Summary of findings 3. Pine bark extract compared to placebo for the treatment of CVD.

Pine bark extract compared to placebo for the treatment of CVD
Patient or population: adults with CVD Setting: not reported Intervention: pine bark extract 1x 10 g pouch daily, taken orally once sachet contents dissolved in 180 mL water resulting in an isotonic solution Comparison: placebo 1x 10 g pouch daily, taken orally once sachet contents dissolved in 180 mL water resulting in an isotonic solution
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with placebo	Risk with pine bark extract
Participant‐reported	No studies reported this outcome.
Investigator‐reported
Diastolic blood pressure (mm Hg) Follow‐up: 2 months	The mean diastolic blood pressure was 92 mm Hg.	MD 3.00 mm Hg lower (4.51 lower to 1.49 lower).	‐	61 (1 RCT)	⊕⊝⊝⊝ VERY LOWa,b,c	It is not known whether pine bark extract supplements decrease diastolic blood pressure.
HDL cholesterol (mmol/L) Follow‐up: 2 months	The mean HDL cholesterol was 0.96 mmol/L.	MD 0.05 mmol/L higher (0.01 lower to 0.11 higher).	‐	61 (1 RCT)	⊕⊝⊝⊝ VERY LOWa,b,c	It is not known whether pine bark extract supplements increase HDL cholesterol.
LDL cholesterol (mmol/L) Follow‐up: 2 months	The mean LDL cholesterol was 1.01 mmol/L.	MD 0.03 mmol/L lower (0.05 lower to 0.00).	‐	61 (1 RCT)	⊕⊝⊝⊝ VERY LOWa,b,c	It is not known whether pine bark extract supplements decrease LDL cholesterol.
All‐cause mortality	No studies reported this outcome.
Serious adverse events: hospitalisation	Hospitalisation of 1 participant occurred in the pine bark extract supplement group of each included study.			176 (2 RCTs)	⊕⊝⊝⊝ VERY LOWa,b,d	It is not known whether pine bark extract supplements increase hospitalisation.
*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CVD: cardiovascular disease; HDL: high‐density lipoprotein; LDL: low‐density lipoprotein; RR: risk ratio.
GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

^a Downgraded once for indirectness: single study only.
^b Downgraded once for risk of bias: concerns regarding selection bias.
^c Downgraded once for imprecision: optimal information size not met.
^d Downgraded twice for imprecision: optimal information size not met; very few events and the 95% CI is very wide.