Goal: heart and blood vessels
Evidence by Goal: Heart and Blood Vessels
Every graded record measured on heart attacks, strokes, blood pressure, cholesterol or the arteries, including the ones that failed. A letter here describes the human trial evidence for that use; it is not advice.
100 graded uses, grouped by what the trials measured, highest letter first within each group. Every letter is copied at build time from the record that owns it, and records graded D, tested without benefit or not yet tested, are listed with the rest.
Measured on deaths and disease events
Trials that counted deaths, heart attacks, strokes, fractures, falls, cancers or other clinical events.
- AHard clinical endpointProtocol · Randomized controlled trial People are assigned to the treatment or a comparison by chance, so the groups differ only in what they received. It is the design that can show cause and effect. (PREDIMED)Endpoint The outcome a trial measures to decide whether the treatment worked, such as heart attacks, blood pressure or a symptom score.: Major cardiovascular events (PREDIMED)
- AHard clinical endpointProtocol · Individual-participant and trial-level meta-analyses A study that pools the numbers from several trials into one combined estimate. of randomized trials, and large randomized trials of intensive against standard targetsGrade for: Lowering blood pressure in people with high blood pressure, against placebo An inactive substitute made to look like the real treatment, so participants cannot tell which one they received. or less treatment: major cardiovascular events and death
- AHard clinical endpointProtocol · Individual-participant and trial-level meta-analyses of randomized trials, and large randomized trials of intensive against standard targetsGrade for: Intensive systolic target (under 120 to 130 mm Hg) against a standard target: major cardiovascular events
- AHard clinical endpointProtocol · Individual-participant meta-analyses and randomized outcome trials; genetic (Mendelian randomization A method that uses gene variants people are born with as a natural experiment, to test whether a factor causes an outcome.) studies are listed as excluded evidence and carry no letterGrade for: Heart attack, stroke and death, lowering LDL Low-density lipoprotein cholesterol, the cholesterol fraction most closely tied to plaque in the arteries. cholesterol in people with established vascular disease or after an acute coronary syndrome
- AHard clinical endpointProtocol · Individual-participant meta-analyses and randomized outcome trials; genetic (Mendelian randomization) studies are listed as excluded evidence and carry no letterGrade for: Heart attack, stroke and cardiovascular death, lowering LDL cholesterol in people without vascular disease who are at raised risk
- AHard clinical endpointPrescription · Randomized controlled trialsEndpoint: Cardiovascular death, heart attack and stroke in people with cardiovascular disease or type 2 diabetes
- AHard clinical endpointPrescription · Randomized controlled trialsEndpoint: Cardiovascular death, heart-failure hospitalization and kidney-failure progression
- AHard clinical endpointPrescription · Randomized controlled trials and individual-participant meta-analyses of randomized trialsGrade for: Death and major cardiovascular events in people with coronary heart disease or other established vascular disease
- AHard clinical endpointPrescription · Randomized controlled trials and individual-participant meta-analyses of randomized trialsGrade for: Heart attack, stroke and cardiovascular death in people without cardiovascular disease who are at raised risk
- BHard clinical endpointSupplement · Randomized controlled trials (REDUCE-IT, GISSI-P)Grade for: Major adverse cardiovascular events, high-dose icosapent ethyl
- BHard clinical endpointSupplement · Randomized controlled trial (Q-SYMBIO)Grade for: Chronic heart failure events, including hospitalization, as an adjunct A treatment tested on top of standard prescribed therapy rather than in place of it. to standard therapy
- BHard clinical endpointSupplement · Randomized controlled trials + pooled analysis (no benefit, D Route 2 Human randomized trials have been run and did not show benefit on the stated outcome. One of the two routes to the lowest letter on EBL's scale.)Grade for: First-stroke prevention in hypertensive adults without prior stroke or MI, in populations without grain folate fortification (0.8 mg/day with enalapril)
- BHard clinical endpointProtocol · Randomized controlled trials (Q-SYMBIO, Morisco 1993) and meta-analysesEndpoint: Heart-failure events, including hospitalization, in chronic heart failure
