SynthesisHerz2019

Effects of monoclonal antibodies against PCSK9 on clinical cardiovascular events : A meta-analysis of randomized controlled trials.

Y Zhu, X Shen, Q Jiang, Z Wang, Z Wang, X Dong, J Li, Q Han, J Zhao, B Wang and 1 more

Abstract readMeta-Analysis
PubMed Publisher
In one paragraph

Synthesis in Herz, 2019. The graph read 4 numbers from its abstract, feeding 1 cell of the map: it . Cited by 2 papers, 1 of them a synthesis that pooled it.

4numbers the graph read from it
1cell of the map it votes in
2citing papers in PubMed, 1 pooled it
0.5field-weighted citation impact, top 30% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

← favours the treatmentfavours the comparator →
1 · no effect
Coronary revascularizationMonoclonal antibodies against PCSK9favours the treatment · ascvd, dyslipidemiafeeds one cell of the map
RR 0.810.75 to 0.88p = 0.000
Monoclonal antibodies against PCSK9 were associated with a significant reduction in positively adjudicated cardiovascular events (relative risk [RR] = 0.87; 95% confidence interval [CI] = 0.81-0.93; z = 4.03; p = 0.000), MI (RR = 0.78; 95% CI = 0.71-0.86; z = 4.96; p = 0.000), coronary revascularization (RR = 0.81, 95% CI = 0.75-0.88; z = 4.93; p = 0.000), and stroke (RR = 0.76, 95% CI = 0.65-0.89; z = 3.47; p = 0.001).
Positively adjudicated cardiovascular eventsMonoclonal antibodies against PCSK9favours the treatment · ascvd, dyslipidemiafeeds one cell of the map
RR 0.870.81 to 0.93p = 0.000
Monoclonal antibodies against PCSK9 were associated with a significant reduction in positively adjudicated cardiovascular events (relative risk [RR] = 0.87; 95% confidence interval [CI] = 0.81-0.93; z = 4.03; p = 0.000), MI (RR = 0.78; 95% CI = 0.71-0.86; z = 4.96; p = 0.000), coronary revascularization (RR = 0.81, 95% CI = 0.75-0.88; z = 4.93; p = 0.000), and stroke (RR = 0.76, 95% CI = 0.65-0.89; z = 3.47; p = 0.001).
MIMonoclonal antibodies against PCSK9favours the treatment · ascvd, dyslipidemiafeeds one cell of the map
RR 0.780.71 to 0.86p = 0.000
Monoclonal antibodies against PCSK9 were associated with a significant reduction in positively adjudicated cardiovascular events (relative risk [RR] = 0.87; 95% confidence interval [CI] = 0.81-0.93; z = 4.03; p = 0.000), MI (RR = 0.78; 95% CI = 0.71-0.86; z = 4.96; p = 0.000), coronary revascularization (RR = 0.81, 95% CI = 0.75-0.88; z = 4.93; p = 0.000), and stroke (RR = 0.76, 95% CI = 0.65-0.89; z = 3.47; p = 0.001).
StrokeMonoclonal antibodies against PCSK9favours the treatment · ascvd, dyslipidemiafeeds one cell of the map
RR 0.760.65 to 0.89p = 0.001
Monoclonal antibodies against PCSK9 were associated with a significant reduction in positively adjudicated cardiovascular events (relative risk [RR] = 0.87; 95% confidence interval [CI] = 0.81-0.93; z = 4.03; p = 0.000), MI (RR = 0.78; 95% CI = 0.71-0.86; z = 4.96; p = 0.000), coronary revascularization (RR = 0.81, 95% CI = 0.75-0.88; z = 4.93; p = 0.000), and stroke (RR = 0.76, 95% CI = 0.65-0.89; z = 3.47; p = 0.001).

clause the extractor read what became the number

2 · Its place on the map

Where it lands on the map

Rows are treatments, columns are outcomes. The coloured squares are the cells this paper feeds, coloured by the vote it casts there. Click one to jump to what this paper adds to it.

supports the treatmentfavours the comparatorno clear differenceread, but no usable result
3 · What it changes

What it adds to each cell

For every cell the paper feeds: the belief in the claim with and without this paper, and this paper's estimate drawn against every other readable study in the cell. The ringed dot is this paper.

