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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

The study found that for induction therapy in adult renal transplantation no treatment regimen appeared more effective than another in reducing graft loss or mortality, and, for maintenance therapy, none of the treatment regimens was better for all outcomes or appeared most effective at reducing graft loss. When comparing all treatment regimens only one combination of treatments was cost-effective.

Health Technology Assessment - NIHR Journals Library.

Version: August 2016

The study found that tacrolimus maintenance therapy (with azathioprine) and basiliximab induction (with tacrolimus and azathioprine maintenance therapy) were likely to be cost-effective therapies for children and adolescents undergoing renal transplantation. When all immunosuppressive regimens were simultaneously compared using extrapolated adult data, only basiliximab induction therapy with tacrolimus and azathioprine maintenance therapy was cost-effective.

Health Technology Assessment - NIHR Journals Library.

Version: August 2016

The primary objectives of this systematic review were to: 1. Determine whether specialized anticoagulation clinics (ACC) are more effective and safer than care in non-specialized clinics (e.g., primary care clinics, physician offices) for management of long- term anticoagulation in adults; 2. Determine whether patient self testing (PST), either alone or in combination with patient self management (PSM), is more effective and safer than standard care; and 3. Identify the risk factors for serious bleeding in patients on chronic anticoagulant therapy.

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

Version: February 2011

This review assessed the efficacy of statins in reducing blood cholesterol. The authors concluded that statins reduced total and low-density lipoprotein cholesterol, and hence were effective for the primary and secondary prevention of coronary artery disease. The potential for selection bias and the pooling of seemingly clinically diverse data make the reliability of the results uncertain.

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

Version: 2003

This guideline updates for primary prevention, the NICE technology appraisal, ‘Statins for the prevention of cardiovascular events’ (TA94, 2007) and reviews and updates the recommendations made in the NICE guideline Lipid Modification (CG67, 2008) for primary and secondary prevention of cardiovascular disease (CVD). The scope for this guideline was limited to the identification and assessment of CVD risk and to the assessment and modification of lipids in people at risk of CVD, or people with known CVD. The guideline development group wishes to make clear that lipid modification should take place as part of a programme of risk reduction which also include attention to the management of all other known CVD risk factors.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: July 2014

Familial hypercholesterolemia (FH) is an inherited disorder of lipoprotein metabolism characterized by highly elevated total cholesterol (TC) concentrations early in life, independent of environmental influences. Around 1 in 200 to 1 in 500 persons in North America and Europe are estimated to have heterozygous FH. When untreated, FH is associated with a high incidence of premature clinical atherosclerotic cardiovascular disease.

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

Version: August 2016

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

This study evaluated the use of a group of statins, atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin, for the prevention of cardiovascular events.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2007

High levels of cholesterol (a fatty substance known as a lipid) in the blood are thought to contribute to the cause of Alzheimer's disease and vascular dementia. The statin family of medications (lovastatin, pravastatin, simvastatin and others) are powerful cholesterol‐lowering medications and are first‐line treatments for reducing cholesterol in people with, or at risk of, cardiovascular disease. There has been much interest in the possible role of statins in the treatment of dementia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

We reviewed the evidence for the effectiveness and safety of statins in children with inherited high blood cholesterol.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

