Articles found in ?language using MEDLINE, 1966 to 1995 (search terms: atherosclerosis, coronary artery disease and regression )

Selection criteria: as above
Appraisal criteria: not detailed in text
Articles excluded if: reduction in total cholesterol in the treatment group compared with the control group was small, and nonstandardised treatment (triiodothyronine, garlic or walnuts)

33 studies were included

The evidence

Comments

  1. 25 trials were concerned with secondary and tertiary prevention, and these are the only results considered in this appraisal.
  2. No individual data on death and MI were given, only numbers needed to treat.
  3. Effort to promote secondary prevention of dyslipidaemic related diseases and mortality seems quite effective. Primary care practitioners are in an excellent position to do it.

Citation

  1. Rembold CM, : Number-needed-to-treat analysis of the prevention of myocardial infarction and death by antidyslipidemic therapy. Journal of Family Practice 1996; 42: 577-586
Contributor: Clare Wotton and Bob Phillips, December 1999
Reviewer: Santiago Alvarez Montero

Clinical Question.

Myocardial Infarction: antidyslipidaemic therapy decreases death and subsequent MI.

Clinical bottom line (level 1a)

  1. Patients with dyslipidaemia and atherosclerotic risk factors who are given antidyslipidaemic therapy as secondary prevention are more likely to have a lowering in cholesterol, than those given a control drug.
  2. Patients given antidyslipidaemic therapy are less likely to die than those given a control drug (NNT = 37 at 4.9 years) .
  3. Patients given antidyslipidaemic therapy are less likely to suffer cardiovascular death (NNT = 33 at 4.9 years) .
  4. Patients given antidyslipidaemic therapy are less likely to have myocardial infarction (NNT = 28 at 4.9 years) .
Rembold : Journal of Family Practice 1996; 42: 577-586
Expires March 2003

The study

Systematic review of randomised primary, secondary and tertiary studies of
  • Patients: dyslipidaemia (suspected myocardial infarction, known coronary atherosclerosis or angina)
  • Intervention: standard antidyslipidaemic therapy (diet, pharmaceuticals and surgery) compared with control
  • Outcome: prevention of myocardial infarction


    • Articles found in ?language using MEDLINE, 1966 to 1995 (search terms: atherosclerosis, coronary artery disease and regression )

    Selection criteria: as above
    Appraisal criteria: not detailed in text
    Articles excluded if: reduction in total cholesterol in the treatment group compared with the control group was small, and nonstandardised treatment (triiodothyronine, garlic or walnuts)

    33 studies were included

    The evidence

    • The number needed to treat was 37 for all deaths in secondary prevention trials.
    • The number needed to treat was 33 for cardiovascular deaths in secondary prevention trials.
    • The number needed to treat was 28 for myocardial infarction in the secondary prevention trials.
    • Mean percentage change in cholesterol in the control arm was 0, and in the antidyslipidaemic arm was -18.0.

    Comments

    1. 25 trials were concerned with secondary and tertiary prevention, and these are the only results considered in this appraisal.
    2. No individual data on death and MI were given, only numbers needed to treat.
    3. Effort to promote secondary prevention of dyslipidaemic related diseases and mortality seems quite effective. Primary care practitioners are in an excellent position to do it.

    Citation

    1. Rembold CM, : Number-needed-to-treat analysis of the prevention of myocardial infarction and death by antidyslipidemic therapy. Journal of Family Practice 1996; 42: 577-586
    Contributor: Clare Wotton and Bob Phillips, December 1999
    Reviewer: Santiago Alvarez Montero

    Clinical Question.
    Patient ischaemic heart disease
    Intervention or Exposure antidyslipidaemic drugs
    Comparison placebo
    Outcome prevention of myocardial infarction
Patient ischaemic heart disease
Intervention or Exposure antidyslipidaemic drugs
Comparison placebo
Outcome prevention of myocardial infarction