronic |
Is equal Than
placebo |
To modify major adverse cardiovascular events, cardiovascular death, all-cause death or renal events. Hospitalization for heart failure was less frequent with dapagliflozin but genital infections and ketoacidosis were more frequent | |
| Heart. 2018 Mar 23. doi: 10.1136/heartjnl-2017-312571. [Epub ahead of print] | Systematic Review | |||
| IN therapeutics, adherence to drug treatment, cardiovascular disease |
The Use of
3 interventions: short message service, fixed-dose combination pill, community health worker intervention As Treatment, Acute |
Is better Than
usual care |
To improve medication adherence: 44% to 99% in the intervention groups VS 13% to 96% in usual care groups | |
| JAMA. 2006 Feb 8;295(6):655-66 | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention |
The Use of
intensive dietary intervention to reduce fat intake and increased intakes of vegetables, fruits, and grains As Prevention, Primary |
Is equal Than
providing diet-related education materials |
To reduce at 8 years coronary heart disease (0.64% both groups), stroke (0.27%), in spite of mild reductions in fat intake and blood lipids | |
| Cochrane Database Syst Rev. 2012;5:CD002137 | Systematic Review, Cochrane Review | |||
| IN atherosclerosis, cardiovascular disease, primary prevention |
The Use of
reduction of dietary saturated fat by partially replacing by unsaturatef fats As Prevention, Primary |
Is better Than
no modification of diet |
To modestly reduce cardiovascular events (RR 0.86) but not to reduce total or cardiovascular mortality | |
| Cochrane Database Syst Rev. 2013;1:CD004816 | Systematic Review, Cochrane Review | |||
| IN atherosclerosis, cardiovascular disease, primary prevention |
The Use of
statins As Prevention, Primary |
Is better Than
placebo |
To reduce all cause mortality (OR 0,86), and cardiovascilar death and events (OR 0,73 to 0,78), after at least 1 year of treatment | |
| Eur Heart J. 2018 Dec 17. doi: 10.1093/eurheartj/ehy813. | Meta-Analysis | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, all ages, all patients, diabetic and high cardiovascular risk patients |
The Use of
aspirin As Prevention, Primary |
Is worse Than
placebo |
To modify all-cause mortality or cardiovascular events (lower inicdence of myocardial infarction, but heterogeneous). Conversely, aspirin increased major bleeding (RR 1.5) and intracranial haemorrhage (RR 1.33) | |
| N Engl J Med. 2018 Oct 18;379(16):1499-1508 | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, healthy old patients |
The Use of
aspirin, 100 mg daily As Prevention, Primary |
Is worse Than
placebo |
To achieve any clinical benefit (composite of death, dementia or persistent physical disability 2.1%/year in both groups) and caused more major bleeding (3.8% aspirin VS 2.8% placebo) | |
| N Engl J Med. 2018 10 18;379(16):1519-1528 | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, healthy old patients |
The Use of
aspirin, 100 mg daily As Prevention, Primary |
Is worse Than
placebo |
To carry any benefit: it increased all-cause death (1.3 %/year aspirin VS 1.1%/year placebo, p significant), mainly caused by cancer. | |
| N Engl J Med. 2018 Oct 18;379(16):1529-1539. doi: 10.1056/NEJMoa1804988 | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, diabetes mellitus, type 2 |
The Use of
aspirin, 100 mg daily As Treatment, Chronic |
Is better Than
placebo |
To reduce at 7.4 years cardiovascular events (8.5% VS 9.5% placebo), but it increased major bleeding (4% aspirin VS 3% placebo), most of the excess being gastrointestinal bleeding and other extracranial bleeding. | |
| BMJ. 2014;349(iss):g4379 | Meta-Analysis | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol |
The Use of
drug treatments targeted to increase high density lipoprotein: niacin, fibrates, and cholesteryl ester transfer protein (CETP) inhibitors As Prevention, Primary |
Is equal Than
placebo or no treatment |
To modify cardiovascular events (all cause mortality, coronary heart disease mortality, non-fatal myocardial infarction, and stroke) | |
| JAMA. 2014 Sep 17;312(11):1136-44 | Systematic Review | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol, older patients |
The Use of
statins As Prevention, Primary |
Is undefined Than
no statin treatment |
To reduce cardiovascular events. No RCT in patients older than 80 years was found | |
| Lancet. 2002 Nov 23;360(9346):1623-30 | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, high cholesterol, older patients |
The Use of
statins, pravastatin 40 mg/d As Prevention, Primary |
Is better Than
placebo |
