451
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Burroughs Peña MS, Velazquez EJ, Rivera JD, Alenezi F, Wong C, Grigsby M, Davila-Roman VG, Gilman RH, Miranda JJ, Checkley W. Biomass fuel smoke exposure was associated with adverse cardiac remodeling and left ventricular dysfunction in Peru. INDOOR AIR 2017; 27:737-745. [PMID: 27990700 PMCID: PMC5489120 DOI: 10.1111/ina.12362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/11/2016] [Indexed: 05/17/2023]
Abstract
While household air pollution from biomass fuel combustion has been linked to cardiovascular disease, the effects on cardiac structure and function have not been well described. We sought to determine the association between biomass fuel smoke exposure and cardiac structure and function by transthoracic echocardiography. We identified a random sample of urban and rural residents living in the high-altitude region of Puno, Peru. Daily biomass fuel use was self-reported. Participants underwent transthoracic echocardiography. Multivariable linear regression was used to examine the relationship of biomass fuel use with echocardiographic measures of cardiac structure and function, adjusting for age, sex, height, body mass index, diabetes, physical activity, and tobacco use. One hundred and eighty-seven participants (80 biomass fuel users and 107 non-users) were included in this analysis (mean age 59 years, 58% women). After adjustment, daily exposure to biomass fuel smoke was associated with increased left ventricular internal diastolic diameter (P=.004), left atrial diameter (P=.03), left atrial area (four-chamber) (P=.004) and (two-chamber) (P=.03), septal E' (P=.006), and lateral E' (P=.04). Exposure to biomass fuel smoke was also associated with worse global longitudinal strain in the two-chamber view (P=.01). Daily biomass fuel use was associated with increased left ventricular size and decreased left ventricular systolic function by global longitudinal strain.
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Affiliation(s)
- M S Burroughs Peña
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - E J Velazquez
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - J D Rivera
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - F Alenezi
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - C Wong
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - M Grigsby
- Program in Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - V G Davila-Roman
- Division of Cardiology, Department of Medicine, Washington University, St. Louis, MO, USA
| | - R H Gilman
- Program in Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J J Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - W Checkley
- Program in Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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452
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Hammoudeh AJ, Alhaddad IA, Khader Y, Tabbalat R, Al-Mousa E, Saleh A, Jarrah M, Nammas A, Izraiq M. Cardiovascular risk factors in Middle Eastern patients undergoing percutaneous coronary intervention: Results from the first Jordanian percutaneous coronary intervention study. J Saudi Heart Assoc 2017; 29:195-202. [PMID: 28652673 PMCID: PMC5475346 DOI: 10.1016/j.jsha.2016.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/17/2016] [Accepted: 10/09/2016] [Indexed: 12/01/2022] Open
Abstract
Background and aims: Cardiovascular disease (CVD) is the leading cause of death in the Middle East. We sought to study the prevalence and coexistence of 6 cardiovascular risk factors (RFs) among patients who underwent percutaneous coronary intervention (PCI), and to evaluate the impact of age and gender on the presence of multiple RFs. METHODS AND RESULTS In this prospective, multicenter study, 2426 consecutive patients were enrolled. Mean age was 59.0 ± 10.1 years and 500 (20.6%) were women. Acute coronary syndrome and stable coronary disease were the indications for PCI in 77.1% and 22.9%, respectively. Hypertension was present in 62.3%, diabetes in 53.8%, hypercholesterolemia in 48.8%, smoking in 43.5%, family history of premature CVD 39.4% and obesity in 28.8%. Only 3.8% did not have any of these RFs. Presence of ⩾3 and ⩾4 RFS was observed in 57.4% and 29.5% of patients, respectively. Presence of ⩾3 RFs was more common in women than men (69.0% vs. 54.5%, p < 0.0001), and among patients 41-65 years of age than older or younger patients (60.1% vs. 52.0% vs. 48.3%, respectively, p = 0.017). Conclusions: Cardiovascular RFs are highly prevalent in this PCI Middle Eastern population undergoing PCI. More than half and more than one-fourth of the patients had at least 3 or 4 RFs; respectively. More women than men and more middle aged patients than older or younger patients had significantly higher rates of presence of multiple RFs.
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Affiliation(s)
| | | | - Yousef Khader
- School of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ramzi Tabbalat
- Cardiology Department, Khalidi Medical Center, Amman, Jordan
| | - Eyas Al-Mousa
- Cardiology Department, Istishari Hospital, Amman, Jordan
| | - Akram Saleh
- Cardiology Section, Internal Medicine Department, Jordan University Hospital, Amman, Jordan
| | - Mohamad Jarrah
- Cardiology Section, Internal Medicine Department, King Abdullah University Hospital, Irbid, Jordan
| | - Assem Nammas
- Cardiology Department, Ibn Haitham Hospital, Amman, Jordan
| | - Mahmoud Izraiq
- Cardiology Department, Specialty Hospital, Amman, Jordan
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453
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Melgarejo JD, Maestre GE, Thijs L, Asayama K, Boggia J, Casiglia E, Hansen TW, Imai Y, Jacobs L, Jeppesen J, Kawecka-Jaszcz K, Kuznetsova T, Li Y, Malyutina S, Nikitin Y, Ohkubo T, Stolarz-Skrzypek K, Wang JG, Staessen JA. Prevalence, Treatment, and Control Rates of Conventional and Ambulatory Hypertension Across 10 Populations in 3 Continents. Hypertension 2017; 70:50-58. [PMID: 28483916 PMCID: PMC11003768 DOI: 10.1161/hypertensionaha.117.09188] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/14/2017] [Accepted: 04/07/2017] [Indexed: 01/19/2023]
Abstract
Hypertension is a major global health problem, but prevalence rates vary widely among regions. To determine prevalence, treatment, and control rates of hypertension, we measured conventional blood pressure (BP) and 24-hour ambulatory BP in 6546 subjects, aged 40 to 79 years, recruited from 10 community-dwelling cohorts on 3 continents. We determined how between-cohort differences in risk factors and socioeconomic factors influence hypertension rates. The overall prevalence was 49.3% (range between cohorts, 40.0%-86.8%) for conventional hypertension (conventional BP ≥140/90 mm Hg) and 48.7% (35.2%-66.5%) for ambulatory hypertension (ambulatory BP ≥130/80 mm Hg). Treatment and control rates for conventional hypertension were 48.0% (33.5%-74.1%) and 38.6% (10.1%-55.3%) respectively. The corresponding rates for ambulatory hypertension were 48.6% (30.5%-71.9%) and 45.6% (18.6%-64.2%). Among 1677 untreated subjects with conventional hypertension, 35.7% had white coat hypertension (23.5%-56.2%). Masked hypertension (conventional BP <140/90 mm Hg and ambulatory BP ≥130/80 mm Hg) occurred in 16.9% (8.8%-30.5%) of 3320 untreated subjects who were normotensive on conventional measurement. Exclusion of participants with diabetes mellitus, obesity, hypercholesterolemia, or history of cardiovascular complications resulted in a <9% reduction in the conventional and 24-hour ambulatory hypertension rates. Higher social and economic development, measured by the Human Development Index, was associated with lower rates of conventional and ambulatory hypertension. In conclusion, high rates of hypertension in all cohorts examined demonstrate the need for improvements in prevention, treatment, and control. Strategies for the management of hypertension should continue to not only focus on preventable and modifiable risk factors but also consider societal issues.
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Affiliation(s)
- Jesus D Melgarejo
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Gladys E Maestre
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Lutgarde Thijs
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Kei Asayama
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - José Boggia
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Edoardo Casiglia
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Tine W Hansen
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Yutaka Imai
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Lotte Jacobs
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Jørgen Jeppesen
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Kalina Kawecka-Jaszcz
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Tatiana Kuznetsova
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Yan Li
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Sofia Malyutina
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Yuri Nikitin
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Takayoshi Ohkubo
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Katarzyna Stolarz-Skrzypek
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Ji-Guang Wang
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS)
| | - Jan A Staessen
- From the Laboratorio de Neurociencias and Instituto Cardiovascular, Universidad del Zulia, Maracaibo, Venezuela (J.M., G.E.M.); Department of Biomedical Sciences, University of Texas Rio Grande Valley School of Medicine, Brownsville (G.E.M.); Graduate School of Pharmaceutical Sciences, Tohoku University, Sendai, Japan (K.A., Y.I.); Studies Coordinating Centre, Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan (K.A., T.O.); Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay (J.B.); Department of Medicine, University of Padua, Italy (E.C.); the Steno Diabetes Center Copenhagen, Gentofte and RCPH, Centre for Health, Capital Region of Denmark, Denmark (T.W.H.); KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium (L.J., T.K., L.T., J.A.S.); Department of Medicine, Glostrup Hospital, University of Copenhagen, Denmark (J.J.); The First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland (K.K.J., K.S.S.); Research Unit Hypertension and Cardiovascular Epidemiology, Center for Epidemiological Studies and Clinical Trials and Center for Vascular Evaluation, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (Y.L., J.-G.W.); Institute of Internal and Preventive Medicine, Novosibirsk, Russia (T.K., S.M., Y.N.); and R & D Group VitaK, Maastricht University, The Netherlands (JAS).
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Cao W, Chang YF, Zhao AC, Chen BD, Liu F, Ma YT, Ma X. Synergistic cardioprotective effects of rAAV9-CyclinA2 combined with fibrin glue in rats after myocardial infarction. J Mol Histol 2017. [PMID: 28643114 DOI: 10.1007/s10735-017-9725-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The present study aimed to investigate the protective effects of rAAV9-CyclinA2 combined with fibrin glue (FG) in vivo in rats after myocardial infarction (MI). Ninety male Sprague-Dawley rats were randomized into 6 groups (15 in each group): sham, MI, rAAV9-green fluorescent protein (GFP) + MI, rAAV9-CyclinA2 + MI, FG + MI, and rAAV9-CyclinA2 + FG + MI. Packed virus (5 × 1011vg/ml) in 150 µl of normal saline or FG was injected into the infarcted myocardium at five locations in rAAV9-GFP + MI, rAAV9-CyclinA2 + MI, and rAAV9-CyclinA2 + FG + MI groups. The sham, MI, and FG + MI groups were injected with an equal volume of normal saline or FG at the same sites. Five weeks after injection, echocardiography was performed to evaluate the left ventricular function. The expressions of CyclinA2, proliferating cell nuclear antigen (PCNA), and phospho-histone-H3 (H3P), vascular density, and infarct area were assessed by Western blot, immunohistochemistry, immunofluorescence, and Masson staining. As a result, the combination of rAAV9-CyclinA2 and FG increased ejection fraction and fractional shortening compared with FG or rAAV9-CyclinA2 alone. The expression level of CyclinA2 was significantly higher in the rAAV9-CyclinA2 + FG + MI group compared with the rAAV9-CyclinA2 + MI and FG + MI groups (70.1 ± 1.86% vs. 14.74 ± 2.02%, P < 0.01; or vs. 50.13 ± 3.80%; P < 0.01). A higher expression level of PCNA and H3P was found in the rAAV9-CyclinA2 + FG + MI group compared with other groups. Comparing with other experiment groups, collagen deposition and the infarct size significantly decreased in rAAV9-CyclinA2 + Fibrin + MI group. The vascular density was much higher in the rAAV9-CyclinA2 + FG + MI group compared with the rAAV9-CyclinA2 + MI group. We concluded that fibrin glue combined with rAAV9-CyclinA2 was found to be effective in cardiac remodeling and improving myocardial protection.
