www.MedicalFinals.co.uk - Clinical Trials

Useful Clinical Trials

With all this evidence based medicine talk about, sometimes you may wonder or be asked "Does medical or surgical treatment really help?". Here's studies of some common treatments which gave a positive outcome, which you might be able to mention in an exam.

ACE inhibitors and ischaemic heart disease/heart failure:

SAVE (1992): captopril with left ventricular ejection fraction of <40%
SOLVD (1992): enalapril and decreased LV function.
ISIS-4 (1998): captopril post-MI.
HOPE (2000): ramipril in patients with high cardiovascular risk.

ACE inhibitors and cardiovascular outcomes:

LIFE: Losartan in high risk hypertensive patients - significant reduction in cardiovascular outcomes, and 25% reduction in stroke risk.

Thrombolysis and MI:

ISIS 2 & 3
GISSI
GUSTO (1993): demonstrated increased survival.

Aspirin and stroke:

SALT (1991): 75mg decreased cardiovascular events post-TIA/CVA.
CURE (2001): Clopidrogrel added to Aspirin provides 20% relative risk reduction in cardiovascular death/stroke/MI for unstable angina patients
CAPRIE: Clopidogrel and risk reduction in further ischaemic vascular events.

Carotid endarterectomy:

MRC European Carotid Surgery Trial: benefits outweighed the risks of surgery in high risk patients (stenosis of 70-99%), NOT in stenosis of <70%.

Type 1 diabetes:

DCCT (1993): Good glycaemic control resulted in less microvascular complications.

Type 2 diabetes:

UKPDS: Good glycaemic control resulted in less eye and kidney disease. Good BP control resulted in decreased mortality, stroke and visual problems.

OTHERS:

ALLHAT (2002): Amlodipine in high risk hypertensive patients and reduced stroke outcome. There is also a good book on Cardiology on Trial which gives more information.