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78 CPD ACTIVITY FROM PAGE 77 2. Gylling H, Plat J, Turley S, Ginsberg HN, Ellegård L, Jessup W, Jones PJ, Lütjohann D, Maerz W, Masana L, Silbernagel G. ‘Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease’. Atherosclerosis, 2014; 232 (2): 346-360. 3. Ras RT, Geleijnse JM, Trautwein EA. ‘LDL-cholesterol- lowering effect of plant sterols and stanols across different dose ranges: A meta-analysis of randomised controlled studies’. Brit J Nutr, 2014; 112 (2): 214-219. 4. Trautwein EA, Vermeer MA, Hiemstra H, Ras RT. ‘LDL- cholesterol lowering of plant sterols and stanols: Which factors influence their efficacy?’ Nutrients, 2018; 10 (9): 1262. 5. Xing LC, Santhi D, Shar AG, Saeed M, Arain MA, Shar AH, Bhutto ZA, Katar MU, Manzoor R, El-Hack ME, Alagawany M. ‘Psyllium husk (Plantago ovata) as a potent hypocholesterolemic agent in animal, human and poultry’. Int J Pharmacol, 2017; 13: 690-697. 6. Jovanovski E, Yashpal S, Komishon A, Zurbau A, Blanco Mejia S, Ho HVT, Li D, Sievenpiper J, Duvnjak L, Vuksan V. ‘Effect of psyllium (Plantago ovata) fibre on LDL cholesterol and alternative lipid targets, non-HDL cholesterol and apolipoprotein B: A systematic review and meta-analysis of randomised controlled trials’. Amer J Clin Nutr, 2018; 108 (5): 922-932. 7. ChangaAG,MartinezNF,PrietoAS,VietiezJG,Liebana MJD, Laiz RD, Vega MS. ‘Dietary fibre and its interaction with drugs’. Nutricion hospitaleria, 2010; 25 (4): 535-539. 8. Skulas-Ray AC, Wilson PW, Harris WS, Brinton EA, Kris- Etherton PM, Richter CK, Jacobson TA, Engler MB, Miller M, Robinson JG, Blum CB. ‘Omega-3 fatty acids for the management of hypertriglyceridemia: A science advisory from the American Heart Association’. Circulation, 2019; 140 (12): e673-e691. 9. Shearer GC, Savinova OV, Harris WS. ‘Fish oil: How does it reduce plasma triglycerides?’ Biochimica et Biophysica Acta (BBA) Molecular and Cell Biology of Lipids, 2012; 1821 (5): 843-851. 10.Eslick GD, Howe PR, Smith C, Priest R, Bensoussan A. ‘Benefits of fish oil supplementation in hyperlipidemia: A systematic review and meta-analysis’ Internat J Cardiol, 2009; 136 (1): 4-16. 11. Bowman L, Mafham M, Stevens W, Haynes R, Aung T, Chen F, Buck G, Collins R, Armitage J and group. TASC. ‘ASCEND: A study of cardiovascular events in diabetes: Characteristics of a randomised trial of aspirin and of omega-3 fatty acid supplementation in 15,480 people with diabetes’. Amer Heart J, 2018; 198: 135-144. 12.Manson JE, Cook NR, Lee IM, Christen W, Bassuk SS, Mora S, Gibson H, Gordon D, Copeland T, D’Agostino D, Friedenberg G. ‘Vitamin D supplements and prevention of cancer and cardiovascular disease’. New Eng J Med, 2019; 380 (1): 33-44. 13. Bhatt DL, Steg PG, Miller M, Brinton EA, Jacobson TA, Ketchum SB, Doyle Jr RT, Juliano RA, Jiao L, Granowitz C, Tardif JC. ‘Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia’. New Eng J Med, 2019; 380 (1): 11-22. 14. Abdelhamid AS, Brown TJ, Brainard JS, Biswas P, Thorpe GC, Moore HJ, Deane KH, Summerbell CD, Worthington HV, Song F, Hooper L. ‘Omega-3 fatty acids for the primary and secondary prevention of cardiovascular disease’. Cochrane Database of Systematic Reviews, 2020 (3). 15.Sivamaruthi BS, Kesika P, Chaiyasut C. ‘A mini-review of human studies on cholesterol-lowering properties of probiotics’ Scientia Pharmaceutica, 2019; 87 (4): 26. 16.Wang L, Guo MJ, Gao Q, Yang JF, Yang L, Pang XL, Jiang XJ. ‘The effects of probiotics on total cholesterol: A meta-analysis of randomised controlled trials’. Medicine, 2018; 97 (5). 17. Fuentes MC, Lajo T, Carrión JM, Cuñé J. ‘A randomised clinical trial evaluating a proprietary mixture of Lactobacillus plantarum strains for lowering cholesterol’. Med J Nutr and Metab, 2016; 9 (2): 125-135. Accreditation Number: A2008RP3 (exp: 31/07/2022). This activity has been accredited for 1 hour of Group One CPD (or 1 CPD credit) suitable for inclusion in an individual pharmacists CPD plan, which may be converted to 1 hour of Group Two CPD (or 2 CPD credits) upon successful completion of the associated assessment activity. 