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Intermittent fasting for the prevention of cardiovascular disease.
CONCLUSIONS: Intermittent fasting was seen to be superior to ad libitum feeding in reducing weight. However, this was not clinically significant. There was no significant clinical difference between IF and CER in improving cardiometabolic risk factors to reduce the risk of CVD. Further research is needed to understand the safety and risk-benefit analysis of IF in specific patient groups (e.g. patients with diabetes or eating disorders) as well as the effect on longer-term outcomes such as all-cause mortality and myocardial infarction. PMID: 33512717 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - January 29, 2021 Category: General Medicine Authors: Allaf M, Elghazaly H, Mohamed OG, Fareen MFK, Zaman S, Salmasi AM, Tsilidis K, Dehghan A Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets in adults with hypertension.
CONCLUSIONS: For the general population of persons with elevated blood pressure, the benefits of trying to achieve a lower blood pressure target rather than a standard target (≤ 140/90 mm Hg) do not outweigh the harms associated with that intervention. Further research is needed to see if some groups of patients would benefit or be harmed by lower targets. The results of this review are primarily applicable to older people with moderate to high cardiovascular risk. They may not be applicable to other populations. PMID: 33332584 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - December 17, 2020 Category: General Medicine Authors: Arguedas JA, Leiva V, Wright JM Tags: Cochrane Database Syst Rev 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

Cerebrolysin for acute ischaemic stroke.
CONCLUSIONS: Moderate-quality evidence indicates that Cerebrolysin probably has little or no beneficial effect on preventing all-cause death in acute ischaemic stroke, or on the total number of people with serious adverse events. Moderate-quality evidence also indicates a potential increase in non-fatal serious adverse events with Cerebrolysin use. PMID: 32662068 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - July 13, 2020 Category: General Medicine Authors: Ziganshina LE, Abakumova T, Hoyle CH Tags: Cochrane Database Syst Rev Source Type: research

Withdrawal of antihypertensive drugs in older people.
CONCLUSIONS: There is no evidence of an effect of discontinuing compared with continuing antihypertensives used for hypertension or primary prevention of cardiovascular disease in older adults on all-cause mortality and myocardial infarction. The evidence was low to very low certainty mainly due to small studies and low event rates. These limitations mean that we cannot make any firm conclusions about the effect of deprescribing antihypertensives on these outcomes. Future research should focus on populations with the greatest uncertainty of the benefit:risk ratio for use of antihypertensive medications, such as those with ...
Source: Cochrane Database of Systematic Reviews - June 9, 2020 Category: General Medicine Authors: Reeve E, Jordan V, Thompson W, Sawan M, Todd A, Gammie TM, Hopper I, Hilmer SN, Gnjidic D 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

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

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.
CONCLUSIONS: We found no evidence of a difference in total mortality, serious adverse events, or total cardiovascular events between people with hypertension and cardiovascular disease treated to a lower or to a standard blood pressure target. This suggests that no net health benefit is derived from a lower systolic blood pressure target. We found very limited evidence on adverse events, which led to high uncertainty. At present, evidence is insufficient to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular disease. More trials are needed to examine this topic....
Source: Cochrane Database of Systematic Reviews - July 20, 2018 Category: General Medicine Authors: Saiz LC, Gorricho J, Garjón J, Celaya MC, Erviti J, Leache L Tags: Cochrane Database Syst Rev Source Type: research

Perioperative beta-blockers for preventing surgery-related mortality and morbidity.
CONCLUSIONS: According to our findings, perioperative application of beta-blockers still plays a pivotal role in cardiac surgery, as they can substantially reduce the high burden of supraventricular and ventricular arrhythmias in the aftermath of surgery. Their influence on mortality, AMI, stroke, congestive heart failure, hypotension and bradycardia in this setting remains unclear.In non-cardiac surgery, evidence shows an association of beta-blockers with increased all-cause mortality. Data from low risk of bias trials further suggests an increase in stroke rate with the use of beta-blockers. As the quality of evidence is...
Source: Cochrane Database of Systematic Reviews - March 13, 2018 Category: General Medicine Authors: Blessberger H, Kammler J, Domanovits H, Schlager O, Wildner B, Azar D, Schillinger M, Wiesbauer F, Steinwender C Tags: Cochrane Database Syst Rev Source Type: research

Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery.
CONCLUSIONS: Our review concludes that prophylactic α-2 adrenergic agonists generally do not prevent perioperative death or major cardiac complications. For non-cardiac surgery, there is moderate-to-high quality evidence that these agents do not prevent death, myocardial infarction or stroke. Conversely, there is moderate quality evidence that these agents have important adverse effects, namely increased risks of hypotension and bradycardia. For cardiac surgery, there is moderate quality evidence that α-2 adrenergic agonists have no effect on the risk of mortality or myocardial infarction, and that they increase the risk...
Source: Cochrane Database of Systematic Reviews - March 6, 2018 Category: General Medicine Authors: Duncan D, Sankar A, Beattie WS, Wijeysundera DN Tags: Cochrane Database Syst Rev Source Type: research

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease.
CONCLUSIONS: No evidence of a difference in total mortality and serious adverse events was found between treating to a lower or to a standard blood pressure target in people with hypertension and cardiovascular disease. This suggests no net health benefit from a lower systolic blood pressure target despite the small absolute reduction in total cardiovascular serious adverse events. There was very limited evidence on adverse events, which lead to high uncertainty. At present there is insufficient evidence to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular dis...
Source: Cochrane Database of Systematic Reviews - October 11, 2017 Category: General Medicine Authors: Saiz LC, Gorricho J, Garjón J, Celaya MC, Muruzábal L, Malón MDM, Montoya R, López A Tags: Cochrane Database Syst Rev Source Type: research

Pharmacotherapy for hypertension in adults aged 18 to 59 years.
CONCLUSIONS: Antihypertensive drugs used to treat predominantly healthy adults aged 18 to 59 years with mild to moderate primary hypertension have a small absolute effect to reduce cardiovascular mortality and morbidity primarily due to reduction in cerebrovascular mortality and morbidity. All-cause mortality and coronary heart disease were not reduced. There is lack of good evidence on withdrawal due to adverse events. Future trials in this age group should be at least 10 years in duration and should compare different first-line drug classes and strategies. PMID: 28813123 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - August 16, 2017 Category: General Medicine Authors: Musini VM, Gueyffier F, Puil L, Salzwedel DM, Wright JM Tags: Cochrane Database Syst Rev Source Type: research

Dipeptidyl-peptidase (DPP)-4 inhibitors and glucagon-like peptide (GLP)-1 analogues for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk for the development of type 2 diabetes mellitus.
CONCLUSIONS: There is no firm evidence that DPP-4 inhibitors or GLP-1 analogues compared mainly with placebo substantially influence the risk of T2DM and especially its associated complications in people at increased risk for the development of T2DM. Most trials did not investigate patient-important outcomes. PMID: 28489279 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 10, 2017 Category: General Medicine Authors: Hemmingsen B, Sonne DP, Metzendorf MI, Richter B Tags: Cochrane Database Syst Rev Source Type: research

Beta-blockers for hypertension.
CONCLUSIONS: Most outcome RCTs on beta-blockers as initial therapy for hypertension have high risk of bias. Atenolol was the beta-blocker most used. Current evidence suggests that initiating treatment of hypertension with beta-blockers leads to modest CVD reductions and little or no effects on mortality. These beta-blocker effects are inferior to those of other antihypertensive drugs. Further research should be of high quality and should explore whether there are differences between different subtypes of beta-blockers or whether beta-blockers have differential effects on younger and older people. PMID: 28107561 [PubMe...
Source: Cochrane Database of Systematic Reviews - January 19, 2017 Category: Journals (General) Authors: Wiysonge CS, Bradley HA, Volmink J, Mayosi BM, Opie LH Tags: Cochrane Database Syst Rev Source Type: research

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