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Appraisals and coping in people living with cancer: a meta-analysis.

The present meta-analysis examined the relationship between primary appraisal dimensions and coping strategies in people with cancer. Primary appraisals were operationalized as appraisals of threat, challenge, and harm/loss. Coping was operationalized according to two coping taxonomies: the first based on coping efforts to manage the stressor itself and/or the distressful feelings associated with it (problem- or emotion-focused coping, respectively) and the second based on the general orientation of the coping efforts (approach or avoidance coping). Appraisals of threat were (counter-intuitively) related to use of problem-focused coping (r=0.20); appraisals of harm and/or loss were related to avoidance coping (r=0.23); and appraisals of challenge were related to both problem-focused (r=0.15) and approach coping (r=0.14). These findings suggest that individuals with cancer who appraise their illness as a threat are likely to use more problem-focused coping strategies. Individuals who appraise their cancer as a harm/loss, however, are likely to use more avoidance coping strategies. And finally, those who appraise their cancer as a challenge are likely to use approach coping strategies. Factors found to moderate the relationship between appraisals and coping included age of the participant, time since diagnosis, and type of cancer.

Adaptation, Psychological↗

Periodontal diseases and the risk of preterm birth and low birth weight: a meta-analysis.

BACKGROUND: This meta-analysis of periodontal disease in relation to the risk of preterm birth/low birth weight (PTB/ LBW) is based on two case-control studies and three prospective cohort studies that met pre-stated inclusion criteria. METHODS: Information on the designs of the studies, characteristics of the study population, exposure and outcome measures, control for confounders, and risk estimates were abstracted independently by two investigators using a standard protocol. RESULTS: Pregnant women with periodontal disease had an overall adjusted risk of preterm birth that was 4.28 (95% confidence interval [CI], 2.62 to 6.99; P <0.005) times that risk for healthy subjects. The overall adjusted odds ratio of preterm low birth weight was 5.28 (95% CI, 2.21 to 12.62; P <0.005), while the overall adjusted odds ratio of a delivery of either PTB or LBW was 2.30 (95% CI, 1.21 to 4.38; P <0.005). CONCLUSIONS: Our findings indicate that periodontal diseases in the pregnant mother significantly increase the risk of subsequent preterm birth or low birth weight. While it remains important to promote good oral hygiene during routine prenatal visits, there is no convincing evidence, on the basis of existing case control and prospective studies, that treatment of periodontal disease will reduce the risk of preterm birth. Consequently, large randomized, placebo-controlled, masked clinical trials are required.

Female↗

Predicting coma and other low responsive patients outcome using event-related brain potentials: a meta-analysis.

OBJECTIVE: A meta-analysis was performed to estimate the predictive power (odd ratio, OR) for awakening of auditory event-related potential (ERP) components in low responsive patients with stroke or hemorrhage, trauma, anoxic, post-operative, and metabolic encephalopathy etiologies. METHODS: We reviewed MEDLINE and analyzed citations for retrieved articles. Logistic regressions were applied on patient samples (Glasgow Coma Scale <12) across and for separate etiologies. RESULTS: For stroke and hemorrhage the ORs with 95% confidence intervals were: 2.05 [1.12-3.75] (N100), 4.47 [1.92-10.44] (MMN), 10.29 [2.00-52.79] (P300), for trauma: 1.63 [0.70-3.80] (N100), 4.72 [1.35-16.44] (MMN), 12.89 [4.82-34.43] (P300), anoxic: 8.03 [2.83-22.75] (N100), 15.50 [4.27-56.26] (MMN), 5.93 [2.38-14.77] (P300), post-operative: 10.66 [1.98-57.50] (N100), metabolic encephalopathy: 2.12 [0.34-13.13] (N100), 3.60 [0.28-46.36] (MMN), 7.71 [0.75-79.77] (P300), and all etiologies: 2.85 [1.91-4.27] (N100), 6.53 [3.55-12.01] (MMN), and 8.79 [4.88-15.83] (P300). Based on six N100 studies (N=548 patients), five MMN studies (N=470), and six P300 studies (N=313), the N100, MMN, or P300, when present, significantly predicted awakening, P300 and MMN being significantly better predictors than N100. CONCLUSIONS: The MMN and P300 appear to be reliable predictors of awakening. SIGNIFICANCE: The prognostic assessment of low responsive patients with auditory ERP should take into account both MMN and P300.

