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Latest & greatest articles for cardiovascular disease
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Estimating individual lifetime benefit and bleeding risk of adding rivaroxaban to aspirin for patients with stable cardiovasculardisease: results from the COMPASS trial Adding rivaroxaban to aspirin in patients with stable atherosclerotic disease reduces the recurrence of cardiovasculardisease (CVD) but increases the risk of major bleeding. The aim of this study was to estimate the individual lifetime treatment benefit and harm of adding low-dose rivaroxaban to aspirin in patients with stable (...) cardiovascular disease.Patients with established CVD from the COMPASS trial (n = 27 390) and SMART prospective cohort study (n = 8139) were used. Using the pre-existing lifetime SMART-REACH model for recurrent CVD, and a newly developed Fine and Gray competing risk-adjusted lifetime model for major bleeding, individual treatment effects from adding low-dose rivaroxaban to aspirin in patients with stable CVD were estimated, expressed in terms of (i) life-years free of stroke or myocardial infarction (MI
Use of fenofibrate on cardiovascular outcomes in statin users with metabolic syndrome: propensity matched cohort study. To investigate whether fenofibrate as add-on to statin treatment reduce persistent cardiovascular risk in adults with metabolic syndrome in a real world setting.Propensity matched cohort study.Population based cohort in Korea.29 771 adults with metabolic syndrome (≥40 years) receiving statin treatment. 2156 participants receiving combined treatment (statin plus fenofibrate (...) ) were weighted based on propensity score in a 1:5 ratio with 8549 participants using statin only treatment.Primary outcome was composite cardiovascular events including incident coronary heart disease, ischaemic stroke, and death from cardiovascular causes.The incidence rate per 1000 person years of composite cardiovascular events was 17.7 (95% confidence interval 14.4 to 21.8) in the combined treatment group and 22.0 (20.1 to 24.1) in the statin group. The risk of composite cardiovascular events
Medium and long-term risks of specific cardiovasculardiseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases. The past few decades have seen substantial improvements in cancer survival, but concerns exist about long-term cardiovasculardisease risk in survivors. Evidence is scarce on the risks of specific cardiovasculardiseases in survivors of a wide range of cancers to inform prevention and management (...) for a range of cardiovasculardisease outcomes using crude and adjusted Cox models. We fitted interactions to investigate effect modification, and flexible parametric survival models to estimate absolute excess risks over time.Between Jan 1, 1990, and Dec 31, 2015, 126 120 individuals with a diagnosis of a cancer of interest still being followed up at least 1 year later were identified and matched to 630 144 controls. After exclusions, 108 215 cancer survivors and 523 541 controls were included
Polypill for CardiovascularDisease Prevention in an Underserved Population. Persons with low socioeconomic status and nonwhite persons in the United States have high rates of cardiovasculardisease. The use of combination pills (also called "polypills") containing low doses of medications with proven benefits for the prevention of cardiovasculardisease may be beneficial in such persons. However, few data are available regarding the use of polypill therapy in underserved communities (...) in the United States, in which adherence to guideline-based care is generally low.We conducted a randomized, controlled trial involving adults without cardiovasculardisease. Participants were assigned to the polypill group or the usual-care group at a federally qualified community health center in Alabama. Components of the polypill were atorvastatin (at a dose of 10 mg), amlodipine (2.5 mg), losartan (25 mg), and hydrochlorothiazide (12.5 mg). The two primary outcomes were the changes from baseline
Modifiable risk factors, cardiovasculardisease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Global estimates of the effect of common modifiable risk factors on cardiovasculardisease and mortality are largely based on data from separate studies, using different methodologies. The Prospective Urban Rural Epidemiology (PURE) study overcomes these limitations by using similar methods to prospectively measure (...) the effect of modifiable risk factors on cardiovasculardisease and mortality across 21 countries (spanning five continents) grouped by different economic levels.In this multinational, prospective cohort study, we examined associations for 14 potentially modifiable risk factors with mortality and cardiovasculardisease in 155 722 participants without a prior history of cardiovasculardisease from 21 high-income, middle-income, or low-income countries (HICs, MICs, or LICs). The primary outcomes
Association of Genetic Variants Related to Combined Exposure to Lower Low-Density Lipoproteins and Lower Systolic Blood Pressure With Lifetime Risk of CardiovascularDisease. The relationship between exposure to lower low-density lipoprotein cholesterol (LDL-C) and lower systolic blood pressure (SBP) with the risk of cardiovasculardisease has not been reliably quantified.To assess the association of lifetime exposure to the combination of both lower LDL-C and lower SBP with the lifetime risk (...) of cardiovascular disease.Among 438 952 participants enrolled in the UK Biobank between 2006 and 2010 and followed up through 2018, genetic LDL-C and SBP scores were used as instruments to divide participants into groups with lifetime exposure to lower LDL-C, lower SBP, or both. Differences in plasma LDL-C, SBP, and cardiovascular event rates between the groups were compared to estimate associations with lifetime risk of cardiovascular disease.Differences in plasma LDL-C and SBP compared with participants
