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Determining optimal strategies for primary prevention of cardiovascular disease: systematic review, cost-effectiveness review and network meta-analysis protocol

机译：确定心血管疾病初步预防的最佳策略：系统审查，成本效益审查和网络元分析方案

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Despite recent improvements in the burden of cardiovascular disease (CVD) in the UK, deaths from CVD are relatively high compared with other high-income countries. An estimated 7 million people in the UK are living with CVD, and the healthcare cost is approximately ￡11 billion annually. In more than 90% of cases, the risk of a first heart attack is thought to be related to modifiable risk factors including smoking, poor diet, lipidemia, high blood pressure, inactivity, obesity and excess alcohol consumption. The aim of the study is to synthesise evidence for the comparative effectiveness and cost-effectiveness of different interventions for the primary prevention of CVD. We will systematically search databases (for example, MEDLINE (Ovid), Embase (Ovid), Cochrane Library) and the reference lists of previous systematic reviews for randomised controlled trials that assess the effectiveness and cost-effectiveness of any form of intervention aimed at adult populations for the primary prevention of CVD, including but not limited to lipid lowering medications, blood pressure lowering medications, antiplatelet agents, nutritional supplements, dietary interventions, health promotion programmes, physical activity interventions or structural and policy interventions. Interventions may or may not be targeted at high-risk groups. Publications from any year will be considered for inclusion. The primary outcome will be all cause mortality. Secondary outcomes will be cardiovascular diseases related mortality, major cardiovascular events, coronary heart disease, incremental costs per quality-adjusted life years gained. If data permits, we will use network meta-analysis to compare and rank effectiveness of different interventions, and test effect modification of intervention effectiveness using subgroup analyses and meta-regression analyses. The results will be important for policymakers when making decisions between multiple possible alternative strategies to prevent CVD. Compared to results from existing multiple separate pairwise meta-analyses, this overarching synthesis of all relevant work will enhance decision-making. The findings will be crucial to inform evidence-based priorities and guidelines for policies and planning prevention strategies of CVD. PROSPERO CRD42019123940.
机译：尽管最近在英国的心血管疾病（CVD）负担的改善，但CVD的死亡与其他高收入国家相比相对较高。英国的估计有700万人与CVD生活，医疗保健费用约为110亿英镑。在90％以上的病例中，据认为，第一次心脏病发作的风险与可改变的危险因素有关，包括吸烟，饮食差，血脂症，高血压，不活动，肥胖和过量的酒精消耗。该研究的目的是综合不同干预措施对CVD的比较有效性和成本效益的证据。我们将系统地搜索数据库（例如，Medline（Ovid），Embase（Ovid），Cochrane库）和先前系统评价的参考列表，用于评估任何针对成人的任何形式的干预的有效性和成本效益用于初级预防CVD的群体，包括但不限于脂质降低药物，血压降低药物，抗血压剂，营养补充剂，饮食干预，健康促进计划，身体活动干预或结构和政策干预。干预可能或可能不会以高风险群体靶向。任何一年的出版物都将被视为包容。主要结果将是所有导致死亡率。二次结果将是心血管疾病的相关死亡率，主要心血管事件，冠心病，每个质量调整后的生命年份增量成本。如果数据允许，我们将使用网络元分析来比较和排名不同干预的效率，并使用子组分析和元回归分析进行干预效果的测试效果修改。在多种可能的替代策略之间做出决策以防止CVD时，结果对于决策者来说，结果将对。与现有多重单独成对荟萃分析的结果相比，这种所有相关工作的总体合成将增强决策。该调查结果将对基于循证的优先事项和CVD的规划预防策略提供信息至关重要。 Prospero CRD42019123940。

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