Comparative effectiveness of antihypertensive medication for primary prevention of cardiovascular disease: systematic review and multiple treatments meta-analysis

Background: We conducted a systematic review of evidence from randomized controlled trials to answer the following research question: What are the relative effects of different classes of antihypertensive drugs in reducing the incidence of cardiovascular disease outcomes for healthy people at risk of cardiovascular disease? Methods: We searched MEDLINE, EMBASE, AMED (up to February 2011) and CENTRAL (up to May 2009), and reference lists in recent systematic reviews. Titles and abstracts were assessed for relevance and those potentially fulfilling our inclusion criteria were then assessed in full text. Two reviewers made independent assessments at each step. We selected the following main outcomes: total mortality, myocardial infarction and stroke. We also report on angina, heart failure and incidence of diabetes. We conducted a multiple treatments meta-analysis using random-effects models. We assessed the quality of the evidence using the GRADE-instrument. Results: We included 25 trials. Overall, the results were mixed, with few significant dif-ferences, and with no drugclass standing out as superior across multiple outcomes. The only significant finding for total mortality based on moderate to high quality evidence was that beta-blockers (atenolol) were inferior to angiotensin receptor blockers (ARB) (relative risk (RR) 1.14; 95% credibility interval (CrI) 1.02 to 1.28). Angiotensin converting enzyme (ACE)- inhibitors came out inferior to calcium-channel blockers (CCB) regarding stroke-risk (RR 1.19; 1.03 to 1.38), but superior regarding risk of heart failure (RR 0.82; 0.69 to 0.94), both based on moderate quality evidence. Diuretics reduced the risk of myocardial infarction compared to beta-blockers (RR 0.82; 0.68 to 0.98), and lowered the risk of heart failure compared to CCB (RR 0.73; 0.62 to 0.84), beta-blockers (RR 0.73; 0.54 to 0.96), and alpha-blockers (RR 0.51; 0.40 to 0.64). The risk of diabetes increased with diuretics compared to ACE-inhibitors (RR 1.43; 1.12 to 1.83) and CCB (RR 1.27; 1.05 to 1.57). Conclusion: Based on the available evidence, there seems to be little or no difference between commonly used blood pressure lowering medications for primary prevention of cardiovascular disease. Beta-blockers (atenolol) and alpha-blockers may not be first-choice drugs as they were the only drug-classes that were not significantly superior to any other, for any outcomes

Risk factors for, and 13-year mortality from, cardiovascular disease by socioeconomic status : a study of 44690 men and 17540 women, ages 40-49.

This is also Hanne Türmers doctoral thesi

Pasientvolum og kvalitet ved behandling av karotisstenose

Source at https://www.helsebiblioteket.no/Kunnskapssenteret fikk i april 2008 forespørsel fra Helse Sør-Øst RHF om å oppda-tere Kunnskapssenterets rapport fra 2007 om pasientvolum og behandlingskvalitet ved hjerte- og karsykdommer. Dette notatet er utført som et hasteoppdrag, med oppdatering av kapitlet om behandling ved forsnevring av halspulsåren (karotisste-nose). Oppdragsgiver var særlig interessert i om det var kommet ny litteratur om betydningen av pasientvolum ved endovaskulær behandling.The hospital provider for south east region in Norway asked NOKC to update our previous systematic review on patient volume and quality of care to assess new pub-lications for carotid stenosis. This work was undertaken as a rapid review

Pasientvolum og behandlingskvalitet ved behandling av abdominale aortaneurismer

Kunnskapssenteret fikk i april 2008 forespørsel fra Helse Sør-Øst RHF om å oppdatere Kunnskapssenterets rapport om pasientvolum og behandlingskvalitet ved hjerte- og karsykdommer fra 2007. Oppdragsgiver var særlig interessert i om det var kommet ny litteratur om betydningen av pasientvolum ved endovaskulær behandling. Vi rapporte-rer i dette notatet oppdatert problemstilling for behandling av abdominale aorta-aneurismer

Patient volume and quality of care for the treatment of abdominal aortic aneurysm