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Affiliation(s)
- Wen Cao
- Department of Cardiology, Second People's Hospital of Wuxi, 68 Zhongshan Road, Wuxi, 214000, China
| | - Ya-Fei Chang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, 830054, China
| | - Ai-Chao Zhao
- Department of Critical Care Medicine, People's Hospital of Dezhou, 1751 Xihu Road, Dezhou, 253000, China
| | - Bang-Dang Chen
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, 830054, China
| | - Fen Liu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, 830054, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, 830054, China.
| | - Xiang Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Road, Urumqi, 830054, China.
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455
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Abstract
BACKGROUND The growing menace of poor quality and falsified drugs constitutes a major hazard, compromising healthcare and patient outcomes. Efforts to assess drug standards worldwide have almost exclusively focused on anti-microbial drugs; with no study to date on cardiovascular drugs. Our study aims to assess quality of seven routinely used cardiovascular medications (anticoagulants, antihypertensives and statins) in ten Sub-Saharan African countries. METHODS Drugs were prospectively collected using standardized methods between 2012 and 2014 from licensed (random pharmacies) and unlicensed (street-markets) places of sale in Africa. We developed a validated reversed-phase liquid chromatography with tandem mass spectrometry method to accurately quantify the active ingredient in a certified public laboratory. Three quality categories were defined based on the ratio of the measured to the expected dosage of the active ingredient: A (good quality): 95% to 105%, B (low quality): 85 to 94.99% or 105.01 to 115%, C (very low quality): <85% or >115%. RESULTS All expected medicines (n=3468 samples) were collected in Benin, Burkina-Faso, Congo-Brazzaville, the Democratic Republic of Congo, Guinea, Côte d'Ivoire, Mauritania, Niger, Togo and Senegal. Out of the 1530 samples randomly tested, poor quality (types B and C) was identified in 249 (16.3%) samples. The prevalence of poor quality was significantly increased in certain specific drugs (amlodipine 29% and captopril 26%), in generic versions (23%) and in drugs produced in Asia (35%). The proportion of poor quality reached 50% when drugs produced in Asia were sold in street-markets. CONCLUSION In this first study assessing the quality of cardiovascular drugs in Africa, we found a significant proportion of poor quality drugs. This requires continued monitoring strategies.
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456
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Jafar TH, Jehan I, de Silva HA, Naheed A, Gandhi M, Assam P, Finkelstein EA, Quigley HL, Bilger M, Khan AH, Clemens JD, Ebrahim S, Turner EL, Kasturiratne A. Multicomponent intervention versus usual care for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: study protocol for a cluster randomized controlled trial. Trials 2017; 18:272. [PMID: 28606184 PMCID: PMC5469065 DOI: 10.1186/s13063-017-2018-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 05/25/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND High blood pressure (BP) is the leading attributable risk for cardiovascular disease (CVD). In rural South Asia, hypertension continues to be a significant public health issue with sub-optimal BP control rates. The goal of the trial is to compare a multicomponent intervention (MCI) to usual care to evaluate the effectiveness and cost-effectiveness of the MCI for lowering BP among adults with hypertension in rural communities in Bangladesh, Pakistan and Sri Lanka. METHODS/DESIGN This study is a stratified, cluster randomized controlled trial with a qualitative component for evaluation of processes and stakeholder feedback. The MCI has five components: (1) home health education by government community health workers (CHWs), (2) BP monitoring and stepped-up referral to a trained general practitioner using a checklist, (3) training public and private providers in management of hypertension and using a checklist, (4) designating hypertension triage counter and hypertension care coordinators in government clinics and (5) a financing model to compensate for additional health services and provide subsidies to low income individuals with poorly controlled hypertension. Usual care will comprise existing services in the community without any additional training. The trial will be conducted on 2550 individuals aged ≥40 years with hypertension (with systolic BP ≥140 mm Hg or diastolic BP ≥90 mm Hg, based on the mean of the last two of three measurements from two separate days, or on antihypertensive therapy) in 30 rural communities in Bangladesh, Pakistan and Sri Lanka. The primary outcome is change in systolic BP from baseline to follow-up at 24 months post-randomization. The incremental cost of MCI per CVD disability-adjusted life years averted will be computed. Stakeholders including policy makers, provincial- and district-level coordinators of relevant programmes, physicians, CHWs, key community leaders, hypertensive individuals and family members in the identified clusters will be interviewed. DISCUSSION The study will provide evidence of the effectiveness and cost-effectiveness of MCI strategies for BP control compared to usual care in the rural public health infrastructure in South Asian countries. If shown to be successful, MCI may be a long-term sustainable strategy for tackling the rising rates of CVD in low resourced countries. TRIAL REGISTRATION ClinicalTrials.gov, NCT02657746 . Registered on 14 January 2016.
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Affiliation(s)
- Tazeen H Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Imtiaz Jehan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - H Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
| | - Aliya Naheed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Mihir Gandhi
- Biostatistics, Singapore Clinical Research Institute, Singapore, 138669, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, 16957, Singapore
| | - Pryseley Assam
- Biostatistics, Singapore Clinical Research Institute, Singapore, 138669, Singapore
| | - Eric A Finkelstein
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Helena Legido Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Marcel Bilger
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | | | | | - Shah Ebrahim
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth L Turner
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Anuradhani Kasturiratne
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka
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457
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Abstract
Noncommunicable and chronic disease are interchangeable terms. According to the World Health Organization, "they are of long duration and generally slow progression. The 4 main types of chronic diseases are cardiovascular diseases (ie, heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes." We have known about the benefits of physical activity (PA) for thousands of years. Perhaps our approach, from public health messaging to the individual clinical encounter, as to how PA and exercise are discussed and prescribed can be improved upon, with the ultimate goal of increasing the likelihood that an individual moves more; ultimately moving more should be the goal. In fact, there is an incongruence between the evidence for the benefits of physical movement and how we message and integrate PA and exercise guidance into health care, if it is discussed at all. Specifically, evidence clearly indicates any migration away from the sedentary phenotype toward a movement phenotype is highly beneficial. As we necessarily move to a proactive, preventive healthcare model, we must reconceptualize how we evaluate and treat conditions that pose the greatest threat, namely chronic disease; there is a robust body of evidence supporting the premise of movement as medicine. The purpose of this perspective paper is to propose an alternate model for promoting, assessing, discussing, and prescribing physical movement.
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458
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Gómez Restrepo C, Muñoz N S, Ruiz AJ, Lanas F. Latin American Clinical Epidemiology Network Series – Paper 1: The Latin American Clinical Epidemiology Network “LatinCLEN”. J Clin Epidemiol 2017; 86:71-74. [DOI: 10.1016/j.jclinepi.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/10/2016] [Indexed: 01/28/2023]
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459
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Daoulah A, Elkhateeb OE, Nasseri SA, Al-Murayeh M, Al-Kaabi S, Lotfi A, Alama MN, Al-Faifi SM, Haddara M, Dixon CM, Alzahrani IS, Alghamdi AA, Ahmed W, Fathey A, Haq E, Alsheikh-Ali AA. Socioeconomic Factors and Severity of Coronary Artery Disease in Patients Undergoing Coronary Angiography: A Multicentre Study of Arabian Gulf States. Open Cardiovasc Med J 2017; 11:47-57. [PMID: 28553410 PMCID: PMC5427707 DOI: 10.2174/1874192401711010047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is a leading cause of death worldwide. The association of socioeconomic status with CAD is supported by numerous epidemiological studies. Whether such factors also impact the number of diseased coronary vessels and its severity is not well established. MATERIALS AND METHODS We conducted a prospective multicentre, multi-ethnic, cross sectional observational study of consecutive patients undergoing coronary angiography (CAG) at 5 hospitals in the Kingdom of Saudi Arabia and the United Arab Emirates. Baseline demographics, socioeconomic, and clinical variables were collected for all patients. Significant CAD was defined as ≥70% luminal stenosis in a major epicardial vessel. Left main disease (LMD) was defined as ≥50% stenosis in the left main coronary artery. Multi-vessel disease (MVD) was defined as having >1 significant CAD. RESULTS Of 1,068 patients (age 59 ± 13, female 28%, diabetes 56%, hypertension 60%, history of CAD 43%), 792 (74%) were from urban and remainder (26%) from rural communities. Patients from rural centres were older (61 ± 12 vs 58 ± 13), and more likely to have a history of diabetes (63 vs 54%), hypertension (74 vs 55%), dyslipidaemia (78 vs 59%), CAD (50 vs 41%) and percutaneous coronary intervention (PCI) (27 vs 21%). The two groups differed significantly in terms of income level, employment status and indication for angiography. After adjusting for baseline differences, patients living in a rural area were more likely to have significant CAD (adjusted OR 2.40 [1.47, 3.97]), MVD (adjusted OR 1.76 [1.18, 2.63]) and LMD (adjusted OR 1.71 [1.04, 2.82]). Higher income was also associated with a higher risk for significant CAD (adjusted OR 6.97 [2.30, 21.09]) and MVD (adjusted OR 2.49 [1.11, 5.56]), while unemployment was associated with a higher risk of significant CAD (adjusted OR 2.21, [1.27, 3.85]). CONCLUSION Communal and socioeconomic factors are associated with higher odds of significant CAD and MVD in the group of patients referred for CAG. The underpinnings of these associations (e.g. pathophysiologic factors, access to care, and system-wide determinants of quality) require further study.
