Skinner Jane S, Cooper Angela
Royal Victoria Infirmary, Newcastle upon Tyne, UK.
BMJ Clin Evid. 2011 Aug 30;2011:0206.
Coronary artery disease is the leading cause of mortality in resource-rich countries, and is becoming a major cause of morbidity and mortality in resource-poor countries. Secondary prevention in this context is long-term treatment to prevent recurrent cardiac morbidity and mortality in people who have had either a prior acute myocardial infarction (MI) or acute coronary syndrome, or who are at high risk due to severe coronary artery stenoses or prior coronary surgical procedures. Secondary prevention in people with an acute MI or acute coronary syndrome within the past 6 months is not included.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of antithrombotic treatment; other drug treatments; cholesterol reduction; blood pressure reduction; non-drug treatments; and revascularisation procedures? We searched: Medline, Embase, The Cochrane Library, and other important databases up to May 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 137 systematic reviews or RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: advice to eat less fat, advice to eat more fibre, advice to increase consumption of fish oils, amiodarone, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, angiotensin II receptor blockers plus ACE inhibitors, antioxidant vitamin combinations, antiplatelet agents, aspirin, beta-blockers, beta-carotene, blood pressure reduction, calcium channel blockers, cardiac rehabilitation including exercise, class I antiarrhythmic agents, coronary artery bypass grafting (CABG), fibrates, hormone replacement therapy (HRT), Mediterranean diet, multivitamins, non-specific cholesterol reduction, oral anticoagulants, oral glycoprotein IIb/IIIa receptor inhibitors, percutaneous coronary intervention (PCI), psychosocial treatment, smoking cessation, statins, vitamin C, and vitamin E.
在资源丰富的国家，冠状动脉疾病是导致死亡的主要原因，并且在资源匮乏的国家正成为发病和死亡的主要原因。在此背景下，二级预防是对既往有急性心肌梗死（MI）或急性冠状动脉综合征，或因严重冠状动脉狭窄或既往冠状动脉手术而处于高风险的人群进行长期治疗，以预防心脏疾病复发和死亡。过去6个月内发生急性MI或急性冠状动脉综合征的患者不包括在二级预防范围内。
我们进行了一项系统评价，旨在回答以下临床问题：抗血栓治疗、其他药物治疗、降低胆固醇、降低血压、非药物治疗以及血运重建术的效果如何？我们检索了：截至2010年5月的Medline、Embase、Cochrane图书馆及其他重要数据库（《临床证据》综述会定期更新，请查看我们的网站获取本综述的最新版本）。我们纳入了来自美国食品药品监督管理局（FDA）和英国药品及保健品监管局（MHRA）等相关组织的危害警示。
我们发现137项系统评价或随机对照试验符合我们的纳入标准。我们对干预措施的证据质量进行了GRADE评估。
在本系统评价中，我们呈现了以下干预措施的有效性和安全性相关信息：少吃脂肪的建议、多吃纤维的建议、增加鱼油摄入量的建议、胺碘酮、血管紧张素转换酶（ACE）抑制剂、血管紧张素II受体阻滞剂、血管紧张素II受体阻滞剂加ACE抑制剂、抗氧化维生素组合、抗血小板药物、阿司匹林、β受体阻滞剂、β-胡萝卜素、降低血压、钙通道阻滞剂、包括运动在内的心脏康复、I类抗心律失常药物、冠状动脉旁路移植术（CABG）、贝特类药物、激素替代疗法（HRT）、地中海饮食、多种维生素、非特异性降低胆固醇、口服抗凝剂、口服糖蛋白IIb/IIIa受体抑制剂、经皮冠状动脉介入治疗（PCI）、心理社会治疗、戒烟、他汀类药物、维生素C和维生素E。
