Effects of combined aspirin and clopidogrel therapy on cardiovascular outcomes: a systematic review and meta-analysis.

BACKGROUND: Aspirin and clopidogrel monotherapies are effective treatments for preventing vascular disease. However, new evidence has emerged regarding the use of combined aspirin and clopidogrel therapy to prevent cardiovascular events. We therefore performed a comprehensive systematic review and meta-analysis to evaluate the benefits and harms of combined aspirin and clopidogrel therapy on major cardiovascular outcomes. METHODOLOGY/PRINCIPAL FINDINGS: We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings to identify studies to fit our analysis. Eligible studies were randomized controlled trials assessing the effect of combined aspirin and clopidogrel therapy compared with aspirin or clopidogrel monotherapy. We identified 7 trials providing data with a total of 48248 patients. These studies reported 5134 major cardiovascular events, 1626 myocardial infarctions, 1927 strokes, and 1147 major bleeding events. Overall, the addition of aspirin to clopidogrel therapy as compared to single drug therapy resulted in a 9% RR reduction (95%CI, 2 to 17) in major cardiovascular events, 14% RR reduction (95%CI, 3 to 24) in myocardial infarction, 16% RR reduction (95%CI, 1 to 28) in stroke, and 62% RR increase (95%CI, 26 to 108) in major bleeding events. We also present the data as ARR to explore net value as the reduction in cardiovascular events. Overall, we observed that combined therapy yielded 1.06% decrease (95%CI, 0.23% to 1.99%) in major cardiovascular events and 1.23% increase (95%CI, 0.52% to 2.14%) in major bleeding events. CONCLUSION/SIGNIFICANCE: Although the addition of aspirin to clopidogrel resulted in small relative reductions in major cardiovascular events, myocardial infarction, and stroke, it also resulted in a relative increase in major bleeding events. In absolute terms the benefits of combined therapy, a 1.06% reduction in major cardiovascular events, does not outweigh the harms, a 1.23% increase in major bleeding events.

Body mass index and health-related quality of life in adults: a population based study in five cities of China.

BACKGROUND: To investigate the relationship between obesity and health-related quality of life (HRQL) in a randomly selected Chinese sample. METHODS: A total of 3600 residents aged 18-80 years were sampled in five cities of China using a randomized stratified multiple-stage sampling method to receive the interview, with a self-completed questionnaire to collect demographic information, and the Mandarin version of Short Form 36 Health Survey questionnaire (SF-36) to assess HRQL, followed by height and weight measurements for calculating body mass index (BMI). Cross-sectional association between BMI and HRQL was analysed. RESULTS: Among the 3207 participants (mean age 42 years) suitable for analysis, BMI differed by age and gender. Based on the international or the Asian BMI categories, in women, meaningful impairments were seen between obese and normal weight participants in four physical health scales, and only one scale of the four mental health scales--vitality scale was affected by obesity; in men, impairments by obesity were not found in all of the eight SF-36 scales, and better HRQL in two mental health scales were observed in obese participants compared to normal weight ones; after adjusting related variables, several physical but not mental health scales were found impaired by obesity. CONCLUSION: Obesity impaired physical but not mental health, and the impairments varied between genders. Public health agencies and government should emphasize the impairments of obesity on physical health.

Effect of folic acid supplementation on cardiovascular outcomes: a systematic review and meta-analysis.

