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Clinical Psychology Review Dec 2013This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the... (Meta-Analysis)
Meta-Analysis Review
This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the prevalence of postpartum depressive episodes. A systematic review identified 37 randomized or quasi-randomized controlled trials in which an intervention was compared to a control condition. Differences between treatment and control conditions in the level of depressive symptoms and prevalence of depressive episodes by 6 months postpartum were assessed in separate analyses. Depressive symptoms were significantly lower at post-treatment in intervention conditions, with an overall effect size in the small range after exclusion of outliers (Hedges' g=0.18). There was a 27% reduction in the prevalence of depressive episodes in intervention conditions by 6 months postpartum after removal of outliers and correction for publication bias. Later timing of the postpartum assessment was associated with smaller differences between intervention and control conditions in both analyses. Among studies that assessed depressive symptoms using the EPDS, higher levels of depressive symptoms at pre-treatment were associated with smaller differences in depressive symptoms by 6 months postpartum. These findings suggest that interventions designed to prevent postpartum depression effectively reduce levels of postpartum depressive symptoms and decrease risk for postpartum depressive episodes.
Topics: Depression; Depression, Postpartum; Female; Humans; Psychotherapy; Treatment Outcome
PubMed: 24211712
DOI: 10.1016/j.cpr.2013.10.004 -
Journal of Athletic Training May 2019To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact).
OBJECTIVE
To evaluate sex differences in incidence rates (IRs) of anterior cruciate ligament (ACL) injury by sport type (collision, contact, limited contact, and noncontact).
DATA SOURCES
A systematic review was performed using the electronic databases PubMed (1969-January 20, 2017) and EBSCOhost (CINAHL, SPORTDiscus; 1969-January 20, 2017) and the search terms AND AND ( OR OR ).
STUDY SELECTION
Studies were included if they provided the number of ACL injuries and the number of athlete-exposures (AEs) by sex or enough information to allow the number of ACL injuries by sex to be calculated. Studies were excluded if they were analyses of previously reported data or were not written in English.
DATA EXTRACTION
Data on sport classification, number of ACL injuries by sex, person-time in AEs for each sex, year of publication, sport, sport type, and level of play were extracted for analysis.
DATA SYNTHESIS
We conducted IR and IR ratio (IRR) meta-analyses, weighted for study size and calculated. Female and male athletes had similar ACL injury IRs for the following sport types: collision (2.10/10 000 versus 1.12/10 000 AEs, IRR = 1.14, = .63), limited contact (0.71/10 000 versus 0.29/10 000 AEs, IRR = 1.21, = .77), and noncontact (0.36/10 000 versus 0.21/10 000 AEs, IRR = 1.49, = .22) sports. For contact sports, female athletes had a greater risk of injury than male athletes did (1.88/10 000 versus 0.87/10 000 AEs, IRR = 3.00, < .001). Gymnastics and obstacle-course races were outliers with respect to IR, so we created a sport category of fixed-object, high-impact rotational landing (HIRL). For this sport type, female athletes had a greater risk of ACL injury than male athletes did (4.80/10 000 versus 1.75/10 000 AEs, IRR = 5.51, < .001), and the overall IRs of ACL injury were greater than all IRs in all other sport categories.
CONCLUSIONS
Fixed-object HIRL sports had the highest IRs of ACL injury for both sexes. Female athletes were at greater risk of ACL injury than male athletes in contact and fixed-object HIRL sports.
Topics: Adolescent; Anterior Cruciate Ligament Injuries; Athletic Injuries; Female; Humans; Incidence; Male; Risk Assessment; Risk Factors
PubMed: 31009238
DOI: 10.4085/1062-6050-407-16 -
JAMA Neurology Nov 2020Delirium is associated with increased hospital costs, health care complications, and increased mortality. Long-term consequences of delirium on cognition have not been... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Delirium is associated with increased hospital costs, health care complications, and increased mortality. Long-term consequences of delirium on cognition have not been synthesized and quantified via meta-analysis.
OBJECTIVE
To determine if an episode of delirium was an independent risk factor for long-term cognitive decline, and if it was, whether it was causative or an epiphenomenon in already compromised individuals.
DATA SOURCES
A systematic search in PubMed, Cochrane, and Embase was conducted from January 1, 1965, to December 31, 2018. A systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-analyses was conducted. Search terms included delirium AND postoperative cognitive dysfunction; delirium and cognitive decline; delirium AND dementia; and delirium AND memory.