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Affiliation(s)
- Amin Daoulah
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Osama E Elkhateeb
- Cardiac Center, King Abdullah Medical City in Holy Capital Makkah, Kingdom of Saudi Arabia
| | - S Ali Nasseri
- Politecnico di Torino, Italy Armed Forces Hospital Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia
| | - Mushabab Al-Murayeh
- Cardiovascular Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia
| | - Salem Al-Kaabi
- Cardiology Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Amir Lotfi
- Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | - Mohamed N Alama
- Cardiology unit, King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Salem M Al-Faifi
- Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Mamdouh Haddara
- Anesthesia Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ciaran M Dixon
- Emergency Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim S Alzahrani
- College of medicine, King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah A Alghamdi
- Anesthesia Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Ahmed
- Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Adnan Fathey
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ejazul Haq
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE. Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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460
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Affiliation(s)
- Jeffrey L Anderson
- From the Intermountain Medical Center Heart Institute, University of Utah School of Medicine, Salt Lake City (J.L.A.); and Brigham and Women's Hospital, Harvard Medical School, Boston (D.A.M.)
| | - David A Morrow
- From the Intermountain Medical Center Heart Institute, University of Utah School of Medicine, Salt Lake City (J.L.A.); and Brigham and Women's Hospital, Harvard Medical School, Boston (D.A.M.)
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461
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Dugas LR, Forrester TE, Plange-Rhule J, Bovet P, Lambert EV, Durazo-Arvizu RA, Cao G, Cooper RS, Khatib R, Tonino L, Riesen W, Korte W, Kliethermes S, Luke A. Cardiovascular risk status of Afro-origin populations across the spectrum of economic development: findings from the Modeling the Epidemiologic Transition Study. BMC Public Health 2017; 17:438. [PMID: 28499375 PMCID: PMC5429531 DOI: 10.1186/s12889-017-4318-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 04/26/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Cardiovascular risk factors are increasing in most developing countries. To date, however, very little standardized data has been collected on the primary risk factors across the spectrum of economic development. Data are particularly sparse from Africa. METHODS In the Modeling the Epidemiologic Transition Study (METS) we examined population-based samples of men and women, ages 25-45 of African ancestry in metropolitan Chicago, Kingston, Jamaica, rural Ghana, Cape Town, South Africa, and the Seychelles. Key measures of cardiovascular disease risk are described. RESULTS The risk factor profile varied widely in both total summary estimates of cardiovascular risk and in the magnitude of component factors. Hypertension ranged from 7% in women from Ghana to 35% in US men. Total cholesterol was well under 200 mg/dl for all groups, with a mean of 155 mg/dl among men in Ghana, South Africa and Jamaica. Among women total cholesterol values varied relatively little by country, following between 160 and 178 mg/dl for all 5 groups. Levels of HDL-C were virtually identical in men and women from all study sites. Obesity ranged from 64% among women in the US to 2% among Ghanaian men, with a roughly corresponding trend in diabetes. Based on the Framingham risk score a clear trend toward higher total risk in association with socioeconomic development was observed among men, while among women there was considerable overlap, with the US participants having only a modestly higher risk score. CONCLUSIONS These data provide a comprehensive estimate of cardiovascular risk across a range of countries at differing stages of social and economic development and demonstrate the heterogeneity in the character and degree of emerging cardiovascular risk. Severe hypercholesterolemia, as characteristic in the US and much of Western Europe at the onset of the coronary epidemic, is unlikely to be a feature of the cardiovascular risk profile in these countries in the foreseeable future, suggesting that stroke may remain the dominant cardiovascular event.
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Affiliation(s)
- Lara R. Dugas
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
| | - Terrence E. Forrester
- Solutions for Developing Countries, University of the West Indies, Mona, Kingston, Jamaica
| | - Jacob Plange-Rhule
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Pascal Bovet
- Ministry of Health, Republic of Seychelles, Seychelles, Seychelles
- Institute of Social & Preventive Medicine, Laussanne University Hospital, Lausanne, Switzerland
| | - Estelle V. Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Guichan Cao
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
| | | | - Rasha Khatib
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
| | - Laura Tonino
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
| | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Stephanie Kliethermes
- Department of Orthopaedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI USA
| | - Amy Luke
- Public Health Sciences, Stritch School of Medicine, Maywood, IL USA
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462
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Blomster JI, Zoungas S, Woodward M, Neal B, Harrap S, Poulter N, Marre M, Williams B, Chalmers J, Hillis GS. The impact of level of education on vascular events and mortality in patients with type 2 diabetes mellitus: Results from the ADVANCE study. Diabetes Res Clin Pract 2017; 127:212-217. [PMID: 28395214 DOI: 10.1016/j.diabres.2017.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
Abstract
AIMS The relationship between educational level and the risk of all-cause mortality is well established, whereas the association with vascular events in individuals with type 2 diabetes is not well described. Any association may reflect a link with common cardiovascular or lifestyle-based risk factors. METHODS The relationships between the highest level of educational attainment and major cardiovascular events, microvascular complications and all-cause mortality were explored in a cohort of 11,140 individuals with type 2 diabetes. Completion of formal education before the age of 16 was categorized as a low level of education. Regional differences between Asia, East Europe and Established Market Economies were also assessed. RESULTS During a median of 5years of follow up, 1031 (9%) patients died, 1147 (10%) experienced a major cardiovascular event and 1136 (10%) a microvascular event. After adjustment for baseline characteristics and risk factors, individuals with lower education had an increased risk of cardiovascular events (hazard ratio (HR) 1.31, 95% CI 1.16-1.48, p<0.0001), microvascular events (HR 1.23, 95% CI 1.08-1.39, p=0.0013) and all-cause mortality (HR 1.34, 95% CI 1.18-1.52, p<0.0001). In regional analyses the increased risk of studied outcomes associated with lower education was weakest in Established Market Economies and strongest in East Europe. CONCLUSIONS A low level of education is associated with an increased risk of vascular events and death in patients with type 2 diabetes, independently of common lifestyle associated cardiovascular risk factors. The effect size varies between geographical regions.
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Affiliation(s)
- J I Blomster
- The George Institute for Global Health, University of Sydney, Sydney, Australia; University of Turku, Turku, Finland.
| | - S Zoungas
- The George Institute for Global Health, University of Sydney, Sydney, Australia; School of Public Health, Monash University, Melbourne, Australia
| | - M Woodward
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, USA; The George Institute for Global Health, University of Oxford, UK
| | - B Neal
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - S Harrap
- Department of Physiology, University of Melbourne and Royal Melbourne Hospital, Melbourne, Australia
| | - N Poulter
- Imperial College London and Hammersmith Hospital, London, UK
| | - M Marre
- Service d'Endocrinologie Diabétologie Nutrition, Groupe Hospitalier Bichat-Claude Bernard, Paris, France
| | - B Williams
- University College London and the National Institute for Health Research UCL Hospitals Biomedical Research Centre, London, UK
| | - J Chalmers
- The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - G S Hillis
- The George Institute for Global Health, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Perth Hospital, Perth, Australia
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Abstract
Cardiovascular diseases (CVDs) have now become the leading cause of mortality in India. A quarter of all mortality is attributable to CVD. Ischemic heart disease and stroke are the predominant causes and are responsible for >80% of CVD deaths. The Global Burden of Disease study estimate of age-standardized CVD death rate of 272 per 100 000 population in India is higher than the global average of 235 per 100 000 population. Some aspects of the CVD epidemic in India are particular causes of concern, including its accelerated buildup, the early age of disease onset in the population, and the high case fatality rate. In India, the epidemiological transition from predominantly infectious disease conditions to noncommunicable diseases has occurred over a rather brief period of time. Premature mortality in terms of years of life lost because of CVD in India increased by 59%, from 23.2 million (1990) to 37 million (2010). Despite wide heterogeneity in the prevalence of cardiovascular risk factors across different regions, CVD has emerged as the leading cause of death in all parts of India, including poorer states and rural areas. The progression of the epidemic is characterized by the reversal of socioeconomic gradients; tobacco use and low fruit and vegetable intake have become more prevalent among those from lower socioeconomic backgrounds. In addition, individuals from lower socioeconomic backgrounds frequently do not receive optimal therapy, leading to poorer outcomes. Countering the epidemic requires the development of strategies such as the formulation and effective implementation of evidence-based policy, reinforcement of health systems, and emphasis on prevention, early detection, and treatment with the use of both conventional and innovative techniques. Several ongoing community-based studies are testing these strategies.
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Affiliation(s)
- Dorairaj Prabhakaran
- From Centre for Chronic Disease Control, Gurgaon, India (D.P., P.J.); Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India (D.P., P.J.); and All India Institute of Medical Sciences, New Delhi, India (A.R.).
| | - Panniyammakal Jeemon
- From Centre for Chronic Disease Control, Gurgaon, India (D.P., P.J.); Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India (D.P., P.J.); and All India Institute of Medical Sciences, New Delhi, India (A.R.)
| | - Ambuj Roy
- From Centre for Chronic Disease Control, Gurgaon, India (D.P., P.J.); Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India (D.P., P.J.); and All India Institute of Medical Sciences, New Delhi, India (A.R.)
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464
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Gupta R, Kaur M, Islam S, Mohan V, Mony P, Kumar R, Kutty VR, Iqbal R, Rahman O, Deepa M, Antony J, Vijaykumar K, Kazmi K, Yusuf R, Mohan I, Panwar RB, Rangarajan S, Yusuf S. Association of Household Wealth Index, Educational Status, and Social Capital with Hypertension Awareness, Treatment, and Control in South Asia. Am J Hypertens 2017; 30:373-381. [PMID: 28096145 DOI: 10.1093/ajh/hpw169] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/22/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Hypertension control rates are low in South Asia. To determine association of measures of socioeconomic status (wealth, education, and social capital) with hypertension awareness, treatment, and control among urban and rural subjects in these countries we performed the present study. METHODS We enrolled 33,423 subjects aged 35-70 years (women 56%, rural 53%, low-education status 51%, low household wealth 25%, low-social capital 33%) in 150 communities in India, Pakistan, and Bangladesh during 2003-2009. Prevalence of hypertension and its awareness, treatment, and control status and their association with wealth, education, and social capital were determined. RESULTS Age-, sex-, and location-adjusted prevalence of hypertension in men was 31.5% (23.9-40.2%) and women was 32.6% (24.9-41.5%) with variations in prevalence across study sites (urban 30-56%, rural 11-43%). Prevalence was significantly greater in urban locations, older subjects, and participants with more wealth, greater education, and lower social capital index. Hypertension awareness was in 40.4% (urban 45.9, rural 32.5), treatment in 31.9% (urban 37.6, rural 23.6), and control in 12.9% (urban 15.4, rural 9.3). Control was lower in men and younger subjects. Hypertension awareness, treatment, and control were significantly lower, respectively, in lowest vs. highest wealth index tertile (26.2 vs. 50.6%, 16.9 vs. 44.0%, and 6.9 vs. 17.3%, P < 0.001) and lowest vs. highest educational status tertile (31.2 vs. 48.4%, 21.8 vs. 42.1%, and 7.8 vs. 19.2%, P < 0.001) while insignificant differences were observed in lowest vs. highest social capital index (38.2 vs. 36.1%, 35.1 vs. 27.8%, and 12.5 vs. 9.1%). CONCLUSIONS This study shows low hypertension awareness, treatment, and control in South Asia. Lower wealth and educational status are important in low hypertension awareness, treatment, and control.
