Importance Unhealthful dietary patterns, low levels of physical activity, and high sedentary time increase the risk of cardiovascular disease. Objective To systematically review the evidence on the benefits and harms of behavioral counseling for the primary prevention of cardiovascular disease in adults without known cardiovascular risk factors to inform the US Preventive Services Task Force. Data Sources MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and PsycINFO for studies published in the English language between January 1, 2013, and May 25, 2016, and ongoing surveillance in targeted publications through March 24, 2017. Studies included in the previous review were reevaluated for inclusion. Study Selection Randomized clinical trials of behavioral interventions targeting improved diet, increased physical activity, decreased sedentary time, or a combination of these among adults without known hypertension, dyslipidemia, diabetes, or impaired fasting glucose. Data Extraction and Synthesis Independent critical appraisal and data abstraction by 2 reviewers. Main Outcomes and Measures Cardiometabolic health and intermediate outcomes, behavioral outcomes, and harms related to interventions. Results Eighty-eight studies (N = 121 190) in 145 publications were included. There was no consistent benefit of the interventions on all-cause or cardiovascular mortality or morbidity (4 trials [n = 51 356]) or health-related quality of life (10 trials [n = 52 423]). There was evidence of small, statistically significant between-group mean differences for systolic blood pressure (−1.26 mm Hg [95% CI, −1.77 to −0.75]; 22 trials [n = 57 953]), diastolic blood pressure (−0.49 mm Hg [95% CI, −0.82 to −0.16]; 23 trials [n = 58 022]), low-density lipoprotein cholesterol level (−2.58 mg/dL [95% CI, −4.30 to −0.85]; 13 trials [n = 5554]), total cholesterol level (−2.85 mg/dL [95% CI, −4.95 to −0.75]; 19 trials [n = 9325]), and body mass index (−0.41 [95% CI, −0.62 to −0.19]; 20 trials [n = 55 059]) at 6 to 12 months as well as small-to-modest associations with dietary and physical activity behaviors. There was no evidence of greater incidence of serious adverse events, injuries, or falls in intervention vs control participants. Conclusions and Relevance Diet and physical activity behavioral interventions for adults not at high risk for cardiovascular disease result in consistent modest benefits across a variety of important intermediate health outcomes across 6 to 12 months, including blood pressure, low-density lipoprotein and total cholesterol levels, and adiposity, with evidence of a dose-response effect, with higher-intensity interventions conferring greater improvements. There is very limited evidence on longer-term intermediate and health outcomes or on harmful effects of these interventions.

/pdf/behavioral-counseling-to-promote-a-healthful-diet-and-4wz89i8tbi.pdf

Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Known Cardiovascular Disease Risk Factors: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Renin angiotensin aldosterone inhibition in the treatment of cardiovascular disease.

Many cardiovascular diseases present renin-angiotensin-aldosterone system (RAAS) hyperactivity as an important pathophysiological mechanism to be target in the therapeutic approaches. Moreover, arterial stiffness is currently considered as a new independent risk factor for cardiovascular disease in different clinical conditions, including hypertension and chronic kidney disease. In fact, excessive stimulation of angiotensin type 1 (AT1) receptors, as well as mineralocorticoid receptors, results in cellular growth, oxidative stress and vascular inflammation, which may lead to arterial stiffness and accelerate the process of vascular aging. In the last decades, a vasoprotective axis of the RAAS has been discovered, and now it is well established that new components with antioxidant and anti-inflammatory properties play important roles promoting vasodilation, natriuresis and reducing collagen deposition, thus attenuating arterial stiffness and improving endothelial function. In this review, we will focus on these pathophysiological mechanisms and the relevance of RAAS inhibition by different strategies to increase arterial compliance and to decelerate vascular aging.