STUDY SELECTION
Inclusion criteria for studies included contrast between groups with delirium and without delirium; an objective continuous or binary measure of cognitive outcome; a final time point of 3 or more months after the delirium episode. The electronic search was conducted according to established methodologies and was executed on October 17, 2018.
DATA EXTRACTION AND SYNTHESIS
Three authors extracted data on individual characteristics, study design, and outcome, followed by a second independent check on outcome measures. Effect sizes were calculated as Hedges g. If necessary, binary outcomes were also converted to g. Only a single effect size was calculated for each study.
MAIN OUTCOMES AND MEASURES
The planned main outcome was magnitude of cognitive decline in Hedges g effect size in delirium groups when contrasted with groups that did not experience delirium.
RESULTS
Of 1583 articles, data subjected from the 24 studies (including 3562 patients who experienced delirium and 6987 controls who did not) were included in a random-effects meta-analysis for pooled effect estimates and random-effects meta-regressions to identify sources of study variance. One study was excluded as an outlier. There was a significant association between delirium and long-term cognitive decline, as the estimated effect size (Hedges g) for 23 studies was 0.45 (95% CI, 0.34-0.57; P < .001). In all studies, the group that experienced delirium had worse cognition at the final time point. The I2 measure of between-study variability in g was 0.81. A multivariable meta-regression suggested that duration of follow-up (longer with larger gs), number of covariates controlled (greater numbers were associated with smaller gs), and baseline cognitive matching (matching was associated with larger gs) were significant sources of variance. More specialized subgroup and meta-regressions were consistent with predictions that suggested that delirium may be a causative factor in cognitive decline.
CONCLUSIONS AND RELEVANCE
In this meta-analysis, delirium was significantly associated with long-term cognitive decline in both surgical and nonsurgical patients.
Topics: Brief Psychiatric Rating Scale; Cognitive Dysfunction; Delirium; Humans; Observational Studies as Topic; Risk Factors
PubMed: 32658246
DOI: 10.1001/jamaneurol.2020.2273 -
International Journal of Environmental... Sep 2021Napping in the workplace is under debate, with interesting results on work efficiency and well-being of workers. In this systematic review and meta-analysis, we aimed to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Napping in the workplace is under debate, with interesting results on work efficiency and well-being of workers. In this systematic review and meta-analysis, we aimed to assess the benefits of a short daytime nap on cognitive performance.
METHODS
PubMed, Cochrane Library, ScienceDirect and PsycInfo databases were searched until 19 August 2021. Cognitive performance in working-aged adults, both before and following a daytime nap or under control conditions (no nap), was analysed by time and by type of cognitive function (alertness, executive function and memory).
RESULTS
We included 11 studies (all in laboratory conditions including one with a subgroup in working conditions) for a total of 381 participants. Mean duration of nap was 55.4 ± 29.4 min. Overall cognitive performance did not differ at baseline (t0) between groups (effect size -0.03, 95% CI -0.14 to 0.07), and improved in the nap group following the nap (t1) (0.18, 0.09 to 0.27), especially for alertness (0.29, 0.10 to 0.48). Sensitivity analyses gave similar results comparing only randomized controlled trials, and after exclusion of outliers. Whatever the model used, performance mainly improved until 120 min after nap, with conflicting results during the sleep inertia period. Early naps in the afternoon (before 1.00 p.m.) gave better cognitive performance (0.24, -0.07 to 0.34). The benefits of napping were independent of sex and age. Duration of nap and time between nap and t1 did not influence cognitive performance.
CONCLUSIONS
Despite the fact that our meta-analyses included almost exclusively laboratory studies, daytime napping in the afternoon improved cognitive performance with beneficial effects of early nap. More studies in real work condition are warranted before implementing daytime napping at work as a preventive measure to improve work efficiency.
Topics: Adult; Attention; Circadian Rhythm; Cognition; Executive Function; Humans; Middle Aged; Sleep
PubMed: 34639511
DOI: 10.3390/ijerph181910212 -
Social Science & Medicine (1982) Jan 2022To review empirical studies that assess saturation in qualitative research in order to identify sample sizes for saturation, strategies used to assess saturation, and...
OBJECTIVE
To review empirical studies that assess saturation in qualitative research in order to identify sample sizes for saturation, strategies used to assess saturation, and guidance we can draw from these studies.
METHODS
We conducted a systematic review of four databases to identify studies empirically assessing sample sizes for saturation in qualitative research, supplemented by searching citing articles and reference lists.
