Objective The aim of this systematic review and meta-analysis of randomised controlled trials is to evaluate the impact of pharmacist-led interventions on cardiovascular disease (CVD) risk factors among patients with type 2 diabetes. Method: A literature review was conducted according to PRISMA guidelines using 4 electronic databases: Embase, MEDLINE, CINHAL and the Cochrane Central Register of Controlled Trials. We searched for pharmacist interventions among adults with type 2 diabetes and cardiovascular disease in randomised controlled trials from inception to May 2021 in primary care, diabetes clinics and hospitals. The clinical outcomes measured glycosylated haemoglobin (HbA1c), blood pressure (BP) and lipid profile. The non-clinical outcomes included medication adherence, smoking, health-related quality of life and the cost of the intervention. For the meta-analysis, clinical outcomes were pooled with the random effect model in RevMan 5.3. The Cochrane risk-of-bias tool was used to assess the quality of the included studies. Results: We retrieved 223 studies,141 of which were included in the review. Ten published articles met the inclusion criteria and were included in the meta-analysis. The pharmacists delivered the interventions alone or collaboratively with other healthcare professionals in hospitals or similar settings. The overall result showed a significant reduction in HbA1c (n = 10; standard deviation in mean value [SDM]: −.53%, 95% CI: −.84, −.23) and systolic BP (n = 10; [SDM]: −.35 mmHg, 95% CI: −.51, −.20) in pharmacist intervention groups. For the non-clinical outcomes, the review revealed variable results from pharmacist intervention compared with those standard care. Conclusion: Pharmacy interventions provide evidence for pharmacists’ decisive role in diabetes care management and reducing cardiovascular risk factors among adults with type 2 diabetes.

Background: Although low-density-lipoprotein cholesterol (LDL-C) remains the primary target of lipid-lowering therapy, many patients with atherosclerotic cardiovascular disease (ASCVD) continue to experience cardiovascular events. This residual risk suggests that LDL-C alone does not fully capture the total atherogenic burden. Alternative lipid measures, including non-high-density lipoprotein cholesterol (non-HDL-C) and cholesterol ratios, may provide a more comprehensive risk assessment, particularly in populations with a high prevalence of metabolic disorders. This study assessed the prevalence and clinical determinants of elevated non-HDL cholesterol and adverse cholesterol ratios among Middle Eastern patients with established ASCVD. Methods: This pooled cross-sectional analysis included 2763 adults with confirmed ASCVD from the Jordan SMuRF-less Study and six cardiovascular registries across the Middle East. Patients were stratified by standard modifiable cardiovascular risk factors (SMuRFs). Demographic, clinical, treatment, and lifestyle data were harmonized and analyzed using multivariable regression models. Results: Elevated non-HDL-C was observed in 54% of patients. Those with elevated non-HDL-C were younger (55.0 vs. 59.9 years) and more frequently current smokers (52.6% vs. 43.1%). Hypertension (64.2% vs. 51.0%) and heart failure (25.0% vs. 15.4%) were more common among patients with lower non-HDL-C, whereas dyslipidemia (90.8% vs. 75.8%) and acute coronary syndrome (88.1% vs. 83.7%) were more prevalent in the elevated group. Elevated non-HDL-C was associated with higher baseline LDL-C levels measured prior to the initiation of lipid-lowering therapy (141.3 vs. 81.1 mg/dL) and higher triglycerides (221.4 vs. 140.9 mg/dL). In multivariable analyses, age > 60 years (OR = 0.45), hypertension (OR = 0.74), and heart failure (OR = 0.61) were inversely associated with elevated non-HDL-C. Conclusions: Elevated non-HDL cholesterol is common among Middle Eastern patients with ASCVD, particularly younger individuals, reflecting early metabolic risk and increased atherogenic burden. Non-HDL-C is a valuable marker of residual cardiovascular risk, supporting earlier screening and region-specific prevention strategies.

Background: Metabolic syndrome (MS), characterized by a constellation of interrelated cardiometabolic abnormalities, markedly amplifies cardiovascular risk. Despite the high prevalence of atherosclerotic cardiovascular disease (ASCVD) in the Middle East, evidence regarding the burden and determinants of MS in this high-risk population remains limited. This study aimed to estimate the prevalence of MS and identify its independent predictors among Middle Eastern patients with established ASCVD. Methods: This comprehensive analysis integrated data from two complementary sources: a prospective cohort derived from the Jordan SMuRF-less Study, which enrolled adults (≥18 years) with confirmed ASCVD across nine centers in Jordan, and a pooled retrospective dataset from six regional cardiovascular registries. Standardized case report forms were used to collect demographic, clinical, and laboratory data. Participants were stratified according to the number of standard modifiable risk factors (SMuRFs) into three categories (0, 1–2, and 3–4 SMuRFs). Multivariable logistic regression analysis was conducted to determine independent predictors of MS. Results: Among 1016 patients with ASCVD, MS was present in 42.7% of the cohort. The prevalence of MS demonstrated a significant graded increase with higher SMuRF burden, rising from 2.2% in patients without SMuRFs to 28.3% in those with one to two SMuRFs and 62.2% in those with three to four SMuRFs (p < 0.001). Patients with MS were significantly older and exhibited higher body mass index and triglyceride levels, lower high-density lipoprotein cholesterol, and a greater prevalence of hypertension, diabetes mellitus, dyslipidemia, chronic kidney disease, and heart failure (all p < 0.001). Independent predictors of MS included advanced age, diabetes mellitus, hypertension, chronic kidney disease, heart failure, elevated body mass index, and increased triglyceride levels. In contrast, higher HDL cholesterol and smoking were inversely associated with MS. Conclusions: MS is highly prevalent among Middle Eastern patients with ASCVD and is strongly associated with cumulative SMuRF burden in a graded manner. These findings highlight the urgent need for targeted, region-specific strategies focusing on early identification and comprehensive management of cardiometabolic risk in this vulnerable population.

We sincerely thank Professor Yousef Khader for his careful reading of our article