Coma↗

Low density lipoprotein cholesterol, statins and cardiovascular events: a meta-analysis.

A recent meta-analysis of the Cholesterol Treatment Trialists' (CTT) Collaboration comes to the clear conclusion that a reduction in LDL-C using statins of 1 mmol/l (39 mg/dl) leads to a decrease in overall mortality by 12%, in coronary mortality by 19% and in the incidence of strokes by 17%, independent of the LDL-C level prior to the start of treatment. We conducted a systematic review retrieving 18 studies with a total of 116,343 [corrected] participants. Differences in average LDL-C reductions between the intervention and control groups during the follow-up and relative risks according to different clinical endpoints were extracted from the original publications. Metaregression analyses showed that reduction in LDL-C accounted for more than 75% of the variance in risk reductions for overall mortality and cardiovascular endpoints. On the basis of our estimates, a reduction in LDL-C of 1 mmol/l (39 mg/dl) leads to reductions in overall mortality, coronary mortality, incidence of non-fatal myocardial infarction, the combination of coronary mortality and non-fatal myocardial infarction, stroke and any vascular event by 15% (95% CI: 11-20%), 24% (95% CI: 20-28%), 27% (95% CI: 20-32%), 25% (95% CI: 22-29%), 24% (18-29%) and 22% (95% CI: 19-26%), respectively. We conclude that the extent to which statins lower LDL-C is strongly related to the improvement of clinical outcomes achieved by this class of drugs.

Cardiovascular Diseases↗

Propranolol and sclerotherapy in the prevention of gastrointestinal rebleeding in patients with cirrhosis: a meta-analysis.

BACKGROUND/AIMS: A meta-analysis of nine selected randomized trials was performed to compare the effects of propranolol and sclerotherapy in the prevention of rebleeding and on survival in patients with cirrhosis. METHODS: Five end points were assessed: rebleeding, esophageal rebleeding, death, death due to bleeding, and adverse events. Analyses were performed according to the intention-to-treat method. For each end point, heterogeneity and treatment efficacy were assessed by the Der Simonian and Peto methods. When a significant difference was observed, sensitivity analyses were performed by successive stratification according to treatment duration, type of publication, severity of cirrhosis, and methodological quality. RESULTS: The mean percentage of patients free of rebleeding, the mean survival rate and the mean percentage of patients free of death from bleeding were not significantly different between patients treated with propranolol and those treated by sclerotherapy. The mean percentage of patients free of variceal rebleeding was 39% in propranolol group and 55% in sclerotherapy group (mean difference: 17%, 95% confidence interval: 9-25%, p < 0.001). The mean percentage of patients free of adverse events was significantly higher in the propranolol group than in the sclerotherapy group (mean difference: 22%, 95% confidence interval: 6-38%, p < 0.007). CONCLUSION: In patients with cirrhosis and esophageal varices, endoscopic sclerotherapy is more effective than propranolol in preventing variceal rebleeding, but the incidence of adverse events is significantly higher with sclerotherapy. There was no difference in survival between the treatments. Propranolol should be considered as a first choice treatment for preventing rebleeding.

Adult↗

Amiodarone versus placebo and class Ic drugs for cardioversion of recent-onset atrial fibrillation: a meta-analysis.

OBJECTIVES: This meta-analysis compared amiodarone with placebo and class Ic drugs for the cardioversion of recent-onset atrial fibrillation (AF), defined as lasting less than seven days. BACKGROUND: Despite the lack of trials that support its efficacy convincingly, amiodarone is widely used for conversion of recent-onset AF. METHODS: We searched Medline and EMBASE databases, as well as the Cochrane Controlled Trials Register for randomized trials on recent-onset AF comparing amiodarone to placebo or class Ic drugs. Data were combined according to a fixed effect model. The primary end point was the rate of conversion at 24 h. To study time-dependency of the drugs, efficacy at 1 to 2 h, 3 to 5 h, 6 to 8 h, and at 24 h was analyzed. RESULTS: We found six studies randomizing amiodarone versus placebo (595 patients) and seven studies versus class Ic drugs (579 patients). There was no significant difference between amiodarone and placebo at 1 to 2 h, but significant efficacy was found after 6 to 8 h (relative risk [RR] 1.23, p = 0.022) and at 24 h (RR 1.44, p < 0.001). Efficacy with amiodarone was inferior to class Ic drugs for up to 8 h (RR 0.67, p < 0.001) but no difference was seen at 24 h (RR 0.95, p = 0.50). There were no major adverse effects. CONCLUSIONS: Amiodarone is superior to placebo for cardioversion of AF, and even though the onset of conversion is delayed, its efficacy is similar at 24 h compared with class Ic drugs. These results favor amiodarone as a reasonable alternative for patients with recent AF in whom class Ic and other, more rapidly acting antiarrhythmic drugs cannot be used.