RESULTS
We identified 23 articles that used empirical data (n = 17) or statistical modeling (n = 6) to assess saturation. Studies using empirical data reached saturation within a narrow range of interviews (9-17) or focus group discussions (4-8), particularly those with relatively homogenous study populations and narrowly defined objectives. Most studies had a relatively homogenous study population and assessed code saturation; the few outliers (e.g., multi-country research, meta-themes, "code meaning" saturation) needed larger samples for saturation.
CONCLUSIONS
Despite varied research topics and approaches to assessing saturation, studies converged on a relatively consistent sample size for saturation for commonly used qualitative research methods. However, these findings apply to certain types of studies (e.g., those with homogenous study populations). These results provide strong empirical guidance on effective sample sizes for qualitative research, which can be used in conjunction with the characteristics of individual studies to estimate an appropriate sample size prior to data collection. This synthesis also provides an important resource for researchers, academic journals, journal reviewers, ethical review boards, and funding agencies to facilitate greater transparency in justifying and reporting sample sizes in qualitative research. Future empirical research is needed to explore how various parameters affect sample sizes for saturation.
Topics: Data Collection; Focus Groups; Humans; Qualitative Research; Research Design; Sample Size
PubMed: 34785096
DOI: 10.1016/j.socscimed.2021.114523 -
Addiction (Abingdon, England) Jan 2023The ability to regulate emotions effectively has been associated with resilience to psychopathology. Individuals with substance use disorders (SUDs) have been shown to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIMS
The ability to regulate emotions effectively has been associated with resilience to psychopathology. Individuals with substance use disorders (SUDs) have been shown to have higher levels of negative emotionality, with some evidence suggesting impairment in emotion regulation compared with individuals without SUDs. However, no previous attempt has been made to systematically review the literature to assess the magnitude of this difference. We aimed to assess the association between SUD diagnosis and emotion regulation as measured by the Difficulties in Emotion Regulation Scale (DERS) and Emotion Regulation Questionnaire (ERQ) through a systematic review and meta-analysis of existing findings.
METHODS
The systematic review was conducted using PubMed, PsycINFO and Embase. We examined cross-sectional studies that compared a SUD group with a control group and measured emotion regulation using the DERS or the ERQ. The primary analysis focused on papers using the DERS, as this was the predominant instrument in the literature.
RESULTS
Twenty-two studies met our primary analysis criteria, representing 1936 individuals with a SUD and 1567 controls. Individuals with SUDs relative to controls had significantly greater DERS scores, with a mean difference of 21.44 [95% confidence interval (CI) = 16.49-26.40, P < 0.001] and Hedges' g = 1.05 (95% CI = 0.86-1.24, P < 0.001). The difference was robust, remaining significant after removing outliers and studies with high risk of bias. Individuals with SUDs demonstrated poorer emotion regulation on each subscale of the DERS, with the largest deficits in the Strategies and Impulse subscales. The ERQ analysis revealed greater use of expressive suppression in those with SUDs relative to controls (Hedges' g = 0.76, 95% CI = 0.25-1.28, P = 0.004).
CONCLUSIONS
People with substance use disorders appear to have greater difficulties in emotion regulation than people without substance use disorders.
Topics: Humans; Emotional Regulation; Cross-Sectional Studies; Substance-Related Disorders; Emotions; Surveys and Questionnaires
PubMed: 35851975
DOI: 10.1111/add.16001 -
Journal of Neuroengineering and... Jun 2021Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Approximately two thirds of stroke survivors maintain upper limb (UL) impairments and few among them attain complete UL recovery 6 months after stroke. Technological progress and gamification of interventions aim for better outcomes and constitute opportunities in self- and tele-rehabilitation.
OBJECTIVES
Our objective was to assess the efficacy of serious games, implemented on diverse technological systems, targeting UL recovery after stroke. In addition, we investigated whether adherence to neurorehabilitation principles influenced efficacy of games specifically designed for rehabilitation, regardless of the device used.
METHOD
This systematic review was conducted according to PRISMA guidelines (PROSPERO registration number: 156589). Two independent reviewers searched PubMed, EMBASE, SCOPUS and Cochrane Central Register of Controlled Trials for eligible randomized controlled trials (PEDro score ≥ 5). Meta-analysis, using a random effects model, was performed to compare effects of interventions using serious games, to conventional treatment, for UL rehabilitation in adult stroke patients. In addition, we conducted subgroup analysis, according to adherence of included studies to a consolidated set of 11 neurorehabilitation principles.
