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1.
Meta-Analysis Comparing the Effect of Rivaroxaban Versus Vitamin K Antagonists for Treatment of Left Ventricular Thrombi.
Saleh, Y, Al-Abcha, A, Abdelkarim, O, Elwany, M, Abdelfattah, OM, Abdelnabi, M, Almaghraby, A
The American journal of cardiology. 2021;:123-125
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Direct Oral Anticoagulants in the Treatment of Left Ventricular Thrombus: A Retrospective, Multicenter Study and Meta-Analysis of Existing Data.
Cochran, JM, Jia, X, Kaczmarek, J, Staggers, KA, Rifai, MA, Hamzeh, IR, Birnbaum, Y
Journal of cardiovascular pharmacology and therapeutics. 2021;(2):173-178
Abstract
AIM: To compare the safety and efficacy of direct oral anticoagulants (DOAC) relative to vitamin K antagonists (VKA) for the treatment of left ventricular thrombus (LVT). METHODS This retrospective study enrolled patients diagnosed with LVT from 2014-2017. Patient characteristics and outcomes within 12 months of LVT diagnosis were recorded and analyzed. A meta-analysis was also performed by pooling our results with existing data in literature. RESULTS 14 DOAC and 59 VKA patients were included. Baseline demographic and clinical characteristics were similar except for age. Although more strokes within 12 months occurred in VKA (15%) than in DOAC (0%) patients, this was not statistically significant (P = 0.189). There were no significant differences in outcomes between patients on DOAC and VKA for acute coronary syndrome (ACS) (7%, vs 3.4%, P = .477), LVT resolution (86% vs 76%, P = .499) or bleeding (14% vs 14%, P = 1) within 12 months. The meta-analysis included 6 studies (n = 408 for DOACs; n = 1207 for VKA). There were no significant differences between DOACs versus VKAs with respect to odds for unresolved thrombus (OR 0.61, 95% CI 0.26,1.41), embolic events (OR 1.24, 95% CI 0.90,1.69), embolic events and death (OR 1.10, 95% CI 0.84,1.45) or bleeding events (OR 1.13, 95% CI 0.74,1.72). CONCLUSIONS Our study and meta-analysis suggest similar efficacy and safety of DOACs in the treatment of LVT compared to VKA. These findings underscore the need for a randomized controlled trial.
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3.
Cardiac Rehabilitation Programs for Chronic Heart Disease: A Bayesian Network Meta-analysis.
Huang, R, Palmer, SC, Cao, Y, Zhang, H, Sun, Y, Su, W, Liang, L, Wang, S, Wang, Y, Xu, Y, et al
The Canadian journal of cardiology. 2021;(1):162-171
Abstract
BACKGROUND Cardiac rehabilitation is a medically supervised program after coronary events that involves exercise and dietary modification. We evaluated the comparative benefits and harms of cardiac rehabilitation strategies via a network meta-analysis. METHODS We followed a pre-specified protocol (PROSPERO CRD42018094998). We searched Embase, MEDLINE, and Cochrane Central Register of Randomized Trials databases for randomized controlled trials that evaluated cardiac rehabilitation vs a second form of rehabilitation or standard/usual care in adults after myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, or angiography. Risk of bias and evidence quality was evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE), respectively. Pairwise and Bayesian network meta-analyses were performed for 11 clinical outcomes. RESULTS We included 134 randomized controlled trials involving 62,322 participants. Compared with standard care, exercise-only cardiac rehabilitation reduced the odds of cardiovascular mortality (odds ratio [OR], 0.70; 95% credibility interval [CrI], 0.51-0.96; moderate-quality evidence), major adverse cardiovascular events (OR, 0.57; 95% CrI, 0.40-0.78; low-quality evidence), nonfatal myocardial infarction (OR, 0.71; 95% CrI, 0.54-0.93; moderate-quality evidence), all-cause hospitalization (OR, 0.74; 95% CrI, 0.54-0.98; moderate-quality evidence), and cardiovascular hospitalization (OR, 0.69; 95% CrI, 0.51-0.88; moderate-quality evidence). Exercise-only cardiac rehabilitation was associated with lower cardiovascular hospitalization risk relative to cardiac rehabilitation without exercise (OR, 0.68; 95% CrI, 0.48-0.97; moderate-quality evidence). CONCLUSIONS Cardiac rehabilitation programs containing exercise might provide broader cardiovascular benefits compared with those without exercise.
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The effect of gum consumption on anthropometric characteristics and cardiac disorders: A systematic review and meta-analysis of randomized controlled trials.
