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SA JOURNAL OF DIABETES & VASCULAR DISEASE

REVIEW

VOLUME 12 NUMBER 2 • NOVEMBER 2015

63

Statistical analysis

Analysis was performed with software review manager 5.1

(Cochrane collaboration,

http://ims.cochrane.org/revman)

and

comprehensive meta-analysis (Englewood, NJ);

p

< 0.05 was

regarded as statistically significant. Meta-analysis was performed in

fixed- or random-effect models.

Odds ratios (OR) and95%confidence intervals (CI)wereestimated

in each study. Pooled ORs were obtained using the Mantel-Haenszel

method in a fixed-effect model, and the DerSimonian-Laid method

in a random-effects model.

24

The significance of pooled ORs was

determined by the Z-test. Cochrane’s

Q

-statistic was used to assess

within- and betweenstudies variations. A

p

< 0.10 on the

Q

-statistic

was regarded as heterogeneity across the studies.

I

2

was also used

to test heterogeneity with the formula:

I

2

= (Q − df)

Q

× 100%

where

I

2

< 25% means no heterogeneity;

I

2

= 25–50% means

moderate heterogeneity;

I

2

> 50% means large or extreme

heterogeneity.

27

The random-effects model was also used for evaluating the

possibility of heterogeneity of studies. Publication bias was

evaluated with Egger’s test and funnel plots,

28

which compensate

for each other’s drawbacks. If there is evidence of publication

bias, the funnel plot is noticeably asymmetric. For the Egger’s test

the significance level was set at 0.05. Sensitivity analysis was also

performed to test reliability of the results, by removing one study at

a time and repeating the meta-analysis.

Results

As shown in Fig. 1, among 3 658 articles potentially relevant to

the search terms (PubMed: 1 103; MEDLINE: 765; Springer: 650;

Elsevier Science Direct: 880; Cochrane Library: 50; Google Scholar:

210), 323 potentially relevant studies were selected after the

duplicates were removed. When the abstracts were screened 276

were excluded (65 were review articles, 156 were not diabetic

patients, 55 did not report on BMS data). Among the remaining 47,

another 41 were excluded (25 only reported on BMS data without

comparisons, 16 were excluded due to unavailable data). Finally, six

studies were included in this meta-analysis.

The characteristics of the included studies are presented in

Table 1. These six studies were conducted from 2002 to 2006 and

published between 2005 and 2008, three in Europeans, two in

Americans, and one in Asians and Americans. A total of 1 259 CAD

Figure 1

. Flow chart of selection of the studies.

Table 2.

Pooled odds ratio for the SES versus the BMS group

Random model

Test of heterogeneity

Egger’s test for publication bias

Subgroups

No. of studies

OR (95% CI)

Z

p

value

Q

p

-value I2 (%)

t

p

-value

Overall effects

6

0.42 (0.24–0.74)

3.00

< 0.01

20.14

< 0.01

75.2

–4.19

0.014

Sample size ≤ 90

3

0.28 (0.16–0.48)

4.60

< 0.01

2.39

0.303

16.3

–3.66

0.62

Sample size > 90

3

0.61 (0.31–1.21)

1.42

0.15

8.70

0.013

77.0

–9.26

0.20

RCT

4

0.28 (0.19–0.42)

6.14

< 0.01

2.40

0.495

0.0

–2.36

0.531

Non-RCT

2

0.87 (0.61–1.24)

0.76

0.446

0.92

0.338

0.0

–5.29

European

3

0.45 (0.27–0.77)

2.95

< 0.01

3.71

0.156

46.1

–7.98

0.46

American and Asian

3

0.37 (0.11–1.27)

1.58

0.115

15.55

< 0.01

87.1

–5.92

0.23

Table 1.

Characteristics of studies included in the meta-analysis

SES group

BMS group

Study

Follow up Sample

Sample

Study

Study year

Country

Ethnicity method

(years)

size Age (years)

size Age (years)

Aoki J,

et al

.

2002–2003 Netherlands

European

Non-RCT

1

112

63 ± 10

118

64 ± 11

Jimenez-Quevedo P,

et al

.

2003

United States

America

RCT

1

80

65.4 ± 8

80

67.9 ± 9

Baumgart D,

et al

.

2002–2004

Germany

European

RCT

1

94

66 ± 9

96

66 ± 10

Daemen J,

et al.

2002–2003 United States

America

Non-RCT

1

206

62.0 ± 10

252

62.7 ± 10

Chan C,

et al.

2002–2004 United States

America

RCT

1

54

58.7 ± 9.7

29

62.5 ± 10.3

and Asia

and Asian

Maresta A,

et al.

2004–2006

Italy

European

RCT

1

68

71 ± 9

70

69 ± 9