Lessons from contemporary trials of cardiovascular prevention and rehabilitation: A systematic review and meta-analysis,☆☆,☆☆☆

https://doi.org/10.1016/j.ijcard.2016.12.125Get rights and content
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Highlights

  • Most prevention and rehabilitation programmes do not longer reduce mortality.

  • Comprehensive prevention and rehabilitation programmes managing six or more risk factors continue to be effective in reducing all-cause mortality.

  • Programmes that integrate prescription of cardioprotective medication also continue to reduce all-cause mortality.

  • Myocardial infarction and, for the first time, cerebrovascular events are reduced.

Abstract

Background

Meta-analyses of cardiac rehabilitation trials up to 2010 showed a significant reduction in all-cause mortality but many of these trials were conducted before the modern management of acute coronary syndromes.

Methods

We undertook a meta-analysis of contemporary randomised controlled trials published in the period 2010 to 2015, including patients with other forms of atherosclerotic cardiovascular disease, to investigate the impact of cardiovascular prevention and rehabilitation on hard outcomes including survival.

Results

18 trials randomising 7691 patients to cardiovascular prevention and rehabilitation or usual care were selected. All-cause mortality was not reduced (RR 1.00, 95% CI 0.88 to 1.14), but cardiovascular mortality was by 58% (95% CI 0.21, 0.88). Myocardial infarction was also reduced by 30% (95% CI 0.54, 0.91) and cerebrovascular events by 60% (95% CI 0.22, 0.74). Comprehensive programmes managing six or more risk factors reduced all-cause mortality in a subgroup analysis (RR 0.63, 95% CI 0.43, 0.93) but those managing less did not. In the three programmes that prescribed and monitored cardioprotective medications for blood pressure and lipids all-cause mortality was also reduced (RR 0.35, 95% CI 0.18, 0.70).

Conclusions

Comprehensive prevention and rehabilitation programmes managing six or more risk factors, and those prescribing and monitoring medications within programmes to lower blood pressure and lipids, continue to reduce all-cause mortality. In addition, these comprehensive programmes not only reduced cardiovascular mortality and myocardial infarction but also, for the first time, cerebrovascular events, and all these outcomes across a broader spectrum of patients with atherosclerotic disease.

Keywords

Myocardial infarction
Angina pectoris
Stroke
Peripheral arterial disease
Atherosclerotic cardiovascular diseases
Cardiac rehabilitation
Cardiovascular prevention

Cited by (0)

All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

☆☆

This study was supported by the Dutch Heart Foundation (NHS 2015-2).

☆☆☆

No potential conflicts exist for all authors.