Adult↗

Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis.

STUDY DESIGN: Meta-analysis. OBJECTIVES: To define the accuracy of clinical tests for assessing anterior cruciate ligament (ACL) ruptures. BACKGROUND: The cruciate ligaments, and especially the ACL, are among the most commonly injured structures of the knee. Given the increasing injury prevalence, there is undoubtedly a growing need for clinical decision making of health care providers. We reviewed the literature to analyze the diagnostic accuracy of the clinical examination for assessing ACL ruptures. METHODS AND MEASURES: MEDLINE (1966 to April 2005), EMBASE (1989 to April 2005), and CINAHL (1982 to April 2005) searches were performed. Also reference lists of the included studies were reviewed. Studies selected for data extraction were those that addressed the accuracy of at least 1 physical diagnostic test for ACL rupture and compared the performance of the clinical examination of the knee with a reference standard, such as arthroscopy, arthrotomy, or MRI. Searching was limited to English, German, and Dutch languages. RESULTS: Twenty-eight studies that assessed the accuracy of clinical tests for diagnosing ACL ruptures met the inclusion criteria. Study results were, however, heterogeneous. The Lachman test is the most valid test to determine ACL tears, showing a pooled sensitivity of 85% (95% confidence interval [CI], 83-87) and a pooled specificity of 94% (95% CI, 92-95). The pivot shift test is very specific, namely 98% (95% CI, 96-99), but has a poor sensitivity of 24% (95% CI, 21-27). The anterior drawer test shows good sensitivity and specificity in chronic conditions, respectively 92% (95% CI, 88-95) and 91% (95% CI, 87-94), but not in acute conditions. CONCLUSION: In case of suspected ACL injury it is recommended to perform the Lachman test. Because the pivot shift test is very specific both in acute as well as in chronic conditions, it is recommended to perform the pivot shift test as well.

Anesthesia↗

Prenatal care and maternal health during adolescent pregnancy: a review and meta-analysis.

PURPOSE: A meta-analysis and review of pregnancy complications and behavioral risk factors associated with infant low birth weight and other poor outcomes which occur during adolescent pregnancy was undertaken using the published literature. METHODS: Studies were eligible for inclusion if they: 1) utilized a clearly defined sample of teenagers 2) provided numeric data on complications of interest or the proportions needed to compute this information 3) included a control or comparison group. RESULTS: Many behavioral risk factors (smoking, drinking and drug use) appeared to be less prevalent among teenage gravidas, particularly when the young women were ethnic minorities. An increased risk of preterm delivery was associated with young maternal age in both developed and developing countries. In the developed world, risk of cesarean delivery was reduced for teenagers and there was a secular decline in maternal anemia and pregnancy induced hypertension in comparison to the risk sustained by more mature women. Programs of comprehensive prenatal care appeared to have the potential to diminish risk of many complications. In the developing world, teenagers were at increased risk of maternal anemia, preterm birth and cesarean delivery. CONCLUSIONS: Although future research efforts will need to address the issues of bias inherent in much of the published research, the published literature suggests that prenatal care regimens which provide social and behavioral services along with medical care could improve both the health of the mother and the outcome of her pregnancy.

Adolescent↗

A comparison of the efficacy and tolerability of adapalene 0.1% gel versus tretinoin 0.025% gel in patients with acne vulgaris: a meta-analysis of five randomized trials.

