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. 2017 Mar 24;7(3):e013650.
doi: 10.1136/bmjopen-2016-013650.

Global cardiovascular risk assessment in the primary prevention of cardiovascular disease in adults: systematic review of systematic reviews

Dylan R J Collins  1 , Alice C Tompson  1 , Igho J Onakpoya  1 , Nia Roberts  2 , Alison M Ward  1 , Carl J Heneghan  1
Affiliations

Global cardiovascular risk assessment in the primary prevention of cardiovascular disease in adults: systematic review of systematic reviews

Dylan R J Collins et al. BMJ Open. .

Abstract

Objective: To identify, critically appraise and summarise existing systematic reviews on the impact of global cardiovascular risk assessment in the primary prevention of cardiovascular disease (CVD) in adults.

Design: Systematic review of systematic reviews published between January 2005 and October 2016 in The Cochrane Library, EMBASE, MEDLINE or CINAHL databases, and post hoc analysis of primary trials.

Participants, interventions, outcomes: Systematic reviews of interventions involving global cardiovascular risk assessment relative to no formal risk assessment in adults with no history of CVD. The primary outcomes of interest were CVD-related morbidity and mortality and all-cause mortality; secondary outcomes were systolic blood pressure (SBP), cholesterol and smoking.

Results: We identified six systematic reviews of variable but generally of low quality (mean Assessing the Methodological Quality of Systematic Reviews 4.2/11, range 0/11 to 7/11). No studies identified by the systematic reviews reported CVD-related morbidity or mortality or all-cause mortality. Meta-analysis of reported randomised controlled trials (RCTs) showed small reductions in SBP (mean difference (MD) -2.22 mm Hg (95% CI -3.49 to -0.95); I2=66%; n=9; GRADE: very low), total cholesterol (MD -0.11 mmol/L (95% CI -0.20 to -0.02); I2=72%; n=5; GRADE: very low), low-density lipoprotein cholesterol (MD -0.15 mmol/L (95% CI -0.26 to -0.05), I2=47%; n=4; GRADE: very low) and smoking cessation (RR 1.62 (95% CI 1.08 to 2.43); I2=17%; n=7; GRADE: low). The median follow-up time of reported RCTs was 12 months (range 2-36 months).

Conclusions: The quality of existing systematic reviews was generally poor and there is currently no evidence reported in these reviews that the prospective use of global cardiovascular risk assessment translates to reductions in CVD morbidity or mortality. There are reductions in SBP, cholesterol and smoking but they may not be clinically significant given their small effect size and short duration. Resources need to be directed to conduct high-quality systematic reviews focusing on hard patient outcomes, and likely further primary RCTs.

Trial registration number: CRD42015019821.

Keywords: cardiovascular risk assessment; primary prevention; risk score; total cardiovascular risk.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow diagram of included systematic reviews, primary studies and the outcomes reported.
Figure 2
Figure 2
Forest plot and meta-analysis of the mean difference of mean change in systolic blood pressure (mm Hg) from baseline to follow-up between intervention and control groups.
Figure 3
Figure 3
Forest plot and meta-analysis of the mean difference of mean change in total cholesterol (mmol/L) from baseline to follow-up between intervention and control group.
Figure 4
Figure 4
Forest plot and meta-analysis of the mean difference of mean change in LDL cholesterol (mmol/L) from baseline to follow-up between intervention and control group. LDL, low-density lipoprotein.
Figure 5
Figure 5
Forest plot and meta-analysis of the risk ratio of quitting smoking from baseline to follow-up between intervention and control group.
See this image and copyright information in PMC

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