- BHard clinical endpointProtocol · Individual-participant meta-analyses and randomized outcome trials; genetic (Mendelian randomization) studies are listed as excluded evidence and carry no letterGrade for: Major cardiovascular events, high-dose icosapent ethyl in statin-treated people with raised triglycerides
- BHard clinical endpointPrescription · Randomized controlled trials and individual-participant meta-analyses of randomized trialsGrade for: Major cardiovascular events in adults aged 70 and over without cardiovascular disease
- CHard clinical endpointSupplement · Randomized controlled trials (REDUCE-IT, GISSI-P)Grade for: Secondary prevention after myocardial infarction
- CSupplement · Randomized controlled trial (hard clinical endpoints An outcome that matters directly to a person and is counted without judgment, such as death, heart attack, stroke or fracture.)Grade for: Secondary prevention after myocardial infarction
- CHard clinical endpointProtocol · Meta-analyses of randomized trials (mixed/modest)Endpoint: Cardiovascular events, including coronary death
- CHard clinical endpointProtocol · Randomized controlled trialEndpoint: Death, heart attack and stroke in coronary heart disease
- CHard clinical endpointProtocol · Observational Research that watches what people already do rather than assigning a treatment. It can show that two things travel together, not that one causes the other. synthesis for the headline; randomized trials and pooled analyses on blood pressure and atrial fibrillationGrade for: Atrial fibrillation recurrence in regular drinkers with AF
- CHard clinical endpointProtocol · Individual-participant and trial-level meta-analyses of randomized trials, and large randomized trials of intensive against standard targetsGrade for: Treating high blood pressure in adults aged 80 and over
- CHard clinical endpointProtocol · Meta-analyses of randomized diet trials, recovered data from two 1960s and 1970s randomized trials, and randomized feeding trials of blood lipids and inflammatory markers; cohort studies An observational study that follows a group of people over time and compares what happens to them. and a non-randomized hospital trial are listed as excluded evidence and carry no letterGrade for: Coronary and cardiovascular events when linoleic-acid oils replace saturated fat
- DHard clinical endpoint · Not yet testedSupplement · RCT Randomized controlled trial: people are assigned to the treatment or a comparison by chance, so the groups differ only in what they received. It is the design that can show cause and effect. + observational meta-analysisGrade for: Cardiovascular events and all-cause mortality
- DHard clinical endpoint · Tested, no benefitSupplement · RCTs + meta-analyses (use-specific)Grade for: Cardiovascular prevention (already-replete adults)
- DHard clinical endpoint · Tested, no benefitSupplement · Large randomized trials and pooled reviews, no benefit, harm signal in one trialGrade for: Major cardiovascular events
- DHard clinical endpoint · Tested, no benefitSupplement · Pooled reviews of randomized trials and large randomized trialsGrade for: Major cardiovascular events
- DHard clinical endpoint · Tested, no benefitSupplement · Randomized controlled trials + pooled analysis (no benefit, D Route 2)Grade for: Major cardiovascular events in people with vascular disease (folic acid with vitamins B6 and B12)
- DHard clinical endpoint · Tested, no benefitSupplement · Two large randomized outcome trials, no benefit (D Route 2)Endpoint: Tested at scale on top of statins. Extended-release niacin alone (AIM-HIGH) and extended-release niacin with laropiprant (HPS2-THRIVE) did not reduce vascular events; the laropiprant combination increased serious adverse events.
- DHard clinical endpoint · Not yet testedSupplement · Small randomized trials, narrow postoperative indications onlyGrade for: Systemic inflammation, cardiovascular or longevity useEndpoint: Any systemic or long-term health outcome
- DHard clinical endpoint · Tested, harm foundSupplement · Randomized controlled trialGrade for: Atrial fibrillation recurrence after catheter ablation
- DHard clinical endpoint · Tested, no benefitProtocol · Cochrane meta-analysis of randomized trials (found no mortality benefit → D)Endpoint: All-cause, cardiovascular and cancer mortality in adults unselected for disease
- DHard clinical endpoint · Tested, harm foundProtocol · Randomized controlled trial with extended follow-up + systematic reviews A review that searches for every study on a question using a method set in advance, then assesses them together.Endpoint: Chronic disease in healthy postmenopausal women, including breast cancer, stroke and blood clots
