Dietary Supplements in Adults Taking Cardiovascular Drugs [Internet]
Notice bibliographique
Résumé
Background A substantial proportion of patients with cardiovascular diseases use dietary supplements in anticipation of benefit. This also poses risks of adverse events from supplement-drug interactions and nonadherence associated with polypharmacy. Objectives For supplements commonly used by patients with cardiovascular disease, we examined benefits, harms, and effects on cardiovascular drug pharmacokinetics of coadministration of dietary supplements with cardiovascular drugs. We also sought evidence regarding variability among subgroups, and of statistical interactions between supplements and drugs. Data Sources We searched MEDLINE®, Embase, the Cochrane Library, International Bibliographic Information on Dietary Supplements (IBIDS), and Allied and Complementary Medicine Database (AMED), as well as gray literature, from inception to September 2011. Study Selection Following a predefined protocol, two reviewers included experimental and observational studies comparing a supplement plus cardiovascular drug versus drug alone published in English or German; other languages were excluded due to concerns with study quality and applicability. Data Extraction One reviewer extracted data into a standardized electronic form, assessed study risk of bias, graded the strength of the body of evidence, and reported its applicability. Study risk of bias and strength of evidence regarding gradable outcomes were independently verified, as was a random 10 percent subset of all data. Data Synthesis Sixty-seven randomized controlled trials, two controlled clinical trials, and one observational study contributed evidence of limited validity in highly selected populations. Evidence was insufficient for all gradable clinical efficacy and harms outcomes (e.g., mortality, thrombotic events, serious adverse events) because there were few, small studies per supplement. One pragmatic trial in women showed no benefit from coadministering vitamin E with aspirin on a composite cardiovascular outcome. Evidence for most intermediate outcomes of efficacy was insufficient or of low strength and suggested no effect. Notable findings were incremental improvement of triglyceridemia with omega-3 fatty acid supplementation, stabilization of international normalized ratio with vitamin K added to warfarin therapy, and improved high-density lipoprotein cholesterol (HDL-C) with added garlic. Clinically nonsignificant or otherwise inconclusive changes were noted for pharmacokinetic outcomes. Limitations The evidence base principally consisted of underpowered short-term studies in selected populations, generally with moderate risk of bias. Conclusions Limitations of the evidence base precluded meaningful conclusions across most supplement-drug combinations. Low-strength evidence indicates benefits of omega-3 fatty acids, vitamin K, and garlic coadministration on specific intermediate outcomes. Evidence regarding harms was inconclusive. Care providers and researchers should query supplement use to improve care and to facilitate research regarding drug-supplement interactions.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,018 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,003 | 0,001 |
| Bibliométrie | 0,010 | 0,011 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,040 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».