In this systematic review that included 93 reports of Randomized Clinical Trials (RCTs) from 6 high-impact journals, positive spin of statistically nonsignificant primary outcomes was found in 57% of abstracts and 67% of main text of the published articles. Despite peer review, manipulation of language in the cardiovascular literature is common and may have implications for scientific integrity, patient care, peer review, and medical progress. This study suggests that in reports of cardiovascular RCTs with statistically nonsignificant primary outcomes, investigators often manipulate the language of the report to detract from the neutral primary outcomes. To best apply evidence to patient care, consumers of cardiovascular research should be aware that peer review does not always preclude the use of misleading language in scientific articles. This systematic review is reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cohort studies.

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