October 21, 1988

Overview of results of randomized clinical trials in heart disease. II. Unstable angina, heart failure, primary prevention with aspirin, and risk factor modification

Structured PICO

Do common treatments for unstable angina, heart failure, and primary prevention reduce mortality or major morbidity?

Population

Patients with unstable angina, congestive heart failure, or individuals targeted for primary prevention with aspirin and risk factor modification

Intervention

Common treatments for unstable angina, congestive heart failure, primary prevention with aspirin, and risk factor modification

Comparator

Control groups in the included randomized trials

Outcome

Mortality or major morbidityhard clinical

This overview summarizes the effects of common treatments on mortality and major morbidity in unstable angina, heart failure, and primary prevention to guide clinical decision-making.

Abstract

THIS is the second of a two-part article on the results of randomized trials of treatments designed to reduce mortality or major morbidity in heart disease. Our goal is to summarize the results of trials of common treatments on major outcomes in unstable angina, congestive heart failure, primary prevention with aspirin, and risk factor modification. This summary should provide useful background information against which clinicians must consider other information (eg, patient prognosis, risk of side effects, drug interactions, and specific clinical picture) in making decisions about individual patients. We do not deal in either article with trials of coronary artery bypass graft surgery for stable angina, trials of valve replacement, or congenital heart disease. The risk reductions are based on the odds ratio calculated by the Mantel-Haenszel method as applied to combining data from several trials. When event rates are low, the odds ratio and the relative risk are numerically

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