To to reduce at 3 years cardiovascular events: 14% pravastatine VS 16% placebo. Reduction was due to reduction in non-fatal myocardial infaction, no significant difference in stroke and death | |
| J Am Coll Cardiol. 2013 Dec 3;62(22):2090-9 | Meta-Analysis | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, older patients |
The Use of
statins As Prevention, Primary |
Is better Than
placebo |
To reduce myocardial infarction (RR 0.60) and stroke (RR 0.76) but it did not reduced mortality (either total or cardiovascular) | |
| N Engl J Med. 2016 May 26;374(21):2021-31 | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, intermediate risk patients, normal or high cholesterol |
The Use of
statins, rosuvastatin 10 mg/day for > 5 years As Prevention, Primary |
Is better Than
placebo |
To reduce cardiovascular events (cardiovascular death, nonfatal myocardial infarction or stroke) at 5.6 years: 3.7% rosuvastatin VS 4.8% placebo. No difference in mortality: 2.8-2.9% both. Muscle symptoms in 5.8% of patients on rosuvastatin. | |
| JAMA Intern Med. 2017 Jul 01;177(7):955-965 | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, low to moderate risk patients, older patients |
The Use of
statin, pravastatin, 40 mg/d As Prevention, Primary |
Is equal Than
usual care |
To modify, after 6 years, mortality or coronary disease | |
| N Engl J Med. 2008 Nov 20;359(21):2195-207 | Randomized Controlled Trial, Multicenter Study | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, normal cholesterol, elevated C-reactive protein |
The Use of
statins, rosuvastatin As Prevention, Primary |
Is better Than
placebo |
To reduce the incidence of major cardiovascular events at 2 years: 0.77% per year statin VS 1.4% per year placebo. | |
| Cochrane Database Syst Rev. 2018 07 18;7:CD003177 | Systematic Review, Cochrane Review | |||
| IN atherosclerosis, cardiovascular disease, primary prevention, secondary prevention |
The Use of
omega-3 fatty acids As Treatment, Chronic |
Is equal Than
placebo |
To polyunsaturated fatty acids from oily fish had little or no effect on mortality or cardiovascular health (high-quality evidence). Alpha-linolenic acid from plants may slightly reduce CVD events and mortality (low-quality evidence) | |
| JAMA. 2011 Mar 2;305(9):913-22 | Meta-Analysis | |||
| IN cardiovascular death, atherosclerosis, patients with a history of cardiovascular disease or diabetes but without hypertension |
The Use of
antihypertensive drugs, no information at all about which specific antihypertensive drugs were studied As Treatment, Chronic |
Is better Than
placebo |
To reduce stroke (RR 0.77, NNT 129), myocardial infarction (RR 0.80, NNT 75), heart failure (RR 0.85, NNT 23), and all-cause mortality (RR 0.87, NNT 75) | |
| JAMA. 2013 Sep 4;310(9):918-29 | Randomized Controlled Trial, Multicenter Study | |||
| IN cardiovascular disease |
The Use of
polypill, fixed-dose combinations of drugs, 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and 50 mg atenolol As Prevention, Primary |
Is better Than
usual care |
To improve medication adherence (86% polypill VS 65% usual) and statistically significant but small improvements in blood pressure and LDL-C | |
| Cochrane Database Syst Rev. 2014;4:CD009868 | Systematic Review, Cochrane Review | |||
| IN cardiovascular disease, cardiovascular death |
The Use of
polypill, fixed-dose combinations of drugs As Treatment, Chronic |
Is equal Than
Comparison to be defined |
To cardiovascular mortality and cardiovascular events. Reductions in blood pressure and lipid parameters are generally lower than those previously projected. | |
| N Engl J Med. 2008 Feb 7;358(6):580-91 | Randomized Controlled Trial | |||
| IN diabetes mellitus, type 2, microalbuminuria, cardiovascular disease |
The Use of
intensified multifactorial intervention: tight glucose control plus use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents (statins) As Treatment, Chronic |
Is better Than
usual (conventional) therapy |
To reduce, at 13 years, all-cause mortality (30% multifactorial Tt VS 50% usual Tt), cardiovascular events (HR 0.54) and advenced reanl disease. | |
| N Engl J Med. 2015 Nov 26;373(22):2117-28 | Randomized Controlled Trial, Multicenter Study | |||
| IN diabetes mellitus, type 2, patients with cardiovascular disease |
The Use of
renal sodium-glucose cotransporter inhibitor, gliflozins, empagliflozin, on top or in substitution of previous antidiabetes Tt As Treatment, Chronic |
Is better Than
placebo |
To reduce death from cardiovascular causes (3.7% empag VS 5.9% placebo), death from any cause (5.7% VS 8.3% placebo) and hospitalization for heart failure (2.7% VS 4.1% placebo) | |