Abstract
BackgroundMyocardial Infarction (MI) has become a major cause of morbidity and mortality in China, but little is known about the prevalence of guideline-recommended cardiovascular medications after MI events over the last two decades. This systematic review and meta-analysis aims to summarize cardiovascular medication use between 1995–2015 and to assess factors in associated with the trends in cardiovascular medications.MethodA systematic search was conducted in four databases (Pubmed, Embase, CENTRAL, and CNKI) to obtain observational studies published between 1995 and 2015, reporting on the use of cardiovascular medications in China. Risk of bias of individual studies was appraised and selected studies were pooled for estimated prevalence of cardiovascular medication. Prevalence of cardiovascular medication use for 1995 and 2015 was estimated by random effects meta-regression model.ResultsFrom 13,940 identified publications, 35 studies, comprising 28,000 patients, were included. The pooled prevalence for aspirin, beta-blockers, statins, ACE-Inhibitors, ACE-Inhibitor/ARBs and nitrates was 92% [95% confidence interval (CI): 0.89–0.95], 63% (95% CI: 0.57–0.69), 72% (95% CI: 0.60–0.82), 49% (95% CI: 0.41–0.57), 59% (95% CI: 0.48–0.69) and 79% (95% CI: 0.74–0.91), respectively. A significant increase in beta-blocker and statin use and a decrease of nitrate use was observed over time. The estimated prevalence of beta-blockers, statins, and nitrates was 78%, 91.1%, and 59.3% in 2015, compared to 32%, 17% and 96% in 1995, respectively.ConclusionCardiovascular medication use after MI is far from optimal in Chinese patients, even though the prevalence of use increased over the period 1995–2015. With a rapidly increasing number of MI patients in China, a comprehensive strategy on secondary prevention is warranted.Systematic review registrationPROSPERO (CRD42015025246)
Highlights
Increasing per capita income and an aging population have led to profound demographic and epidemiologic changes in China. [1,2,3] Cardiovascular disease (CVD) has become the leading non-communicable disease over the past two decades.[1]
The pooled prevalence for aspirin, beta-blockers, statins, ACE-Inhibitors, ACE-Inhibitor/ angiotensin receptor blockers (ARB) and nitrates was 92% [95% confidence interval (CI): 0.89–0.95], 63%, 72%, 49%, 59% and 79%, respectively
Cardiovascular medication use after myocardial infarction (MI) is far from optimal in Chinese patients, even though the prevalence of use increased over the period 1995–2015
Summary
Increasing per capita income and an aging population have led to profound demographic and epidemiologic changes in China. [1,2,3] Cardiovascular disease (CVD) has become the leading non-communicable disease over the past two decades.[1]. Healthcare system reforms, improved medical insurance coverage and evidence-based guideline recommendations have been recently introduced by the Chinese government. This has led to some remarkable strides in MI management with better quality of care and more effective medical therapy.[1,3,4,5] Widespread and long-term medical therapy by using cardiovascular medications for secondary prevention after MI events have been highly recommended in the Chinese prevention guideline to reduce mortality rates from MI and recurrent acute cardiac events.[6] the prevalence of guideline-recommended cardiovascular medication in daily practice has been rarely assessed. This systematic review and meta-analysis aims to summarize cardiovascular medication use between 1995–2015 and to assess factors in associated with the trends in cardiovascular medications
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