Huang, M, Luo, J, Luo, G, Berahmand, F, Găman, MA, Sedanur Macit, M, Zhang, X
Complementary therapies in medicine. 2020;:102578
Abstract
OBJECTIVE No systematic review and (or) meta-analysis has been conducted so far to study the effect of gum consumption on anthropometric indices and blood pressure. Thus, our objective was to conduct a systematic review and meta-analysis of the randomized controlled trials investigating the effect of gum consumption on anthropometric indices and cardiac disorders. METHODS The literature search was implemented in the Scopus, Web of Science, PubMed/Medline and Google Scholar databases to discover trials that investigated the impact of gum on obesity indices and cardiac disorders up to April 2019. In order to calculate effect sizes, the random-effects model (using the DerSimonian-Laird method) was applied. RESULTS Finally, 21 articles were included in this meta-analysis. Combined results indicated that body weight (WMD: -0.60 kg, 95 % CI: -1.13, -0.07, P = 0.026, I2 = 89 %), and WC (WMD: -1.36 cm, 95 % CI: -2.50, -0.22, P = 0.019, I2 = 96 %) changed significantly following gum consumption. Subgroup analyses showed that a gum dosage ≤15 g/day (WMD: -1.23 kg/m2, 95 % CI: -2.03 to -0.43, I2 = 99 %) significantly decreased BMI. Moreover, gum consumption had significant effects on cardiac disorders. CONCLUSION In conclusion, gum supplementation may be an adjuvant for controlling obesity and can possess potential benefits in the management of cardiac disorders.
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Diagnostic performance of PET for detection of cardiac amyloidosis: A systematic review and meta-analysis.
Kim, SH, Kim, YS, Kim, SJ
Journal of cardiology. 2020;(6):618-625
Abstract
OBJECTIVES The purpose of the current investigation was to evaluate the diagnostic accuracy of amyloid and F-18 sodium fluoride (NaF) positron emission tomography/computed tomography (PET/CT) for the detection of cardiac amyloidosis (CA) using diagnostic accuracy test. MATERIALS AND METHODS The PubMed, Cochrane, and EMBASE database, from the earliest available date of indexing through February 29, 2020, were searched for results investigating the diagnostic accuracy of amyloid and F-18 NaF PET for the diagnosis of CA. We calculated the pooled sensitivities and specificities of included studies, calculated positive and negative likelihood ratios (LR+ and LR-), and obtained summary receiver operating characteristic (SROC) curves. RESULTS Across 13 studies with 14 results (90 patients), the pooled sensitivity of amyloid PET was 0.97 and a pooled specificity was 0.98. The pooled sensitivity of F-18 NaF PET was 0.63 and a pooled specificity was 1.00. The pooled sensitivity of combined amyloid and F-18 NaF PET was 0.88 and a pooled specificity was 0.98. CONCLUSION Amyloid PET has a high sensitivity and specificity for the detection of CA. However, F-18 NaF PET showed relatively low sensitivity with high specificity. At present, the literature regarding the use of amyloid and F-18 NaF PET for diagnosis of CA is still limited; thus, further large multicenter studies would be necessary to substantiate the diagnostic accuracy of amyloid and F-18 NaF PET for detection of CA.
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The Efficacy of Non-Vitamin K Antagonist Oral Anticoagulants in the Prevention of Left Atrial Thrombus in Patients With Atrial Fibrillation Compared With Vitamin K Antagonists: A Meta-Analysis.
Liu, J, Wu, Y, Li, S, Song, L, Hu, C
The heart surgery forum. 2020;(6):E733-E739
Abstract
BACKGROUND There is still a paucity of data on the efficacy of non-vitamin K antagonist oral anticoagulants (NOACs) in the prevention of left atrial thrombus (LAT) formation before cardioversion or catheter ablation. To assess the efficacy of NOACs in the prevention of LAT in patients with non-valvular atrial fibrillation (NVAF) compared with vitamin K antagonists (VKAs), we conducted a meta-analysis. METHODS We searched PubMed, Embase, and the Cochrane Library databases. For meta-analysis, dichotomous variables were analyzed by using the odds ratios (OR) computed using the Mantel Haenszel method (random models). All results were reported with 95% confidence intervals (CI). RESULTS A total of 13 studies (one randomized controlled investigation and 12 observational studies) were included in the meta-analysis. There was no statistically significant difference between the NOACs and VKAs groups with respect to the odds of LAT/LAAT formations (OR 0.79; 95% CI: 0.52-1.21; P = .29; (I2 = 14%). CONCLUSIONS NOACs were as effective as VKAs in the prevention of LAT/LAAT formation in patients with NVAF. Though patients on NOACs therapy showed a lower incidence of LAT/LAAT formation compared with VKAs, it was not significant (P = .29).
