Dear authors,

I appreciate your hard work putting this work together, I have a few comments for the methodological approach of this systematic review and meta-analysis.

1. I believe eligibility criteria should be more informative around the PICOTS elements of the research question in a more structured way.
2. What specific CVD events were explored? The age range of participants >18 is not the usual case for CVD related clinical trials.
3. The exclusion criteria for studies should also be mentioned in my view.
4. Why were studies with short-term follow-up (e.g. a week) acceptable for this type of intervention? Is that enough to deem change?
5. Why were 10 years chosen as a timeframe for eligibility? Methodologically that would work only if a major Public Health change happened ain this timeframe; otherwise, a time cut-off is not a methodologically sound approach.
6. Were MeSH terms used in the search strategy?
7. Were any software used for the search and handling of literatures searches.
8. Page 6 line 47. If one authors retrieved data what kinds of disagreements had to be resolved by consensus?
9. Heterogeneity should not only be assessed with the sole use of I2, as Cochrane suggests some forms of heterogeneity might not be measurable.
10. The study number seems small to perform a meta-analysis. It would be great to understand why the authors thought this was acceptable.
11. The studies seem very different in almost all aspects from timelines to interventions. This could compromise the value of a meta-analysis in this review.
12. Quality assessment is based on an RCT study design, but based on the page 7 line 30, there is a single arm study there. How was the quality of this study assessed?
13. There is a lack of reference to numeric results and statistical tests significance throughout the manuscript including the Tables of results. The latter is not informative about the actual results of the studies.