- DHard clinical endpoint · Not yet testedProtocol · Randomized controlled trials and meta-analyses of randomized trials (LDL cholesterol, HbA1c A blood test that reflects average blood sugar over the previous two to three months.); cohort evidence only for events and mortalityGrade for: Heart attack, stroke, mortality and longevity
- DHard clinical endpoint · Tested, no benefitProtocol · Randomized controlled trial (scheduled phlebotomy in peripheral artery disease); natural-experiment and cohort evidence only in healthy donorsEndpoint: All-cause death; death, nonfatal heart attack or stroke
- DHard clinical endpoint · Not yet testedProtocol · Meta-analyses of randomized trials and randomized trials (meaning, purpose, distress, physical and cognitive tests); population studies of purpose with death, dementia and heart disease are listed as excluded evidence and carry no letterGrade for: Death, dementia and heart disease
- DHard clinical endpoint · Tested, no benefitProtocol · Meta-analyses of randomized trials and randomized trials; population studies on heart disease, dementia and death are listed as excluded evidenceGrade for: Heart attack, stroke and death, periodontal treatment
- DHard clinical endpoint · Not yet testedProtocol · Randomized trials of disclosing APOE results and a meta-analysis of trials of DNA-based risk results (found no benefit on behavior or risk factors, D); risk estimates for e4 carriers come from genetic and population studies and are listed as excluded evidenceGrade for: Dementia, heart disease and death after learning the APOE result
- DHard clinical endpoint · Tested, harm foundProtocol · Individual-participant meta-analyses and randomized outcome trials; genetic (Mendelian randomization) studies are listed as excluded evidence and carry no letterGrade for: Heart attack, stroke and death, raising HDL cholesterol with CETP inhibitors, niacin or apolipoprotein A1 infusion
- DHard clinical endpoint · Tested, no benefitProtocol · Individual-participant meta-analyses and randomized outcome trials; genetic (Mendelian randomization) studies are listed as excluded evidence and carry no letterGrade for: Heart attack, stroke and cardiovascular death, lowering triglycerides with a fibrate added to a statin
- DHard clinical endpoint · Tested, no benefitDevice or therapy · Randomized trials and meta-analyses of CPAP against usual care, sham A fake version of a procedure or device used as the comparison, so participants cannot tell which one they received. CPAP or inactive controlGrade for: Heart attack, stroke and cardiovascular death in adults with moderate to severe obstructive sleep apnea, mostly without daytime sleepiness
- DHard clinical endpoint · Tested, no benefitPrescription · Randomized controlled trials and individual-participant meta-analyses of randomized trialsGrade for: Disability-free survival (living without dementia or persistent physical disability) in adults aged 70 and over without cardiovascular disease
Measured on function, or by a blinded clinician
Trials that measured performance with an instrument, or used a scale scored by a clinician who did not know the treatment.
- CMeasured functionSupplement · Randomized trials, mostly null on clinical outcomes; one unreplicated positiveGrade for: Six-minute walk distance in peripheral artery disease
- CMeasured functionDevice or therapy · Randomized controlled trialsGrade for: Chronic heart failure (adjunct)Endpoint: BNP, 6-min walk, symptoms
- DMeasured function · Tested, no benefitSupplement · Randomized trials and meta-analyses; markers positive, performance and clinical outcomes nullGrade for: Exercise capacity in heart failure with preserved ejection fraction
Measured on a blood marker or other stand-in
Trials that measured a number standing in for the outcome, such as blood pressure, LDL cholesterol or HbA1c. These letters stop at B.
- BSurrogate biomarkerSupplement · RCT + meta-analysis of randomized trialsEndpoint: HbA1c, fasting glucose and LDL cholesterol in type 2 diabetes and dyslipidemia
- BSurrogate biomarkerSupplement · Randomized controlled trialsEndpoint: Resting blood pressure (systolic and diastolic)
- BSurrogate biomarkerSupplement · Meta-analyses of randomized trials + 12-month RCTEndpoint: LDL cholesterol
- BSurrogate biomarkerSupplement · RCT + meta-analysis of randomized trialsGrade for: Lipid profile (LDL, triglycerides)
- BSurrogate biomarkerProtocol · Meta-analysis of randomized trialsGrade for: Resting blood pressure
