A Systematic Review of Community Pharmacists' Interventions in Reducing Major Risk Factors for Cardiovascular Disease.

OBJECTIVES

To conduct a systematic literature review and assess the effectiveness of community pharmacists' interventions in reducing major risk factors for cardiovascular diseases.

METHODS

A comprehensive literature search from 2000 onwards was performed using MEDLINE (1946 to June 4, 2013), EMBASE (1947 to present), CINAHL, and Cochrane Library. The gray literature was also searched. Studies were classified as diabetes, hypertension, dyslipidemia, and tobacco dependence. Data abstracted from the articles included study design/participants, study duration, key components of intervention, primary outcome, and key findings. Study quality was assessed using a checklist appropriate to the study design.

RESULTS

A total of 1020 citations were initially identified, with 27 meeting inclusion criteria. Eight studies were randomized controlled trials, five were cluster randomized trials, two were randomized before-after design studies, five were nonrandomized controlled before-after design studies, and seven were uncontrolled before-after design studies. Interventions focused on diabetes (n = 8), hypertension (n = 9), dyslipidemia (n = 7), and tobacco dependence (n = 3). Effect sizes ranged from 7.8 to 17.7 mm Hg and from 0.2% to 2.2% reductions in systolic blood pressure and hemoglobin A, respectively, while reductions in total cholesterol ranged from 18.2 to 27.1 mg/dl. Study quality was generally poor.

CONCLUSIONS

Available evidence suggests a potential for substantial benefit in diabetes and hypertension but clinical benefits in lipid management remain unclear. The true effect of interventions is uncertain due to poor study quality, inconsistent results, and potential for publication bias. Further well-designed studies are needed to determine the true impact of community pharmacists' interventions in reducing major risk factors for cardiovascular disease.