| アブストラクト | Cardiovascular disease (CVD) is a leading cause of death globally. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB), compared in the ONTARGET trial, each prevent CVD. However, trial results may not be generalisable and their effectiveness in underrepresented groups is unclear. Using trial emulation methods within routine-care data to validate findings, we explored generalisability of ONTARGET results. For people prescribed an ACEi/ARB in the UK Clinical Practice Research Datalink GOLD from 1/1/2001-31/7/2019, we applied trial criteria and propensity-score methods to create an ONTARGET trial-eligible cohort. Comparing ARB to ACEi, we estimated hazard ratios for the primary composite trial outcome (cardiovascular death, myocardial infarction, stroke, or hospitalisation for heart failure), and secondary outcomes. As the pre-specified criteria were met confirming trial emulation, we then explored treatment heterogeneity among three trial-underrepresented subgroups: females, those aged >/=75 years and those with chronic kidney disease (CKD). In the trial-eligible population (n=137,155), results for the primary outcome demonstrated similar effects of ARB and ACEi, (HR 0.97 [95% CI: 0.93, 1.01]), meeting the pre-specified validation criteria. When extending this outcome to trial-underrepresented groups, similar treatment effects were observed by sex, age and CKD. This suggests that ONTARGET trial findings are generalisable to trial-underrepresented subgroups. |
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| ジャーナル名 | American journal of epidemiology |
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| Pubmed追加日 | 2024/6/19 |
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| 投稿者 | Baptiste, Paris J; Wong, Angel Y S; Schultze, Anna; Clase, Catherine M; Leyrat, Clemence; Williamson, Elizabeth; Powell, Emma; Mann, Johannes F E; Cunnington, Marianne; Teo, Koon; Bangdiwala, Shrikant I; Gao, Peggy; Tomlinson, Laurie; Wing, Kevin |
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| 組織名 | Department of Non-communicable Disease Epidemiology, London School of Hygiene and;Tropical Medicine, Keppel Street, London, United Kingdom.;Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary;University of London, London, United Kingdom.;Department of Medicine, McMaster University, Hamilton, Canada.;Department of Health Research Methods, Evidence and Impact, McMaster University,;Hamilton, Canada.;Department of Medical Statistics, London School of Hygiene & Tropical Medicine,;Keppel Street, London, United Kingdom.;Dept. of Medicine 4, Friedrich Alexander Univ. Erlangen, Germany and KfH Kidney;Center, Munchen-Schwabing, Germany.;Population Health Research Institute, McMaster University, Hamilton, Canada.;Analysis Group Inc., London, United Kingdom. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38896054/ |
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