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Remote ischaemic preconditioning versus no remote ischaemic preconditioning for vascular and endovascular surgical procedures
CONCLUSIONS: Overall, compared with no RIPC, RIPC probably leads to little or no difference in perioperative mortality, myocardial infarction, renal impairment, stroke, hospital stay, and operating time, and may lead to little or no difference in limb loss in people undergoing elective major vascular and endovascular surgery. Adequately powered and designed randomised studies are needed, focusing in particular on the clinical endpoints and patient-centred outcomes.PMID:36645250 | DOI:10.1002/14651858.CD008472.pub3
Source: Cochrane Database of Systematic Reviews - January 16, 2023 Category: General Medicine Authors: Fuxiang Liang Shidong Liu Guangzu Liu Hongxu Liu Bing Song Liang Yao Qi Wang Source Type: research

Antiplatelet agents and anticoagulants for hypertension
CONCLUSIONS: There is no evidence that antiplatelet therapy modifies mortality in patients with elevated BP for primary prevention. ASA reduced the risk of cardiovascular events and increased the risk of major bleeding events. Antiplatelet therapy with ASA probably reduces the risk of non-fatal and all cardiovascular events when compared to clopidogrel. Clopidogrel increases the risk of major bleeding events compared to ASA in patients with elevated BP for secondary prevention. There is no evidence that warfarin modifies mortality in patients with elevated BP for secondary prevention. The benefits and harms of the newer dr...
Source: Cochrane Database of Systematic Reviews - July 28, 2022 Category: General Medicine Authors: Eduard Shantsila Monika Kozie ł-Siołkowska Gregory Yh Lip Source Type: research

Calcium channel blockers versus other classes of drugs for hypertension
CONCLUSIONS: For the treatment of hypertension, there is moderate certainty evidence that diuretics reduce major cardiovascular events and congestive heart failure more than CCBs. There is low to moderate certainty evidence that CCBs probably reduce major cardiovascular events more than beta-blockers. There is low to moderate certainty evidence that CCBs reduced stroke when compared to angiotensin-converting enzyme (ACE) inhibitors and reduced myocardial infarction when compared to angiotensin receptor blockers (ARBs), but increased congestive heart failure when compared to ACE inhibitors and ARBs. Many of the differences ...
Source: Cochrane Database of Systematic Reviews - January 9, 2022 Category: General Medicine Authors: Jiaying Zhu Ning Chen Muke Zhou Jian Guo Cairong Zhu Jie Zhou Mengmeng Ma Li He Source Type: research

Renal denervation for resistant hypertension
CONCLUSIONS: In patients with resistant hypertension, there is low-certainty evidence that renal denervation does not improve major cardiovascular outomes and renal function. Conversely, moderate-certainty evidence exists that it may improve 24h ABPM and diastolic office-measured BP. Future trials measuring patient-centred instead of surrogate outcomes, with longer follow-up periods, larger sample size and more standardised procedural methods are necessary to clarify the utility of this procedure in this population.PMID:34806762 | DOI:10.1002/14651858.CD011499.pub3
Source: Cochrane Database of Systematic Reviews - November 22, 2021 Category: General Medicine Authors: Anna Pisano Luigi Francesco Iannone Antonio Leo Emilio Russo Giuseppe Coppolino Davide Bolignano Source Type: research

Calcium channel blockers versus other classes of drugs for hypertension
CONCLUSIONS: For the treatment of hypertension, there is moderate certainty evidence that diuretics reduce major cardiovascular events and congestive heart failure more than CCBs. There is low to moderate certainty evidence that CCBs probably reduce major cardiovascular events more than beta-blockers. There is low to moderate certainty evidence that CCBs reduced stroke when compared to angiotensin-converting enzyme (ACE) inhibitors and reduced myocardial infarction when compared to angiotensin receptor blockers (ARBs), but increased congestive heart failure when compared to ACE inhibitors and ARBs. Many of the differences ...
Source: Cochrane Database of Systematic Reviews - October 17, 2021 Category: General Medicine Authors: Jiaying Zhu Ning Chen Muke Zhou Jian Guo Cairong Zhu Jie Zhou Mengmeng Ma Li He Source Type: research

(Ultra-)long-acting insulin analogues for people with type 1 diabetes mellitus
CONCLUSIONS: Comparing insulin detemir with NPH insulin for T1DM showed lower risk of severe hypoglycaemia in favour of insulin detemir (moderate-certainty evidence). However, the 95% prediction interval indicated inconsistency in this finding. Both insulin detemir and insulin glargine compared with NPH insulin did not show benefits or harms for severe nocturnal hypoglycaemia. For all other main outcomes with overall low risk of bias and comparing insulin analogues with each other, there was no true beneficial or harmful effect for any intervention. Data on patient-important outcomes such as QoL, macrovascular and microvas...
Source: Cochrane Database of Systematic Reviews - March 4, 2021 Category: General Medicine Authors: Bianca Hemmingsen Maria-Inti Metzendorf Bernd Richter Source Type: research