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Affiliation(s)
- Rajeev Gupta
- Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | | | - Prem Mony
- Department of Community Medicine, St John's Medical College and Research Institute, Bangalore, India
| | - Rajesh Kumar
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omar Rahman
- School of Life Sciences, Independent University, Dhaka, Bangladesh; and
| | - Mohan Deepa
- Madras Diabetes Research Foundation, Chennai, India
| | - Justy Antony
- Department of Community Medicine, St John's Medical College and Research Institute, Bangalore, India
| | | | - Khawar Kazmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh; and
| | - Indu Mohan
- Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Raja Babu Panwar
- Administrative Office, Rajasthan University of Health Sciences, Jaipur, India
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
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465
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Han X, Hu Z, Chen J, Huang J, Huang C, Liu F, Gu C, Yang X, Hixson JE, Lu X, Wang L, Liu DP, He J, Chen S, Gu D. Associations Between Genetic Variants of NADPH Oxidase-Related Genes and Blood Pressure Responses to Dietary Sodium Intervention: The GenSalt Study. Am J Hypertens 2017; 30:427-434. [PMID: 28200110 PMCID: PMC6191854 DOI: 10.1093/ajh/hpw200] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/09/2016] [Accepted: 01/13/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The aim of this study was to comprehensively test the associations of genetic variants of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase-related genes with blood pressure (BP) responses to dietary sodium intervention in a Chinese population. METHODS We conducted a 7-day low-sodium intervention followed by a 7-day high-sodium intervention among 1,906 participants in rural China. BP measurements were obtained at baseline and each dietary intervention using a random-zero sphygmomanometer. Linear mixed-effect models were used to assess the additive associations of 63 tag single-nucleotide polymorphisms in 11 NADPH oxidase-related genes with BP responses to dietary sodium intervention. Gene-based analyses were conducted using the truncated product method. The Bonferroni method was used to adjust for multiple testing in all analyses. RESULTS Systolic BP (SBP) response to high-sodium intervention significantly decreased with the number of minor T allele of marker rs6967221 in RAC1 (P = 4.51 × 10-4). SBP responses (95% confidence interval) for genotypes CC, CT, and TT were 5.03 (4.71, 5.36), 4.20 (3.54, 4.85), and 0.56 (-1.08, 2.20) mm Hg, respectively, during the high-sodium intervention. Gene-based analyses revealed that RAC1 was significantly associated with SBP response to high-sodium intervention (P = 1.00 × 10-6) and diastolic BP response to low-sodium intervention (P = 9.80 × 10-4). CONCLUSIONS These findings suggested that genetic variants of NADPH oxidase-related genes may contribute to the variation of BP responses to sodium intervention in Chinese population. Further replication of these findings is warranted.
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Affiliation(s)
- Xikun Han
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zunsong Hu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Los Angeles, USA
| | - Jianfeng Huang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chen Huang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fangchao Liu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Charles Gu
- School of Medicine, Washington University, St. Louis, Missouri, USA
| | - Xueli Yang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - James E Hixson
- School of Public Health, University of Texas, Houston, Texas, USA
| | - Xiangfeng Lu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Laiyuan Wang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - De-Pei Liu
- National Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Los Angeles, USA
| | - Shufeng Chen
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dongfeng Gu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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466
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6080] [Impact Index Per Article: 868.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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467
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Abstract
Dyslipidemia is the most important atherosclerotic risk factor. Review of population based studies in India shows increasing mean total cholesterol levels. Recent studies have reported that high cholesterol is present in 25–30% of urban and 15–20% rural subjects. This prevalence is lower than high-income countries. The most common dyslipidemia in India are borderline high LDL cholesterol, low HDL cholesterol and high triglycerides. Studies have reported that over a 20-year period total cholesterol, LDL cholesterol and triglyceride levels have increased among urban populations. Case-control studies have reported that there is significant association of coronary events with raised apolipoproteinB, total cholesterol, LDL cholesterol and non-HDL cholesterol and inverse association with high apolipoproteinA and HDL cholesterol. Prevalence of suspected familial hypercholesterolemia in urban subjects varies from 1:125 to 1:450. Only limited studies exist regarding lipid abnormalities in children. There is low awareness, treatment and control of hypercholesterolemia in India.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology and Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Ravinder S Rao
- Department of Preventive Cardiology and Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Anoop Misra
- Department of Metabolic Diseases, Fortis C-DOC Centre, Chiragh Enclave, New Delhi, India
| | - Samin K Sharma
- Department of Cardiology, Mount Sinai Hospital and Icahn School of Medicine, New York, USA
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468
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Álvarez-Fernández C, Vaquero-Abellán M, Ruíz-Gandara Á, Romero-Saldaña M, Álvarez-López C. [Cardiovascular risk factors in the population at risk of poverty and social exclusión]. Aten Primaria 2017; 49:140-149. [PMID: 27423244 PMCID: PMC6876063 DOI: 10.1016/j.aprim.2016.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/04/2022] Open
Abstract
GOALS Detect if there are differences in prevalence, distribution of cardiovascular risk factors and risk according to REGICOR and SCORE's function; between people belonging to different occupational classes and population at risk of social exclusion. DESIGN Cross-sectional. SITE: Occupational health unit of the City Hall of Córdoba. PARTICIPANTS Sample availability of 628 people, excluding 59 by age or incomplete data. The group of municipal workers was obtained randomly while all contracted exclusion risk was taken. INTERVENTION No preventive, diagnostic or therapeutic actions that modify the course of the previous situation of workers were applied. MAIN MEASUREMENTS Smoke, glucose, lipids, blood pressure and BMI as main variables. T-student were used for comparison of means and percentages for Chi2. Statistical significance attached to an alpha error <5% and confidence interval with a 95% security. Receiver operator curves (ROC) were employed to find out what explanatory variables predict group membership of workers at risk of exclusion. RESULTS Smoking (95% CI: -.224;-.443), hypercholesterolemia (95% CI: -.127;-.320), obesity (95% CI: -.005;-0.214), diabetes (95% CI: -.060;-.211) and cardiovascular risk were higher in men at risk of exclusion. In women there were differences in the same variables except smoking (P=.053). CONCLUSIONS The existence of inequalities in prevalence of cardiovascular risk factors is checked. In a context of social crisis, health promotion and primary prevention programs directing to the most vulnerable, they are needed to mit.
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Affiliation(s)
| | - Manuel Vaquero-Abellán
- Dirección General de Prevención y Protección Ambiental, Universidad de Córdoba, Córdoba, España
| | | | | | - Carlos Álvarez-López
- Distrito Sanitario Guadalquivir (Córdoba), Servicio Andaluz de Salud, Córdoba, España
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469
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Ueda P, Woodward M, Lu Y, Hajifathalian K, Al-Wotayan R, Aguilar-Salinas CA, Ahmadvand A, Azizi F, Bentham J, Cifkova R, Di Cesare M, Eriksen L, Farzadfar F, Ferguson TS, Ikeda N, Khalili D, Khang YH, Lanska V, León-Muñoz L, Magliano DJ, Margozzini P, Msyamboza KP, Mutungi G, Oh K, Oum S, Rodríguez-Artalejo F, Rojas-Martinez R, Valdivia G, Wilks R, Shaw JE, Stevens GA, Tolstrup JS, Zhou B, Salomon JA, Ezzati M, Danaei G. Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys. Lancet Diabetes Endocrinol 2017; 5:196-213. [PMID: 28126460 PMCID: PMC5354360 DOI: 10.1016/s2213-8587(17)30015-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 11/08/2016] [Accepted: 11/14/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years. METHODS Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores. FINDINGS Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for Czech men (using a ≥10% risk threshold), and in low-income countries ranged from 2% in Uganda (men and women) to 13% in Iranian men (using a ≥20% risk threshold). More than 80% of adults were similarly classified as low or high risk by the laboratory-based and office-based risk scores. However, the office-based model substantially underestimated the risk among patients with diabetes. INTERPRETATION Our risk charts provide risk assessment tools that are recalibrated for each country and make the estimation of CVD risk possible without using laboratory-based measurements. FUNDING National Institutes of Health.