- BSurrogate biomarkerProtocol · Meta-analysis of randomized trialsEndpoint: LDL cholesterol
- BSurrogate biomarkerProtocol · Randomized trials + meta-analysis of randomized trialsEndpoint: Blood pressure in people with hypertension
- BSurrogate biomarkerProtocol · Randomized controlled trialEndpoint: HbA1c and LDL cholesterol in type 2 diabetes
- BSurrogate biomarkerProtocol · Observational synthesis for the headline; randomized trials and pooled analyses on blood pressure and atrial fibrillationGrade for: Blood pressure in people drinking more than two drinks a day
- BSurrogate biomarkerProtocol · Meta-analyses of randomized trials, psyllium-specific and genus-levelEndpoint: Total and LDL cholesterol
- BSurrogate biomarkerProtocol · Meta-analyses of randomized trials, with a molecular-weight trialEndpoint: LDL cholesterol
- BSurrogate biomarkerProtocol · Randomized controlled trials + meta-analysisGrade for: Blood pressure against an unrestricted diet, adults without diabetes
- BSurrogate biomarkerProtocol · Randomized controlled feeding trials (DASH, DASH-Sodium) + meta-analyses of randomized trialsEndpoint: Systolic and diastolic blood pressure (DASH, DASH-Sodium)
- BSurrogate biomarkerProtocol · Meta-analysis of randomized trials (Cochrane)Endpoint: Systolic and diastolic blood pressure (Cochrane meta-analysis)
- BSurrogate biomarkerProtocol · Randomized controlled trials and meta-analyses of randomized trials (LDL cholesterol, HbA1c); cohort evidence only for events and mortalityGrade for: LDL cholesterol compared with a typical omnivorous diet
- BSurrogate biomarkerProtocol · Meta-analyses of randomized diet trials, recovered data from two 1960s and 1970s randomized trials, and randomized feeding trials of blood lipids and inflammatory markers; cohort studies and a non-randomized hospital trial are listed as excluded evidence and carry no letterGrade for: LDL and total cholesterol when linoleic-acid oils replace saturated fat
- BSurrogate biomarkerDevice or therapy · RCT + meta-analysis of randomized trialsGrade for: Resting systolic blood pressure, high-resistance inspiratory muscle strength training
- BSurrogate biomarkerDevice or therapy · Meta-analysis of randomized trialsEndpoint: Blood pressure reduction (validated surrogate)
- BSurrogate biomarkerDevice or therapy · Randomized trials and meta-analyses of CPAP against usual care, sham CPAP or inactive controlGrade for: Blood pressure in adults with obstructive sleep apnea
- BSurrogate biomarkerDevice or therapy · A randomized crossover A trial design in which each participant receives both the treatment and the comparison, one after the other, and serves as their own control. against CPAP and network meta-analyses of randomized trialsGrade for: Apnea severity, daytime sleepiness and blood pressure against inactive control and against CPAP
- CSurrogate biomarker
- CSurrogate biomarker
- CSurrogate biomarkerSupplement · Meta-analyses of randomized trials and randomized trialsGrade for: Cholesterol, blood pressure and arterial stiffness
- CSurrogate biomarkerSupplement · Randomized controlled trialGrade for: Blood pressure in adults with raised cholesterol
- CSurrogate biomarkerSupplement · Randomized controlled trial (3-year, arterial stiffness)Endpoint: Arterial stiffness and coronary artery calcification
- CSurrogate biomarkerSupplement · Small randomized trials; surrogate positive, functional outcomes nullGrade for: Brachial artery flow-mediated dilation in older adults
- CSurrogate biomarkerSupplement · RCT + meta-analysis of randomized trialsEndpoint: Blood pressure in hypertension
- CSurrogate biomarkerSupplement · Pooled reviews of randomized trials and large randomized trialsGrade for: Blood pressure
- CSurrogate biomarkerSupplement · Meta-analyses of randomized trials + RCT (surrogates)Grade for: Blood pressure in adults
- CSurrogate biomarkerSupplement · Meta-analyses of randomized trials + RCTsEndpoint: Inflammatory and endothelial markers (CRP, VCAM-1)
- CSupplement · RCTs (small) + systematic reviewEndpoint: Sleep quality, mood and heart-rate variability (self-report and surrogate)
- CSurrogate biomarkerSupplement · RCT + meta-analysis of randomized trialsGrade for: Systemic inflammation (CRP) and endothelial function
- CSurrogate biomarkerSupplement · Two small randomized controlled trialsEndpoint: LDL cholesterol and liver enzymes (surrogate)
- CSurrogate biomarkerSupplement · Randomized trials and meta-analyses; markers positive, performance and clinical outcomes nullGrade for: Cardiac output and filling pressures in heart failure
- CSurrogate biomarkerProtocol · Meta-analyses of randomized trials + one-year RCTsEndpoint: Weight and cardiometabolic markers, compared with daily calorie restriction
