Global cardiovascular risk assessment yielded no evidence for reducing CVD morbidity or mortality, though it produced small reductions in systolic blood pressure (MD -2.22 mm Hg).
Systematic Review
Does global cardiovascular risk assessment reduce CVD-related morbidity and mortality in adults with no history of CVD?
Current systematic reviews provide no evidence that global cardiovascular risk assessment reduces CVD morbidity or mortality, though it may yield small, likely clinically insignificant improvements in surrogate markers like blood pressure and cholesterol.
Objective To identify, critically appraise and summarise existing systematic reviews on the impact of global cardiovascular risk assessment in the primary prevention of cardiovascular disease (CVD) in adults. Design Systematic review of systematic reviews published between January 2005 and October 2016 in The Cochrane Library, EMBASE, MEDLINE or CINAHL databases, and post hoc analysis of primary trials. Participants, interventions, outcomes Systematic reviews of interventions involving global cardiovascular risk assessment relative to no formal risk assessment in adults with no history of CVD. The primary outcomes of interest were CVD-related morbidity and mortality and all-cause mortality; secondary outcomes were systolic blood pressure (SBP), cholesterol and smoking. Results We identified six systematic reviews of variable but generally of low quality (mean Assessing the Methodological Quality of Systematic Reviews 4.2/11, range 0/11 to 7/11). No studies identified by the systematic reviews reported CVD-related morbidity or mortality or all-cause mortality. Meta-analysis of reported randomised controlled trials (RCTs) showed small reductions in SBP (mean difference (MD) −2.22 mm Hg (95% CI −3.49 to −0.95); I 2 =66%; n=9; GRADE: very low), total cholesterol (MD −0.11 mmol/L (95% CI −0.20 to −0.02); I 2 =72%; n=5; GRADE: very low), low-density lipoprotein cholesterol (MD −0.15 mmol/L (95% CI −0.26 to −0.05), I 2 =47%; n=4; GRADE: very low) and smoking cessation (RR 1.62 (95% CI 1.08 to 2.43); I 2 =17%; n=7; GRADE: low). The median follow-up time of reported RCTs was 12 months (range 2–36 months). Conclusions The quality of existing systematic reviews was generally poor and there is currently no evidence reported in these reviews that the prospective use of global cardiovascular risk assessment translates to reductions in CVD morbidity or mortality. There are reductions in SBP, cholesterol and smoking but they may not be clinically significant given their small effect size and short duration. Resources need to be directed to conduct high-quality systematic reviews focusing on hard patient outcomes, and likely further primary RCTs. Trial registration number CRD42015019821.
Collins et al. (Wed,) conducted a systematic review in Primary prevention of cardiovascular disease. Global cardiovascular risk assessment vs. No formal risk assessment was evaluated on CVD-related morbidity and mortality and all-cause mortality. Global cardiovascular risk assessment yielded no evidence for reducing CVD morbidity or mortality, though it produced small reductions in systolic blood pressure (MD -2.22 mm Hg).