What We Learned with Recent Network Meta-analyses on Atherosclerosis Prevention and Treatment.
OBJECTIVE
The management of atherosclerosis requires a complex integration of the knowledge on its pathophysiology, patient values, and the synthesis of the global scientific evidence informing on its prevention and treatment. Novel statistical methods such as umbrella reviews and network meta-analyses (NMAs) offer a unique opportunity for integrating different sources of evidence stemming from randomized controlled trials (RCTs) or internally valid observational studies. We aimed to provide an updated perspective on the most important contributions of recent network meta-analyses on atherosclerosis prevention and treatment.


RESULTS
We identified and appraised in detail 9 NMAs on atherosclerosis prevention, all published in 2016, whereas a total of 12 NMAs on atherosclerosis treatment published between 2014 and 2016 were identified. Most NMAs focused on RCTs only, with primary prevention analyses including on average more trials and patients than those focusing on secondary prevention. In most cases, conclusive findings for clinically relevant outcomes could be provided. Yet, several inconclusive findings were reported, suggesting thus that NMAs can also guide new research by emphasizing where new evidence is most needed. NMAs provide a unique opportunity for poignant synthesis of high-quality evidence. In particular, they seem particularly promising when the evidence base has reached a sufficient level of maturity, and several competing interventions require comprehensive and comparative risk-benefit appraisal.
Unità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, Italy.|Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano, Italy.
Arturo
A
Giordano
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.
Mariangela
M
Peruzzi
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.
Antonino G M
AG
Marullo
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.|Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
Giacomo
G
Frati
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.|Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy.
Sebastiano
S
Sciarretta
Cardiology and Coronary Care Unit, Presidio Ospedaliero S. Giuliano, ASL Napoli 2 Nord, Giugliano, Italy.
Giovanni
G
Napolitano
Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy. giuseppe.biondizoccai@uniroma1.it.|Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy. giuseppe.biondizoccai@uniroma1.it.
Giuseppe
G
Biondi-Zoccai
D050197:Atherosclerosis / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D011322:Primary Prevention; D018570:Risk Assessment
Atherosclerosis; Evidence synthesis; Mixed treatment comparison; Network meta-analysis; Prevention; Treatment