Vitamin D Supplementation and Its Impact on Mortality and Cardiovascular Outcomes: Systematic Review and Meta-Analysis of 80 Randomized Clinical Trials

Background: The impact of vitamin D supplementation on cardiovascular outcomes and mortality risk reduction remains unclear due to conflicting study findings. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), published between 1983 and 2022, that reported the effect of vitamin D supplementation in adults versus placebo or no treatment on all-cause mortality (ACM), cardiovascular mortality (CVM), non-cardiovascular mortality (non-CVM), and cardiovascular morbidities. Only studies with a follow-up period longer than one year were included. The primary outcomes were ACM and CVM. Secondary outcomes were non-CVM, myocardial infarction, stroke, heart failure, and major or extended adverse cardiovascular events. Subgroup analyses were performed according to low-, fair- and good-quality RCTs. Results: Eighty RCTs were assessed, including 82,210 participants receiving vitamin D supplementation and 80,921 receiving placebo or no treatment. The participants’ mean (SD) age was 66.1 (11.2) years, and 68.6% were female. Vitamin D supplementation was associated with a lower risk of ACM (OR: 0.95 [95%CI 0.91–0.99] p = 0.013), was close to statistical significance for a lower risk of non-CVM (OR: 0.94 [95%CI 0.87–1.00] p = 0.055), and was not statistically associated with a lower risk of any cardiovascular morbi-mortality outcome. Meta-analysis of low-quality RCTs showed no association with cardiovascular or non-cardiovascular morbi-mortality outcomes. Conclusions: The emerging results of our meta-analysis present evidence that vitamin D supplementation appears to decrease the risk of ACM (especially convincing in the fair- and good-quality RCTs), while not showing a decrease in the specific cardiovascular morbidity and mortality risk. Thus, we conclude that further research is warranted in this area, with well-planned and executed studies as the basis for more robust recommendations

Inhaler Adherence in COPD: A Crucial Step Towards the Correct Treatment

Miguel Turégano-Yedro,1 Eva Trillo-Calvo,2 Fernando Navarro i Ros,3,4 José David Maya-Viejo,5 Cruz González Villaescusa,6,7 Jose Maria Echave Sustaeta,8 Esperanza Doña,9 Bernardino Alcázar Navarrete10,11 1Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, Spain; 2Centro de Salud Campo de Belchite, Belchite, Zaragoza, Spain; 3Centro de Salud Ingeniero J Benlloch, Valencia, Spain; 4Red Investigadores SEMERGEN, Madrid, Spain; 5Unidad de Gestión Clínica de Camas, Distrito Sanitario Aljarafe-Sevilla Norte, Camas, Sevilla, Spain; 6Servicio de Neumología, Hospital Clínico Universitario de Valencia, Valencia, Spain; 7Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain; 8Servicio de Neumología, Hospital Universitario Quironsalud, Universidad Europea de Madrid, Madrid, Spain; 9Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, Málaga, Spain; 10Servicio de Neumología, Hospital Universitario Virgen de las Nieves, Granada, Spain; 11Instituto de Investigación Biosanitaria, Ibs- Granada, Granada, SpainCorrespondence: Miguel Turégano-Yedro, Centro de Salud Casar de Cáceres, Casar de Cáceres, C/ Barrionuevo Bajo, 49, Casar de Cáceres, Cáceres, 10190, Spain, Tel +34-927291531, Email [email protected]: COPD is a typical example of chronic disease. As such, treatment adherence tends to be as low as between 30% and 50%, with specific issues in COPD due to the use of inhaled therapies. Decreased adherence in COPD is associated with worse outcomes, with increased risk for exacerbations and long-term mortality. Factors that impact adherence are multiple, some related to patient, some related to clinicians and finally some related to healthcare system. Among clinician factors, prescription of simplified treatment regimens delivered by an inhaler adapted to the patient’s characteristics is crucial. Although it has been observed a huge improvement in the design and usability of inhaler devices for COPD in the last two centuries, there is still a clear gap in this field. Smart inhalers as well as simplified treatment regimens could improve adherence and therefore improve long-term outcomes in COPD.Plain Language Summary: Treatment adherence in COPD is crucial as in many other chronic diseases, with specific issues due to inhaled route, and many factors involved. Low adherence in COPD has been linked to an increased risk of exacerbations and future mortality. Many interventions have been developed to improve treatment adherence in COPD. This review summarizes the current knowledge and future prospects for this important aspect of COPD treatment.Keywords: COPD, inhaled therapies, adherence, persistence, posolog

Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review

The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together.La eficacia y la seguridad de la profilaxis con ácido acetilsalicílico (AAS) para la prevención primaria de la enfermedad cardiovascular arteriosclerótica (ECVA) siguen siendo controvertidas en personas con diabetes (DM) sin ECVA, ya que el posible aumento del riesgo de hemorragias graves podría superar la posible disminución del riesgo de mortalidad y de los principales episodios adversos cardiovasculares (MACE) considerados individualmente o en conjunto