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Effect of evidence-based therapy for secondary prevention of cardiovascular disease: Systematic review and
Tian-Tian Ma1, Ian C K Wong1,2, Kenneth K C Man1,2
1Research Department of Practice and Policy, UCL School of Pharmacy, London, United Kingdom.
Insights
Evidence-based combination pharmacotherapy (EBCP) significantly reduces mortality and cardiovascular events in patients with coronary heart disease or cerebrovascular disease. Optimal EBCP, using all four drug classes, provides the greatest risk reduction.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Public Health
Background:
- International guidelines recommend combination pharmacotherapy for cardiovascular disease prevention.
- Limited data exists on the effectiveness of evidence-based combination pharmacotherapy (EBCP).
Purpose of the Study:
- To evaluate the impact of EBCP on mortality and cardiovascular events.
- To assess EBCP in patients with coronary heart disease (CHD) or cerebrovascular disease.
Main Methods:
- Systematic search of EMBASE and Medline for cohort and case-control studies up to October 2018.
- Meta-analyses using random effects models to determine pooled risk ratios.
- Primary outcomes included all-cause mortality and major cardiovascular events.
Main Results:
- EBCP use was associated with a 40% reduction in all-cause mortality (RR 0.60).
- Significant reductions observed for vascular mortality (RR 0.70), myocardial infarction (RR 0.73), and cerebrovascular events (RR 0.79).
- Optimal EBCP (all 4 drug classes) showed the greatest benefit, reducing all-cause mortality by 50% (RR 0.50).
Conclusions:
- EBCP is effective in reducing mortality and cardiovascular events in patients with CHD or cerebrovascular disease.
- The benefits of EBCP are additive, with optimal therapy yielding the highest risk reduction.
- EBCP represents a crucial strategy for secondary cardiovascular disease prevention.
Background:
The combination pharmacotherapy of antiplatelet agents, lipid-modifiers, ACE inhibitors/ARBs and beta-blockers are recommended by international guidelines. However, data on effectiveness of the evidence-based combination pharmacotherapy (EBCP) is limited.
Objectives:
To determine the effect of EBCP on mortality and Cardiovascular events in patients with Coronary Heart Disease (CHD) or cerebrovascular disease.
Methods:
Publications in EMBASE and Medline up to October 2018 were searched for cohort and case-control studies on EBCP for the secondary prevention of cardiovascular disease. The main outcomes were all-cause mortality and major cardiovascular events. Meta-analyses were performed based on random effects models.
Results:
21 studies were included. Comparing EBCP to either monotherapy or no therapy, the pooled risk ratios were 0.60 (95% confidence interval 0.55 to 0.66) for all-cause mortality, 0.70 (0.62 to 0.79) for vascular mortality, 0.73 (0.64 to 0.83) for myocardial infarction and 0.79 (0.68 to 0.91) for cerebrovascular events. Optimal EBCP (all 4 classes of drug prescribed) had a risk ratio for all-cause mortality of 0.50 (0.40 to 0.64). This benefit became more dilute as the number of different classes of drug comprising EBCP was decreased-for 3 classes of drug prescribed the risk ratio was 0.58 (0.49 to 0.69) and for 2 classes, the risk ratio was 0.67 (0.60 to 0.76).
Conclusions:
EBCP reduces the risk of all-cause mortality and cardiovascular events in patients with CHD or cerebrovascular disease. The different classes of drugs comprising EBCP work in an additive manner, with optimal EBCP conferring the greatest benefit.
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