Box 2.

—Treatments discovered through randomised controlled trials

Treatments that reduce mortality or morbidity

Acute myocardial infarction: thrombolytics, aspirin (and other antiplatelet agents such as the thienopyridines), β blockers, angiotensin converting enzyme inhibitors, lipid lowering drugs, warfarin (in the absence of aspirin), direct angioplasty (highly suggestive, but not conclusive, evidence)

• Unstable angina: aspirin, new antiplatelet agents, thrombin inhibitors

• Heart failure: angiotensin converting enzyme inhibitors, β blockers, spironolactone, digoxin

• Surgery: coronary artery bypass graft surgery or carotid endarterectomy in patients at high risk

• Devices: implantable defibrillators

• Primary prevention: lipid lowering drugs, blood pressure lowering drugs, aspirin (suggestive, but not conclusive, evidence)

Treatments that are harmful or useless

• Acute myocardial infarction: prolonged bed rest, magnesium, class I antiarrhythmics, calcium channel blockers

• Heart failure: phosphodiesterase inhibitor inotropes, direct vasodilators

• Surgery: extracranial-intracranial bypass

• Prevention: β carotene, hormone replacement therapy (highly suggestive, but not conclusive, evidence)