The purpose of this meta-analysis was to determine if adapalene 0.1% gel (Differin) provided superior efficacy and better tolerability than tretinoin 0.025% gel in the treatment of acne vulgaris. All comparative studies, both published and unpublished, from the United States and Europe, that fulfilled rigorous protocol criteria (multicentre, randomized, investigator-blind) were used. Five comparative studies met these criteria. In total, the meta-analysis evaluated 900 patients (450 treated with adapalene 0.1% gel, 450 treated with tretinoin 0.025% gel) with mild-to-moderate acne from the combined clinical trials. To avoid study bias, the meta-analysis used an intention-to-treat analysis. Statistical methodology for the meta-analysis included analysis of covariance, analysis of variance and Cochran-Mantel-Haenszel test. All statistical tests were two-sided, with the 0.05 probability level used to establish statistical significance, and 95% confidence intervals used to assess equivalence. Adapalene demonstrated equivalent efficacy to tretinoin in terms of reducing total lesion count. Adapalene demonstrated more rapid efficacy, as evidenced by a significant difference in the reduction of inflammatory and total lesions at week 1. Adapalene also demonstrated considerably greater local tolerability at all evaluation periods. The findings from this meta-analysis suggest that adapalene 0.1% gel constitutes a pharmacologic advance over such classic retinoids as tretinoin for the treatment of acne vulgaris.

Acne Vulgaris↗

The use and misuse of meta-analysis.

OBJECTIVE: To demonstrate how the results of a meta-analysis can confuse rather than clarify therapeutic dilemmas if clinical heterogeneity among trials is ignored. Then to further discuss the qualities emergency physicians should expect from published meta-analyses if they are to affect clinical practice. SUBJECTS AND METHODS: The data and results were examined from 23 randomised controlled trials of selective decontamination of the digestive tract (SDD), which have been combined in a previous meta-analysis. These were reviewed to take account of clinical heterogeneity, particularly with regard to severity of patient illness. RESULTS: Severity of patient illness predicts degree of reduction in mortality with SDD in a regression analysis: log odds ratio (OR) of death with SDD = -0.0074 - (0.0035 x control group mortality rate), P = 0.017. This is also true when trials are stratified into more and less severely ill patients: pooled OR (a) for CMR > 41% = 0.69 (0.54 to 0.89), with (b) CMR < 3% = 1.02 (0.86 to 1.21). This difference was not suggested by the original meta-analysis result. CONCLUSIONS: Failure to take account of clinical heterogeneity between trials can mean a meta-analysis result ignores important differences in the effect of a treatment on different groups of patients. The discussion indicates how emergency physicians might guard against basing clinical practice on misleading meta-analysis results.

Anti-Bacterial Agents↗

Is meta-analysis clinically useful for perianesthesia nurses?

Meta-analyses can provide clinicians with the evidence-based information necessary to effect change in patient care delivery. Meta-analysis, the application of statistical techniques to condense data from a group of individual studies, is the most sophisticated summary of research evidence. An example meta-analysis study of inadvertent surgical hypothermia is used in this article to describe how nurses can locate, evaluate, and apply synthesized research data for perianesthesia clinical practice. Without data to support decisions, nurses will increasingly be faced with decisions made by others based on cost-cutting measures alone. Although meta-analysis may resolve a controversy or solve a clinical problem, it will not provide simple statistical answers for complex problems or obviate the need for sound and compassionate clinical judgment.

Clinical Competence↗

Meta-analysis of clinical trials: a consumer's guide.

Meta-analysis is a popular statistical tool allowing the synthesis of related research studies in a quantitative manner. Components of a good meta-analysis are first discussed, with a view toward critical reading of reports of meta-analyses. Examples include lipid-lowering drugs and coronary artery bypass graft surgery. A role for meta-analysis in the design and monitoring of clinical trials was examined at a workshop held at the National Institutes of Health and aspects of these uses of meta-analyses are considered. Basic analytical and graphical methods of meta-analysis are briefly reviewed. The goal is to encourage more thoughtful evaluation of the many meta-analyses that are published or are presented.

Clinical Trials as Topic↗

Effects of acadesine on myocardial infarction, stroke, and death following surgery. A meta-analysis of the 5 international randomized trials. The Multicenter Study of Perioperative Ischemia (McSPI) Research Group.