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Affiliation(s)
- Peter Ueda
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Yuan Lu
- Yale/Yale-New Haven Hospital, Center for Outcomes Research and Evaluation, New Haven, CT, USA
| | | | - Rihab Al-Wotayan
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, "Salvador Zubirán", Mexico City, Mexico
| | - Alireza Ahmadvand
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - James Bentham
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Renata Cifkova
- Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic
| | - Mariachiara Di Cesare
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Natural Sciences, School of Science and Technology, Middlsex University, London, UK
| | - Louise Eriksen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Trevor S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Nayu Ikeda
- Center for International Collaboration and Partnership, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
| | - Vera Lanska
- Statistical Unit, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Luz León-Muñoz
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health, Madrid, Spain
| | | | - Paula Margozzini
- Department of Public Health, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Gerald Mutungi
- Non-communicable Diseases Prevention and Control Program at the Ministry of Health, Kampala, Uganda
| | - Kyungwon Oh
- Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Cheongwon-gun, South Korea
| | - Sophal Oum
- University of Health Sciences, Phnom Penh, Cambodia
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, and CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Rosalba Rojas-Martinez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Publica, Cuernavaca, Mexico
| | - Gonzalo Valdivia
- División Salud Pública y Medicina Familiar, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rainford Wilks
- Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Kingston, Jamaica
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Gretchen A Stevens
- Department of Information, Evidence and Research, WHO, Geneva, Switzerland
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Bin Zhou
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK; Wellcome Trust Centre for Global Health Research, London, UK
| | - Goodarz Danaei
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
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The Emerging Epidemic of Cardiovascular Risk Factors and Atherosclerotic Disease in Developing Countries. Can J Cardiol 2017; 33:358-365. [DOI: 10.1016/j.cjca.2016.12.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 11/20/2022] Open
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Reed JL, Prince SA, Elliott CG, Mullen KA, Tulloch HE, Hiremath S, Cotie LM, Pipe AL, Reid RD. Impact of Workplace Physical Activity Interventions on Physical Activity and Cardiometabolic Health Among Working-Age Women: A Systematic Review and Meta-Analysis. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003516. [PMID: 28228457 DOI: 10.1161/circoutcomes.116.003516] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death among women in high-income Organization for Economic Co-operation and Development countries. Physical activity is protective for cardiovascular disease. The realities of modern life require working-age women to address work-related, family, and social demands. Few working-age women meet current moderate-to-vigorous-intensity physical activity (MVPA) recommendations. Given that working-age women spend a substantial proportion of their waking hours at work, places of employment may be an opportune and a controlled setting to implement programs, improving MVPA levels and enhancing cardiometabolic health. METHODS AND RESULTS Eight electronic databases were searched to identify all prospective cohort and experimental studies reporting an MVPA outcome of workplace interventions for working-age women (mean age, 18-65 years) in high-income Organization for Economic Co-operation and Development countries. Risk of bias was assessed using the Cochrane risk of bias tool; quality of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A qualitative synthesis was performed for all studies, and meta-analyses were conducted where possible. Twenty-four studies met the inclusion criteria; 20 studies were included in the meta-analyses. Workplace interventions significantly increased minutes per week of metabolic equivalents (4 studies; standardized mean differences, 2.07; 95% confidence interval [CI], 1.44 to 2.69), but not minutes per week of MVPA (13 studies; standardized mean differences, 0.38; 95% CI, -0.15 to 0.92) or metabolic equivalents per week (3 studies; standardized mean differences, 0.11; 95% CI, -0.48 to 0.71). Workplace interventions also significantly decreased body mass (7 studies; mean differences, -0.83 kg; 95% CI, -1.64 to -0.02), body mass index (6 studies; mean differences, -0.35 kg/m2; 95% CI, -0.62 to -0.07), low-density lipoprotein (4 studies; mean differences, -0.11 mmol/L; 95% CI, -0.17 to -0.04), and blood glucose (2 studies; mean differences, -0.18 mmol/L; 95% CI, -0.29 to -0.07). These workplace interventions targeting MVPA levels and known beneficial cardiometabolic health sequelae were of lower quality evidence. CONCLUSIONS Workplace interventions variably improve MVPA levels and related cardiometabolic health sequelae of working-age women in high-income Organization for Economic Co-operation and Development countries. Our findings underscore the need for ongoing research in this area but also increased dissemination of the existing programs and knowledge.
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Affiliation(s)
- Jennifer L Reed
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.).
| | - Stephanie A Prince
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Cara G Elliott
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Kerri-Anne Mullen
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Heather E Tulloch
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Swapnil Hiremath
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Lisa M Cotie
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Andrew L Pipe
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
| | - Robert D Reid
- From the Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ontario, Canada (J.L.R., S.A.P., C.G.E., K.-A.M., H.E.T., L.M.C., A.L.P., R.D.R.); and Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ontario, Canada (S.H.)
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472
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Chen YT, Chen HT, Hsu CY, Chao PW, Kuo SC, Ou SM, Shih CJ. Dual Antiplatelet Therapy and Clinical Outcomes after Coronary Drug-Eluting Stent Implantation in Patients on Hemodialysis. Clin J Am Soc Nephrol 2017; 12:262-271. [PMID: 28174317 PMCID: PMC5293329 DOI: 10.2215/cjn.04430416] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/19/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND OBJECTIVES We aimed to investigate the benefits and risks of dual antiplatelet therapy (DAPT) after coronary drug-eluting stent (DES) implantation in patients undergoing hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A nested case-control analysis of patients on hemodialysis after receipt of DES and DAPT treatment was conducted using data from Taiwan's National Health Insurance Research Database for the period 2007-2011. Cases of myocardial infarction or death within 1 year after DES implantation were matched one-to-one with control patients. Odds ratios were calculated to compare DAPT continuation with discontinuation. Additionally, a propensity score-adjusted 6-month landmark cohort analysis was also conducted to evaluate the long-term benefits and risks of prolonged (>6 months) compared with ≤6 months of DAPT use. The primary outcomes were death and myocardial infarction. The secondary outcomes were ischemic stroke, revascularization, and major bleeding. RESULTS In the nested case-control analysis, patients who continued DAPT had a lower rate of death or myocardial infarction within 1 year after receipt of a DES (adjusted odds ratio, 0.54; 95% confidence interval, 0.36 to 0.81; P=0.003), whereas this association became statistically nonsignificant when compared with patients who discontinued DAPT for the period between 6 and 12 months after receipt of a DES (adjusted odds ratio, 1.51; 95% confidence interval, 0.75 to 3.04). In the propensity score-adjusted cohort analysis, >6 months of DAPT use was not associated with different primary or secondary outcomes than shorter-term use. CONCLUSIONS Our findings support that the clinical effectiveness of extended DAPT in a hemodialysis population may be tempered after 6 months post-DES implantation.
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Affiliation(s)
- Yung-Tai Chen
- Divisions of *Nephrology and
- Institute of Clinical Medicine
| | - Hung-Ta Chen
- Endocrinology and Metabolism, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
- School of Medicine, and
| | - Chien-Yi Hsu
- Institute of Clinical Medicine
- Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiology and Cardiovascular Research Center, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
- College of Medicine and
| | - Pei-Wen Chao
- College of Medicine and
- Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | | | - Shuo-Ming Ou
- Institute of Clinical Medicine
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; and
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473
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Yan R, Li W, Yin L, Wang Y, Bo J. Cardiovascular Diseases and Risk-Factor Burden in Urban and Rural Communities in High-, Middle-, and Low-Income Regions of China: A Large Community-Based Epidemiological Study. J Am Heart Assoc 2017; 6:JAHA.116.004445. [PMID: 28167497 PMCID: PMC5523752 DOI: 10.1161/jaha.116.004445] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Most cardiovascular diseases occur in low‐ and middle‐income regions of the world, but the socioeconomic distribution within China remains unclear. Our study aims to investigate whether the prevalence of cardiovascular diseases differs among high‐, middle‐, and low‐income regions of China and to explore the reasons for the disparities. Methods and Results We enrolled 46 285 individuals from 115 urban and rural communities in 12 provinces across China between 2005 and 2009. We recorded their medical histories of cardiovascular diseases and calculated the INTERHEART Risk Score for the assessment of cardiovascular risk‐factor burden, with higher scores indicating greater burden. The mean INTERHEART Risk Score was higher in high‐ and middle‐income regions than in low‐income regions (9.47, 9.48, and 8.58, respectively, P<0.0001). By contrast, the prevalence of total cardiovascular disease (stroke, ischemic heart disease, and other heart diseases that led to hospitalization) was lower in high‐ and middle‐income regions than in low‐income regions (7.46%, 7.42%, and 8.36%, respectively, Ptrend=0.0064). In high‐ and middle‐income regions, urban communities have higher INTERHEART Risk Score and higher prevalent rate than rural communities. In low‐income regions, however, the prevalence of total cardiovascular disease was similar between urban and rural areas despite the significantly higher INTERHEART Risk Score for urban settings. Conclusions We detected an inverse trend between risk‐factor burden and cardiovascular disease prevalence in urban and rural communities in high‐, middle‐, and low‐income regions of China. Such asymmetry may be attributed to the interregional differences in residents’ awareness, quality of healthcare, and availability and affordability of medical services.
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Affiliation(s)
- Ruohua Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Bo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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474
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Zhao Y, Peng R, Zhao W, Liu Q, Guo Y, Zhao S, Xu D. Zhibitai and low-dose atorvastatin reduce blood lipids and inflammation in patients with coronary artery disease. Medicine (Baltimore) 2017; 96:e6104. [PMID: 28207527 PMCID: PMC5319516 DOI: 10.1097/md.0000000000006104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/09/2017] [Accepted: 01/20/2017] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Atorvastatin decreases blood lipids but is associated with side effects. Zhibitai is a traditional Chinese medicine used to treat blood lipid disorders. The objective of this study is to evaluate the lipid-lowering effect, antiinflammatory effect, and adverse events of zhibitai combined to atorvastatin in patients with coronary heart diseases (CHDs). METHODS Patients with CHD (n = 150) were randomized to: zhibitai 480 mg + atorvastatin 10 mg (ZA10 group), atorvastatin 20 mg (A20 group), and atorvastatin 40 mg (A40 group). Lipid profile, cardiotrophin-1 (CT-1), and C-reactive protein (CRP) were measured after 4 and 8 weeks of treatment. Self-reported side effects, liver function, kidney function, and creatine kinase levels were monitored. RESULTS After 8 weeks, triglycerides, total cholesterol (TC), LDL-cholesterol (LDL-C), and apolipoprotein B100 (ApoB100) levels were decreased in the ZA10 group (-64%, -37%, -46%, and -54%, respectively, compared with baseline), and these changes were similar to those of the A40 group (P > 0.05). CT-1 and high sensitivity-C reactive protein (hs-CRP) levels were significantly decreased in the ZA10 group after 4 and 8 weeks (4 weeks: -73% and 96%; 8 weeks: -89% and -98%; all P < 0.01), without differences among the 3 groups (P > 0.05). After 8 weeks of treatment, adverse events (abdominal distention, nausea, vomiting, and hunger) were found in 4, 5, and 7 patients in the ZA10, A20, and A40 groups, respectively. CONCLUSION ZA10 significantly reduced triglycerides, TC, LDL-C, ApoB, CT-1, and hs-CRP levels in patients with CHD, similar to the effects of A40 and A20, but ZA10 lead to fewer adverse events.
