A meta-analysis of published studies of XXXX does not support its routine clinical use.

@entity1 @entity409 @entity65
BACKGROUND: @entity409 is a marker of future @entity65 ( @entity65 ) risk, yet epidemiological studies have yielded inconsistent results. We therefore studied the association between @entity409 and @entity65 under diverse circumstances. METHODS AND RESULTS: Literature-based meta-analysis of prospective observational studies with >=   12  months of follow-up published in Medline and having information on endothelial function and @entity65 outcomes. Tabular data on @entity1 characteristics, endothelial function assessments and incident @entity65 outcomes were abstracted from individual studies. Random-effects meta-analysis was used to quantify pooled associations, and I(2) statistic to evaluate between-study heterogeneity. Potential sources of heterogeneity were explored by subgroup analyses and meta-regression. Thirty five studies involving 17,206 @entity1 met the inclusion criteria. During more than 80,000 @entity1 -years of observation, up to 2755 @entity65 events were accrued, yielding a pooled relative risk (RR) of 1.25 (95% confidence interval 1.15-1.35) for @entity65 comparing top (i.e. more severe) vs. bottom (less severe) third of @entity409 . There was significant between-study heterogeneity and evidence of publication bias. RRs varied importantly according to the method used to ascertain endothelial function, and were higher among older individuals and among @entity1 with risk factors for @entity65 or established @entity65 at baseline. CONCLUSIONS: Although @entity409 is an important determinant of cardiovascular outcomes in @entity1 with pre-existing @entity65 , current evidence base does not support its use as a potentially useful measurement for risk stratification in @entity1 at lower risk of @entity65 .
