The Decline Effect in Cardiovascular Medicine: Is the Effect of Cardiovascular Medicine and Stent on Cardiovascular Events Decline Over the Years?

Abstract

The term decline effect is referred to a diminution of scientifically discovered effects over time. Reasons for the decline effect are multifaceted and include publication bias, selective reporting, outcomes reporting bias, regression to the mean, scientific paradigm shift, overshadowing and habituation, among others. Such effects can be found in cardiovascular medicines through medications (e.g., aspirin, antithrombotics, proton pump inhibitor, beta-blockers, statins, estrogen/progestin, angiotensin converting enzyme inhibitor etc.), as well as with interventional devices (e.g., angioplasty, percutaneous coronary intervention, stents). The scientific community should understand the various dimensions of the decline effects, and effective steps should be undertaken to prevent or recognize such decline effects in cardiovascular medicines.

Preoperative Low-dose and High-dose Pregabalin and Cardiovascular Response to Endotracheal Intubation: A Prospective, Randomized, Single-blind, Controlled Study in China

“…12 However, the optimal medicine or method to avoid stress responses in these patients has not been unequivocally established. 13 Pregabalin is a new generation of antiepileptic drug that interacts with the a 2 -d subunit of voltagedependent calcium channels in the CNS and inhibits neuronal excitability. 14 Compared with that of gabapentin, another commonly used antiepileptic drug, the absorption of pregabalin in the gastrointestinal tract shows a better drug disposition, with peak plasma concentration occurring within 1 hour of administration in a dose-independent manner and without limitation of transport saturation.…”

Contradicting/negative results in clinical research: Why (do we get these)? Why not (get these published)? Where (to publish)?

“…This declining effect has been reported to exist in all fields of medicine, especially cardiovascular and psychiatry. [ 2 3 ] Ioannidis[ 4 ] studied 49 trials that were cited more than 1000 times and published in journals with high impact factor and found 16% producing contradictory results, more common in nonrandomized than in randomized studies. Contradictory results are rampantly seen in genomic studies.…”