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Affiliation(s)
- Yuhong Zhao
- Internal Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha, Hunan
- Affiliated Peace Changzhi Medical College Hospital, Changzhi, Shanxi, China
| | - Ran Peng
- Internal Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha, Hunan
| | - Wang Zhao
- Internal Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha, Hunan
| | - Qiong Liu
- Internal Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha, Hunan
| | - Yuan Guo
- Internal Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha, Hunan
| | - Shuiping Zhao
- Internal Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha, Hunan
| | - Danyan Xu
- Internal Cardiovascular Medicine, Second Xiangya Hospital of Central South University, Changsha, Hunan
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475
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Mansi IA, English JL, Morris MJ, Zhang S, Mortensen EM, Halm EA. Statins for primary prevention in physically active individuals: Do the risks outweigh the benefits? J Sci Med Sport 2017; 20:627-632. [PMID: 28185810 DOI: 10.1016/j.jsams.2016.12.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/16/2016] [Accepted: 12/01/2016] [Indexed: 01/02/2023]
Abstract
OBJECTIVES There are little data on the potential benefits and adverse events of statins among physically fit individuals. Our objective was to examine the associations of statin use with beneficial cardiovascular outcomes and adverse events in active duty military (a surrogate for high level of physical fitness). DESIGN This is a retrospective propensity score-matched cohort study of healthy active duty military (fiscal years [FY] 2002-2011). METHODS Statin-users received statins during FY 2005 as their only prescription medication. FY 2002-2004 was used to describe baseline characteristics; and FY 2006-2011were used to capture outcomes. Study outcomes included major acute cardiovascular events (MACE), diabetes mellitus and its complications, kidney diseases, musculoskeletal diseases, obesity, and malignancy. RESULTS We propensity score matched 837 statin-users to 2488 nonusers. During follow-up, 1.6% statin-users and 1.5% nonusers were diagnosed with MACE (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.55-1.98), 12.5% of statin-users and 5.8% of nonusers were diagnosed with diabetes (OR 2.34, 95% CI 1.79-3.04), and 1.7% statin- users and 0.7% nonusers were diagnosed with diabetes with complication (OR 2.47, 95% CI 1.21-5.04). There were no differences in rates of other adverse events. CONCLUSIONS Among healthy physically active individuals, statin use was associated with doubled the odds of diabetes and diabetic complications without countervailing cardiovascular benefits.
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Affiliation(s)
- Ishak A Mansi
- Department of Medicine, VA North Texas Health Care System, United States; Departments of Internal Medicine, University of Texas Southwestern Medical Center, United States; Departments of Clinical Sciences, University of Texas Southwestern Medical Center, United States.
| | - Jenny L English
- Patient Administration Systems & Biostatistics Activity (PASBA), MEDCOM Head Quarter, JBSA Fort Sam, United States
| | - Michael J Morris
- Pulmonary/Critical Care Service, Department of Medicine, San Antonio Military Medical Center, JBSA Fort Sam, United States
| | - Song Zhang
- Departments of Clinical Sciences, University of Texas Southwestern Medical Center, United States
| | - Eric M Mortensen
- Department of Medicine, VA North Texas Health Care System, United States; Departments of Internal Medicine, University of Texas Southwestern Medical Center, United States; Departments of Clinical Sciences, University of Texas Southwestern Medical Center, United States
| | - Ethan A Halm
- Departments of Internal Medicine, University of Texas Southwestern Medical Center, United States; Departments of Clinical Sciences, University of Texas Southwestern Medical Center, United States
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476
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Waters DD. The Rise and Fall of Tuberculosis and Atherosclerosis: First There Is a Mountain…. Can J Cardiol 2017; 33:295-297. [PMID: 28081868 DOI: 10.1016/j.cjca.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 11/17/2016] [Accepted: 11/17/2016] [Indexed: 01/03/2023] Open
Affiliation(s)
- David D Waters
- Division of Cardiology, San Francisco General Hospital, and the Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
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477
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Harumi Higuchi Dos Santos M, Sharma A, Sun JL, Pieper K, McMurray JJV, Holman RR, Lopes RD. International Variation in Outcomes Among People with Cardiovascular Disease or Cardiovascular Risk Factors and Impaired Glucose Tolerance: Insights from the NAVIGATOR Trial. J Am Heart Assoc 2017; 6:JAHA.116.003892. [PMID: 28087508 PMCID: PMC5523624 DOI: 10.1161/jaha.116.003892] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Regional differences in risk of diabetes mellitus and cardiovascular outcomes in people with impaired glucose tolerance are poorly characterized. Our objective was to evaluate regional variation in risk of new‐onset diabetes mellitus, cardiovascular outcomes, and treatment effects in participants from the NAVIGATOR (Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research) trial. Methods and Results NAVIGATOR randomized people with impaired glucose tolerance and cardiovascular risk factors or with established cardiovascular disease to valsartan (or placebo) and to nateglinide (or placebo) with a median 5‐year follow‐up. Data from the 9306 participants were categorized by 5 regions: Asia (n=552); Europe (n=4909); Latin America (n=1406); North America (n=2146); and Australia, New Zealand, and South Africa (n=293). Analyzed outcomes included new‐onset diabetes mellitus; cardiovascular death; a composite cardiovascular outcome of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke; and treatment effects of valsartan and nateglinide. Respective unadjusted 5‐year risks for new‐onset diabetes mellitus, cardiovascular death, and the composite cardiovascular outcome were 33%, 0.4%, and 4% for Asia; 34%, 2%, and 6% for Europe; 37%, 4%, and 8% for Latin America; 38%, 2%, and 6% for North America; and 32%, 4%, and 8% for Australia, New Zealand, and South Africa. After adjustment, compared with North America, European participants had a lower risk of new‐onset diabetes mellitus (hazard ratio 0.86, 95% CI 0.78–0.94; P=0.001), whereas Latin American participants had a higher risk of cardiovascular death (hazard ratio 2.68, 95% CI 1.82–3.96; P<0.0001) and the composite cardiovascular outcome (hazard ratio 1.48, 95% CI 1.15–1.92; P=0.003). No differential interactions between treatment and geographic location were identified. Conclusions Major regional differences regarding the risk of new‐onset diabetes mellitus and cardiovascular outcomes in NAVIGATOR participants were identified. These differences should be taken into account when planning global trials. Clinical Trial Registration URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00097786.
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Affiliation(s)
| | - Abhinav Sharma
- Duke Clinical Research Institute, Duke University, Durham, NC.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jie-Lena Sun
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - Karen Pieper
- Duke Clinical Research Institute, Duke University, Durham, NC
| | - John J V McMurray
- University of Cardiology, Western Infirmary, Glasgow, United Kingdom
| | - Rury R Holman
- Diabetes Trials Unit, Oxford Centre for Diabetes, Endocrinology, and Metabolism, University of Oxford, United Kingdom
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University, Durham, NC
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478
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Haraldsdottir S, Gudmundsson S, Thorgeirsson G, Lund SH, Valdimarsdottir UA. Regional differences in mortality, hospital discharges and primary care contacts for cardiovascular disease. Scand J Public Health 2017; 45:260-268. [DOI: 10.1177/1403494816685341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Aims: Surveillance of geographical variations in cardiovascular health is important in order to achieve the objectives of reducing regional health disparities. We aimed to explore differences in cardiovascular disease (CVD) mortality and prevalence of CVD diagnoses made in primary and in-patient care, as well as risk factor distribution by geographic regions (urban/rural) in Iceland. Methods: From nationwide health registers, we obtained data on CVD mortalities ( N = 7113), primary healthcare CVD contacts ( N = 58,246) and hospital CVD discharges ( N = 14,039), as well as data on CVD risk factors from a national health survey ( N = 5909; response rate 60.3%). Age-standardised annual mortality, primary healthcare contact and hospital discharge rates due to CVD were calculated per 100,000 population inside (urban) and outside (rural) the Capital Area (CA). Logistic regression was used to explore regional differences in CVD risk factors. Results: We observed slightly higher total CVD mortality rates among women outside compared to inside the CA (Standardised Rate Ratio (SRR) 1.06 (95% confidence interval (CI) 1.05–1.07)), particularly due to atrial fibrillation (SRR 1.47 (95% CI 1.46–1.48)), heart failure (SRR 1.29 (95% CI 1.27–1.31)) and ischemic heart disease (SRR 1.11 (95% CI 1.10–1.12)), while reduced mortality risk for cerebrovascular disease (SRR 0.81 (95% CI 0.80–0.83)). The rates of hospital discharges and primary care contacts for these diseases, as well as prevalence of several modifiable risk factors, were generally higher outside the CA, particularly among women. Conclusions:The higher prevalence of modifiable risk factors and CVD in rural areas, especially among women, calls for refined treatment and health-promoting efforts in rural areas.
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Affiliation(s)
- Sigridur Haraldsdottir
- Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Division of Health Information and Research, Directorate of Health, Reykjavik, Iceland
| | - Sigurdur Gudmundsson
- Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Guđmundur Thorgeirsson
- Department of Medicine, Landspitali University Hospital, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Sigrun H. Lund
- Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Unnur A. Valdimarsdottir
- Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
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479
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Uribe-Leitz T, Jaramillo J, Maurer L, Fu R, Esquivel MM, Gawande AA, Haynes AB, Weiser TG. Variability in mortality following caesarean delivery, appendectomy, and groin hernia repair in low-income and middle-income countries: a systematic review and analysis of published data. LANCET GLOBAL HEALTH 2017; 4:e165-74. [PMID: 26916818 DOI: 10.1016/s2214-109x(15)00320-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 11/25/2015] [Accepted: 12/08/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgical interventions occur at lower rates in resource-poor settings, and complication and death rates following surgery are probably substantial but have not been well quantified. A deeper understanding of outcomes is a crucial step to ensure that high quality accompanies increased global access to surgical care. We aimed to assess surgical mortality following three common surgical procedures--caesarean delivery, appendectomy, and groin (inguinal and femoral) hernia repair--to quantify the potential risks of expanding access without simultaneously addressing issues of quality and safety. METHODS We collected demographic, health, and economic data for 113 countries classified as low income or lower-middle income by the World Bank in 2005. We did a systematic review of Ovid, MEDLINE, PubMed, and Scopus from Jan 1, 2000, to Jan 15, 2015, to identify studies in these countries reporting all-cause mortality following the three commonly undertaken operations. Reports from governmental and other agencies were also identified and included. We modelled surgical mortality rates for countries without reported data using a two-step multiple imputation method. We first used a fully conditional specification (FCS) multiple imputation method to establish complete datasets for all missing variables that we considered potentially predictive of surgical mortality. We then used regression-based predictive mean matching imputation methods, specified within the multiple imputation FCS method, for selected predictors for each operation using the completed dataset to predict mortality rates along with confidence intervals for countries without reported mortality data. To account for variability in data availability, we aggregated results by subregion and estimated surgical mortality rates. FINDINGS From an initial 1302 articles and reports identified, 247 full-text articles met our inclusion criteria, and 124 provided data for surgical mortality for at least one of the three selected operations. We identified 42 countries with mortality data for at least one of the three procedures. Median reported mortality was 7·9 per 1000 operations for caesarean delivery (IQR 2·8-19·9), 2·2 per 1000 operations for appendectomy (0·0-17·2), and 4·9 per 1000 operations for groin hernia (0·0-11·7). Perioperative mortality estimates by subregion ranged from 2·8 (South Asia) to 50·2 (East Asia) per 1000 caesarean deliveries, 2·4 (South Asia) to 54·0 (Central sub-Saharan Africa) per 1000 appendectomies, and 0·3 (Andean Latin America) to 25·5 (Southern sub-Saharan Africa) per 1000 hernia repairs. INTERPRETATION All-cause postoperative mortality rates are exceedingly variable within resource-constrained environments. Efforts to expand surgical access and provision of services must include a strong commitment to improve the safety and quality of care. FUNDING None.
