title: Lessons from contemporary trials of cardiovascular prevention and rehabilitation: A systematic review and meta-analysis.
abstract: BACKGROUND
  Meta-analyses of cardiac rehabilitation trials up to 2010 showed a significant reduction in all-cause mortality but many of these trials were conducted before the modern management of acute coronary syndromes.
  
  
  METHODS
  We undertook a meta-analysis of contemporary randomised controlled trials published in the period 2010 to 2015, including patients with other forms of atherosclerotic cardiovascular disease, to investigate the impact of cardiovascular prevention and rehabilitation on hard outcomes including survival.
  
  
  RESULTS
  18 trials randomising 7691 patients to cardiovascular prevention and rehabilitation or usual care were selected. All-cause mortality was not reduced (RR 1.00, 95% CI 0.88 to 1.14), but cardiovascular mortality was by 58% (95% CI 0.21, 0.88). Myocardial infarction was also reduced by 30% (95% CI 0.54, 0.91) and cerebrovascular events by 60% (95% CI 0.22, 0.74). Comprehensive programmes managing six or more risk factors reduced all-cause mortality in a subgroup analysis (RR 0.63, 95% CI 0.43, 0.93) but those managing less did not. In the three programmes that prescribed and monitored cardioprotective medications for blood pressure and lipids all-cause mortality was also reduced (RR 0.35, 95% CI 0.18, 0.70).
  
  
  CONCLUSIONS
  Comprehensive prevention and rehabilitation programmes managing six or more risk factors, and those prescribing and monitoring medications within programmes to lower blood pressure and lipids, continue to reduce all-cause mortality. In addition, these comprehensive programmes not only reduced cardiovascular mortality and myocardial infarction but also, for the first time, cerebrovascular events, and all these outcomes across a broader spectrum of patients with atherosclerotic disease.
authors.affiliation: Department of Cardiology, Thoraxcentre Erasmus Medical Centre, Rotterdam, The Netherlands; International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK.
authors.forename: Gijs
authors.initials: G
authors.lastname: van Halewijn
authors.affiliation: Department of Cardiology, Thoraxcentre Erasmus Medical Centre, Rotterdam, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Deckers
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK.
authors.forename: Hung Yong
authors.initials: HY
authors.lastname: Tay
authors.affiliation: Department of Cardiology, Thoraxcentre Erasmus Medical Centre, Rotterdam, The Netherlands. Electronic address: r.vandomburg@erasmusmc.nl.
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK.
authors.forename: Kornelia
authors.initials: K
authors.lastname: Kotseva
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wood
mesh_terms: D000072038:Cardiac Rehabilitation / Q000379:methods*; D002318:Cardiovascular Diseases / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death / Q000639:trends; D014943:Global Health; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate / Q000639:trends
keywords: Angina pectoris; Atherosclerotic cardiovascular diseases; Cardiac rehabilitation; Cardiovascular prevention; Myocardial infarction; Peripheral arterial disease; Stroke