Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.

<h4>Introduction</h4>Myocardial ischemia (MI) is a top ranked cause of death among diabetic patients, yet it is mostly asymptomatic or "silent". There is a need for summary epidemiologic measures on this highly lethal and unnoticeable complication of diabetes. The proposed syst...

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Autores principales:	Christophe Dongmo Fokoua-Maxime, Eric Lontchi-Yimagou, Takeude Erwan Cheuffa-Karel, Tchana Loic Tchato-Yann, Simeon Pierre-Choukem
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/588564c0312c4481b8f1560ff57be025
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spelling	oai:doaj.org-article:588564c0312c4481b8f1560ff57be0252021-12-02T20:07:11ZPrevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.1932-620310.1371/journal.pone.0252511https://doaj.org/article/588564c0312c4481b8f1560ff57be0252021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0252511https://doaj.org/toc/1932-6203<h4>Introduction</h4>Myocardial ischemia (MI) is a top ranked cause of death among diabetic patients, yet it is mostly asymptomatic or "silent". There is a need for summary epidemiologic measures on this highly lethal and unnoticeable complication of diabetes. The proposed systematic review and meta-analysis aims to estimate of the global prevalence of silent MI among diabetic patients.<h4>Methods and analysis</h4>This protocol was prepared according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will include all observational studies published until March 23, 2021 and reporting on the prevalence of silent MI in diabetic patients. Electronic sources including MEDLINE(PubMed), Embase, Cochrane Library, and Web of Science will be searched for potentially eligible studies, restricted to only studies published in English. Two investigators will select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger's tests. The heterogeneity between studies will be assessed with the Cochrane's Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; it will decide if a meta-analysis can be conducted. In case a meta-analysis cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will be used to further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist.<h4>Strengths and limitations of this study</h4>The intended review will provide an up-to-date summary of the global prevalence of silent MI in diabetic patients. We will conduct a thorough literature search for eligible studies, and we will use robust meta-analysis tools to provide reliable estimates of the global prevalence of silent MI in diabetic patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that the strict inclusion criteria of these studies might have excluded other patients; the risk of type 1 error emanating from the high number of subgroup and sensitivity analyses.<h4>Prospero registration number</h4>CRD42019138136.Christophe Dongmo Fokoua-MaximeEric Lontchi-YimagouTakeude Erwan Cheuffa-KarelTchana Loic Tchato-YannSimeon Pierre-ChoukemPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0252511 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Christophe Dongmo Fokoua-Maxime Eric Lontchi-Yimagou Takeude Erwan Cheuffa-Karel Tchana Loic Tchato-Yann Simeon Pierre-Choukem Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.
description	<h4>Introduction</h4>Myocardial ischemia (MI) is a top ranked cause of death among diabetic patients, yet it is mostly asymptomatic or "silent". There is a need for summary epidemiologic measures on this highly lethal and unnoticeable complication of diabetes. The proposed systematic review and meta-analysis aims to estimate of the global prevalence of silent MI among diabetic patients.<h4>Methods and analysis</h4>This protocol was prepared according to the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. The systematic review will include all observational studies published until March 23, 2021 and reporting on the prevalence of silent MI in diabetic patients. Electronic sources including MEDLINE(PubMed), Embase, Cochrane Library, and Web of Science will be searched for potentially eligible studies, restricted to only studies published in English. Two investigators will select studies and use a pre-pilot tested form to extract data. Further, they will independently perform a qualitative assessment of the risk of bias and overall quality of the selected studies, followed by a quantitative assessment using funnel plots and Egger's tests. The heterogeneity between studies will be assessed with the Cochrane's Q statistic, and the I2 statistic will measure the percentage of variation across studies that is due to their heterogeneity rather than chance; it will decide if a meta-analysis can be conducted. In case a meta-analysis cannot be conducted, a descriptive analysis will be performed. Otherwise, study-specific estimates will be pooled using either a fixed-effects or a random-effects model depending on the value of the I2 statistic. Subgroup and random effects meta-regression analyses will be used to further investigate the potential sources of heterogeneity. Finally, sensitivity analyses will be performed to measure the impact of low-quality studies on the results of the meta-analysis, and power calculations will determine the probability that we will detect a true effect if it does exist.<h4>Strengths and limitations of this study</h4>The intended review will provide an up-to-date summary of the global prevalence of silent MI in diabetic patients. We will conduct a thorough literature search for eligible studies, and we will use robust meta-analysis tools to provide reliable estimates of the global prevalence of silent MI in diabetic patients. Two major limitations could be: the predominance of clinical trials that might limit the generalizability of the findings, given that the strict inclusion criteria of these studies might have excluded other patients; the risk of type 1 error emanating from the high number of subgroup and sensitivity analyses.<h4>Prospero registration number</h4>CRD42019138136.
format	article
author	Christophe Dongmo Fokoua-Maxime Eric Lontchi-Yimagou Takeude Erwan Cheuffa-Karel Tchana Loic Tchato-Yann Simeon Pierre-Choukem
author_facet	Christophe Dongmo Fokoua-Maxime Eric Lontchi-Yimagou Takeude Erwan Cheuffa-Karel Tchana Loic Tchato-Yann Simeon Pierre-Choukem
author_sort	Christophe Dongmo Fokoua-Maxime
title	Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.
title_short	Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.
title_full	Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.
title_fullStr	Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.
title_full_unstemmed	Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.
title_sort	prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: protocol for a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/588564c0312c4481b8f1560ff57be025
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Prevalence of asymptomatic or "silent" myocardial ischemia in diabetic patients: Protocol for a systematic review and meta-analysis.

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