There is evidence of a reduction in subsequent serious vascular events from statin therapy in patients with a history of ischaemic stroke or transient ischaemic attack (TIA). Studies have shown that interventions for reducing either total serum cholesterol or low density lipoprotein cholesterol levels reduce the risk of coronary heart disease (CHD) and stroke events in people with a history of CHD. However, for stroke patients the relation between the level of serum cholesterol and cholesterol subfractions with the risk of future stroke or cardiovascular events is unclear. This review, which includes eight studies involving approximately 10,000 participants, shows statin therapy, but not other lipid‐lowering measures, reduces the risk of subsequent major vascular events and a marginal benefit in decreasing stroke events, but not all‐cause mortality in those with a history of ischaemic cerebrovascular disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Cardiovascular disease (CVD), which comprises heart attacks (myocardial infarction), angina and strokes, is ranked as the number one cause of mortality and is a major cause of morbidity world wide. High blood cholesterol is linked to CVD events and is an important risk factor. Reducing high blood cholesterol, is thus an important way to reduce the chances of suffering a CVD event. Statins ‐ cholesterol lowering drugs ‐ (e.g. simvastatin, pravastatin, atorvastatin) are the first‐choice treatments. Since the early statin randomised controlled trials were reported in the 1990s, several reviews of the effects of statins have been published highlighting their benefits particularly in people with a past history of CVD. Benefits include a reduction in CVD events. Statins have also been shown to reduce the risk of a first event in otherwise healthy individuals at high risk of CVD (primary prevention) but information on possible hazards has not been reported fully. The aim of this updated systematic review is to assess the effects, both in terms of benefits and harms of statins, for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE until 2011. We found 18 randomised controlled trials with 19 trial arms (56,934 patients) dating from 1994 to 2008. All were randomised control trials comparing statins with usual care or placebo. The mean age of the participants was 57 years (range 28 ‐ 97 years), 60.3% were men, and of the eight trials that reported on ethnicity, 85.9 % were Caucasian. Duration of treatment was a minimum one year and with follow‐up of a minimum of six months. All‐cause mortality and fatal and non‐fatal CVD events were reduced with the use of statins as was the need for revascularisation (the restoration of an adequate blood supply to the heart) by means of surgery (coronary artery bypass graft ) or by angioplasty (PTCA). Of 1000 people treated with a statin for five years, 18 would avoid a major CVD event which compares well with other treatments used for preventing cardiovascular disease. Taking statins did not increase the risk of serious adverse effects such as cancer. Statins are likely to be cost‐effective in primary prevention.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Non‐alcoholic fatty liver disease (NAFLD) and non‐alcoholic steatohepatitis (NASH) in patients with no or very little alcohol consumption is characterised by hepatic histological changes similar to those associated with alcohol‐induced liver injury. A range of histological changes can be seen. Some patients have fat accumulation in hepatocytes without significant inflammation or fibrosis (simple hepatic steatosis or NAFLD), but others have hepatic steatosis with prominent necro‐inflammatory changes with or without associated fibrosis (this is NASH). Although NAFLD and NASH are common conditions, no effective medical treatment is available to correct the abnormal liver enzymes and adverse outcomes associated with them. This systematic review identified two randomised clinical trials with very small numbers of participants. One of the trials was a pilot trial and compared simvastatin with placebo, and the other trial assessed atorvastatin versus fenofibrate versus a combination of the two. The small pilot trial (n = 16 patients) assessing simvastatin versus placebo in NASH patients did not show significant effects on liver enzyme activities or liver histology. No adverse events were reported. The other trial compared atorvastatin versus fenofibrate versus a group receiving both interventions in 186 patients with NAFLD. There were no statistically significant differences between any of the three intervention groups regarding the 54 week mean activities of aspartate aminotransferase, alanine aminotransferase, gamma‐glutamyl transpeptidase, or alkaline phosphatases (liver enzymes) in the blood. The triglyceride levels seemed higher in the fenofibrate group compared with the atorvastatin group. Liver histology was not assessed in this trial. The presence of biochemical and ultrasonographic evidence of NAFLD seemed higher in the fenofibrate group compared with the other two intervention groups. Three patients discontinued treatment due to myalgia and elevated serum creatine kinase activity, one from the atorvastatin group and two from the combination group. Another patient from the atorvastatin group discontinued treatment due to raised alanine aminotransferase activity, over three times the upper normal limit. Both trials were at high risk of bias (that is, overestimation of benefits and underestimation of harms). Furthermore, the groups were small raising the risks of random errors (that is, play of chance). Accordingly, we did not find evidence to support or refute the use of statins for patients with NAFLD or NASH. Further unbiased trials with larger numbers of patients looking explicitly at patient‐related outcomes of interest (for example, quality of life, development of cirrhosis, and mortality) are needed to assess the effects of statins on NAFLD or NASH.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in the United States but is potentially preventable with statin therapy. The U.S. Preventive Services (USPSTF) commissioned this review to inform the development of new recommendations on use of statin therapy for prevention of CVD in adults.

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

Version: November 2016

This review updates prior reviews on screening for lipid disorders in adults, and will be used by the U.S. Preventive Services Task Force (USPSTF) to update its 2008 recommendation. Unlike prior USPSTF reviews, this one focuses on screening in younger adults, defined as adults ages 21 to 39 years, as there is more uncertainty about the need to perform lipid screening in this population than in older adults.

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

Version: November 2016

This report provides expanded guidance on several topics that originally appeared in Chapter 9 (“Conducting Quantitative Synthesis When Comparing Medical Interventions”) of the 2007 draft “Methods Reference Guide for Effectiveness and Comparative Effectiveness Reviews.” Selected topics from this chapter were posted on the Effective Health Care Program Web site after public comments and were also published as a journal manuscript. The topics in the current report were cut from the 2007 draft methods reference guide to make the currently posted quantitative synthesis document a manageable length. The current report complements the posted document and includes the following topics: combining a small number of studies, combining composite outcome, control rate meta-regression, and interpretation and translation of results of meta-analyses.

Methods Guide for Effectiveness and Comparative Effectiveness Reviews [Internet] - Agency for Healthcare Research and Quality (US).

Version: March 13, 2013

This review assessed evidence for interventions aimed at preventing or delaying the onset of age-related cognitive decline, mild cognitive impairment (MCI), or clinical Alzheimer’s-type dementia (CATD).

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

Version: March 2017

Angina is pain or constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress. It is the main symptomatic manifestation of myocardial ischaemia and is usually caused by obstructive coronary artery disease restricting oxygen delivery to the cardiac myocytes. Other factors may exacerbate angina either by further restricting oxygen delivery (for example severe anaemia) or by increasing oxygen demand (for example left ventricular hypertrophy). Angina symptoms are associated with other cardiac disease such as aortic stenosis but the management of angina associated with non-coronary artery disease is outside the scope of this guideline.

NICE Clinical Guidelines - National Clinical Guidelines Centre (UK).

Version: July 2011

Type 1 diabetes affects over 370,000 adults in the UK, representing approximately 10% of adults diagnosed with diabetes. Given the complexity of its treatment regimens, successful outcomes depend, perhaps more than with any other long-term condition, on full engagement of the adult with type 1 diabetes in life-long day-by-day self-management. In order to support this, the health service needs to provide informed, expert support, education and training as well as a range of other more conventional biomedical services and interventionsfor the prevention and management of long term complications and disability.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: August 2015

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