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The current state of niacin in cardiovascular disease prevention: a systematic review and meta-regression

This review concluded that niacin reduced cardiovascular disease events, and this might not be mediated by changes in high-density lipoprotein cholesterol levels. The authors? conclusions reflect the evidence presented, but limitations to the search, a lack of reporting of review methods, and variation between trials, mean that the reliability of their conclusions is uncertain.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Ezetimibe for hypercholesterolaemia: Executive summary of final report A10-02, Version 1.0

The aim of this investigation is the benefit assessment of treatment with ezetimibe (in mono- or combination therapy) compared to treatment with placebo or other lipid-lowering drugs, as well as to non-drug treatment options in patients with hypercholesterolaemia. The focus of the assessment was on patient-relevant outcomes.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: July 18, 2011

Comparing Statins and Combination Drugs

How do statins and combination drugs compare in lowering "bad" cholesterol (LDL-c)?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: November 1, 2010

Drug Class Review: HMG-CoA Reductase Inhibitors (Statins) and Fixed-dose Combination Products Containing a Statin: Final Report Update 5 [Internet]

In the United States, coronary heart disease and cardiovascular disease account for nearly 40% of all deaths each year. Coronary heart disease continues to be the leading cause of mortality and a significant cause of morbidity among North Americans. In 2006, coronary heart disease claimed 607 000 lives, translating into about 1 out of every 5 deaths in the United States. High levels of cholesterol, or hypercholesterolemia, are an important risk factor for coronary heart disease. The 3-hydroxy-3-methylglutaryl-coenzyme (HMG-CoA) reductase inhibitors, also known as statins, are the most effective class of drugs for lowering serum low-density lipoprotein cholesterol concentrations. They are first-line agents for patients who require drug therapy to reduce serum low-density lipoprotein cholesterol concentrations. The purpose of this review is to compare the benefits and harms of different statins in adults and children with hypercholesterolemia.

Drug Class Reviews - Oregon Health & Science University.

Version: November 2009
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Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care

This guideline has been developed to advise on supporting people with dementia and their carers in health and social care. The guideline recommendations have been developed by a multidisciplinary team of health and social care professionals, a person with dementia, carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to practitioners and service commissioners in providing and planning high-quality care for those with dementia while also emphasising the importance of the experience of care for people with dementia and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2007
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High cholesterol levels: Can ezetimibe lower the risk of complications?

There is not enough research on whether people with high cholesterol levels have a benefit by taking ezetimibe in addition to a statin. There is not enough data on adverse effects of ezetimibe.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: December 8, 2011

Type 2 Diabetes: National Clinical Guideline for Management in Primary and Secondary Care (Update)

Over 90% of people with diabetes have Type 2 diabetes. This is still perceived as the milder form, and while this may be true in some respects, such as the risk of ketoacidosis, the causation of Type 2 diabetes is more complex and the management is not necessarily easier. Type 2 diabetes can cause severe complications, affecting the eye, the nervous system and the kidney. The overall risk of cardiovascular disease is more than doubled, and life expectancy is reduced by an average 7 years. In 2002, NICE published a suite of five guidelines dealing with different aspects of the care of Type 2 diabetes. The rising prevalence of the disease, and the range of complications which can arise, reinforce the importance of up-to-date guidance and accordingly NICE have asked the National Collaborating Centre for Chronic Conditions (NCC-CC) to produce this guideline, amalgamating and updating the previously published work.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: 2008
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Elucigene FH20 and LIPOchip for the Diagnosis of Familial Hypercholesterolaemia: A Systematic Review and Economic Evaluation

Familial hypercholesterolemia (FH) is an autosomal dominant genetic condition causing a high risk of coronary heart disease. The prevalence of this disease is about 1 in 500 in the UK, affecting about 120,000 people across the whole of the UK. Current guidelines recommend DNA testing, however, these guidelines are poorly implemented, therefore 102,000 or 85% of this group remain undiagnosed.

Health Technology Assessment - NIHR Journals Library.

Version: March 2012
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Closing the Quality Gap: Revisiting the State of the Science (Vol. 4: Medication Adherence Interventions: Comparative Effectiveness)

To assess the effectiveness of patient, provider, and systems interventions (Key Question [KQ] 1) or policy interventions (KQ 2) in improving medication adherence for an array of chronic health conditions. For interventions that are effective in improving adherence, we then assessed their effectiveness in improving health, health care utilization, and adverse events.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: September 2012
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Newer Agents for Blood Glucose Control in Type 2 Diabetes (Supplement) [Internet]

NICE issued an updated guideline (Clinical Guideline 66) for the management of all aspects of type 2 diabetes in May 2008. However new drug developments means that this guideline itself already requires an update. This technology assessment report aims to provide information to support the Short Guideline Development Group (GDG) which will produce a “new drugs update” to the 2008 guideline.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: May 2009

Screening for Lipid Disorders in Adults: Selective Update of 2001 US Preventive Services Task Force Review [Internet]

Both the US Preventive Services Task Force (USPSTF) and the National Cholesterol Education Program (NCEP ATP III) have issued recommendations on screening for dyslipidemia in adults. To guide the USPSTF in updating its 2001 recommendations, we reviewed evidence relevant to discrepancies between these recommendations.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: June 2008
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Preventing Alzheimer's Disease and Cognitive Decline