OBJECTIVE: To determine the effects of a purine nucleoside, acadesine, on the incidence of fatal and nonfatal cardiovascular and cerebrovascular complications following coronary artery bypass graft (CABG) surgery. DATA SOURCES: Individual patient data from 5 randomized, placebo-controlled, double-blind clinical trials, including 81 international medical centers of the United States, Canada, and Europe. STUDY SELECTION: All patients from all clinical trials were included: a total of 4043 patients undergoing CABG surgery, evaluable for efficacy, and randomized to receive either placebo (n= 2031) or acadesine (0.1 mg x kg(-1) x min(-1); n=2012) by intravenous infusion for 7 continuous hours and via the cardioplegia solution. DATA EXTRACTION: Individual patient data were collected prospectively using standardized forms and methods and double-data entry. A general parametric approach and analysis-by-patient meta-analysis were used, including both fixed effects and random effects models. Inclusion and exclusion criteria, general methodology, and outcome assessment techniques were similar for all trials. DATA SYNTHESIS: Acadesine decreased the incidence of the primary outcome, perioperative myocardial infarction (MI) by 27% (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.51-0.95; P=.02), decreased the incidence of cardiac death through postoperative day 4 by 50% (OR, 0.52; 95% Cl, 0.27-0.98; P=.04), and decreased the incidence of combined outcome (MI, stroke, or cardiac death) by 26% (OR, 0.73; 95% Cl, 0.57-0.93; P=.01). The random effects models for these outcomes also yielded significant results. The incidence of cerebrovascular accident was not significantly reduced by acadesine (OR, 0.69; 95% Cl, 0.44-1.08; P=.10). A secondary analysis of cardiac death following MI through postoperative day 4 demonstrated that acadesine decreased by 89% the number of deaths from 13.3% (13 deaths/98 MIs) in the placebo group to 1.4% (1 death/71 MIs) in acadesine-treated patients (P=.003). Acadesine also reduced the use of ventricular-assistance devices for severe postoperative heart failure by approximately one third (P=.05). Finally, regarding safety, the incidence of adverse events was similar in the acadesine vs placebo groups, with the exception of a transient increase in serum uric acid in the acadesine group. CONCLUSIONS: The results of this meta-analysis indicate that in patients undergoing CABG surgery, treatment with acadesine before and during surgery can reduce early cardiac death, MI, and combined adverse cardiovascular outcomes.

Aminoimidazole Carboxamide↗

Meta-analysis and quality of evidence in the economic evaluation of drug trials.

Meta-analysis is an important part of assessing cost-effectiveness in that it may help determine which treatments are indeed effective and estimate the level of effectiveness of each. Meta-analysis uses the data from all the relevant trials and is a powerful tool for detecting effects too small to be picked up by individual trials. The assessment of quality of studies in a meta-analysis is critical, with priority needing to be given to high quality randomised studies. A written protocol, literature retrieval system, evaluation and selection criteria, choice of endpoints and ways to evaluate bias must all be pre-defined. Nevertheless, problems can arise when meta-analysis is used for cost-effectiveness analysis, due to variation in study medication protocols, duration of follow-up, and difficulties in interpreting patient subgroups and compliance. Despite being subject to the design flaws of both the trials analysed and the methods used in the analysis itself, meta-analysis provides a more objective and thorough means of evaluating effectiveness and hence the cost-effectiveness of treatments. Based on the meta-analysis evidence, we recommend that the current QALY league tables be split into an implementation table for clearly effective therapies, and a research priority table where the evidence of treatment effectiveness is less clear and more research is needed.

Clinical Protocols↗

Basic concepts in meta-analysis: A primer for clinicians.

With the expanding volume of medical literature, meta-analysis, a form of systematic review, has become indispensable for clinicians for evidence-based decision making. While the number of meta-analyses has substantially increased during recent years, there are still controversial issues regarding their methodology, interpretation and clinical application. In this review, the basic concepts of meta-analysis have been discussed from a clinician's perspective in order to facilitate its understanding, appraising and applicability in clinical practice. Although randomised controlled trials are the usual source for meta-analysis, observational studies are also being increasingly considered for meta-analysis. Like every other research design, meta-analysis starts with formulating a question, followed by searching for related data, based on predefined criteria and strategies. Inclusion of studies must be carried out with careful consideration of their quality and assessment of homogeneity using graphical means as well as statistical tools such as Q statistics, I(2) statistics and meta-regression. The pooled effect size is commonly calculated using either a 'fixed effect model' or 'random effect model'. Publication bias and other source of bias should be investigated and the impact of potential confounders should be eliminated as required. Given the above-mentioned considerations, meta-analysis can provide a more precise estimate of an effect size to be used in clinical decision making.

Bias↗

Outcomes of Experiencing Interpersonal Violence in Autism: A Mixed Methods Systematic Review and Meta-Analysis.

