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PCSK9 monoclonal antibodies for the primary and secondary prevention of cardiovascular disease.
CONCLUSIONS: The evidence for the clinical endpoint effects of  evolocumab and alirocumab were graded as high. There is a strong evidence base to prescribe PCSK9 monoclonal antibodies to people who might not be eligible for other lipid-lowering drugs, or to people who cannot meet their lipid goals on more traditional therapies, which was the main patient population of the available trials.  The evidence base of PCSK9 inhibitors compared with active treatment is much weaker (low very- to low-certainty evidence) and it is unclear whether evolocumab or alirocumab might be effectively used as replacement therapies. Related...
Source: Cochrane Database of Systematic Reviews - October 20, 2020 Category: General Medicine Authors: Schmidt AF, Carter JL, Pearce LS, Wilkins JT, Overington JP, Hingorani AD, Casas JP Tags: Cochrane Database Syst Rev Source Type: research

Alcohol intake reduction for controlling hypertension.
CONCLUSIONS: An intervention for decreasing alcohol intake consumption did not result in differences in systolic and diastolic blood pressure when compared with a control intervention, although there was a reduction in alcohol intake favouring the active intervention. No differences were found either for overall mortality, cardiovascular mortality or cardiovascular events. No data on serious adverse events or quality of life were available to assess. Adequate randomised controlled trials are needed to provide additional evidence on this specific question. PMID: 32960976 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 20, 2020 Category: General Medicine Authors: Acin MT, Rueda JR, Saiz LC, Parent Mathias V, Alzueta N, Solà I, Garjón J, Erviti J Tags: Cochrane Database Syst Rev Source Type: research

Endovascular therapy versus medical treatment for symptomatic intracranial artery stenosis.
CONCLUSIONS: This systematic review provides moderate-quality evidence showing that ET, compared with CMT, in people with recent symptomatic severe intracranial atherosclerotic stenosis probably does not prevent recurrent stroke and appears to carry an increased hazard. The impact of delayed ET intervention (more than three weeks after a qualifying event) is unclear and may warrant further study. PMID: 32789891 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - August 10, 2020 Category: General Medicine Authors: Wang T, Luo J, Wang X, Yang K, Jadhav V, Gao P, Ma Y, Zhao N, Jiao L Tags: Cochrane Database Syst Rev Source Type: research

Metformin monotherapy for adults with type 2 diabetes mellitus.
CONCLUSIONS: There is no clear evidence whether metformin monotherapy compared with no intervention, behaviour changing interventions or other glucose-lowering drugs influences patient-important outcomes. PMID: 32501595 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - June 4, 2020 Category: General Medicine Authors: Gnesin F, Thuesen ACB, Kähler LKA, Madsbad S, Hemmingsen B Tags: Cochrane Database Syst Rev Source Type: research

Reduction in saturated fat intake for cardiovascular disease.
CONCLUSIONS: The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events. ...
Source: Cochrane Database of Systematic Reviews - May 18, 2020 Category: General Medicine Authors: Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS Tags: Cochrane Database Syst Rev Source Type: research

Screening strategies for hypertension.
CONCLUSIONS: There is an implicit assumption that early detection of hypertension through screening can reduce the burden of morbidity and mortality, but this assumption has not been tested in rigorous research studies. High-quality evidence from RCTs or programmatic evidence from NRCTs on the effectiveness and costs or harms of different screening strategies for hypertension (mass, targeted, or opportunistic) to reduce hypertension-related morbidity and mortality is lacking. PMID: 32378196 [PubMed - in process]
Source: Cochrane Database of Systematic Reviews - May 6, 2020 Category: General Medicine Authors: Schmidt BM, Durao S, Toews I, Bavuma CM, Hohlfeld A, Nury E, Meerpohl JJ, Kredo T Tags: Cochrane Database Syst Rev Source Type: research

Community pharmacy interventions for health promotion: effects on professional practice and health outcomes.
CONCLUSIONS: Health-promotion interventions in the community pharmacy context probably improve pharmacy workers' behaviour and probably have a slight beneficial effect on health-related behaviour, intermediate clinical outcomes, and quality of life for pharmacy users. Such interventions are likely to be cost-effective and the effects are seen across a range of clinical conditions and health-related behaviours. Nevertheless the magnitude of the effects varies between conditions, and more effective interventions might be developed if greater consideration were given to the theoretical basis of the intervention and mechanisms...
Source: Cochrane Database of Systematic Reviews - December 5, 2019 Category: General Medicine Authors: Steed L, Sohanpal R, Todd A, Madurasinghe VW, Rivas C, Edwards EA, Summerbell CD, Taylor SJ, Walton RT 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

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack.
CONCLUSIONS: Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular...
Source: Cochrane Database of Systematic Reviews - October 8, 2019 Category: General Medicine Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Metformin and second- or third-generation sulphonylurea combination therapy for adults with type 2 diabetes mellitus.
CONCLUSIONS: There is inconclusive evidence whether M+S combination therapy compared with metformin plus another glucose-lowering intervention results in benefit or harm for most patient-important outcomes (mortality, SAEs, macrovascular and microvascular complications) with the exception of hypoglycaemia (more harm for M+S combination). No RCT reported on health-related quality of life. PMID: 30998259 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 17, 2019 Category: General Medicine Authors: Madsen KS, Kähler P, Kähler LKA, Madsbad S, Gnesin F, 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

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

Diet, physical activity or both 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: There is no firm evidence that diet alone or physical activity alone compared to standard treatment influences the risk of T2DM and especially its associated complications in people at increased risk of developing T2DM. However, diet plus physical activity reduces or delays the incidence of T2DM in people with IGT. Data are lacking for the effect of diet plus physical activity for people with intermediate hyperglycaemia defined by other glycaemic variables. Most RCTs did not investigate patient-important outcomes. PMID: 29205264 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - December 4, 2017 Category: General Medicine Authors: Hemmingsen B, Gimenez-Perez G, Mauricio D, Roqué I Figuls M, Metzendorf MI, Richter B Tags: Cochrane Database Syst Rev Source Type: research

Peroxisome proliferator-activated receptor gamma agonists for preventing recurrent stroke and other vascular events in people with stroke or transient ischaemic attack.
CONCLUSIONS: Peroxisome proliferator-activated receptor gamma agonists probably reduce recurrent stroke and total events of cardiovascular death, non-fatal myocardial infarction or non-fatal stroke, and may improve insulin sensitivity and the stabilisation of carotid plaques. Their effects on adverse events are uncertain. Our conclusions should be interpreted with caution considering the small number and the quality of the included studies. Further well-designed, double-blind RCTs with large samples are required to assess the efficacy and safety of PPAR-γ agonists in the secondary prevention of stroke and related vascular...
Source: Cochrane Database of Systematic Reviews - December 2, 2017 Category: General Medicine Authors: Liu J, Wang LN Tags: Cochrane Database Syst Rev Source Type: research

Low glycaemic index diets for the prevention of cardiovascular disease.
CONCLUSIONS: There is currently no evidence available regarding the effect of low GI diets on cardiovascular disease events. Moreover, there is currently no convincing evidence that low GI diets have a clear beneficial effect on blood lipids or blood pressure parameters. PMID: 28759107 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - July 31, 2017 Category: General Medicine Authors: Clar C, Al-Khudairy L, Loveman E, Kelly SA, Hartley L, Flowers N, Germanò R, Frost G, Rees K Tags: Cochrane Database Syst Rev Source Type: research

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