Strategies for cardiovascular prevention by evidence based medicine

Costanzo, Pierluigi

Medicine
April 2015

Thesis or dissertation


Rights
© 2015 Pierluigi Costanzo. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
Abstract

Cardiovascular prevention aims to early identify patients at higher risk of developing a cardiovascular event, Prompt identification and treatment of those can potentially reduce the risk of events to occur.

The purpose of this study was to assess the efficacy of drug therapy in primary and secondary cardiovascular prevention using the evidence based medicine approach.

In the first part of this thesis, the focus is on the role of two main surrogate end points for cardiovascular events, for which the prognostic role is still unclear (serial measurement of carotid intimamedia thickness (IMT) and left ventricular hypertrophy (LVH)).

In the second part, the efficacy of drug therapy strategies for cardiovascular events prevention is assessed for three topics lacking of clear evidence:
1) Calcium Channel Blockers (CCBs) and clinical outcomes
2) The role of Ace Inhibitors (ACE-Is) vs Angiotensin Receptor Blockers (ARBs) in patients without left ventricular systolic dysfunction
3) The efficacy of statin therapy in primary prevention according to the gender.

Literature review was performed by collecting all the articles relevant to the objectives of the study. A meta-regression analysis was performed to test the relationship between serial IMT or LVH changes and clinical outcomes. A meta-analysis was performed to calculate the overall estimates of effect of ACE-Is vs ARBs in patients without heart failure, of CCBs in hypertension or coronary artery disease and of statins in primary prevention according to gender. A publication bias test and sensitivity analysis were also performed.

The results showed that neither carotid IMT or LVH change predict the risk of cardiovascular events.

Furthermore, CCBs reduced the risk of myocardial infarction and were more effective than ACE-Is in preventing stroke, however they are possibly less effective than other medications in preventing heart failure.

In patients without heart failure, ARBs were not as effective as ACE-is in reducing cardiovascular outcomes.

Finally, statins in primary prevention of coronary heart disease appeared more effective in men than in women.

Publications portfolio:

Journal of the American College of Cardiology; 2010; 56:2006-20: http://www.sciencedirect.com/science/article/pii/S0735109710040507

International journal of cardiology; 2013; 167:2757-64: http://www.sciencedirect.com/science/article/pii/S0167527312008753

Journal of hypertension; 2009; 27:1136-51: http://ovidsp.tx.ovid.com/sp-3.24.1b/ovidweb.cgi?&S=JKLOFPEJGODDJDOENCHKMFGCNABLAA00&Link+Set=S.sh.22.23.27.31%7c8%7csl_10

Journal of the American College of Cardiology; 2013;61:131-42: http://www.sciencedirect.com/science/article/pii/S0735109712053016

International journal of cardiology; 2010; 138:25-31: http://www.sciencedirect.com/science/article/pii/S0167527308009431

Publisher
Hull York Medical School, The University of Hull and University of York
Qualification level
Doctoral
Qualification name
MD
Language
English
Extent
2 MB
Identifier
hull:14574
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