1. Journal Club 1 The bigger picture

2. How we hope it works http://dundeeresearch.wordpress.com/ – Introduction – Discussion Points – Summary

3. Article 1- Chocolate can lower your BP

4. Journal Article 1 Effect of Cocoa on Blood Pressure Ried K, Sullivan TR, Fakler P, Frank OR, Stocks NP. Effect of cocoa on blood pressure. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD008893. DOI: 10.1002/14651858.CD008893.pub2. Cochrane Library – Review of 20 studies 856 participants

5. Selection of Trials ‘Randomised controlled, parallel or crossover, single- blind, double-blind or open-label trials of ≥ 14 days’ ‘Trials were included if the control group received a placebo or a minimal dose of flavanol-containing cocoa product. Minimal dose of cocoa accepted as control is defined as products containing ≤ 10% of the dose of cocoa polyphenols given as the active intervention product.’ “Primary outcomes – Difference in systolic and diastolic blood pressure at final follow-up between cocoa and control group and adjusted for baseline.”

6. The first thing you see...

7. Questions Is 2-3mmHg change in BP likely to be solely down to the treatment? If yes, what dose should be used (given that the variability between doses of cocoa products ranged from 3.6g to 105g)? Can you even control the dose of a dietary compound? Is two weeks long enough to determine change in BP? Were the controls enough?

8. So what can we take from this review? Flavanols probably do have some effect on blood pressure – This may be useful as foods containing these compounds are readily available e.g. dark chocolate

9. What can we not take from this review? Flavanols have a molecular basis for lowering BP Chocolate will lower your BP – If you eat lots and lots of chocolate...

10. CCT trial: Statin therapy in low- risk individuals Lancet 2012; 380: 581–90

11. Trial selection 27 trials, 174149 participants – All randomised trials published before 06/11 and included at least one intervention whose main effect was to lower LDL no other possible intended confounding interventions/factors at least 1000 participants and for >=2 years duration – Investigating major vascular events, major coronary events, coronary revascularisation procedure, cancer, and cause-specific mortality

12. What they did with the trials Statistical models and risk – Participants grouped into =5% to =10% to =20% to 30%, or >30%

13. What they found

14. Points to note/Questions Does having previous vascular disease affect the results Effect on mortality Any adverse affects? Relative vs Absolute Risk

15. What can/can’t we take from this study? Statins are beneficial for low risk individuals as well as high risk individuals – Benefit likely outweighs any risks BUT – the benefit is rather small Guidelines/NHS vs the study – Should everyone be on a statin?