To assess whether previous research on purported risk or protective factors for Alzheimer’s disease (AD) and cognitive decline is of sufficient strength to warrant specific recommendations for behavioral, lifestyle, or pharmaceutical interventions/modifications targeted to these endpoints.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: April 2010
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Racial and Ethnic Disparities in the VA Healthcare System: A Systematic Review [Internet]

Numerous studies have demonstrated racial and ethnic disparities in health care in the United States.These disparities have been demonstrated in the Veterans Affairs (VA) healthcare system, where financial barriers to receiving care are minimized. The VA is committed to delivering high-quality care in an equitable manner, and as such, to eliminating racial and ethnic disparities in health care. To inform this effort, we systematically reviewed the existing evidence on disparities within the VA, to address the following objectives: 1) Determine in which clinical areas racial and ethnic disparities are prevalent within the VA; 2) Describe what is known about the sources of those disparities; and 3) Qualitatively synthesize that knowledge to determine the most promising avenues for future research aimed at improving equity in VA health care.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: June 2007
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Combination Therapy Versus Intensification of Statin Monotherapy: An Update [Internet]

To assess the benefits and harms of combination of statin and other lipid-modifying medication compared to intensification of statin monotherapy. This is an update to a 2009 review.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: February 2014
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Screening for Lipid Disorders in Children and Adolescents [Internet]

Dyslipidemias, disorders of lipid metabolism, are important risk factors for coronary heart disease (CHD). Identification of children with dyslipidemias could lead to interventions aimed at decreasing their risk of CHD as adults.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: July 2007
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Screening for Type 2 Diabetes Mellitus: Update of 2003 Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Diabetes poses a tremendous and increasing clinical and public health burden for Americans; 19.3 million Americans over the age of 20 years are affected, one third of whom are undiagnosed.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: June 2008
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Identification and Management of Familial Hypercholesterolaemia (FH) [Internet]

While the NHS in England and Wales has made spectacular progress in improving the secondary prevention of cardiovascular disease, we now need to work harder to identify those who are at particularly high risk of myocardial infarction.

NICE Clinical Guidelines - National Collaborating Centre for Primary Care (UK).

Version: August 2008
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Meta-analysis of comparison of effectiveness of lowering apolipoprotein B versus low-density lipoprotein cholesterol and nonhigh-density lipoprotein cholesterol for cardiovascular risk reduction in randomized trials

This study evaluated the relation between apolipoprotein B (apoB) decrease and coronary heart disease, stroke, and cardiovascular disease risk. Bayesian random-effects meta-analysis was used to evaluate the association of mean absolute apoB decrease (milligrams per deciliter) with relative risk of coronary heart disease (nonfatal myocardial infarction and coronary heart disease death), stroke (nonfatal stroke and fatal stroke), or cardiovascular disease (coronary heart disease, stroke, and coronary revascularization). Analysis included 25 trials (n = 131,134): 12 on statin, 4 on fibrate, 5 on niacin, 2 on simvastatin-ezetimibe, 1 on ileal bypass surgery, and 1 on aggressive versus standard low-density lipoprotein (LDL) cholesterol and blood pressure targets. Combining the 25 trials, each 10-mg/dl decrease in apoB was associated with a 9% decrease in coronary heart disease, no decrease in stroke, and a 6% decrease in major cardiovascular disease risk. Non-high-density lipoprotein (non-HDL) cholesterol decrease modestly outperformed apoB decrease for prediction of coronary heart disease (Bayes factor [BF] 1.45) and cardiovascular disease (BF 2.07) risk decrease; apoB decrease added to non-HDL cholesterol plus LDL cholesterol decrease slightly improved cardiovascular disease risk prediction (1.13) but did not improve coronary heart disease risk prediction (BF 1.03) and worsened stroke risk prediction (BF 0.83). In the 12 statin trials, apoB and non-HDL cholesterol decreases similarly predicted cardiovascular disease risk; apoB improved coronary heart disease prediction when added to non-HDL cholesterol/LDL cholesterol decrease (BF 3.33) but did not improve stroke risk prediction when added to non-HDL cholesterol/LDL cholesterol decrease (BF 1.06). In conclusion, across all drug classes, apoB decreases did not consistently improve risk prediction over LDL cholesterol and non-HDL cholesterol decreases. For statins, apoB decreases added information to LDL cholesterol and non-HDL cholesterol decreases for predicting coronary heart disease but not stroke or overall cardiovascular disease risk decrease.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Dietary Supplements in Adults Taking Cardiovascular Drugs [Internet]

A substantial proportion of patients with cardiovascular diseases use dietary supplements in anticipation of benefit. This also poses risks of adverse events from supplement-drug interactions and nonadherence associated with polypharmacy.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2012
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Use Versus Nonuse of Dietary Supplements in Adults Taking Cardiovascular Drugs

In response to a request from the public regarding the use of dietary supplements by patients currently undergoing pharmacologic cardiovascular treatment, a review was undertaken to evaluate the evidence regarding the benefits and harms of concomitant use of dietary supplements with cardiovascular drugs. The systematic review included 70 studies published through September 2011. The full report, listing all studies, is available at www.effectivehealthcare.ahrq.gov/dietary-supplements.cfm. This summary is provided to inform discussions with patients of options and to assist in decisionmaking along with consideration of a patient's values and preferences. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines.

Comparative Effectiveness Review Summary Guides for Clinicians [Internet] - Agency for Healthcare Research and Quality (US).

Version: April 10, 2013

Systematic Reviews in PubMed

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