Summary of findings 1. CVD risk scoring for the primary prevention of cardiovascular disease.
| CVD risk scoring for the primary prevention of cardiovascular disease | ||||||
| Patient or population: adults without prevalent cardiovascular disease (primary cardiovascular disease prevention) Setting: outpatient Intervention: providing CVD risk scores Comparison: not providing CVD risk scores/usual care | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | N of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with not providing CVD risk scores/usual care | Risk with providing CVD risk scores | |||||
| CVD events follow‐up: range 1‐10 years | Study population | RR 1.01 (0.95 to 1.08) | 99,070 (3 RCTs) | ⊕⊕⊝⊝ Lowa,b | — | |
| 53 per 1000 | 54 per 1000 (51 to 58) | |||||
| Total cholesterol (mmol/L) follow‐up: median 1 years | In the comparison group, the range of mean total cholesterol level was 5.1 to 6.6 mmol/L and the range of mean change from baseline in total cholesterol level was 0.09 lower to 0.14 mmol/L higher | The mean difference in total cholesterol in the intervention group was 0.10 mmol/L lower (0.20 lower to 0.00) | — | 20,437 (12 RCTs) | ⊕⊕⊝⊝ Lowc,d | — |
| Systolic blood pressure (mmHg) follow‐up: median 1 years | In the comparison group, the range of mean systolic blood pressure level was 124.1 to 159.0 mmHg and the range of mean change from baseline in systolic blood pressure level was 5.3 lower to 1.0 higher mmHg | The mean difference in systolic blood pressure in the intervention group was 2.77 mmHg lower (4.16 lower to 1.38 lower) | — | 32,954 (16 RCTs) | ⊕⊕⊝⊝ Lowc,d | — |
| Change in multivariable CVD risk (SD) follow‐up: median 1 years | In the comparison group, the range of mean change from baseline in multivariable CVD risk was 5.3 lower to 0.77 higher SDs | The mean difference in multivariable CVD risk in the intervention group was 0.21 SDs lower (0.39 lower to 0.02 lower) | — | 9549 (9 RCTs) | ⊕⊕⊝⊝ Lowc,d | Standardised mean differences were calculated for this outcome due to the use of different multivariable CVD risk scales. An effect size of ~0.20 SD units reflects a small effect. |
| Investigator‐defined adverse events follow‐up: range 1 month to 1 year | Study population | RR 0.72 (0.49 to 1.04) | 4630 (4 RCTs) | ⊕⊕⊝⊝ Lowe,f | Adverse events were defined heterogeneously by investigators and included some events that may have been due to newly prescribed medications rather than the provision of a CVD risk score itself. | |
| 27 per 1000 | 19 per 1000 (13 to 28) | |||||
| New/intensified lipid‐lowering medication follow‐up: median 6 months | Study population | RR 1.47 (1.15 to 1.87) | 14,175 (11 RCTs) | ⊕⊕⊝⊝ Lowd,e | Prescribing rates in the comparison group varied among the included trials (range 4% to 22%). Median prescribing rate presented | |
| 107 per 1000 | 157 per 1000 (123 to 200) | |||||
| New/intensified antihypertensive medication follow‐up: median 1 years | Study population | RR 1.51 (1.08 to 2.11) | 13,255 (8 RCTs) | ⊕⊕⊝⊝ Lowd,e | Prescribing rates in the comparison group varied among the included trials (range 0% to 27%). Median prescribing rate presented | |
| 114 per 1000 | 172 per 1000 (123 to 240) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SD: standard deviation. | ||||||
| GRADE Working Group grades of evidence High quality: we are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect Very low quality: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect | ||||||
aDowngraded due to study limitations, primarily driven by high risk of selection bias in Holt 2010 and high risk of reporting bias in Bucher 2010 and Jorgensen 2014. bDowngraded due to imprecision; trials reported being underpowered for CVD events. cDowngraded due to study limitations, primarily in the domains of attrition bias (missing data for follow‐up risk factor levels) and other sources of bias (poor intervention fidelity, potential conflicts of interest). dDowngraded due to heterogeneity in pooled estimates. eDowngraded due to study limitations, primarily in the domains of attrition bias (missing data for medication prescribing in follow‐up) and other sources of bias (poor intervention fidelity, potential conflicts of interest). fDowngraded due to imprecision, because confidence interval includes 1 and sample size does not meet threshold for optimal information size.