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[Management of cardiovascular co-morbidities in young patients with early onset psychosis: State of the art and therapeutic perspectives].
Frajerman, A, Morin, V, Chaumette, B, Kebir, O, Krebs, MO
L'Encephale. 2020;(5):390-398
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Abstract
Patients with psychiatric disorders have a decrease in their life expectancy. Excess mortality of patients with schizophrenia was demonstrated by a meta-analysis in the late 1990s and has not decreased for the past 30years. A recent meta-analysis including nearly 250,000 patients with schizophrenia found an average decrease in life expectancy of 14.5years (CI95: 11,2-17,8), more important for men than for women: 15.9 (CI95: 13,8-18,0) vs 13.6 (CI95: 11,4-15,8). A closer look at the somatic comorbidities, including metabolic syndrome, and investigation of causes of death of these patients highlighted already well-known factors, namely late diagnosis and insufficient treatment of physical diseases, side effects of antipsychotics, unhealthy lifestyle (poor diet, smoking, excessive alcohol consumption and lack of exercise), and higher risk of suicide and accident. Concerning ultra-high risk (UHR) patients, a 2016 meta-analysis of 47 studies evaluated the cardiovascular risk factors. They reported a higher prevalence of smoking in UHR (odds ratio 2,3) and a lower level of physical activity associated with a normal BMI (Body Mass Index) compared to the control population. A meta-analysis about patients with a first episode of psychosis (FEP) found reduced total and LDL cholesterol levels and an increased triglyceride level compared to the control population. One study found alteration of the fasting plasmatic levels of glucose and insulin, as well as insulin resistance in FEP patients, compared to controls albeit the HbA1c level was not significantly different. A meta-analysis reported a prevalence of metabolic syndrome of 10 % in FEP or drug naïve patients versus 35 % and 20 % in treated and untreated patients with chronic schizophrenia respectively. Somatic comorbidities usually appear during the first two years of the disease. Some interventions have proven their efficacy in reducing the occurrence of metabolic syndrome and other cardiovascular risk factors. For instance, metformin, a treatment for type 2 diabetes that is allowed from the age of 10, has shown benefits in children and adolescents receiving second-generation antipsychotics in a recent meta-analysis, with a mean weight loss of 3.23kg (IC95 % -5.59 -0.86) after 16 weeks. Dietary-hygienic interventions are also effective in reducing cardiovascular risk. Other interventions such as omega-3 supplementation, vitamin D, N-acetylcysteine, and fasting have not proven to be effective. Comprehensive care programs have been developed to promote somatic care in psychiatric patients, such as the Canadian HeAL (Healthy Active Lives) program. These programs are more effective when proposed from the beginning of the disease and the introduction of antipsychotics. In this review, because there is no French recommendation, we translate a tool for the prescription of metformin and the Canadian recommendations from the HeAL program. Generalization of these programs to all young psychotic patients could improve their life expectancy and reduce the overall mortality. Prevention of cardiovascular risk factors and cardio-metabolic monitoring of treatments must be part of the standard of care in early psychosis. These programs aim at providing patients with the quality of somatic and mental care they are entitled to. This requires the involvement of all stakeholders, including patients and their families but also psychiatrists and other caregivers.
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Chocolate and risk of chronic disease: a systematic review and dose-response meta-analysis.
Morze, J, Schwedhelm, C, Bencic, A, Hoffmann, G, Boeing, H, Przybylowicz, K, Schwingshackl, L
European journal of nutrition. 2020;(1):389-397
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Abstract
PURPOSE Evidence for the association between chocolate intake and risk of chronic diseases is inconclusive. Therefore, we aimed to synthesize and evaluate the credibility of evidence on the dose-response association between chocolate consumption with risk of all-cause mortality, coronary heart disease (CHD), stroke, heart failure (HF), type 2 diabetes (T2D), colorectal cancer (CRC), and hypertension. METHODS Prospective studies were searched until July 2018 in PubMed, Embase, and Web of Science. Random-effects meta-analyses comparing highest versus lowest intake categories, linear, and non-linear dose-response analyses were conducted. The credibility of evidence was evaluated with the NutriGrade scoring-system. RESULTS Overall, 27 investigations were identified (n = 2 for all-cause mortality, n = 9 for CHD, n = 8 for stroke, n = 6 for HF, n = 6 for T2D, n = 2 for hypertension and CRC, respectively). No associations with HF (RR 0.99, 95% CI 0.94, 1.04) and T2D (RR 0.94, 95% CI 0.88, 1.01) per each 10 g/day increase in chocolate intake were observed in the linear dose-response meta-analyses. However, a small inverse association for each 10 g/daily increase could be shown for the risk of CHD (RR 0.96, 95% CI 0.93, 0.99), and stroke (RR 0.90, 95% CI 0.82, 0.98). The credibility of evidence was rated either very low (all-cause mortality, HF, T2D, CRC or hypertension) or low (CHD, stroke). CONCLUSION Chocolate consumption is not related to risk for several chronic diseases, but could have a small inverse association with CHD and stroke. Our findings are limited by very low or low credibility of evidence, highlighting important uncertainty for chocolate-disease associations.
