Adherence to cardiovascular medications in the South Asian population:A systematic review of current evidence and future directions

AIM: To review methods of assessing adherence and strategies to improve adherence to cardiovascular disease(CVD) medications,among South Asian CVD patients. METHODS: We conducted a systematic review of English language studies that examined CVD medication adherence in South Asian populations from 1966 to April 1,2015 in SCOPUS and Pub Med. Working in duplicate,we identified 61 studies. After exclusions,26 studies were selected for full text review. Of these,17 studies were included in the final review. We abstracted data on several factors including study design,study population,method of assessing adherence and adherence rate. RESULTS: These studies were conducted in India(n = 11),Pakistan(n = 3),Bangladesh(n = 1),Nepal(n = 1) and Sri Lanka(n = 1). Adherence rates ranged from 32%-95% across studies. Of the 17 total publications included,10 focused on assessing adherence to CVD medications and 7 focused on assessing the impact of interventions on medication adherence. The validated Morisky Medication Adherence Scale(MMAS) was used as the primary method of assessing adherence in five studies. Three studies used validated questionnaires similar to the MMAS,and one study utilized Medication Event Monitoring System caps,with the remainder of the studies utilizing pill count and self-report measures. As expected,studies using non-validated self-report measures described higher rates of adherence than studies using validated scale measurements and pill count. The included intervention studies examined the use of polypill therapy,provider education and patient counseling to improve medication adherence. CONCLUSION: The overall medication adherence rates were low in the region,which suggest a growing need for future interventions to improve adherence.

Moderate cold exposure contributes to the extension of lifespan by alleviating the aggregation of disease-related proteins

Growing evidence demonstrate that cold stimulation as a nonpharmacological strategy can be applied to prevent the development of ageing.However,the optimal ambient temperature to mammals and the mechanism for low temperature to extend lifespan remain poorly understood.In this editorial,we highlight the data presented by Hyun et al.suggesting that a beneficial role of moderate cold temperature in reducing disease-related aggregation thereby age-related deteriorations[1].