PCSK9 inhibitors×cardiovascular events

No readable resultOpen on the map →What to test next →

10 readable studies in this cell: 8 favour the treatment, 2 find no difference, 0 favour the comparator.

Belief with this paper
1.00established · 6 families support, 0 contradict · against placebo
Without itNot a counted family in this claim, so removing it changes nothing.
← favours the treatmentfavours the comparator →
1 · no effect
NCT0176463327,564 enrolled · 2013
HR 0.850.79 to 0.92
NCT0166340218,924 enrolled · 2012
HR 0.850.78 to 0.93
NCT0387240112,301 enrolled · 2019
HR 0.750.65 to 0.86

This paper's own estimate is on a different scale from the rest of the cell, so it is not drawn here.

4 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

5 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 5 citations in OpenAlex.

  1. Pooled it
  2. Review
6 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

7 · Who and what money

Authors and funding

11 authors at 1 institution in 1 country.

Y ZhuDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
X ShenCardiovascular Department of Dongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China. alienstg@163.com.
Q JiangICU Department of Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China.
Z WangDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
Z WangDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
X DongDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
J LiDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
Q HanDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
J ZhaoDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
B WangDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
L LiuDongzhimen Hospital, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, 100700, Beijing, China.
Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine · CN

Funding

No grant is acknowledged in the PubMed record.

8 · The paper itself

Abstract

The marked sentences are the ones the graph read a number from.

backgroundThe present meta-analysis was designed to improve statistical power and review the effects of monoclonal antibodies against PCSK9 on clinical cardiovascular events.

methodsPubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to May 2017. Studies considered to be eligible were randomized controlled trials about the effects of monoclonal antibodies against PCSK9 on clinical cardiovascular events. The primary endpoint was positively adjudicated cardiovascular events; the secondary endpoint comprised cardiac mortality, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization for unstable angina.

resultsWe included 20 randomized controlled trials involving 67,934 patients. Monoclonal antibodies against PCSK9 were associated with a significant reduction in positively adjudicated cardiovascular events (relative risk [RR] = 0.87; 95% confidence interval [CI] = 0.81-0.93; z = 4.03; p = 0.000), MI (RR = 0.78; 95% CI = 0.71-0.86; z = 4.96; p = 0.000), coronary revascularization (RR = 0.81, 95% CI = 0.75-0.88; z = 4.93; p = 0.000), and stroke (RR = 0.76, 95% CI = 0.65-0.89; z = 3.47; p = 0.001). Monoclonal antibodies against PCSK9 did not reduce hospitalization rates due to unstable angina. The results of subgroup analysis showed that evolocumab was associated with a lower risk of positively adjudicated cardiovascular events, MI, coronary revascularization, and stroke without reducing cardiac mortality. Alirocumab reduced the incidence of cardiac mortality but not of other cardiovascular events, while bococizumab was associated with a reduced risk of stroke.

conclusionMonoclonal antibodies against PCSK9 were associated with a lower risk of positively adjudicated cardiovascular events, MI, coronary revascularization, and stroke.

Indexed as

Anticholesteremic AgentsCardiovascular DiseasesProprotein Convertase 9Antibodies, MonoclonalCholesterol, LDLDouble-Blind MethodHumansProspective StudiesRandomized Controlled Trials as TopicAntibodies, MonoclonalAnticholesteremic AgentsCholesterol, LDLPCSK9 protein, humanProprotein Convertase 9Cardiovascular diseaseLow-density lipoprotein cholesterolMeta-analysisProprotein convertase, subtilisin-kexin type 9Stroke

Identifiers

PMID29116337
OpenAlexW2767669362

What Socratic holds

Texttitle and abstract
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.