Fixed-dose combination therapy for the prevention of cardiovascular disease
Angharad N de Cates,Matthew R. B. Farr,Nicola Wright,Morag C. Jarvis,Karen Rees,Shah Ebrahim,Mark D. Huffman +6 more
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TLDR
To determine the effectiveness of fixed-dose combination therapy on reducing fatal and non-fatal CVD events and on improving blood pressure and lipid CVD risk factors for both primary and secondary prevention of CVD, nine randomised controlled trials were found.Abstract:
Cardiovascular diseases (CVD), including heart attacks and strokes, are the leading cause of death and disability worldwide. Drug therapy with blood pressure and cholesterol lowering medications, particularly statins, have been proven to reduce the likelihood that individuals will experience a fatal or non-fatal cardiovascular event. Aspirin has also been proven to prevent heart attacks, certain types of strokes, and death in people with prior cardiovascular disease. The concept of fixed-dose combination therapy is to combine mulitple medications in a single pill as this has been shown to improve adherence in patients with high blood pressure and human immunodeficiency virus (HIV). There have been recent randomised controlled clinical trials to evaluate the effect of fixed-dose combination therapy for CVD prevention. The aim of this systematic review was to determine the effects of fixed-dose combination therapy on all-cause mortality, fatal and non-fatal CVD events, adverse events, blood pressure, lipids, discontinuation rates, quality of life, and costs for CVD prevention.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and EMBASE until 2013. We found nine randomised controlled trials of two-drug through to five-drug fixed-dose combination therapy with placebo, single drug active component, or usual care in 7047 patients, dating from 2009 to 2013. Trials were generally short-term, ranging from six weeks to 15 months, and included middle-age adults with and without prior CVD.
Compared with placebo, single drug active component, or usual care, the effects of fixed-dose combination therapy on all-cause mortality or CVD events were uncertain. However, the event rates for these outcomes were relatively uncommon, only two out of nine trials reported these outcomes, these trials were primarily designed to observed changes in CVD risk factor levels rather than clinical events, and the trials had a high risk of bias in at least one domain, suggesting that these results should not viewed with confidence. Of 1000 people treated with fixed-dose combination therapy during the study period, 297 (range 264 to 315) would experience a side effect compared with 242 people treated with placebo. Fixed-dose combination therapy was associated with lower systolic blood pressure (-7.05 mmHg, range -10.18 to -3.87) and total cholesterol (-0.75 mmol/L, range -1.05 to -0.46). However, there was a high degree of statistical heterogeneity in these comparisons so these results should be viewed with caution. Of 1000 patients treated with fixed-dose combination therapy during the study period, 140 (range 122 to 186) would discontinue the therapy compared with 115 patients treated with placebo. The effects on quality of life were uncertain, and no cost data were reported. Ongoing trials of fixed-dose combination therapy will likely inform these important endpoints.read more
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European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012)
Massimo Piepoli,Arno W. Hoes,Stefan Agewall,Christian Albus,Carlos Brotons,Alberico L. Catapano,Marie Therese Cooney,Ugo Corrà,Bernard Cosyns,Christi Deaton,Ian D. Graham,Michael Stephen Hall,FD Richard Hobbs,Maja Lisa Løchen,Herbert Löllgen,Pedro Marques-Vidal,Joep Perk,Eva Prescott,Josep Redon,Dimitrios J. Richter,Naveed Sattar,Y.M. Smulders,Monica Tiberi,H. Bart van der Worp,Ineke van Dis,W M Monique Verschuren +25 more
TL;DR: In this paper, a randomized clinical trial was conducted to evaluate the effect of preterax and Diamicron Modified Release Controlled Evaluation (MDE) on the risk of stroke.
Journal ArticleDOI
2016 European Guidelines on cardiovascular disease prevention in clinical practice
Massimo Piepoli,Arno W. Hoes,Stefan Agewall,Christian Albus,Carlos Brotons,Alberico L. Catapano,Marie Therese Cooney,Ugo Corrà,Bernard Cosyns,Christi Deaton,Ian D. Graham,Michael Stephen Hall,FD Richard Hobbs,Maja-Lisa Løchen,Herbert Löllgen,Pedro Marques-Vidal,Joep Perk,Eva Prescott,Josep Redon,Dimitrios J. Richter,Naveed Sattar,Yvo M. Smulders,Monica Tiberi,H. Bart van der Worp,Ineke van Dis,W. M. Monique Verschuren +25 more
TL;DR: ABI is ankle-brachial (blood pressure) index and ABPM is ambulatory blood pressure monitoring as mentioned in this paper ; ACCORD is action to control cardiovascular risk in Diabetes and Vascular disease.
Journal ArticleDOI
2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).
Massimo Piepoli,Arno W. Hoes,Stefan Agewall,Christian Albus,Carlos Brotons,Alberico L. Catapano,Marie-Therese Cooney,Ugo Corrà,Bernard Cosyns,Christi Deaton,Ian D. Graham,Michael Stephen Hall,F. D. Richard Hobbs,Maja-Lisa Løchen,Herbert Löllgen,Pedro Marques-Vidal,Joep Perk,Eva Prescott,Josep Redon,Dimitrios J. Richter,Naveed Sattar,Y.M. Smulders,Monica Tiberi,H. Bart van der Worp,Ineke van Dis,W M Monique Verschuren,Additional Contributor: Simone Binno,Guy De Backer,Marco Roffi,Victor Aboyans,Norbert Bachl,Héctor Bueno,Scipione Carerj,Leslie Cho,John Cox,Johan De Sutter,Günther Egidi,Miles Fisher,Donna Fitzsimons,Oscar H. Franco,Maxime Guenoun,Catriona Jennings,Borut Jug,Paulus Kirchhof,Kornelia Kotseva,Gregory Y.H. Lip,François Mach,Giuseppe Mancia,Franz Martin Bermudo,Alessandro Mezzani,Alexander Niessner,Piotr Ponikowski,Bernhard Rauch,Lars Rydén,Adrienne Stauder,Guillaume Turc,Olov Wiklund,Stephan Windecker,José Luis Zamorano +58 more
Journal ArticleDOI
2016 European Guidelines on cardiovascular disease prevention in clinical practice
Massimo Piepoli,Arno W. Hoes,Stefan Agewall,Christian Albus,Carlos Brotons,Alberico L. Catapano,Marie Therese Cooney,Ugo Corrà,Bernard Cosyns,Christi Deaton,Ian D. Graham,Michael Stephen Hall,FD Richard Hobbs,Maja-Lisa Løchen,Herbert Löllgen,Pedro Marques-Vidal,Joep Perk,Eva Prescott,Josep Redon,Dimitrios J. Richter,Naveed Sattar,Yvo M. Smulders,Monica Tiberi,H. Bart van der Worp,Ineke van Dis,W. M. Monique Verschuren +25 more
TL;DR: ABI is ankle-brachial (blood pressure) index and ABPM is ambulatory blood pressure monitoring as mentioned in this paper ; ACCORD is action to control cardiovascular risk in Diabetes and Vascular disease.
Journal ArticleDOI
Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many
TL;DR: It is now recognised that the prescribing of ‘many’ medicines can be entirely appropriate in patients with several chronic conditions and that the risks of adverse drug events that have been associated with polypharmacy may be greatly reduced when patients’ clinical context is taken into consideration.
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European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012)
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TL;DR: In this paper, a randomized clinical trial was conducted to evaluate the effect of preterax and Diamicron Modified Release Controlled Evaluation (MDE) on the risk of stroke.
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TL;DR: Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S2 The goals of the …
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