BP lowering and cardiovascular risk reduction

Overview of: The Blood Pressure Lowering Treatment Triallists’ Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet 2021;397:1625–36.

Quality improvement and usability testing of the PortfolioDiet.app, a web-based health application to translate nutrition therapy for cardiovascular risk reduction in primary care (Preprint)

BACKGROUND The Portfolio Diet, or Dietary Portfolio, is a therapeutic dietary pattern that combines cholesterol-lowering foods to manage dyslipidemia for the prevention of cardiovascular disease. To translate the Portfolio Diet for primary care, we developed the PortfolioDiet.app as a patient and physician educational and engagement tool for personal computers and smartphones. The PortfolioDiet.app is currently being used as an add-on therapy to the standard of care (usual care) for the prevention of cardiovascular disease in primary care. To enhance the adoption of this tool, it is important to ensure the PortfolioDiet.app meets the needs of its target end-users. OBJECTIVE The objective of this project was to undertake and describe user testing of the PortfolioDiet.app as part of ongoing engagement in quality improvement (QI). METHODS We undertook a 2-phase QI project between February 2021 to September 2021. We recruited users by convenience sampling. Users included patients, family physicians, dietitians, and nutrition and medical students. For both phases, users were asked to use the PortfolioDiet.app daily for seven days. In phase 1, a mixed-form questionnaire was administered to evaluate the user’s perceived acceptability, knowledge acquisition, and engagement with the PortfolioDiet.app. The questionnaire collected both quantitative data and qualitative data including two open-ended questions. Responses were used to inform modifications to the PortfolioDiet.app. In phase 2, the System Usability Scale (SUS) was used to assess the usability of the updated PortfolioDiet.app, with a score of above 70 being considered acceptable. RESULTS A total of 30 and 19 users were recruited for phase 1 and phase 2, respectively. For phase 1, the PortfolioDiet.app increased users’ perceived knowledge of the Portfolio Diet and influenced their perceived food choices. Between the project phases, modifications were made to the PortfolioDiet.app to incorporate and address user feedback. At phase 2, the average SUS score was 85.39 ± 11.47, with 100 being the best possible. CONCLUSIONS The PortfolioDiet.app educates users on the Portfolio Diet and is considered acceptable by users. While further refinements to the app will continue to be made, the result of this QI project will now be an improved clinical tool that better meets user needs. CLINICALTRIAL This QI project was formally reviewed by institutional authorities at Unity Health Toronto and deemed to neither require Research Ethics Board approval nor written informed consent from participants.

Systematic Review and Meta-Analysis of the Effect of Statins on Circulating E-Selectin, L-Selectin, and P-Selectin

The pleiotropic effects of statins might involve preventing inflammatory cell adhesion to the endothelium, which is a critical step in the pathogenesis of atherosclerosis. We conducted a systematic review and meta-analysis of the effects of statins on the circulating cell adhesion molecules E-Selectin, L-Selectin, and P-Selectin. A literature search was conducted in PubMed, Web of Science, and Scopus, from inception to July 2021. Risk of bias and certainty of evidence were assessed using the Joanna Briggs Institute Critical Appraisal Checklist and GRADE, respectively. In 61 studies, statins significantly reduced P-selectin (standard mean difference, SMD = −0.39, 95% CI −0.55 to −0.22, p < 0.001; moderate certainty of evidence), L-selectin (SMD = −0.49, 95% CI −0.89 to −0.10, p = 0.014; very low certainty of evidence), and E-Selectin (SMD = −0.73, 95% CI −1.02 to −0.43, p < 0.001; moderate certainty of evidence), independently of baseline lipid profile and other study and patient characteristics. The corresponding pooled SMD values in sensitivity analysis were not substantially altered when individual studies were sequentially removed. Simvastatin had a significant lowering effect on both P-selectin and E-selectin. Therefore, statins significantly reduce circulating selectins. Further studies are required to investigate whether selectin lowering mediates cardiovascular risk reduction with these agents. (PROSPERO registration number: CRD42021282778).

Evidence born from ASCOT trial – still important after 15 years

The paper presents the overview evolution of hypertension identification and treatment during last 15 years after publication of ASCOT trial (AngloScandinavian Cardiac Outcomes Trial) results. It discusses possible mechanism of more significant cardiovascular risk reduction in amlodipine/ perindopril group comparing with atenolol/diuretic group: central blood pressure, arterial stiffness, asleep blood pressure and BP variability. Innovative approaches in time of ASCOТ trial such as combined antihypertensive therapy from start and RAAS inhibitor as first line now became routine practice in actual guidelines. Importance of early prescribing of fixed antihypertensive combination and choice of safe drugs help to improve adherence and decrease resistant hypertension prevalence. Prevention of new onset of diabetes in metabolic patients needs application of metabolically neutral drugs and including of renin-angiotensin-aldosterone inhibitors in combination therapy. Results of ASCOT-Legacy trial demonstrated long-term protective effect of amlodipine/perindopril combination resulting in decreasing mortality, rate of stroke and coronary events during 20-years follow-up.