RESULTS
Meta-analysis of 42 trials, including 1760 participants, showed better improvements in favor of interventions using serious games when compared to conventional therapies, regarding UL function (SMD = 0.47; 95% CI = 0.24 to 0.70; P < 0.0001), activity (SMD = 0.25; 95% CI = 0.05 to 0.46; P = 0.02) and participation (SMD = 0.66; 95% CI = 0.29 to 1.03; P = 0.0005). Additionally, long term effect retention was observed for UL function (SMD = 0.42; 95% CI = 0.05 to 0.79; P = 0.03). Interventions using serious games that complied with at least 8 neurorehabilitation principles showed better overall effects. Although heterogeneity levels remained moderate, results were little affected by changes in methods or outliers indicating robustness.
CONCLUSION
This meta-analysis showed that rehabilitation through serious games, targeting UL recovery after stroke, leads to better improvements, compared to conventional treatment, in three ICF-WHO components. Irrespective of the technological device used, higher adherence to a consolidated set of neurorehabilitation principles enhances efficacy of serious games. Future development of stroke-specific rehabilitation interventions should further take into consideration the consolidated set of neurorehabilitation principles.
Topics: Activities of Daily Living; Adult; Humans; Recovery of Function; Stroke; Stroke Rehabilitation; Upper Extremity
PubMed: 34130713
DOI: 10.1186/s12984-021-00889-1 -
The Cochrane Database of Systematic... Nov 2014Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Fear of falling is common in older people and associated with serious physical and psychosocial consequences. Exercise (planned, structured, repetitive and purposive physical activity aimed at improving physical fitness) may reduce fear of falling by improving strength, gait, balance and mood, and reducing the occurrence of falls.
OBJECTIVES
To assess the effects (benefits, harms and costs) of exercise interventions for reducing fear of falling in older people living in the community.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2013), the Central Register of Controlled Trials (CENTRAL 2013, Issue 7), MEDLINE (1946 to July Week 3 2013), EMBASE (1980 to 2013 Week 30), CINAHL (1982 to July 2013), PsycINFO (1967 to August 2013), AMED (1985 to August 2013), the World Health Organization International Clinical Trials Registry Platform (accessed 7 August 2013) and Current Controlled Trials (accessed 7 August 2013). We applied no language restrictions. We handsearched reference lists and consulted experts.
SELECTION CRITERIA
We included randomised and quasi-randomised trials that recruited community-dwelling people (where the majority were aged 65 and over) and were not restricted to specific medical conditions (e.g. stroke, hip fracture). We included trials that evaluated exercise interventions compared with no intervention or a non-exercise intervention (e.g. social visits), and that measured fear of falling. Exercise interventions were varied; for example, they could be 'prescriptions' or recommendations, group-based or individual, supervised or unsupervised.
DATA COLLECTION AND ANALYSIS
Pairs of review authors independently assessed studies for inclusion, assessed the risk of bias in the studies and extracted data. We combined effect sizes across studies using the fixed-effect model, with the random-effect model used where significant statistical heterogeneity was present. We estimated risk ratios (RR) for dichotomous outcomes and incidence rate ratios (IRR) for rate outcomes. We estimated mean differences (MD) where studies used the same continuous measures and standardised mean differences (SMD) where different measures or different formats of the same measure were used. Where possible, we performed various, usually prespecified, sensitivity and subgroup analyses.
