Session 3: Meta-analysis (Perez)

Learning Objectives:

  • Define what meta-analysis is and why and how it is done.
  • Identify methodological issues unique to meta-analysis
  • Interpret tests for heterogeneity, "forest plots" and "funnel plots."
  • Systematically critique the validity and applicability of published meta-analyses.
 

Case:


You are a seeing a 60 year old African-American man with hypertension for a routine visit. He is feeling well and has no complaints. His current medications are HCTZ, 25 mg and lisinopril, 10 mg daily. His blood pressure today is 140/78. A recent lipid panel revealed total cholesterol 160 mg/dl, LDL 100 mg/dl, HDL 40 mg/dl, triglycerides 120 mg/dl. Your preceptor, with a copy of the recent AHA cholesterol guidelines in one hand, Crestor coffee mug in the other, tells you to start your patient on a statin. You calculate your patient’s 10 year risk of first atherosclerotic cardiovascular disease event [Do this yourself at http://clincalc.com/Cardiology/ASCVD/PooledCohort.aspx ] and are surprised to see that lipid lowering therapy is in fact recommended for your patient (in addition, of course, to “lifestyle modification” and in accordance with “patient preference”). You decide to take a look at the evidence yourself for lipid lowering in primary prevention yourself. You come across a recently published Cochrane systematic review. . .



Readings:

Pre-Session Questions due PM prior to session