Unmet need in the hyperlipidaemia population with high risk of cardiovascular disease: a targeted literature review of observational studies

BACKGROUND: The aim of this study was to examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine LDL-C targets recommended by guidelines, and to examine the proportions of patients who do not achieve targeted LDL-C levels in real-world studies. METHODS: Electronic databases were searched: Medline, Medline In-Process, Embase, BIOSIS, and the Cochrane Library (1 January 2005 to 31 December 2013). Guideline searches were limited to publications in the last 5 years. There were no geographical or language restrictions. RESULTS: Seventeen guidelines and 42 observational studies that reported on high-risk hyperlipidaemia patients were identified. The National Cholesterol Education Program-Adult Treatment Panel III\u27s LDL-C target levels were the most common guidelines used for patients with very high hyperlipidaemia. However, between 68 and 96 % of patients in the studies did not achieve an LDL-C goal/dL, except in one study conducted in China (16.9 %). In high-risk patients, 61.8 to 93.8 % did not achieve a target of/dL. Regarding common comorbidities, patients with concomitant CVD or diabetes were least likely to reach their target LDL-C goals. CONCLUSION: In patients with high risk for CVD, the majority of patients do not attain recommended LDL-C goals, highlighting worldwide suboptimal hyperlipidaemia management and missed opportunities for reduction of the patients CVD risk. Lipid-modifying management strategies need to be intensified

Comparison of two independent systematic reviews of trials of recombinant human bone morphogenetic protein-2 (rhBMP-2) : The Yale Open Data Access Medtronic Project

Background: It is uncertain whether the replication of systematic reviews, particularly those with the same objectives and resources, would employ similar methods and/or arrive at identical findings. We compared the results and conclusions of two concurrent systematic reviews undertaken by two independent research teams provided with the same objectives, resources, and individual participant-level data. Methods: Two centers in the USA and UK were each provided with participant-level data on 17 multi-site clinical trials of recombinant human bone morphogenetic protein-2 (rhBMP-2). The teams were blinded to each other's methods and findings until after publication. We conducted a retrospective structured comparison of the results of the two systematic reviews. The main outcome measures included (1) trial inclusion criteria; (2) statistical methods; (3) summary efficacy and risk estimates; and (4) conclusions. Results: The two research teams' meta-analyses inclusion criteria were broadly similar but differed slightly in trial inclusion and research methodology. They obtained similar results in summary estimates of most clinical outcomes and adverse events. Center A incorporated all trials into summary estimates of efficacy and harms, while Center B concentrated on analyses stratified by surgical approach. Center A found a statistically significant, but small, benefit whereas Center B reported no advantage. In the analysis of harms, neither showed an increased cancer risk at 48 months, although Center B reported a significant increase at 24 months. Conclusions reflected these differences in summary estimates of benefit balanced with small but potentially important risk of harm. Conclusions: Two independent groups given the same research objectives, data, resources, funding, and time produced broad general agreement but differed in several areas. These differences, the importance of which is debatable, indicate the value of the availability of data to allow for more than a single approach and a single interpretation of the data. Systematic review registration: PROSPERO CRD42012002040and CRD42012001907

Modifiable risk factors for RA: prevention, better than cure?

Objective. To perform a meta-synthesis of the evidence for modifiable lifestyle risk factors for inflammatory polyarthritis (IP) and RA

Systematic review of methods used in meta-analyses where a primary outcome is an adverse or unintended event

addresses: Peninsula College of Medicine and Dentistry, St Luke's Campus, University of Exeter, Exeter, UK. [email protected]: PMCID: PMC3528446types: Journal Article; Research Support, Non-U.S. Gov't© 2012 Warren et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Adverse consequences of medical interventions are a source of concern, but clinical trials may lack power to detect elevated rates of such events, while observational studies have inherent limitations. Meta-analysis allows the combination of individual studies, which can increase power and provide stronger evidence relating to adverse events. However, meta-analysis of adverse events has associated methodological challenges. The aim of this study was to systematically identify and review the methodology used in meta-analyses where a primary outcome is an adverse or unintended event, following a therapeutic intervention