1. Which of the following statements regarding cholesterol is INCORRECT? A) Dyslipidaemia accounts for most of the population-attributed risk for myocardial infarction worldwide. B) A 27 per cent increase in total cholesterol is associated with a 10 per cent increase in the incidence of CHD. C) Hypertriglyceridaemia is associated with the development of early onset CVD and significantly increases the risk of acute pancreatitis. D) The mainstay of treatment for hypercholesterolaemia are the statins. E) Theadditionoffibratestostatintherapyhasbeenshowntomoreeffectivelylower LDL-C and TC than statins alone. 2. Which of the following statements regarding plant sterols and stanols is INCORRECT? A) Plant sterols are bioactive compounds with similar functions to those of cholesterol in mammals. B) Plant sterols differ from cholesterol in the structure of their side chains. C) The meta-analysis by Ras et al concluded that both plant sterols and plant stanols are effective at lowering LDL-C by an average of 12 per cent when consumed in standard doses of up to 3g daily. D) Plant stanols are the 6 alpha-unsaturated derivatives of plant sterols. E) Studiesindicatethatthetimingofthedoseofplantsterolenrichedfoodsseemstoplay a role in their effectiveness in lowering LDL-C. 3. Which of the following statements regarding recent systematic reviews and meta-analysis of randomised controlled trials examining the effects of psyllium on LDL-C is CORRECT? A) The average daily intake of psyllium was 5.2g. B) The LDL-C lowering effect of psyllium depended on the baseline cholesterol status of patients. C) The authors concluded that psyllium fibre effectively improves conventional and alternative lipid markers, potentially delaying the process of atherosclerosis-associated CVD risk in those with or without hypercholesterolaemia. D) Pooled analysis of 27 studies found that psyllium has negligible effect on non- HDL cholesterol. E) Psylliumfibreincreaseslithiumconcentrationsandlithiumdoseadjustmentwillusually be required. 4. Whichofthefollowingstatementsaboutfindingsfromstudiesofomega-3 supplementation is CORRECT? A) The 2009 meta-analysis by Eslick et al concluded that fish oil supplements significantly decreased plasma TG levels (by approximately 14 per cent) but did not result in clinically significant changes in TC, LDL-C or HDL-C levels after approximately one month of treatment. B) The triglyceride lowering effect of fish oil supplementation is only seen in doses of at least 3g daily. C) The ASCEND study concluded that among patients with diabetes without evidence of CVD, omega-3 supplementation provided no significant reductions in risk of serious vascular events compared to placebo. D) The most recent Cochrane Review of the effects of omega-3 fats on cardiovascular health, which reviewed 86 randomised controlled trials, found little or no effect of increasing omega-3 fatty acids on all-cause mortality, cardiovascular mortality, cardiovascular events, stroke or arrhythmia. E) ALL the above are CORRECT. 5. Whichofthefollowingstatementsregardingtherandomisedclinicaltrialconducted by Fuentes et al, and the meta-analysis conducted by Wang et al is INCORRECT? A) Results indicated that the efficacy of probiotic intervention on lowering TC was impacted by baseline TC and intervention duration. B) The authors cited deficiencies in the quality of literature, small sample sizes, and heterogeneity as issues. C) The L. plantarum strains examined by Fuentes et al were CECT 65327, 7521 and 7540. D) In the trial conducted by Fuentes et al, patients with TG >3.95 mmol/lt and those taking lipid-altering medications were excluded. E) StudiesexaminedbyWangetalhaddurationsof1-24weeks. Complementary therapies for cholesterol management: evidence for outcomes 2 CPD CREDITS RETAIL PHARMACY • AUG 2020