Efficacy of statin treatment based on cardiovascular outcomes in elderly patients: a standard meta-analysis and Bayesian network analysis

Figures

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  Figure 1.. Search strategy based on the PRISMA statement. PRISMA, Preferred Reporting Items for Systematic Reviews.

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  Figure 2.. Methodological quality of included trials. This risk-of-bias tool incorporates an assessment of randomization (sequence generation and allocation concealment), blinding (participants, personnel, and outcome assessors), completeness of outcome data, selection of outcomes reported, and other sources of bias. The items were scored with “yes,” “no,” or “unsure.”

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  Figure 3.. Risk of bias. Each risk-of-bias item is presented as percentages across all included trials, which indicate the proportion of different levels of risk of bias for each item.

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  Figure 4.. Network plots of evidence for overall clinical outcomes. Line: Direct comparison between two linked drugs (statins/control). Each line links a statin regimen that have been directly compared in studies, while the thickness of the line is proportional to the precision of each direct estimate. The number of trials per comparison is reported next to each line. Circle: Statin types/control for trial comparisons. The width of each circle is proportional to the number of studies included. In addition, the number of patients included in each treatment (statins/control) is reported in the bracket below the statin/control name.

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  Figure 5.. Forest plot of the meta-analysis estimate for each statin compared with the control group, and of each statin against control within the networks for clinical outcomes in secondary prevention with at least two trials compared with the corresponding ranking probability (SUCRA) and quality of evidence (GRADE) for each statin regimen for each outcome. SUCRA, surface under the cumulative ranking curve; GRADE, Grading of Recommendations Assessment, Development and Evaluation.

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  Figure 6.. Results of the trial sequential analysis (TSA) of the risks of clinical outcomes for older patients in secondary prevention. TSA provided a termination criterion for clinical trials by estimating the required information size (RIS). Red dotted line: TSA boundary curve. Green dotted line: The conventional boundary curve. Blue line: The cumulative z-curve of the meta-analysis. Abscissa: The cumulated sample sizes of included trials in meta-analysis. The accumulated Z-curve passed through the conventional boundary curve and also across the TSA boundary curve, indicating a positive and reliable conclusion has been reached before reaching the expected amount of information size (including cardiovascular events, all-cause mortality, cardiovascular mortality, and revascularization).

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  Figure 7.. Trial sequential analysis (TSA) of the risks of clinical outcomes for the older patients in primary prevention.