The Role of Renin–Angiotensin–Aldosterone System and Its New Components in Arterial Stiffness and Vascular Aging

Background: The modified Dietary Approaches to Stop Hypertension (DASH) diet was a potentially effective treatment for pre-hypertensive and hypertensive patients. The evidence for the effect of the modified DASH diet on blood pressure reduction was inconsistent. The study was designed to assess the effects of the modified DASH diet on blood pressure (BP) in hypertensive and pre-hypertensive adults. Methods: We searched Medline, Embase, CENTRAL, CNKI, VIP, Wanfang Data, SINOMED, Google Scholar, the World Health Organization's International Clinical Trials Registry Platform, and Clinicaltrials.gov from inception to July 1st, 2021. Randomized controlled trials (RCTs) assessing the effects of the modified DASH diet on systolic and diastolic BP, cardiovascular risk factors (body weight, body mass index, waist circumference, fasting glucose, blood lipids), cardiovascular events, and all-cause mortality were included. Statistical analysis was performed using Stata software. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE. Results: A total of 10 RCTs were included. Compared with control diet, the modified DASH diet could reduce mean systolic (-3.26 mmHg; 95% confidence interval -5.58, -0.94 mmHg; P = 0.006) and diastolic (-2.07 mmHg; 95% confidence interval -3.68, -0.46 mmHg; P = 0.01) BP. Compared with the controlling diet, the modified DASH diet could reduce systolic BP to a greater extent in trials with a mean baseline BP ≥ 140/90 mmHg compared with 8 weeks compared with ≤8 weeks. The modified DASH diet could affect mean waist circumference (difference: 1.57 cm; 95% confidence interval -2.98, -0.15) and triglyceride concentration (difference: 1.04 mol/L; 95% confidence interval -1.47, -0.60). Conclusions: The modified DASH diet can reduce BP, waist circumference, and triglyceride concentration in hypertension patients. A higher baseline BP is associated with more marked systolic and diastolic BP reduction. Systematic Review Registration: PROSPERO registration number: CRD42020190860.

/pdf/effects-of-the-modified-dash-diet-on-adults-with-elevated-2nd0040ial.pdf

Effects of the Modified DASH Diet on Adults With Elevated Blood Pressure or Hypertension: A Systematic Review and Meta-Analysis

Health care systems are continually being reformed, however care improvement and intervention effectiveness are often assumed, not measured. This paper aimed to review findings from published studies about the appropriateness of eye care delivery, using existing published evidence and/or experts’ practice and to describe the methods used to measure appropriateness of eye care. A systematic search was conducted using Medline, Embase and CINAHL (2006 to September 2016). Studies reporting the processes of eye care delivery against existing published evidence and/or experts’ practice were selected. Data was extracted from published reports and the methodological quality using a modified critical appraisal tool. The primary outcomes were percentage of appropriateness of eye care delivery. This study was registered with PROSPERO, reference CRD42016049974. Fifty-seven studies were included. Most studies assessed glaucoma and diabetic retinopathy and the overall methodological quality for most studies was moderate. The ranges of appropriateness of care delivery were 2–100% for glaucoma, 0–100% for diabetic retinopathy and 0–100% for other miscellaneous conditions. Published studies assessed a single ocular condition, a sample from a single centre or a single domain of care, but no study has attempted to measure the overall appropriateness of eye care delivery. These findings indicated a wide range of appropriateness of eye care delivery, for glaucoma and diabetic eye care. Future research would benefit from a comprehensive approach where appropriateness of eye care is measured across multiple conditions with a single methodology, to guide priorities within eye care delivery and monitor quality improvement initiatives.

/pdf/systematic-review-of-the-appropriateness-of-eye-care-3zbcect949.pdf

Systematic review of the appropriateness of eye care delivery in eye care practice

The effectiveness of Dietary Approaches to Stop Hypertension (DASH) counselling on estimated 10-year cardiovascular risk among patients with newly diagnosed grade 1 hypertension: A randomised clinical trial

The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings: A cross-sectional study.

The incidence of all-cause, cardiovascular and respiratory disease admission among 20,252 users of lisinopril vs. perindopril: A cohort study

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The effectiveness of Dietary Approaches to Stop Hypertension (DASH) counselling on estimated 10-year cardiovascular risk among patients with newly diagnosed grade 1 hypertension: A randomised clinical trial

The adoption of the Reference Framework for diabetes care among primary care physicians in primary care settings: A cross-sectional study.

The incidence of all-cause, cardiovascular and respiratory disease admission among 20,252 users of lisinopril vs. perindopril: A cohort study