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Affiliation(s)
| | | | - Lydia Maurer
- Stanford University School of Medicine, Stanford, CA, USA
| | - Rui Fu
- Management Science and Engineering, Stanford University, Stanford, CA, USA
| | | | - Atul A Gawande
- Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Alex B Haynes
- Ariadne Labs: a Joint Center for Health System Innovation, Boston, MA, USA; Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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480
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Prevalence of Pragmatically Defined High CV Risk and its Correlates in LMIC: A Report From 10 LMIC Areas in Africa, Asia, and South America. Glob Heart 2017; 11:27-36. [PMID: 27102020 DOI: 10.1016/j.gheart.2015.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/15/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Currently available tools for assessing high cardiovascular risk (HCR) often require measurements not available in resource-limited settings in low- and middle-income countries (LMIC). There is a need to assess HCR using a pragmatic evidence-based approach. OBJECTIVES This study sought to report the prevalence of HCR in 10 LMIC areas in Africa, Asia, and South America and to investigate the profiles and correlates of HCR. METHODS Cross-sectional analysis using data from the National Heart, Lung, and Blood Institute-UnitedHealth Group Centers of Excellence. HCR was defined as history of heart disease/heart attack, history of stroke, older age (≥50 years for men and ≥60 for women) with history of diabetes, or older age with systolic blood pressure ≥160 mm Hg. Prevalence estimates were standardized to the World Health Organization's World Standard Population. RESULTS A total of 37,067 subjects ages ≥35 years were included; 53.7% were women and mean age was 53.5 ± 12.1 years. The overall age-standardized prevalence of HCR was 15.4% (95% confidence interval: 15.0% to 15.7%), ranging from 8.3% (India, Bangalore) to 23.4% (Bangladesh). Among men, the prevalence was 1.7% for the younger age group (35 to 49 years) and 29.1% for the older group (≥50); among women, 3.8% for the younger group (35 to 59 years) and 40.7% for the older group (≥60). Among the older group, measured systolic blood pressure ≥160 mm Hg (with or without other conditions) was the most common criterion for having HCR, followed by diabetes. The proportion of having met more than 1 criterion was nearly 20%. Age, education, and body mass index were significantly associated with HCR. Cross-site differences existed and were attenuated after adjusting for age, sex, education, smoking, and body mass index. CONCLUSIONS The prevalence of HCR in 10 LMIC areas was generally high. This study provides a starting point to define targeted populations that may benefit from interventions combining both primary and secondary prevention strategies.
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481
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Strijdom H, De Boever P, Walzl G, Essop MF, Nawrot TS, Webster I, Westcott C, Mashele N, Everson F, Malherbe ST, Stanley K, Kessler HH, Stelzl E, Goswami N. Cardiovascular risk and endothelial function in people living with HIV/AIDS: design of the multi-site, longitudinal EndoAfrica study in the Western Cape Province of South Africa. BMC Infect Dis 2017; 17:41. [PMID: 28061822 PMCID: PMC5219697 DOI: 10.1186/s12879-016-2158-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background There is growing evidence of an interaction between HIV-infection, anti-retroviral therapy (ART) and cardiovascular diseases (CVD). Epidemiological studies in Europe and North America have been observing a shift towards an increased incidence of coronary heart disease and acute myocardial infarctions in HIV-infected populations compared to the general population even after adjusting for traditional cardiovascular risk factors. Despite South Africa (and sub-Saharan Africa, SSA) being regarded as the epicentre of the global HIV epidemic, very little is known about the prevalence of cardiovascular risk factors and precursors of vascular disease in HIV-infected populations in this region. The knowledge gap is further widened by the paucity of data from prospective studies. We present the rationale, objectives and key methodological features of the EndoAfrica study, which aims to determine whether HIV-infection and ART are associated with altered cardiovascular risk and changes in vascular endothelial structure and function in adults living in the Western Cape Province of South Africa. Methods In this longitudinal study, comprehensive cardiovascular assessments of HIV-negative and HIV-positive (with and without ART) study participants are performed by clinical and biochemical screening for traditional cardiovascular risk factors and biomarkers of CVD. Vascular and endothelial function is determined by brachial artery flow-mediated dilatation (FMD), carotid-intima-thickness (IMT) measurements and quantitative retinal blood vessel analyses, complemented by vascular endothelial biomarker assays. Finally, we aim to statistically determine whether HIV-infection and/or ART are associated with increased cardiovascular risk and vascular endothelial dysfunction, and determine whether there is progression/regression in these endpoints 18 months after the baseline assessments. Discussion The EndoAfrica study provides a unique opportunity to recruit a cohort of HIV-infected patients and HIV-negative controls who will be comprehensively and longitudinally assessed for cardiovascular risk and disease profile with vascular endothelial function as a potentially important intermediate cardiovascular phenotype. To our knowledge, it is the first time that such a systematic study has been established in the context of SSA and South Africa.
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Affiliation(s)
- Hans Strijdom
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa.
| | - Patrick De Boever
- Environmental Risk and Health Unit, Flemish Institute for Technological Research (VITO), Boeretang 200, 2400, Mol, Belgium.,Centre for Environmental Studies, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium
| | - Gerhard Walzl
- Division of Molecular Biology and Human Genetics, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research and SAMRC Centre for Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - M Faadiel Essop
- Cardio-Metabolic Research Group (CMRG), Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, 7600, South Africa
| | - Tim S Nawrot
- Centre for Environmental Studies, Hasselt University, Agoralaan, 3590, Diepenbeek, Belgium.,Department of Public Health and Primary Care, Leuven University, Kapucijnenvoer 35, 3000, Leuven, Belgium
| | - Ingrid Webster
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Corli Westcott
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Nyiko Mashele
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Frans Everson
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Stephanus T Malherbe
- Division of Molecular Biology and Human Genetics, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research and SAMRC Centre for Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Kim Stanley
- Division of Molecular Biology and Human Genetics, DST/NRF Centre of Excellence for Biomedical Tuberculosis Research and SAMRC Centre for Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 241, Cape Town, 8000, South Africa
| | - Harald H Kessler
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria
| | - Evelyn Stelzl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Universitätsplatz 4, 8010, Graz, Austria
| | - Nandu Goswami
- Gravitational Physiology and Medicine Research Unit, Institute of Physiology, Medical University of Graz, Harrachgasse 21/V, 8010, Graz, Austria
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482
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Das A, Ambale-Venkatesh B, Lima JAC, Freedman JE, Spahillari A, Das R, Das S, Shah RV, Murthy VL. Cardiometabolic disease in South Asians: A global health concern in an expanding population. Nutr Metab Cardiovasc Dis 2017; 27:32-40. [PMID: 27612985 DOI: 10.1016/j.numecd.2016.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/30/2016] [Accepted: 08/01/2016] [Indexed: 12/27/2022]
Abstract
Cardiovascular disease (CVD) is one of the main causes of mortality and morbidity worldwide. As an emerging population, South Asians (SAs) bear a disproportionately high burden of CVD relative to underlying classical risk factors, partly attributable to a greater prevalence of insulin resistance and diabetes and distinct genetic and epigenetic influences. While the phenotypic distinctions between SAs and other ethnicities in CVD risk are becoming increasingly clear, the biology of these conditions remains an area of active investigation, with emerging studies involving metabolism, genetic variation and epigenetic modifiers (e.g., extracellular RNA). In this review, we describe the current literature on prevalence, prognosis and CVD risk in SAs, and provide a landscape of translational research in this field toward ameliorating CVD risk in SAs.
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Affiliation(s)
- A Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - B Ambale-Venkatesh
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J A C Lima
- Department of Medicine and Cardiology, Heart and Vascular Institute, Johns Hopkins Medical Institutions, The Johns Hopkins University, Baltimore, USA
| | - J E Freedman
- Department of Cardiology, UMass Memorial Health Care, MA, USA
| | - A Spahillari
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R Das
- The John Hopkins University, Baltimore, USA
| | - S Das
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - R V Shah
- Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - V L Murthy
- Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, USA.
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483
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Antonisamy B, Vasan SK, Geethanjali FS, Gowri M, Hepsy YS, Richard J, Raghupathy P, Karpe F, Osmond C, Fall CHD. Weight Gain and Height Growth during Infancy, Childhood, and Adolescence as Predictors of Adult Cardiovascular Risk. J Pediatr 2017; 180:53-61.e3. [PMID: 27823768 PMCID: PMC5179199 DOI: 10.1016/j.jpeds.2016.09.059] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/29/2016] [Accepted: 09/28/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To investigate independent relationships of childhood linear growth (height gain) and relative weight gain to adult cardiovascular disease (CVD) risk traits in Asian Indians. STUDY DESIGN Data from 2218 adults from the Vellore Birth Cohort were examined for associations of cross-sectional height and body mass index (BMI) and longitudinal growth (independent conditional measures of height and weight gain) in infancy, childhood, adolescence, and adulthood with adult waist circumference (WC), blood pressure (BP), insulin resistance (homeostatic model assessment-insulin resistance [HOMA-IR]), and plasma glucose and lipid concentrations. RESULTS Higher BMI/greater conditional relative weight gain at all ages was associated with higher adult WC, after 3 months with higher adult BP, HOMA-IR, and lipids, and after 15 years with higher glucose concentrations. Taller adult height was associated with higher WC (men β = 2.32 cm per SD, women β = 1.63, both P < .001), BP (men β = 2.10 mm Hg per SD, women β = 1.21, both P ≤ .001), and HOMA-IR (men β = 0.08 log units per SD, women β = 0.12, both P ≤ .05) but lower glucose concentrations (women β = -0.03 log mmol/L per SD P = .003). Greater height or height gain at all earlier ages were associated with higher adult CVD risk traits. These positive associations were attenuated when adjusted for adult BMI and height. Shorter length and lower BMI at birth were associated with higher glucose concentration in women. CONCLUSIONS Greater height or weight gain relative to height during childhood or adolescence was associated with a more adverse adult CVD risk marker profile, and this was mostly attributable to larger adult size.
