title: Impact of pharmacist care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  Pharmacists may improve the clinical management of major risk factors for cardiovascular disease (CVD) prevention. A systematic review was conducted to determine the impact of pharmacist care on the management of CVD risk factors among outpatients.
  
  
  METHODS
  The MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials that involved pharmacist care interventions among outpatients with CVD risk factors. Two reviewers independently abstracted data and classified pharmacists' interventions. Mean changes in blood pressure, total cholesterol, low-density lipoprotein cholesterol, and proportion of smokers were estimated using random effects models.
  
  
  RESULTS
  Thirty randomized controlled trials (11,765 patients) were identified. Pharmacist interventions exclusively conducted by a pharmacist or implemented in collaboration with physicians or nurses included patient educational interventions, patient-reminder systems, measurement of CVD risk factors, medication management and feedback to physician, or educational intervention to health care professionals. Pharmacist care was associated with significant reductions in systolic/diastolic blood pressure (19 studies [10,479 patients]; -8.1 mm Hg [95% confidence interval {CI}, -10.2 to -5.9]/-3.8 mm Hg [95% CI,-5.3 to -2.3]); total cholesterol (9 studies [1121 patients]; -17.4 mg/L [95% CI,-25.5 to -9.2]), low-density lipoprotein cholesterol (7 studies [924 patients]; -13.4 mg/L [95% CI,-23.0 to -3.8]), and a reduction in the risk of smoking (2 studies [196 patients]; relative risk, 0.77 [95% CI, 0.67 to 0.89]). While most studies tended to favor pharmacist care compared with usual care, a substantial heterogeneity was observed.
  
  
  CONCLUSIONS
  Pharmacist-directed care or in collaboration with physicians or nurses improve the management of major CVD risk factors in outpatients.
authors.affiliation: Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada. valerie.santschi@gmail.com
authors.forename: Valérie
authors.initials: V
authors.lastname: Santschi
authors.forename: Arnaud
authors.initials: A
authors.lastname: Chiolero
authors.forename: Bernard
authors.initials: B
authors.lastname: Burnand
authors.forename: April L
authors.initials: AL
authors.lastname: Colosimo
authors.forename: Gilles
authors.initials: G
authors.lastname: Paradis
mesh_terms: D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D010595:Pharmacists; D011369:Professional-Patient Relations; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D002784:Cholesterol