Cardiovascular disease (CVD) has been classified as one of the leading causes of morbidity and mortality worldwide. CVD risk factors include smoking, hypertension, dyslipidaemia, obesity, inflammation and diabetes. The gut microbiota can influence human health through multiple interactions and community changes are associated with the development and progression of numerous disease states, including CVD. The gut microbiota are involved in the production of several metabolites, such as short-chain fatty acids (SCFAs), bile acids and trimethylamine-N-oxide (TMAO). These products of microbial metabolism are important modulatory factors and have been associated with an increased risk of CVD. Due to its association with CVD development, the gut microbiota has emerged as a target for therapeutic approaches. In this review, we summarise the current knowledge on the role of the gut microbiome in CVD development, and associated microbial communities, functions, and metabolic profiles. We also discuss CVD therapeutic interventions that target the gut microbiota such as probiotics and faecal microbiota transplantation.

Gastrointestinal toxicity (GIT) is a debilitating side effect of Irinotecan (CPT-11) and limits its clinical utility. Gut dysbiosis has been shown to mediate this side effect of CPT-11 by increasing gut bacterial β-glucuronidase (GUSB) activity and impairing the intestinal mucosal barrier (IMB). We have recently shown the opposing effects of omega-6 (n-6) and omega-3 (n-3) polyunsaturated fatty acids (PUFA) on the gut microbiome. We hypothesized that elevated levels of tissue n-3 PUFA with a decreased n-6/n-3 PUFA ratio would reduce CPT-11-induced GIT and associated changes in the gut microbiome. Using a unique transgenic mouse (FAT-1) model combined with dietary supplementation experiments, we demonstrate that an elevated tissue n-3 PUFA status with a decreased n-6/n-3 PUFA ratio significantly reduces CPT-11-induced weight loss, bloody diarrhea, gut pathological changes, and mortality. Gut microbiome analysis by 16S rRNA gene sequencing and QIIME2 revealed that improvements in GIT were associated with the reduction in the CPT-11-induced increase in both GUSB-producing bacteria (e.g., Enterobacteriaceae) and GUSB enzyme activity, decrease in IMB-maintaining bacteria (e.g., Bifidobacterium), IMB dysfunction and systemic endotoxemia. These results uncover a host–microbiome interaction approach to the management of drug-induced gut toxicity. The prevention of CPT-11-induced gut microbiome changes by decreasing the tissue n-6/n-3 PUFA ratio could be a novel strategy to prevent chemotherapy-induced GIT.

An Electronic Patient Record (EPR) is a repository for medical and pharmaceutical information in Community Pharmacies. Studies have shown that almost three-quarters of EPRs have at least one discrepancy between information documented in the EPR and patient-reported information, while drug therapy alerts failed to appear for about one-third of patients due to a lack of documented medical and/or pharmaceutical data(1). More complete documentation in Community Pharmacy EPRs could improve the quality of patient care provided. To-date, there is limited research available concerning documentation in Community Pharmacy EPRs in Ireland. The aim of this study was to identify the key barriers and facilitators to documentation in Community Pharmacy EPRs in Ireland. Registered Community Pharmacists were invited to participate via email using convenience sampling. Participant Information Leaflet and Consent Forms were emailed to each community pharmacist at least 24 hours prior to each interview explaining why and how the research study was being carried out. Semi-structured interviews were carried out until theoretical saturation was reached. 11 interviews were conducted virtually through the UCC-approved Google Meet and two interviews took place by telephone. Finally, the audio recordings from interviews were transcribed verbatim and then analysed using Braun and Clarke’s thematic analysis(2). A total of 13 Community Pharmacists were interviewed. The majority of participants were female (n=9), supervising pharmacists (n=8), and had greater than 10 years community pharmacy experience (n=8). All pharmacists document the basic personal and clinical patient information necessary for safe supply as advised by the Pharmaceutical Society of Ireland (PSI), but most did not document additional information such as morbidities or over-the-counter medication. The key barriers identified were accessing information from Healthcare Professionals and patients, software limitations and time. The key facilitators identified were Standard Operating Procedures and a centralised Electronic Health Record system. Most pharmacists were willing to participate in a training program to enhance documentation practices. This study highlighted the key barriers that need to be addressed to facilitate more complete documentation. A limitation is the potential for social desirability bias in participants in minimising the extent of negative documentation practices. Comprehensive interventions combining more guidance from the PSI, webinars on utilising the EPR, and software modifications could encourage practice change. Future research should evaluate the impact of these measures on documentation completeness in Community Pharmacy EPRs in Ireland. 1. Floor-Schreudering A, Heringa M, Buurma H, Bouvy ML, De Smet PAGM. Missed drug therapy alerts as a consequence of incomplete electronic patient records in Dutch community pharmacies. Ann Pharmacother. 2013;47(10):1272–9. 2. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol [Internet]. 2006 [cited 2022 Apr 21];3(2):77–101. Available from: https://www.tandfonline.com/doi/abs/10.1191/1478088706qp063oa