BACKGROUND: Folic acid is widely used to lower homocysteine concentrations and prevent adverse cardiovascular outcomes. However, the effect of folic acid on cardiovascular events is not clear at the present time. We carried out a comprehensive systematic review and meta-analysis to assess the effects of folic acid supplementation on cardiovascular outcomes. METHODOLOGY AND PRINCIPAL FINDINGS: We systematically searched Medline, EmBase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings for relevant literature. We included randomized placebo-controlled trials that reported on the effects of folic acid on cardiovascular events compared to placebo. Of 1594 identified studies, we included 16 trials reporting data on 44841 patients. These studies reported 8238 major cardiovascular events, 2001 strokes, 2917 myocardial infarctions, and 6314 deaths. Folic acid supplementation as compared to placebo had no effect on major cardiovascular events (RR, 0.98; 95% CI, 0.93-1.04), stroke (RR, 0.89; 95% CI,0.78-1.01), myocardial infarction (RR, 1.00; 95% CI, 0.93-1.07), or deaths from any cause (RR, 1.00;95% CI, 0.96-1.05). Moreover, folic acid as compared to placebo also had no effect on the following secondary outcomes: risk of revascularization (RR, 1.05; 95%CI, 0.95-1.16), acute coronary syndrome (RR, 1.06; 95%CI, 0.97-1.15), cancer (RR, 1.08; 95%CI, 0.98-1.21), vascular death (RR, 0.94; 95%CI,0.88-1.02), or non-vascular death (RR, 1.06; 95%CI, 0.97-1.15). CONCLUSION/SIGNIFICANCE: Folic acid supplementation does not effect on the incidence of major cardiovascular events, stroke, myocardial infarction or all cause mortality.

Steroids in the treatment of IgA nephropathy to the improvement of renal survival: a systematic review and meta-analysis.

BACKGROUND: Studies have shown that steroids can improve kidney survival and decrease the risk of proteinuria in patients with Immunoglobulin A nephropathy, but the overall benefit of steroids in the treatment of Immunoglobulin A nephropathy remains controversial. The aim of this study was to evaluate the benefits and risks of steroids for renal survival in adults with Immunoglobulin A nephropathy. METHODOLOGY AND PRINCIPAL FINDINGS: We searched the Cochrane Renal Group Specialized Register, Cochrane Controlled Trial Registry, MEDLINE and EMBASE databases. All eligible studies were measuring at least one of the following outcomes: end-stage renal failure, doubling of serum creatinine and urinary protein excretion. Fifteen relevant trials (n = 1542) that met our inclusion criteria were identified. In a pooled analysis, steroid therapy was associated with statistically significant reduction of the risk in end-stage renal failure (RR: 0.46, 95% CI: 0.27 to 0.79), doubling of serum creatinine (RR = 0.34, 95%CI = 0.15 to 0.77) and reduced urinary protein excretion (MD = -0.47 g/day, 95%CI = -0.64 to -0.31). CONCLUSIONS/SIGNIFICANCE: We identified that steroid therapy was associated with a decrease of proteinuria and with a statistically significant reduction of the risk in end-stage renal failure. Moreover, subgroup analysis also suggested that long-term steroid therapy had a higher efficiency than standard and short term therapy.

Allowable Total Error and Limits for Erroneous Results (ATE/LER) zones for agreement measurement.

BACKGROUND: When assessing the agreement of two methods, the simple correlation coefficient, the most frequently used but easy to cause misleading interpretation of results, is still comprehensively adopted in journals of clinical chemistry or diagnostic laboratory. This study is aimed at comparing the correlation coefficient with the alternative method, which came from FDA recommended guidance for waiver assays--Allowable Total Error (ATE)/Limits for Erroneous Results (LER) zones, and fully addressing the applicable conditions of the later one. METHODS: The data we use were both real and simulated data to calculate correlation coefficient and ATE/LER zones, respectively, when assessing the agreement. And a modified ATE/LER zones method was brought forward to assess the agreement of repeated measurements and the repeatability of each single method. RESULTS: The high correlation can only indicate that the two methods are linearly related rather than in agreement with each other. However, the ATE/LER zones can avoid this shortcoming by using certain statistical strategies considering the clinical judgment. The modified method is suitable to evaluate the repeatability of single method and the agreement of repeated measurement by two measuring methods. CONCLUSION: The ATE/LER zones method is a relatively reasonable and widely considering method for assessing the agreement.