Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
JAMA Intern Med. 2013 Apr 22;173(8):664-71. doi: 10.1001/jamainternmed.2013.3018.
Numerous cardiovascular biomarkers are proposed as potential predictors of cardiovascular risk.
To evaluate whether there is evidence for biases favoring statistically significant results and inflating associations in this literature.
PubMed search for meta-analyses of cardiovascular biomarkers that are not part of the Framingham Risk Score.
We estimated summary effects and between-study heterogeneity (considered "very large" for I2 > 75%). We evaluated whether large studies had significantly more conservative results than smaller studies (small-study effects) and whether there were too many studies with statistically significant results compared with what would be expected on the basis of the findings of the largest study in each meta-analysis.
Of 56 eligible meta-analyses, 49 had statistically significant results. Very large heterogeneity and small-study effects were seen in 9 and 13 meta-analyses, respectively. In 29 meta-analyses (52%), there was a significant excess of studies with statistically significant results. Only 13 of the statistically significant meta-analyses had more than 1000 cases and no hints of large heterogeneity, small-study effects, or excess significance. These included the associations of glomerular filtration rate and albumin to creatinine ratio in general and high-risk populations with cardiovascular disease mortality and of non-high-density lipoprotein cholesterol, serum albumin, Chlamydia pneumoniae IgG, glycosylated hemoglobin, nonfasting insulin, apolipoprotein B/AI ratio, erythrocyte sedimentation rate, and lipoprotein-associated phospholipase mass or activity with coronary heart disease.
Selective reporting biases may be common in the evidence on emerging cardiovascular biomarkers. Most of the proposed associations of these biomarkers may be inflated.
许多心血管生物标志物被提议作为心血管风险的潜在预测因子。
评估该文献中是否存在有利于统计学显著结果的偏倚，并夸大关联的证据。
在PubMed 上搜索不属于弗雷明汉风险评分的心血管生物标志物的荟萃分析。
我们估计了汇总效应和研究间异质性（I2 > 75%，认为“非常大”）。我们评估了大型研究的结果是否比小型研究更保守（小样本研究效应），以及与每个荟萃分析中最大研究的发现相比，是否有太多的研究结果具有统计学意义。
在 56 项合格的荟萃分析中，有 49 项具有统计学意义。9 项荟萃分析显示出非常大的异质性和小样本研究效应，分别为 13 项。在 29 项荟萃分析（52%）中，具有统计学意义的研究结果过多。只有 13 项统计学上显著的荟萃分析有超过 1000 例，且没有明显的大异质性、小样本研究效应或过度显著的迹象。这些包括肾小球滤过率和白蛋白与肌酐比值在一般人群和高危人群中的关联，以及心血管疾病死亡率与非高密度脂蛋白胆固醇、血清白蛋白、肺炎衣原体 IgG、糖化血红蛋白、非空腹胰岛素、载脂蛋白 B/AI 比值、红细胞沉降率和脂蛋白相关磷脂酶质量或活性与冠心病的关联。
新兴心血管生物标志物证据中可能存在选择性报告偏倚。这些生物标志物的大多数拟议关联可能被夸大了。
