Bibliographic record
Abstract
Success is going from failure to failure without a loss of enthusiasm Winston Churchill (1874–1965) British politician and statesman Cardiovascular disease (CVD) is the most common and one of the most preventable causes of death worldwide. The incident risk of stroke, myocardial infarction and peripheral vascular disease vary among ethnic groups. For example, individuals with African or Caribbean background have a high incidence of stroke and end-stage renal failure compared with Caucasians. On the other hand, South Asians have higher incidence of CVD.1,2 The recently published guidelines for the primary stroke prevention highlighted the increased age-adjusted prevalence of stroke in Asian (1.8%/100 000), Blacks (4.6%/100 000) and Hispanics (1.9%/100 000) compared with whites.3 The underlying causes of these disparities are not well understood. Differences in dietary and genetic factors, prevalence of hypertension, diabetes, or dyslipidemia and the response to preventative treatment are some commonly attributed determinants.3 More interestingly, the Framingham score may underestimate the 10-year risk of CVD in some ethnic groups (e.g. South-Asians), as the data (over 20 years old) are mostly derived from Caucasians middle class North American population with limited ethnic representation or individuals from low socioeconomic subgroups.4,5 In this issue of QJ Med, Minocher Homji et al.6 conducted a systematic review that aims at identifying the proportion of immigrants and different ethnic groups reported in randomized clinical trial (RCTs) in primary cardiovascular prevention. Data sources included MEDLINE, EMBASE and Cochrane databases between 1980 and December 2009. Selection criteria also include studies with at least 100 participants. Among 44 RCTs that met the inclusion criteria, 10 [22.2%, 95% confidence interval (CI) 12.4–36.5] included and/or reported on the ethnic status of the participants (n = 130 969). Overall, the weighted proportion of non-white participants was 10.7% (95% CI 6.9–16.2), whereas Asian or Asian Pacific ancestry comprised 2.2% (95% CI 1.1–4.7) in the four trials that reported the ethnic background. Interestingly, no study analyzed the efficacy of the intervention stratified by ethnicity, and none reported on the number of participants who were immigrants. The risk of myocardial infarction, stroke and peripheral vascular disease vary among different ethnic groups. As known, the efficacy of different therapeutic alternatives differs among Caucasians, Blacks, Hispanics, African-Americans, South-Asians, etc. For example, the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT-BPLA) analyzed the effect of adding thiazide or perindopril to unchanged monotherapy (atenolol or amlodipine). Blood pressure levels in Black (n = 203) patients were significantly less responsive (mean systolic difference +1.7 mmHg) compared with White patients of European countries (n = 4368).7 Similarly, heart failure was significantly more common among Black than non-Black hypertensive patients (hazard ratio 2.30, 95% CI 1.24–4.28).8,9 Therefore, it is important to clearly describe the population target by also including the ethnic background in randomized clinical trials in CVD and cerebrovascular disease. The authors also argue that recent immigrants may differ from native born in dietary practices, and lower incident risk of vascular risk factors such as hypertension. The so-called ‘healthy immigrant effect’ may also affect the results of interventional trials. This may be an issue considering the lower expected absolute risk reduction due to the high pre-recruitment prevalence (and efficacy) of participants on combined antithrombotic, antihypertensive and lipid-lowering therapy in cardiovascular trials. Limitations to this study (and acknowledged by the authors) include publications only in the English literature. Publication bias, common to all systematic reviews, cannot be ruled out. Nevertheless, major trials in cardiovascular prevention have been included, and the potential exclusion of studies (likely smaller) published in other languages than English or non-indexed journals are unlikely to change these results. In the future, clinicians, readers, policymakers and editors should be aware of the scope of the trial and the specific efficacy of the interventions in primary and secondary cardiovascular prevention across ethnic groups. Heart and Stroke Foundation of Canada; Canadian Institutes for Health Research; Department of Research at St Michael’s Hospital and Connaught Foundation (University of Toronto) to G.S. Conflicts of interest: The authors report no commercial conflicts of interest. G.S. receives salary support from the Clinician-Scientist Award from the Heart and Stroke Foundation of Ontario.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.026 | 0.118 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.003 | 0.003 |
| Scholarly communication | 0.006 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.025 | 0.019 |
| Insufficient payload (model declined to judge) | 0.018 | 0.013 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".