MAIN RESULTS
We included 30 studies, which evaluated 3D exercise (Tai Chi and yoga), balance training or strength and resistance training. Two of these were cluster-randomised trials, two were cross-over trials and one was quasi-randomised. The studies included a total of 2878 participants with a mean age ranging from 68 to 85 years. Most studies included more women than men, with four studies recruiting women only. Twelve studies recruited participants at increased risk of falls; three of these recruited participants who also had fear of falling.Poor reporting of the allocation methods in the trials made it difficult to assess the risk of selection bias in most studies. All of the studies were at high risk of performance and detection biases as there was no blinding of participants and outcome assessors and the outcomes were self reported. Twelve studies were at high risk of attrition bias. Using GRADE criteria, we judged the quality of evidence to be 'low' for fear of falling immediately post intervention and 'very low' for fear of falling at short or long-term follow-up and all other outcomes.Exercise interventions were associated with a small to moderate reduction in fear of falling immediately post intervention (SMD 0.37 favouring exercise, 95% confidence interval (CI) 0.18 to 0.56; 24 studies; 1692 participants, low quality evidence). Pooled effect sizes did not differ significantly between the different scales used to measure fear of falling. Although none of the sensitivity analyses changed the direction of effect, the greatest reduction in the size of the effect was on removal of an extreme outlier study with 73 participants (SMD 0.24 favouring exercise, 95% CI 0.12 to 0.36). None of our subgroup analyses provided robust evidence of differences in effect in terms of either the study primary aim (reduction of fear of falling or other aim), the study population (recruitment on the basis of increased falls risk or not), the characteristics of the study exercise intervention or the study control intervention (no treatment or alternative intervention). However, there was some weak evidence of a smaller effect, which included no reduction, of exercise when compared with an alternative control.There was very low quality evidence that exercise interventions may be associated with a small reduction in fear of falling up to six months post intervention (SMD 0.17, 95% CI -0.05 to 0.38; four studies, 356 participants) and more than six months post intervention (SMD 0.20, 95% CI -0.01 to 0.41; three studies, 386 participants).Very low quality evidence suggests exercise interventions in these studies that also reported on fear of falling reduced the risk of falling measured either as participants incurring at least one fall during follow-up or the number of falls during follow-up. Very low quality evidence from four studies indicated that exercise interventions did not appear to reduce symptoms of depression or increase physical activity. The only study reporting the effects of exercise interventions on anxiety found no difference between groups. No studies reported the effects of exercise interventions on activity avoidance or costs. It is important to remember that our included studies do not represent the totality of the evidence of the effect of exercise interventions on falls, depression, anxiety or physical activity as our review only includes studies that reported fear of falling.
AUTHORS' CONCLUSIONS
Exercise interventions in community-dwelling older people probably reduce fear of falling to a limited extent immediately after the intervention, without increasing the risk or frequency of falls. There is insufficient evidence to determine whether exercise interventions reduce fear of falling beyond the end of the intervention or their effect on other outcomes. Although further evidence from well-designed randomised trials is required, priority should be given to establishing a core set of outcomes that includes fear of falling for all trials examining the effects of exercise interventions in older people living in the community.
Topics: Accidental Falls; Aged; Aged, 80 and over; Exercise; Fear; Female; Humans; Independent Living; Male; Postural Balance; Randomized Controlled Trials as Topic; Resistance Training; Tai Ji; Yoga
PubMed: 25432016
DOI: 10.1002/14651858.CD009848.pub2 -
The American Journal of Sports Medicine Jul 2018There has been a surge in high-level studies investigating platelet-rich plasma (PRP) for tendon and ligament injuries. A number of meta-analyses have been published,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There has been a surge in high-level studies investigating platelet-rich plasma (PRP) for tendon and ligament injuries. A number of meta-analyses have been published, but few studies have focused exclusively on tendon and ligament injuries.
PURPOSE
To perform a meta-analysis assessing the ability of PRP to reduce pain in patients with tendon and ligament injuries.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of the literature was carried out in April 2017 using electronic databases PubMed, MEDLINE, and the Cochrane Library. Only level 1 studies were included. Platelet and leukocyte count, injection volume, kit used, participant age/sex, comparator, and activating agent used were recorded. The short-term and long-term efficacy of PRP was assessed using the visual analog scale (VAS) to measure pain intensity. Injury subgroups (rotator cuff, tendinopathy, anterior cruciate ligament, and lateral epicondylitis) were evaluated. Funnel plots and the Egger test were used to screen for publication bias, and sensitivity analysis was performed to evaluate the effect of potential outliers by removing studies one at a time.
RESULTS
Thirty-seven articles were included in this review, 21 (1031 participants) of which could be included in the quantitative analysis. The majority of studies published investigated rotator cuff injuries (38.1%) or lateral epicondylitis (38.1%). Seventeen studies (844 participants) reported short-term VAS data, and 14 studies (771 participants) reported long-term VAS data. Overall, long-term follow-up results showed significantly less pain in the PRP group compared with the control group (weighted mean difference [WMD], -0.84; 95% CI, -1.23 to -0.44; P < .01). Patients treated with PRP for rotator cuff injuries (WMD, -0.53; 95% CI, -0.98 to -0.09; P = .02) and lateral epicondylitis (WMD, -1.39; 95% CI, -2.49 to -0.29; P = .01) reported significantly less pain in the long term. Substantial heterogeneity was reported at baseline ( I = 72.0%; P < .01), short-term follow-up ( I = 72.5%; P < .01), long-term follow-up ( I = 76.1%; P < .01), and overall ( I = 75.8%; P < .01). The funnel plot appeared to be asymmetric, with some missingness at the lower right portion of the plot suggesting possible publication bias.