plasma glucose ABI Ankle–brachial index ABPM Ambulatory blood pressure monitoring ACCORD Action to Control Cardiovascular Risk in Diabetes ACE Acarbose Cardiovascular Evaluation ACEI Angiotensin-converting enzyme inhibitor ACS Acute coronary syndrome ADA American Diabetes Association ADVANCE Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation ADDITION Anglo-Danish-Dutch Study of Intensive Treatment In People with Screen Detected Diabetes in Primary Care ADOPT (...) A Diabetes Outcome Progression Trial AF Atrial fibrillation ARB Angiotensin receptor blocker ART Arterial Revascularization Trial ASCEND A Study of Cardiovascular Events iN Diabetes ASCVD Atherosclerotic cardiovasculardisease ATLAS-ACS TIMI 51 Anti-Xa Therapy to Lower cardiovascular events in Addition to Standard therapy in subjects with Acute Coronary Syndromes - Thrombolysis In Myocardial Infarction 51 BARI 2D Bypass Angioplasty Revascularization Investigation 2 Diabetes BEST Randomized Comparison
Canagliflozin and Cardiovascular and Renal Outcomes in Type 2 Diabetes Mellitus and Chronic Kidney Disease in Primary and Secondary Cardiovascular Prevention Groups Canagliflozin reduces the risk of kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, but effects on specific cardiovascular outcomes are uncertain, as are effects in people without previous cardiovasculardisease (primary prevention).In CREDENCE (Canagliflozin and Renal Events in Diabetes (...) ]). The risk of the primary composite renal outcome and the composite of cardiovascular death or hospitalization for heart failure were also consistently reduced in both the primary and secondary prevention groups (P for interaction >0.5 for each outcome).Canagliflozin significantly reduced major cardiovascular events and kidney failure in patients with type 2 diabetes mellitus and chronic kidney disease, including in participants who did not have previous cardiovascular disease.URL: https
Effects of Liraglutide Compared With Placebo on Events of Acute Gallbladder or Biliary Disease in Patients With Type 2 Diabetes at High Risk for Cardiovascular Events in the LEADER Randomized Trial To explore gallbladder- and biliary tract-related events reported for the liraglutide and placebo groups in the Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER) trial.LEADER was an international, randomized, double-blind, controlled cardiovascular (CV (...) ) outcomes trial. Participants with type 2 diabetes at high risk for CV events (n = 9,340) were randomized 1:1 to receive either liraglutide (≤1.8 mg daily; n = 4,668) or placebo (n = 4,672), with both groups also receiving standard care (treatment period: 3.5-5 years). Acute gallstone disease was a medical event of special interest. This post hoc analysis categorized captured events of acute gallbladder or biliary disease into four groups: uncomplicated gallbladder stones, complicated gallbladder stones
Effectiveness of polypill for primary and secondary prevention of cardiovasculardiseases (PolyIran): a pragmatic, cluster-randomised trial. A fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovasculardisease, especially in low-income and middle-income countries (LMICs). The PolyIran study aimed to assess the effectiveness and safety of a four-component polypill including aspirin, atorvastatin, hydrochlorothiazide, and either (...) developed cough during follow-up were switched by a trained study physician to polypill two, which included valsartan 40 mg instead of enalapril 5 mg. Participants were followed up for 60 months. The primary outcome-occurrence of major cardiovascular events (including hospitalisation for acute coronary syndrome, fatal myocardial infarction, sudden death, heart failure, coronary artery revascularisation procedures, and non-fatal and fatal stroke)-was centrally assessed by the GCS follow-up team, who were
2019LancetControlled trial quality: predicted high
Eligibility and subsequent burden of cardiovasculardisease of four strategies for blood pressure-lowering treatment: a retrospective cohort study. Worldwide treatment recommendations for lowering blood pressure continue to be guided predominantly by blood pressure thresholds, despite strong evidence that the benefits of blood pressure reduction are observed in patients across the blood pressure spectrum. In this study, we aimed to investigate the implications of alternative strategies (...) for offering blood pressure treatment, using the UK as an illustrative example.We did a retrospective cohort study in primary care patients aged 30-79 years without cardiovasculardisease, using data from the UK's Clinical Practice Research Datalink linked to Hospital Episode Statistics and Office for National Statistics mortality. We assessed and compared four different strategies to determine eligibility for treatment: using 2011 UK National Institute for Health and Care Excellence (NICE) guideline
Association of Smoking Cessation With Subsequent Risk of CardiovascularDisease. The time course of cardiovasculardisease (CVD) risk after smoking cessation is unclear. Risk calculators consider former smokers to be at risk for only 5 years.To evaluate the association between years since quitting smoking and incident CVD.Retrospective analysis of prospectively collected data from Framingham Heart Study participants without baseline CVD (original cohort: attending their fourth examination (...) in 1954-1958; offspring cohort: attending their first examination in 1971-1975) who were followed up through December 2015.Time-updated self-reported smoking status, years since quitting, and cumulative pack-years.Incident CVD (myocardial infarction, stroke, heart failure, or cardiovascular death). Primary analyses included both cohorts (pooled) and were restricted to heavy ever smokers (≥20 pack-years).The study population included 8770 individuals (original cohort: n = 3805; offspring cohort: n