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Occupational exposure to silica and risk of heart disease: a systematic review with meta-analysis.
Liu, K, Mu, M, Fang, K, Qian, Y, Xue, S, Hu, W, Ye, M
BMJ open. 2020;(1):e029653
Abstract
OBJECTIVE To search for evidence of the relationship between occupational silica exposure and heart disease. DESIGN A systematic review and meta-analysis. BACKGROUND Growing evidence suggests a relationship between occupational silica exposure and heart disease; however, the link between them is less clear. DATA SOURCES PubMed, ScienceDirect, Springer and EMBASE were searched for articles published between 1 January 1995 and 20 June 2019. Articles that investigated the effects of occupational silica exposure on the risk of heart disease were considered. STUDY SELECTION We included cohort studies, including prospective, retrospective and retroprospective studies. DATA EXTRACTION AND SYNTHESIS We extracted data using a piloted data collection form and conducted random-effects meta-analysis and exposure-response analysis. The meta-relative risk (meta-RR), a measure of the average ratio of heart disease rates in those with and without silica exposure, was used as an inverse variance-weighted average of relative risks from the individual studies. The Newcastle-Ottawa Quality Assessment Scale for cohort studies was used for study quality assessment. OUTCOME MEASURE We calculated the risk of heart diseases such as pulmonary heart disease, ischaemic heart disease and others. RESULTS Twenty cohort studies were included. The results suggest a significant increase in the risk of overall heart disease (meta-RR=1.08, 95% CI 1.03 to 1.13). Stronger evidence of association with pulmonary heart disease was found in the risk estimate of both categories of heart disease (meta-RR=1.24, 95% CI 1.08 to 1.43) and in the exposure-response analysis (meta-RR=1.39, 95% CI 1.19 to 1.62). Our subgroup analyses also revealed that the statistical heterogeneity among studies could be attributed mainly to the diversity in reference group, occupation and study quality score. CONCLUSIONS Silica-exposed workers are at an increased risk for overall heart disease, especially pulmonary heart disease. Further research is needed to better clarify the relationship between occupational silica exposure and ischaemic heart disease. PROSPERO REGISTRATION NUMBER CRD42019124673.
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Effects of Vitamin C on Organ Function in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis.
Hill, A, Clasen, KC, Wendt, S, Majoros, ÁG, Stoppe, C, Adhikari, NKJ, Heyland, DK, Benstoem, C
Nutrients. 2019;(9)
Abstract
BACKGROUND Cardiac surgery is associated with oxidative stress and systemic inflammation, which both contribute to postoperative organ dysfunction. Vitamin C is a pleiotropic, antioxidant, and potentially organ-protective micronutrient. Past clinical trials and meta-analyses have focused predominantly on occurrence of postoperative atrial fibrillation. Therefore, we investigated the influence of perioperative vitamin C administration on clinically relevant parameters closer related to the patient's recovery, especially organ function, and overall outcomes after cardiac surgery. METHODS Randomized controlled trials (RCTs) comparing perioperative vitamin C administration versus placebo or standard of care in adult patients undergoing cardiac surgery were identified through systematic searches in Pubmed, EMBASE, and CENTRAL on 23 November 2018. Published and unpublished data were included. Assessed outcomes include organ function after cardiac surgery, adverse events, in-hospital mortality, intensive care unit, and hospital length-of-stay. Data was pooled only when appropriate. RESULTS A total of 19 RCTs with 2008 patients were included in this meta-analysis. Vitamin C significantly decreased the incidence of atrial fibrillation (p = 0.008), ventilation time (p < 0.00001), ICU length-of-stay (p = 0.004), and hospital length-of-stay (p < 0.0001). However, on average, vitamin C had no significant effects on in-hospital mortality (p = 0.76), or on the incidence of stroke (p = 0.82). High statistical heterogeneity was observed in most analyses. CONCLUSIONS Vitamin C impacts clinically and economically important outcomes, such as ICU and hospital length-of-stay, duration of mechanical ventilation and lowers the incidence of atrial fibrillation. Due to missing reports on organ dysfunction, this meta-analysis cannot answer the question, if vitamin C can improve single- or multiorgan function after cardiac surgery.