CONCLUSION
This review shows that PRP may reduce pain associated with lateral epicondylitis and rotator cuff injuries.
Topics: Anterior Cruciate Ligament; Anterior Cruciate Ligament Injuries; Humans; Pain; Platelet-Rich Plasma; Rotator Cuff; Rotator Cuff Injuries; Tendinopathy; Tennis Elbow; Treatment Outcome; Visual Analog Scale
PubMed: 29268037
DOI: 10.1177/0363546517743746 -
Circulation Oct 2019Randomized trials of therapies that primarily lowered triglycerides have not consistently shown reductions in cardiovascular events. (Meta-Analysis)
Meta-Analysis
Association Between Triglyceride Lowering and Reduction of Cardiovascular Risk Across Multiple Lipid-Lowering Therapeutic Classes: A Systematic Review and Meta-Regression Analysis of Randomized Controlled Trials.
BACKGROUND
Randomized trials of therapies that primarily lowered triglycerides have not consistently shown reductions in cardiovascular events.
METHODS
We performed a systematic review and trial-level meta-regression analysis of 3 classes of lipid-lowering therapies that reduce triglycerides to a greater extent than they do low-density lipoprotein cholesterol (LDL-C): fibrates, niacin, and marine-derived omega-3 fatty acids. Key inclusion criteria were a randomized controlled trial that reported major vascular events. We also incorporated data from a previous meta-regression of 25 statin trials. The main outcome measure was the risk ratio (RR) for major vascular events associated with absolute reductions in lipid parameters.
RESULTS
A total of 197 270 participants from 24 trials of nonstatin therapy with 25 218 major vascular events and 177 088 participants from 25 trials of statin therapy with 20 962 major vascular events were included, for a total of 374 358 patients and 46 180 major cardiovascular events. Starting with non-high-density lipoprotein cholesterol, a surrogate for very-low-density lipoproteins and low-density lipoproteins, the RR per 1-mmol/L reduction in non-high-density lipoprotein cholesterol was 0.79 (95% CI, 0.76-0.82; <0.0001; 0.78 per 40 mg/dL). In a multivariable meta-regression model that included terms for both LDL-C and triglyceride (surrogates for low-density lipoproteins and very-low-density lipoproteins, respectively), the RR was 0.80 (95% CI, 0.76-0.85; <0.0001) per 1-mmol/L (0.79 per 40 mg/dL) reduction in LDL-C and 0.84 (95% CI, 0.75-0.94; =0.0026) per 1-mmol/L (0.92 per 40 mg/dL) reduction in triglycerides. REDUCE-IT (Reduction of Cardiovascular Events With Icosapent Ethyl-Intervention Trial) was a significant outlier and strongly influential trial in the meta-regression. When removed, the RRs became 0.79 (95% CI, 0.76-0.83; <0.0001) per 1-mmol/L (0.78 per 40 mg/dL) reduction in LDL-C and 0.91 (95% CI, 0.81-1.006; =0.06) per 1-mmol/L (0.96 per 40 mg/dL) reduction in triglycerides. In regard to omega-3 dose, each 1 g/d eicosapentaenoic acid administered was associated with a 7% relative risk reduction in major vascular events (RR, 0.93 [95% CI, 0.91-0.95]; <0.0001), whereas there was no significant association between the dose of docosahexaenoic acid and the relative risk reduction in major vascular events (RR 0.96 [95% CI, 0.89-1.03]).
CONCLUSIONS
In randomized controlled trials, triglyceride lowering is associated with a lower risk of major vascular events, even after adjustment for LDL-C lowering, although the effect is less than that for LDL-C and attenuated when REDUCE-IT is excluded. Furthermore, the benefits of marine-derived omega-3 fatty acids, particularly high-dose eicosapentaenoic acid, appear to exceed their lipid-lowering effects.
Topics: Cardiovascular Diseases; Cholesterol, LDL; Fatty Acids, Omega-3; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Niacin; Randomized Controlled Trials as Topic; Risk; Triglycerides
PubMed: 31530008
DOI: 10.1161/CIRCULATIONAHA.119.041998