Monografies del Montseny - 37

Antoni Pladevall Font va fer possible el naixement de la col.lecció completa de les Monografies del Montseny, n’ha estat el director durant molts anys, ha publicat més de seixanta treballs d’investigació històrica, i ha estat el mestre que ha mostrat el camí a seguir en la tasca d’aprofundiment de la història del Montseny i el seu entorn més proper. En el pròleg del volum 37 de les Monografies del Montseny es glosa la figura d’Antoni Pladevall Font, qui l’any 1966 inicià la col·laboració en el Servei de Conservació i Catalogació de Monuments Històrics a la Diputació de Barcelona; dos anys més tard, passà a exercir com a professor d’història medieval a la Facultat de Teologia de Barcelona. Obtingué el títol d’Arxiver Municipal de Vic l’any 1979, mentre treballa a la Diputació, i al 1981començà a treballar en el Departament de Cultura de la Generalitat fins a la seva jubilació l’any 1999. L’aleshores conseller de Cultura de la Generalitat Max Cahner li va encarregar d’organitzar el Servei de Conservació i Restauració de Monuments Arquitectònics on se li va assignar la secció d’inventari i la de cap de servei en funcions. Dos anys després hi va exercir com a director general del Patrimoni Arquitectònic. En aquesta etapa va col·laborar amb la Fundació i Editorial de la Gran Enciclopèdia Catalana, en la qual va exercir la direcció d’obres tan importants com la “Catalunya Romànica” i “L’Art Gòtic de Catalunya”, i va assessorar la “Gran Geografia Comarcal de Catalunya”.Objectius de Desenvolupament Sostenible::11 - Ciutats i Comunitats SosteniblesObjectius de Desenvolupament Sostenible::4 - Educació de QualitatPostprint (published version

Additional file 1: of Unmet need in the hyperlipidaemia population with high risk of cardiovascular disease: a targeted literature review of observational studies

Table S1. MEDLINE Literature Search Strategy. Table S2. Recommended LDL-C Targets for High-Risk Patients From Treatment Guidelines. Table S3. Patients With Pre-existing Conditions Not Achieving Target LDL-C Levels. (DOCX 63 kb

Risk of new onset autoimmune disease in 9- to 25-year-old women exposed to human papillomavirus-16/18 AS04-adjuvanted vaccine in the United Kingdom

To assess the risk of autoimmune disease (AD) in 9-25 year-old women within 1 year after the first AS04-HPV-16/18vaccine dose, a retrospective, observational database cohort study was conducted using CPRD GOLD. From CPRD GOLD 4 cohorts (65,000 subjects each) were retrieved: 1 exposed female cohort (received ≥1 AS04-HPV-16/18 vaccine dose between Sep2008-Aug2010) and 3 unexposed cohorts: historical female (Sep2005-Aug2007), concurrent male, and historical male. Co-primary endpoints were confirmed neuroinflammatory/ophthalmic AD and other AD, secondary endpoints were confirmed individual AD. Risk of new onset of AD was compared between cohorts (reference: historical cohort) using Poisson regression. The main analysis using confirmed cases showed no neuroinflammatory/ophthalmic AD cases in the female exposed cohort. Incidence rate ratio (IRR) (95% CI) of other AD was 1.41 (0.86 to 2.31) in female and 1.77 (0.94 to 3.35) in male cohorts when compared to the female and male historical cohort, respectively. Secondary endpoints were evaluated for diseases with \u3e10 cases, which were Crohn\u27s disease (IRR: 1.21 [0.37 to 3.95] for female and 4.22 [0.47 to 38.02] for male cohorts), autoimmune thyroiditis (IRR: 3.75 [1.25 to 11.31] for female and no confirmed cases for male cohorts) and type 1 diabetes (IRR: 0.30 [0.11 to 0.83] for female and 2.46 [1.08 to 5.60] for male cohorts). Analysis using confirmed and non-confirmed cases showed similar results, except for autoimmune thyroiditis in females, IRR: 1.45 (0.79 to 2.64). There was no evidence of an increased risk of AD in women aged 9 to 25 years after AS04-HPV-16/18 vaccination

Communication issues in nutritional observational research

Observational epidemiological studies involving foods and nutrients often attract great attention from both the press and the public as they involve substances that are part of the daily lives of millions of individuals. In the digital era, findings of this research can be disseminated to very large audiences almost instantaneously, informing health beliefs and potentially triggering lifestyle changes. In this context, communication of results from observational nutritional epidemiology often involves specific issues that may limit the accuracy of the information ultimately being delivered to the public. In this narrative review we discuss some of these issues, with a special attention to the selective reporting of research studies by the media, the presentation of study findings as if they were free of bias, the reporting of inconsistent study results, and the issues related to the real-life uptake of research findings presented in the press. Collaborative efforts by all stakeholders involved in the dissemination process may help ameliorate this situation, and with this purpose we discuss some innovative approaches that may help reduce these issues