1.
Evaluation of a package of risk-based pharmaceutical and lifestyle interventions in patients with hypertension and/or diabetes in rural China: A pragmatic cluster randomised controlled trial.
Wei, X, Zhang, Z, Chong, MKC, Hicks, JP, Gong, W, Zou, G, Zhong, J, Walley, JD, Upshur, REG, Yu, M
PLoS medicine. 2021;(7):e1003694
Abstract
BACKGROUND Primary prevention of cardiovascular disease (CVD) requires adequate control of hypertension and diabetes. We designed and implemented pharmaceutical and healthy lifestyle interventions for patients with diabetes and/or hypertension in rural primary care, and assessed their effectiveness at reducing severe CVD events. METHODS AND FINDINGS We used a pragmatic, parallel group, 2-arm, controlled, superiority, cluster trial design. We randomised 67 township hospitals in Zhejiang Province, China, to intervention (34) or control (33). A total of 31,326 participants were recruited, with 15,380 in the intervention arm and 15,946 in the control arm. Participants had no known CVD and were either patients with hypertension and a 10-year CVD risk of 20% or higher, or patients with type 2 diabetes regardless of their CVD risk. The intervention included prescription of a standardised package of medicines, individual advice on lifestyle change, and adherence support. Control was usual hypertension and diabetes care. In both arms, as usual in China, most outpatient drug costs were out of pocket. The primary outcome was severe CVD events, including coronary heart disease and stroke, during 36 months of follow-up, as recorded by the CVD surveillance system. The study was implemented between December 2013 and May 2017. A total of 13,385 (87%) and 14,745 (92%) participated in the intervention and control arms, respectively. Their mean age was 64 years, 51% were women, and 90% were farmers. Of all participants, 64% were diagnosed with hypertension with or without diabetes, and 36% were diagnosed with diabetes only. All township hospitals and participants completed the 36-month follow-up. At 36 months, there were 762 and 874 severe CVD events in the intervention and control arms, respectively, yielding a non-significant effect on CVD incidence rate (1.92 and 2.01 per 100 person-years, respectively; crude incidence rate ratio = 0.90 [95% CI: 0.74, 1.08; P = 0.259]). We observed significant, but small, differences in the change from baseline to follow-up for systolic blood pressure (-1.44 mm Hg [95% CI: -2.26, -0.62; P < 0.001]) and diastolic blood pressure (-1.29 mm Hg [95% CI: -1.77, -0.80; P < 0.001]) in the intervention arm compared to the control arm. Self-reported adherence to recommended medicines was significantly higher in the intervention arm compared with the control arm at 36 months. No safety concerns were identified. Main study limitations include all participants being informed about their high CVD risk at baseline, non-blinding of participants, and the relatively short follow-up period available for judging potential changes in rates of CVD events. CONCLUSIONS The comprehensive package of pharmaceutical and healthy lifestyle interventions did not reduce severe CVD events over 36 months. Improving health system factors such as universal coverage for the cost of essential medicines is required for successful risk-based CVD prevention programmes. TRIAL REGISTRATION ISRCTN registry ISRCTN58988083.
2.
Biomarkers of dairy fat intake and risk of cardiovascular disease: A systematic review and meta analysis of prospective studies.
Liang, J, Zhou, Q, Kwame Amakye, W, Su, Y, Zhang, Z
Critical reviews in food science and nutrition. 2018;(7):1122-1130
Abstract
BACKGROUND Circulating biomarkers of dairy fat provide objective measures of dairy fat intake and facilitate conclusions relevant to populations with different diets and susceptibility to cardiovascular diseases (CVD). OBJECTIVE To assess the relationship between circulating pentadecanoic acid (15:0), heptadecanoic acid (17:0) and trans-palmitoleic acid (trans-16:1n-7) and the risk of CVD. METHODS Pubmed, Medline and Embase were searched for prospective cohort studies of the relationship between biomarkers of dairy fat and CVD risk, which included coronary heart disease (CHD), stroke, heart failure and CVD mortality, supplemented by bibliographies of retrieved articles and previous reviews. For each study, relative risks (RR) and 95% confidence intervals (CI) were extracted and pooled with the random effect model. RESULTS Thirteen studies involving 7,680 CVD cases were included. The pooled RRs of the risk of CVD for the top third vs. bottom third 15:0, 17:0 and trans-16:1n-7 level were 0.94 (95%CI: 0.77-1.15), 0.82 (95% CI: 0.68-0.99) and 0.82 (95% CI: 0.67-1.02), respectively. Subgroup analysis indicated that there were no associations between the concentration of 15:0 with CHD and stroke, but a negative relationship with heart failure (RR = 0.72, 95% CI: 0.55-0.95). Null association was observed between circulating 17:0 and trans-16:1n-7 level and subtypes of CVD except for only one study which reported a negative relationship between 17:0 and heart failure. CONCLUSION Higher dairy fat exposure is not associated with an increased risk of CVD.
3.
Effects of Avena nuda L. on metabolic control and cardiovascular disease risk among Chinese patients with diabetes and meeting metabolic syndrome criteria: secondary analysis of a randomized clinical trial.
Ma, X, Gu, J, Zhang, Z, Jing, L, Xu, M, Dai, X, Jiang, Y, Li, Y, Bao, L, Cai, X, et al
European journal of clinical nutrition. 2013;(12):1291-7
Abstract
BACKGROUND/OBJECTIVES Most patients with Type 2 diabetes mellitus(DM) also have metabolic syndrome (MetS), which is associated with an increased risk of coronary heart disease prevalence. Limited information is available on the effect and effective doses of oat intake with a structured dietary intervention in metabolic control and cardiovascular disease (CVD) risk prevention with the population who has Type 2 DM and meets the MetS criteria. SUBJECTS/METHODS A total of 260 Type 2 DM patients meeting MetS National Cholesterol Education Program Adult Treatment Panel III criteria were selected from 445 patients between 50 and 65 years of age, and they participated in a single-blinded, 30-day centralized management of a dietary program in China. Participants in the program were randomly assigned into one of the four groups: usual care group (control group, only basic health advice), diet group (systematic diet plans and intensive education), 50 g-organic naked oat with whole germ group (ONOG) and 100 g-organic naked oat with whole germ group (daily ONOG replacement boiled into porridge based on diet group). The primary outcomes were the relative changes in glycosylated hemoglobin (HbA1c) and insulin resistance after a 30-day intervention among the four groups. RESULTS HbA1c decreased significantly with the increase in interventions (Ptrend<0.05). Similar results were also obtained in plasma glucose, serum lipid and hypersensitive C-reactive protein (hs-CRP). For the 100 g-ONOG group but not 50 g-ONOG group, HbA1c and hs-CRP reduced significantly by 0.51% and 1.29 mg/l (P<0.05, vs diet group), respectively. The 100 g-ONOG group showed a reduction by 0.22 U*mol/l(2) in insulin resistance, compared with the 50 g-ONOG group (P=0.039). CONCLUSIONS Compared with diet alone or no diet, 50-100 g/day ONOG supplement to structured dietary intervention, at a dose of 100 g/day especially, contributes to the Type 2 DM patients meeting MetS criteria in their metabolic control and CVD risk prevention, with external factors being controlled.