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The primary definition of major adverse cardiovascular events was the composite of death from cardiovascular causes, non fatal myocardial infarction, and non fatal stroke or the composite of death from any cause, non fatal myocardial infarction, and non fatal stroke as evaluated by universal clinical guidelines. Other eligible definitions were death from cardiovascular causes and myocardial infarction; death from any cause and myocardial infarction; death from cardiovascular causes; and fatal and non fatal myocardial infarction. We required that the components subsumed under the definition of major adverse cardiovascular events were sensitive and unbiased measurable events of the same underlying disease process. We excluded studies reporting only all cause mortality because of the high likelihood of bias by events without an underlying cardiovascular cause. Studies reporting only composite end points, including the clinician driven proxy outcomes of revascularisation or admission to hospital, were excluded because of uncertainties about precision, reproducibility, correlation with clinical end points, the use of non standardised definitions, and a high risk of reporting bias.23 24