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A multistudy analysis investigating systematic differences in cardiovascular trial results between Europe and Asia
  1. Louise C Hartley1,2,
  2. Alan J Girling2,
  3. Russell J Bowater3,
  4. Richard J Lilford2
  1. 1Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
  2. 2School of Health and Population Sciences, University of Birmingham, Birmingham, UK
  3. 3Faculty of Engineering, Universidad Autónoma de Querétaro, Cerro de las Campanas, Santiago de Querétaro, Qro, Mexico
  1. Correspondence to Dr Louise C Hartley, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; L.C.Hartley{at}


Objective To assess whether there are differences in the results of cardiovascular trials between Europe and Asia using data from an extensive collection of randomised controlled trials.

Study design and setting All meta-analyses containing randomised controlled trials (RCT's) for the treatment or prevention of cardiovascular diseases were searched for in The Cochrane Library (2000–2008) and MEDLINE (2005–2008). Analysis was then conducted within and over each meta-analysis which satisfied given criteria. Separate estimates of treatment effect were calculated for Europe and Asia in each meta-analysis and then compared. Estimates of a common inter-continental difference over all meta-analyses were also calculated and meta-regression was performed. This was performed for both fatal and non-fatal end points.

Results The literature search identified 59 meta-analyses that satisfied the inclusion criteria. After exclusion, the number of meta-analyses reporting greater effect sizes in Asia than in Europe was significantly more than would be expected by chance (fatal 12/14, p=0.013; non-fatal 23/32, p=0.020).

Conclusions This study provides some evidence that for cardiovascular interventions treatment effect estimation differs between Europe and Asia, with respect to both fatal and non-fatal end points.

  • Cardiovascular disease

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