Genetic variation at the coronary artery disease risk locus GUCY1A3 modifies cardiovasculardisease prevention effects of aspirin Efficacy of aspirin in primary prevention of cardiovasculardisease (CVD) may be influenced by a common allele in guanylate cyclase GUCY1A3, which has been shown to modify platelet function and increase CVD risk.We investigated whether homozygotes of the GUCY1A3 rs7692387 risk (G) allele benefited from aspirin in two long-term, randomized placebo-controlled trials
Lipoprotein(a) and Cardiovascular Outcomes in Coronary Artery Disease Patients With Prediabetes and Diabetes The aim of the current study is to determine the impact of elevated lipoprotein(a) [Lp(a)] on cardiovascular events (CVEs) in stable coronary artery disease (CAD) patients with different glucose metabolism status.In this multicenter study, we consecutively enrolled 5,143 patients from March 2011 to February 2015. Patients were categorized according to status of glucose metabolism (...) (diabetes mellitus [DM], pre-diabetes mellitus [pre-DM], and normal glucose regulation [NGR]) levels and further classified into 12 groups by Lp(a) levels. CVE end points included nonfatal acute myocardial infarction (MI), stroke, and cardiovascular mortality. All subjects were followed up for the occurrence of the CVEs.During a median of 6.1 years' follow-up, 435 (8.5%) CVEs occurred. No significant difference in occurrence of CVEs was observed between NGR and pre-DM groups (hazard ratio 1.131 [95% CI
Alirocumab (Praluent) - In adults with established atherosclerotic cardiovasculardisease to reduce cardiovascular risk by lowering LDL-C levels Published 10 June 2019 Statement of advice SMC2201 alirocumab 75mg / 150mg solution for injection in pre-filled pen (Praluent®) Sanofi-Aventis Ltd 10 May 2019 ADVICE: in the absence of a submission from the holder of the marketing authorisation alirocumab (Praluent®) is not recommended for use within NHSScotland. Indication under review: In adults (...) with established atherosclerotic cardiovasculardisease to reduce cardiovascular risk by lowering LDL-C levels, as an adjunct to correction of other risk factors: ? in combination with the maximum tolerated dose of a statin with or without other lipid- lowering therapies or, ? alone or in combination with other lipid-lowering therapies in patients who are statin- intolerant, or for whom a statin is contraindicated. The holder of the marketing authorisation has not made a submission to SMC regarding
Ultra-processed food intake and risk of cardiovasculardisease: prospective cohort study (NutriNet-Santé). To assess the prospective associations between consumption of ultra-processed foods and risk of cardiovascular diseases.Population based cohort study.NutriNet-Santé cohort, France 2009-18.105 159 participants aged at least 18 years. Dietary intakes were collected using repeated 24 hour dietary records (5.7 for each participant on average), designed to register participants' usual (...) consumption of 3300 food items. These foods were categorised using the NOVA classification according to degree of processing.Associations between intake of ultra-processed food and overall risk of cardiovascular, coronary heart, and cerebrovascular diseases assessed by multivariable Cox proportional hazard models adjusted for known risk factors.During a median follow-up of 5.2 years, intake of ultra-processed food was associated with a higher risk of overall cardiovasculardisease (1409 cases; hazard
The rise and fall of aspirin in the primary prevention of cardiovasculardisease. Aspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovasculardisease. By contrast, the role of aspirin in primary prevention of cardiovasculardisease is controversial. Early trials evaluating aspirin for primary prevention, done before the turn of the millennium, suggested reductions in myocardial infarction and stroke (although (...) not mortality), and an increased risk of bleeding. In an effort to balance the risks and benefits of aspirin, international guidelines on primary prevention of cardiovasculardisease have typically recommended aspirin only when a substantial 10-year risk of cardiovascular events exists. However, in 2018, three large randomised clinical trials of aspirin for the primary prevention of cardiovasculardisease showed little or no benefit and have even suggested net harm. In this narrative Review, we reappraise
Understanding the consequences of education inequality on cardiovasculardisease: mendelian randomisation study. To investigate the role of body mass index (BMI), systolic blood pressure, and smoking behaviour in explaining the effect of education on the risk of cardiovasculardisease outcomes.Mendelian randomisation study.UK Biobank and international genome-wide association study data.Predominantly participants of European ancestry.Educational attainment, BMI, systolic blood pressure (...) , and smoking behaviour in observational analysis, and randomly allocated genetic variants to instrument these traits in mendelian randomisation.The risk of coronary heart disease, stroke, myocardial infarction, and cardiovasculardisease (all subtypes; all measured in odds ratio), and the degree to which this is mediated through BMI, systolic blood pressure, and smoking behaviour respectively.Each additional standard deviation of education (3.6 years) was associated with a 13% lower risk of coronary heart