cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLC10.15829/1728-8800-2024-3925NNCAACcardiovascular-3925Research ArticleМНЕНИЕ ПО ПРОБЛЕМЕOPINION ON A PROBLEMЯвляется ли метаанализ "вершиной пирамиды доказательств" в кардиологии?Is meta-analysis the "top of the evidence pyramid" in cardiology?https://orcid.org/0000-0002-7717-4362МарцевичС. Ю.MartsevichS. Yu.

Марцевич Сергей Юрьевич — д.м.н., профессор, руководитель отдела профилактической фармакотерапии.

Москва

Moscow

sergeymartsevich@mail.ruФГБУ "Национальный медицинский исследовательский центр терапии и профилактической медицины" Минздрава РоссииNational Medical Research Center for Therapy and Preventive Medicine20242402202423139253925Copyright © Марцевич С.Ю., 20242024Марцевич С.Ю.Martsevich S.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/3925

Автор высказывает свое мнение о значимости и месте метаанализов в современной доказательной медицине, в первую очередь, в кардиологии. Кратко описывается история появления метаанализов. Рассматриваются основные ограничения метаанализов. Приводятся примеры, когда метаанализы, посвященные одной и той же проблеме, давали прямо противоположные результаты. Обсуждается значение метаанализов в выявлении побочных действий лекарственных препаратов. Демонстрируется возможность манипулирования результатами метаанализов. Значимость метаанализов в настоящее время оценивается на примере пандемии коронавирусной инфекции, когда разные метаанализы по-разному оценивали эффективность и безопасность одних и тех же лекарственных препаратов.

Автор приходит к выводу, что метаанализы следует исключить из уровня доказательства I и отвести им более скромную роль в иерархии доказательств.

The author comments on the significance and place of meta-analyses in modern evidence-based medicine, primarily in cardiology. The history of meta-analyses is briefly described. The main limitations of meta-analyses are reviewed. Examples are given where meta-analyses on the same problem had directly opposite results. The importance of meta-analyses in identifying side effects of drugs is discussed. The possibility of manipulating the results of meta-analyses is demonstrated. The significance of meta-analyses is currently being assessed through the example of the coronavirus pandemic, when different meta-analyses assessed the effectiveness and safety of the same drugs differently.

The author concludes that meta-analyses should be excluded from level I evidence and given a more modest role in the hierarchy of evidence.

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The authors declare that there are no conflicts of interest present.