In this review and meta-analysis, we aimed to examine outcomes of interpersonal violence among autistic people. Intersectionality and minority theories suggest that negative outcomes are heightened among people with multiple marginalized identities. Thus, we also aimed to investigate gender-related outcomes of interpersonal violence among autistic people. We conducted a systematic database search with inclusion criteria including mixed methods, peer-reviewed research examining any harmful interpersonal act (e.g., physical, sexual, and psychological) experienced by autistic people. We undertook a random-effects meta-analysis with pooled data from 9 studies, comprising 3,647 autistic participants aged 1 to 80&#x2009;years. Violence was associated with worsened mental health, with the strongest association for internalizing symptoms (d&#x2009;=&#x2009;0.66, p&#x2009;<&#x2009;.001; 95% CI [0.51, 0.80]) and suicidal thoughts and behavior (d&#x2009;=&#x2009;0.63, p&#x2009;<&#x2009;.001; [0.44, 0.82]). Narrative synthesis of 57 studies comprising 37,418 participants (13,127 autistic, 24,291 non-autistic) found violence was associated with numerous adverse health, development, and functional outcomes, including worsened mental health and behavioral difficulties compared to non-autistic controls from childhood. Females and gender minorities reported greater intra- and interpersonal health and development difficulties related to violence, emerging in early childhood and enduring into adulthood. Findings provide strong evidence of lifelong negative outcomes associated with interpersonal violence experienced by autistic people, providing evidence for the relevance of minority stress and intersectionality theories in understanding risk. Indeed, our results raise concerns that autistic people, and particularly non-male (female, gender diverse) individuals, have higher susceptibility for abuse from a young age, while being conditioned to respond with social desirability, superficial adaptivity, and dissociation.

Humans↗

Recursive cumulative meta-analysis: a diagnostic for the evolution of total randomized evidence from group and individual patient data.

Meta-analyses of randomized evidence may include published, unpublished, and updated data in an ongoing estimation process that continuously accommodates more data. Synthesis may be performed either with group data or with meta-analysis of individual patient data (MIPD). Although MIPD with updated data is considered the gold standard of evidence, there is a need for a careful study of the impact different sources of data have on a meta-analysis and of the change in the treatment effect estimates over sequential information steps. Unpublished data and late-appearing data may be different from early-appearing data. Updated information after the end of the main study follow-up may be affected by cross-overs, missing information, and unblinding. The estimated treatment effect may thus depend on the completeness and updating of the available evidence. To address these issues, we present recursive cumulative meta-analysis (RCM) as an extension of cumulative metaanalysis. Recursive cumulative meta-analysis is based on the principle of recalculating the results of a cumulative meta-analysis with each new or updated piece of information and focuses on the evolution of the treatment effect as a more complete and updated picture of the evidence becomes available. An examination of the perturbations of the cumulative treatment effect over sequential information steps may signal the presence of bias or heterogeneity in a meta-analysis. Recursive cumulative meta-analysis may suggest whether there is a true underlying treatment effect to which the meta-analysis is converging and how treatment effects are sequentially altered by new or modified evidence. The method is illustrated with an example from the conduct of an MIPD on acyclovir in human immunodeficiency virus infection. The relative strengths and limitations of both metaanalysis of group data and MIPD are discussed through the RCM perspective.

Acyclovir↗

Angiotensin-converting enzyme inhibitors and type 2 diabetic nephropathy: a meta-analysis.

OBJECTIVE: To perform a meta-analysis on studies evaluating the effect of angiotensin-converting enzyme (ACE) inhibitors on diabetic nephropathy in patients with type 2 diabetes mellitus. METHODS: A computerized literature search was conducted for articles of studies comparing ACE inhibitors with a control in patients with diabetes, in which measurement of albuminuria or proteinuria was an outcome. Each article was abstracted by two of the authors. Data from the articles were presented as geometric or arithmetic means. The data were summarized separately by using standard techniques for meta-analysis. MAIN RESULTS: Statistically significant reductions in albuminuria were observed regardless of whether data were described with geometric or arithmetic means. Both were associated with significant heterogeneity. When studies reporting geometric means were stratified and analyzed, the heterogeneity was lost and statistically significant reductions in albuminuria were observed. The same procedure was repeated for studies reporting arithmetic means, but heterogeneity remained. CONCLUSION: The ACE inhibitors produce statistically significant reductions in albuminuria associated with significant heterogeneity of effect. Stratification reduces the heterogeneity and supports treatment with ACE inhibitors to reduce the progression of nephropathy in patients with type 2 diabetes mellitus.

Albuminuria↗