Renin inhibitors versus angiotensin converting enzyme (ACE) inhibitors for primary hypertension.
CONCLUSIONS: For the treatment of hypertension, we have low certainty that renin inhibitors (RI) and angiotensin converting enzyme (ACE) inhibitors do not differ for all-cause mortality and myocardial infarction. We have low to moderate certainty that they do not differ for adverse events. Small reductions in blood pressure with renin inhibitors compared to ACE inhibitors are of low certainty.  More independent, large, long-term trials are needed to compare RIs with ACE inhibitors, particularly assessing morbidity and mortality outcomes, but also on blood pressure-lowering effect. PMID: 33089502 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - October 22, 2020 Category: General Medicine Authors: Wang GM, Li LJ, Tang WL, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.
CONCLUSIONS: We found there is probably little to no difference in total mortality and cardiovascular mortality between people with hypertension and cardiovascular disease treated to a lower compared to a standard blood pressure target. There may also be little to no difference in serious adverse events or total cardiovascular events. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on withdrawals due to adverse effects, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (135/85 mmHg or le...
Source: Cochrane Database of Systematic Reviews - September 8, 2020 Category: General Medicine Authors: Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L Tags: Cochrane Database Syst Rev Source Type: research

Chelation therapy for atherosclerotic cardiovascular disease.
CONCLUSIONS: There is currently insufficient evidence to determine the effectiveness or ineffectiveness of chelation therapy in improving clinical outcomes of people with atherosclerotic cardiovascular disease. More high-quality, randomised controlled trials are needed that assess the effects of chelation therapy on longevity and quality of life among people with atherosclerotic cardiovascular disease. PMID: 32367513 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - May 4, 2020 Category: General Medicine Authors: Villarruz-Sulit MV, Forster R, Dans AL, Tan FN, Sulit DV Tags: Cochrane Database Syst Rev Source Type: research

Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis in people with low surgical risk.
CONCLUSIONS: Our meta-analysis indicates that, in the short term, TAVI probably has little or no mortality difference compared to SAVR for severe AS in individuals with low surgical risk. Similarly, there is probably little or no difference in risk of stroke, MI, and cardiac death between the two approaches. TAVI may reduce the risk of rehospitalisation, but we are uncertain about the effects on LOS. TAVI reduces the risk of atrial fibrillation, AKI, and bleeding. However, this benefit is offset by the increased risk of PPM implantation. Long-term follow-up data are needed to further assess and validate these outcomes, esp...
Source: Cochrane Database of Systematic Reviews - December 19, 2019 Category: General Medicine Authors: Kolkailah AA, Doukky R, Pelletier MP, Volgman AS, Kaneko T, Nabhan AF Tags: Cochrane Database Syst Rev Source Type: research

Metformin for prevention or delay of type 2 diabetes mellitus and its associated complications in persons at increased risk for the development of type 2 diabetes mellitus.
CONCLUSIONS: Metformin compared with placebo or diet and exercise reduced or delayed the risk of T2DM in people at increased risk for the development of T2DM (moderate-quality evidence). However, metformin compared to intensive diet and exercise did not reduce or delay the risk of T2DM (moderate-quality evidence). Likewise, the combination of metformin and intensive diet and exercise compared to intensive diet and exercise only neither showed an advantage or disadvantage regarding the development of T2DM (very low-quality evidence). Data on patient-important outcomes such as mortality, macrovascular and microvascular diabe...
Source: Cochrane Database of Systematic Reviews - December 2, 2019 Category: General Medicine Authors: Madsen KS, Chi Y, Metzendorf MI, Richter B, Hemmingsen B Tags: Cochrane Database Syst Rev Source Type: research

Alpha-glucosidase inhibitors for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus.
CONCLUSIONS: AGI may prevent or delay the development of T2DM in people with IGT. There is no firm evidence that AGI have a beneficial effect on cardiovascular mortality or cardiovascular events. PMID: 30592787 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 28, 2018 Category: General Medicine Authors: Moelands SV, Lucassen PL, Akkermans RP, De Grauw WJ, Van de Laar FA Tags: Cochrane Database Syst Rev Source Type: research

Omega-6 fats for the primary and secondary prevention of cardiovascular disease.
CONCLUSIONS: This is the most extensive systematic assessment of effects of omega-6 fats on cardiovascular health, mortality, lipids and adiposity to date, using previously unpublished data. We found no evidence that increasing omega-6 fats reduces cardiovascular outcomes other than MI, where 53 people may need to increase omega-6 fat intake to prevent 1 person from experiencing MI. Although benefits of omega-6 fats remain to be proven, increasing omega-6 fats may be of benefit in people at high risk of MI. Increased omega-6 fats reduce serum total cholesterol but not other blood fat fractions or adiposity. PMID: 3048...
Source: Cochrane Database of Systematic Reviews - November 29, 2018 Category: General Medicine Authors: Hooper L, Al-Khudairy L, Abdelhamid AS, Rees K, Brainard JS, Brown TJ, Ajabnoor SM, O'Brien AT, Winstanley LE, Donaldson DH, Song F, Deane KH Tags: Cochrane Database Syst Rev Source Type: research

First-line drugs inhibiting the renin angiotensin system versus other first-line antihypertensive drug classes for hypertension.
CONCLUSIONS: All-cause death is similar for first-line RAS inhibitors and first-line CCBs, thiazides and beta-blockers. There are, however, differences for some morbidity outcomes. First-line thiazides caused less HF and stroke than first-line RAS inhibitors. First-line CCBs increased HF but decreased stroke compared to first-line RAS inhibitors. The magnitude of the increase in HF exceeded the decrease in stroke. Low-quality evidence suggests that first-line RAS inhibitors reduced stroke and total CV events compared to first-line beta-blockers. The small differences in effect on blood pressure between the different classe...
Source: Cochrane Database of Systematic Reviews - November 14, 2018 Category: General Medicine Authors: Chen YJ, Li LJ, Tang WL, Song JY, Qiu R, Li Q, Xue H, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

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