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Global cardiovascular risk assessment in the primary prevention of cardiovascular disease in adults: systematic review of systematic reviews
  1. Dylan R J Collins1,
  2. Alice C Tompson1,
  3. Igho J Onakpoya1,
  4. Nia Roberts2,
  5. Alison M Ward1,
  6. Carl J Heneghan1
  1. 1Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Oxford, UK
  2. 2Bodleian Health Care Libraries, University of Oxford, Oxford, UK
  1. Correspondence to Dylan R J Collins; dylan.collins{at}phc.ox.ac.uk

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.

  • total cardiovascular risk
  • risk score
  • primary prevention
  • cardiovascular risk assessment

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Footnotes

  • ▸ Additional material is available. To view please visit the journal online (http://dx.doi.org/10.1136/bmjopen-2016-013650).

  • Contributors DRJC conceived of the study, screened articles, extracted data, analysed the data and wrote the manuscript. ACT screened articles, extracted data, contributed to analysis and manuscript writing. IJO contributed to GRADE appraisal, analysis and manuscript writing. NR reviewed and contributed to the database search strategies. AMW contributed to the analysis and manuscript writing. CJH contributed to the methodological approach, the analysis and manuscript writing.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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