What is the clinical evidence from this study?

Study design: Review. Population: Ischemic heart disease. Intervention: Secondary prevention therapies. Primary outcome: Mortality rates and cardiovascular morbidity.

What does this research mean for the field?

Several interventions, including specific anticoagulants, beta-blockers, ACE inhibitors, statins, and dietary modifications, significantly reduce total mortality and cardiovascular morbidity in patients with established ischemic heart disease. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 13, 1997

Secondary Prevention for Ischemic Heart Disease

Key Result

A review of 25 trials found statistically significant improvements in total mortality rates with warfarin, timolol, propranolol, captopril, ramipril, simvastatin, and diet in ischemic heart disease.

Structured PICO

Do secondary prevention strategies reduce mortality and cardiovascular morbidity in patients with established ischemic heart disease?

Population

Patients with established ischemic heart disease (clinical manifestations)

Intervention

Secondary prevention strategies including aspirin, antiplatelet agents, anticoagulants, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, cholesterol lowering, exercise rehabilitation, diet, or vitamins

Outcome

Total mortality rates and cardiovascular morbidityhard clinical

Several secondary prevention strategies, including specific medications and diet, significantly improve total mortality in patients with established ischemic heart disease.

Abstract

Secondary prevention of ischemic heart disease refers to the process of preventing further morbidity and reducing mortality rates in patients with clinical manifestations of the disease. Twenty-five large randomized, clinical trials addressing mortality rates and cardiovascular morbidity in patients with established ischemic heart disease are reviewed. Broadly defined, these were trials of aspirin and antiplatelet agents, anticoagulants, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, lowering of cholesterol levels, exercise rehabilitation, and diet or vitamins. In trials using warfarin sodium, timolol maleate, propranolol hydrochloride, captopril, ramipril, and simvastatin and 2 diet studies, statistically significant improvements in total mortality rates were seen. Most other studies showed non-significant reductions in total mortality rates, with statistically significant reductions in 1 or more measures of cardiovascular morbidity. The methods necessary for the reader to calculate the number (of patients) needed to treat for other studies are also reviewed. The uses and limitations of the number needed to treat as a method to compare studies of different interventions in similar populations are discussed.

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