Source at https://www.helsebiblioteket.no/Kunnskapssenteret fikk i april 2008 forespørsel fra Helse Sør-Øst RHF om å oppdatere Kunnskapssenterets rapport om pasientvolum og behandlingskvalitet ved hjerte- og karsykdommer fra 2007. Oppdragsgiver var særlig interessert i om det var kommet ny litteratur om betydningen av pasientvolum ved endovaskulær behandling. Vi rapporte-rer i dette notatet oppdatert problemstilling for behandling av abdominale aorta-aneurismer.The hospital provider for south east region in Norway asked NOKC to update our pre-vious systematic review on patient volume and quality of care to assess new publica-tions for abdominal aortic aneurysm. This work was undertaken as a rapid review

Psychometric evaluation of a Norwegian version of the Hearing Disability and Handicap Scale

Aim: To evaluate the Hearing Disability and Handicap Scale (HDHS) in an unselected population of adults with hearing impairment. Subjects and methods: A total of 342 consecutive adults who consulted the outpatient unit of audiology in the ENT department of a Norwegian university hospital answered HDHS, which intends to assess the negative consequences of hearing loss. The psychometric evaluation included internal structure analyses and made use of principal factors followed by varimax rotation, construct validity by corrected item-total correlation, and internal consistency reliability by Cronbach's alpha coefficient. Results: HDHS showed good psychometric properties with three factors, i.e. speech perception (five items), non-speech sound (five items) and participation restriction (10 items). All had good internal consistency reliability. The inventory distinguished between activity limitations and other problems related to social life participation. Conclusion: HDHS was found to be adequate for research and clinical purposes in an unselected adult population with a quite different cultural background and language than the original one

Nutritional risk is associated with long term mortality in hospitalized patients with chronic heart failure

SummaryBackground & aimsMortality among patients with chronic heart failure (CHF) is still high despite progress in medical and surgical treatment. The patients' nutritional condition may play an important role, and needs further investigation. The aim of this study was to evaluate whether nutritional risk in hospitalized patients with CHF was associated with three-year mortality.MethodsA prospective study was conducted in 131 hospitalized Norwegian patients with CHF. Nutritional screening was performed using Nutritional Risk Screening (NRS-2002). The primary clinical outcome was death from any cause.ResultsThe prevalence of nutritional risk was 57% (NRS-2002 score ≥ 3). The overall mortality rate was 52.6% within three-year follow up. More patients at nutritional risk (N = 51) died compared to patients not at nutritional risk (N = 18) (P < 0.001). In adjusted analyses patients at nutritional risk had more than five-time higher odds (OR 5.85; 95% CI 2.10–16.24) to die before three-year follow-up than those not at nutritional risk. In adjusted Cox multivariate analysis, the nutritional risk was associated with increased mortality (HR 2.78; 95% CI 1.53–5.03). Furthermore, in adjusted analysis components in NRS-2002 were associated with mortality, i.e. nutritional status (HR 1.82; 95% CI 1.03–3.22), severity of disease (NYHA-class IV) (HR 1.78; 95% CI 1.00–3.16) and age (≥ 70 year) (HR 3.24; 95% CI 1.48–7.10).ConclusionNutritional risk as defined by NRS-2002 in hospitalized patients with CHF was significantly associated with long term mortality

Primærforebygging av hjerte- og karsykdom, med hovedvekt på medikamentelle tiltak

Kunnskapssenteret ble av Sosial- og helsedirektoratet (nå Helsedirektoratet) bedt om å gjennomføre en systematisk kunnskapsoppsummering om effekten av tiltak for primærforebygging av hjerte- og karsykdom. Arbeidet skulle benyttes som grunnlagsdokument for utarbeiding av nye nasjonale retningslinjer på feltet.Primary prevention of cardiovascular disease, with emphasis on pharmacological intervention

Primary prevention of cardiovascular disease, with emphasis on pharmacological interventions

Kunnskapssenteret ble av Sosial- og helsedirektoratet (nå Helsedirektoratet) bedt om å gjennomføre en systematisk kunnskapsoppsummering om effekten av tiltak for primærforebygging av hjerte- og karsykdom. Arbeidet skulle benyttes som grunnlagsdokument for utarbeiding av nye nasjonale retningslinjer på feltet.Primary prevention of cardiovascular disease, with emphasis on pharmacological intervention