- CSurrogate biomarkerProtocol · Umbrella review and meta-analyses of randomized trials + epilepsy RCTsGrade for: Longevity and cardiometabolic markers in adults
- CSurrogate biomarkerProtocol · Meta-analyses of randomized trials and randomized trials; population studies on heart disease, dementia and death are listed as excluded evidenceGrade for: Blood pressure and artery function, intensive periodontal treatment
- CSurrogate biomarkerDevice or therapy · Randomized controlled trialsGrade for: Vascular / oxidative-stress markersEndpoint: endothelial function, urinary 8-epi-PGF2a
- CSurrogate biomarkerDevice or therapy · Systematic review / meta-analysis of randomized trialsGrade for: Heart rate variability in the hour after immersionEndpoint: Vagally mediated heart rate variability (RMSSD, high-frequency power) during and up to an hour after immersion
- CSurrogate biomarkerDevice or therapy · Meta-analyses of small randomized trials, inconsistentGrade for: Total and LDL cholesterol in adults with overweight, obesity or metabolic disorders
- CSurrogate biomarkerDevice or therapy · Randomized trials of REHIT; background meta-analyses of sprint and interval trainingGrade for: Blood pressure
- CSurrogate biomarkerDevice or therapy · Randomized trials and meta-analyses of randomized trialsEndpoint: Resting systolic blood pressure (surrogate, objective)
- CSurrogate biomarkerDevice or therapy · Randomized trials of sleep extension and a meta-analysis of them; mortality data are observational and carry no gradeGrade for: Blood pressure, insulin sensitivity and glucose after behavioral sleep extension in habitual short sleepers
- CSurrogate biomarkerDevice or therapy · Randomized controlled trialsGrade for: Blood pressure and fitness when sauna follows regular exerciseEndpoint: Systolic blood pressure and cardiorespiratory fitness (VO2max The most oxygen the body can use during all-out exercise, a standard measure of aerobic fitness.) after 8 weeks
- CSurrogate biomarkerDevice or therapy · Randomized sham-controlled, delayed-activation and withdrawal trials of implanted stimulatorsGrade for: Blood pressure in implanted adults with obstructive sleep apnea
- DSurrogate biomarker · Tested, no benefit
- DSurrogate biomarker · Tested, harm foundSupplement · Randomized controlled trialGrade for: LDL cholesterol in adults enrolled for raised cholesterol
- DSurrogate biomarker · Not yet testedSupplement · Case series + animal only (D Route 1 No human randomized trial has been run, so the record rests on animal or mechanistic evidence only. One of the two routes to the lowest letter on EBL's scale.)Endpoint: No randomized trial has tested rhamnan sulfate on plaque or vascular outcomes; one small randomized trial for constipation found no effect on blood lipids. Route 1: one uncontrolled case series plus preclinical data.
- DSurrogate biomarker · Tested, no benefitSupplement · Single-arm Phase II studies for the prostate use; two null placebo-controlled trials in other usesGrade for: Collagen turnover and cardiac remodeling markers in hypertension with raised galectin-3
- DSurrogate biomarker · Tested, no benefitSupplement · Randomized controlled trials, small and short, mixed; meta-analyses in autism and schizophreniaGrade for: Blood pressure and endothelial function in hypertension
- DSurrogate biomarker · Tested, no benefitSupplement · Cochrane reviews of small randomized trials; one placebo-controlled trialGrade for: Blood glucose, lipids and blood pressure in type 2 diabetes and metabolic syndrome
- DSurrogate biomarker · Tested, no benefitSupplement · Randomized trials and meta-analyses; markers positive, performance and clinical outcomes nullGrade for: Blood pressure
- DSurrogate biomarker · Not yet testedProtocol · No trial of magnesium glycinate on this endpoint (D Route 1); class evidence from other magnesium salts shown as contextEndpoint: Blood pressure
- DSurrogate biomarker · Tested, no benefitDevice or therapy · Randomized sham-controlled trials and meta-analyses, by useGrade for: Heart rate variability in healthy adults
- DSurrogate biomarker · Tested, no benefitDevice or therapy · Randomized controlled trialsGrade for: Vascular function in stable coronary artery diseaseEndpoint: Brachial flow-mediated dilation, arterial stiffness and blood pressure after 8 weeks
- DSurrogate biomarker · Tested, no benefitDevice or therapy · Randomized controlled trialsGrade for: Heart rate variability when sauna follows regular exerciseEndpoint: Time- and frequency-domain heart rate variability after 8 weeks
Related pages