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Affiliation(s)
| | - Senthil K Vasan
- Oxford Center for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, United Kingdom.
| | | | - Mahasampath Gowri
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Y S Hepsy
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - Joseph Richard
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - P Raghupathy
- Department of Child Health, Christian Medical College, Vellore, India
| | - Fredrik Karpe
- Oxford Center for Diabetes, Endocrinology, and Metabolism, University of Oxford, Oxford, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospital, Oxford, United Kingdom
| | - Clive Osmond
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Caroline H D Fall
- Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
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484
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Pierin AMG, Silva SSBED, Colósimo FC, Toma GDA, Serafim TDS, Meneghin P. Chronic and asymptomatic diseases influence the control of hypertension treatment in primary care. Rev Esc Enferm USP 2016; 50:763-770. [PMID: 27982394 DOI: 10.1590/s0080-623420160000600008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/23/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To identify the association between blood pressure control and the following variables: a) bio-social and lifestyle characteristics of hypertensive patients; and b) factors related to the antihypertensive treatment. METHODS This is an exploratory study with 290 people with hypertension from primary care. We used a specific instrument, self-administered, with 21 questions on factors that can hinder treatment, divided into four dimensions: medication, socioeconomic, institutional and personal beliefs. We adopted a significance level of p <0.05. RESULTS The control of blood pressure was associated (p <0.05) with female gender, Caucasian ethnicity, primary/secondary education, not drinking alcohol, higher income and regular physical activity. Regarding the factors that can hinder treatment, there was association of hypertension control with only two questions: "feel nothing" and "have to do treatment for life". CONCLUSION Sociodemographic variables and beliefs concerning the absence of symptoms and chronicity of the disease influenced the control of hypertension and should be considered in the adherence process to the treatment. OBJETIVO Identificar a associação entre o controle da pressão arterial e as seguintes variáveis: a) características biossociais e hábitos de vida dos hipertensos; e b) fatores relacionados ao tratamento anti-hipertensivo. MÉTODOS Realizou-se estudo exploratório com 290 hipertensos da atenção primária. Utilizou-se de instrumento específico, autoaplicável, com 21 questões sobre fatores que podem dificultar o tratamento, divididas em quatro domínios: medicamentos, socioeconômico, institucional e crenças pessoais. Adotou-se nível de significância de p < 0,05. RESULTADOS O controle da pressão arterial se associou (p < 0,05) com sexo feminino, etnia branca, ensino fundamental/médio, não ingerir bebida alcoólica, maior renda e atividade física regular. Quanto aos fatores que podem dificultar o tratamento, houve associação do controle com apenas duas questões: "não sentir nada" e "ter que fazer tratamento para vida toda". CONCLUSÃO Variáveis sociodemográficas e crenças relativas à ausência de sintomatologia e cronicidade da doença influenciaram o controle dos hipertensos e devem ser consideradas no processo de adesão ao tratamento.
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Affiliation(s)
| | | | - Flávia Cortez Colósimo
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem na Saúde do Adulto, São Paulo, SP, Brazil
| | | | | | - Paolo Meneghin
- Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil
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485
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Palafox B, McKee M, Balabanova D, AlHabib KF, Avezum AJ, Bahonar A, Ismail N, Chifamba J, Chow CK, Corsi DJ, Dagenais GR, Diaz R, Gupta R, Iqbal R, Kaur M, Khatib R, Kruger A, Kruger IM, Lanas F, Lopez-Jaramillo P, Minfan F, Mohan V, Mony PK, Oguz A, Palileo-Villanueva LM, Perel P, Poirier P, Rangarajan S, Rensheng L, Rosengren A, Soman B, Stuckler D, Subramanian SV, Teo K, Tsolekile LP, Wielgosz A, Yaguang P, Yeates K, Yongzhen M, Yusoff K, Yusuf R, Yusufali A, Zatońska K, Yusuf S. Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries. Int J Equity Health 2016; 15:199. [PMID: 27931255 PMCID: PMC5146857 DOI: 10.1186/s12939-016-0478-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study. METHODS A cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples. RESULTS Overall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden). CONCLUSION Inequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.
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Affiliation(s)
- Benjamin Palafox
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Martin McKee
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Dina Balabanova
- ECOHOST - The Centre for Health and Social Change, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Ahmad Bahonar
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noorhassim Ismail
- Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jephat Chifamba
- Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Clara K Chow
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | | | | | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Santa Fe, Argentina
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rasha Khatib
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Annamarie Kruger
- Africa Unit for Transdisciplinary Health Research and Medical Research Council Research Unit for Hypertension and Cardiovascular Disease, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Iolanthe Marike Kruger
- Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | | | - Patricio Lopez-Jaramillo
- Research Institute, Fundacion Oftalmologica de Santander; and Medical School, University of Santander, Floridablanca, Bucaramanga, Colombia
| | - Fu Minfan
- Daxing Health Center, Shenyang City, Liaoning Province, China
| | | | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Aytekin Oguz
- Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Pablo Perel
- World Heart Federation, Geneva, Switzerland.,The London School of Hygiene & Tropical Medicine, London, UK
| | - Paul Poirier
- Faculté de Pharmacie, Université Laval Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Lei Rensheng
- Center for Disease Control & Prevention, Nanchang City, Jiangxi Province, China
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden
| | - Biju Soman
- Health Action by People, Thiruvananthapuram, and Achutha Menon Centre for Health Science Studies, Sree Chitra Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - David Stuckler
- Department of Sociology, University of Oxford, Oxford, UK
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard University, Boston, MA, USA
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Peng Yaguang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, FuWai Hospital, Beijing, China
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Canada
| | - Mo Yongzhen
- Institute of Geriatrics, Nanjing City, Jiangsu Province, China
| | - Khalid Yusoff
- UCSI University, Kuala Lumpur, Malaysia.,Universiti Teknologi MARA, Selayang, Selangor, Malaysia
| | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | | | - Katarzyna Zatońska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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486
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Association of Pre-hospital ECG Administration With Clinical Outcomes in ST-Segment Myocardial Infarction: A Systematic Review and Meta-analysis. Can J Cardiol 2016; 32:1531-1541. [DOI: 10.1016/j.cjca.2016.06.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 02/03/2023] Open
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487
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Iyengar SS, Gupta R, Ravi S, Thangam S, Alexander T, Manjunath CN, Keshava R, Patil CB, Sheela A, Sawhney JPS. Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry. Indian Heart J 2016; 69:211-216. [PMID: 28460769 PMCID: PMC5414957 DOI: 10.1016/j.ihj.2016.09.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 09/14/2016] [Accepted: 09/29/2016] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) occurs at younger age in India but only a limited number of studies have evaluated risk factors and management status. This is a multisite observational registry to assess risk factors and treatment patterns in young patients presenting with acute coronary syndrome (ACS) and stable ischemic heart disease (IHD). METHODS We recruited 997 young patients (men <55, women <65y) presenting with ACS or stable IHD successively at 22 centers across India. Details of baseline risk factors and management status were obtained. Descriptive statistics are reported. RESULTS Mean age of participants was 49.1±8y, 72% were men and 68% had ACS. Family history of CAD was in 50%, diabetes 44%, hypertension 49%, history of dyslipidemia 11%, smoking/tobacco use 39%, and sedentary habits in 20%. 1.3% had "possible familial hypercholesterolemia". Metabolic risk factors (high BMI, diabetes and hypertension) were significantly greater in women (p<0.01). Women were older at diagnosis of CAD and presented more often with non-ST elevation ACS. In the study cohort antiplatelet use was in 85%, beta-blockers 38%, statins 63% and ACE inhibitors/ARBs in 41% while in ACS patients it was 80.5%, 54.6%, 80.8% and 40.8%, respectively. 35.9% patients underwent percutaneous coronary intervention while coronary bypass surgery was performed in 10.4%. CONCLUSIONS Conventional risk factors including family history continue to play a pivotal role in premature CAD in Indians. Women have more of metabolic risk factors, present at a later age and have non-ST elevation ACS more often. There is a need to focus on improving use of evidence-based drug therapies and interventions.
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Affiliation(s)
| | - Rajiv Gupta
- Eterna Heart Care Centre and Research Institute, Jaipur, India
| | - Sandhya Ravi
- Lotus Clinical Research Academy, Bangalore, India
| | | | | | - C N Manjunath
- Sri Jaideva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | | | - C B Patil
- St Philomena Hospital, Bangalore, India
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488
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Charlton K, Ware LJ, Menyanu E, Biritwum RB, Naidoo N, Pieterse C, Madurai S(L, Baumgartner J, Asare GA, Thiele E, Schutte AE, Kowal P. Leveraging ongoing research to evaluate the health impacts of South Africa's salt reduction strategy: a prospective nested cohort within the WHO-SAGE multicountry, longitudinal study. BMJ Open 2016; 6:e013316. [PMID: 27903563 PMCID: PMC5168565 DOI: 10.1136/bmjopen-2016-013316] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Attempting to curb the rising epidemic of hypertension, South Africa implemented legislation in June 2016 mandating maximum sodium levels in a range of manufactured foods that contribute significantly to population salt intake. This natural experiment, comparing two African countries with and without salt legislation, will provide timely information on the impact of legislative approaches addressing the food supply to improve blood pressure in African populations. This article outlines the design of this ongoing prospective nested cohort study. METHODS AND ANALYSIS Baseline sodium intake was assessed in a nested cohort of the WHO Study on global AGEing and adult health (WHO-SAGE) wave 2 (2014-2015), a multinational longitudinal study on the health and well-being of adults and the ageing process. The South African cohort consisted of randomly selected households (n=4030) across the country. Spot and 24-hour urine samples are collected in a random subsample (n=1200) and sodium, potassium, creatinine and iodine analysed. Salt behaviour and sociodemographic data are captured using face-to-face interviews, alongside blood pressure and anthropometric measures. Ghana, the selected control country with no formal salt policy, provided a nested subsample (n=1200) contributing spot and 24-hour urine samples from the SAGE Ghana cohort (n=5000). Follow-up interviews and urine collection (wave 3) in both countries will take place in 2017 (postlegislation) to assess change in population-level sodium intake and blood pressure. ETHICS AND DISSEMINATION SAGE was approved by the WHO Ethics Review Committee (reference number RPC149) with local approval from the North-West University Human Research Ethics Committee and University of the Witwatersrand Human Research Ethics Committee (South Africa), and University of Ghana Medical School Ethics and Protocol Review Committee (Ghana). The results of the study will be published in peer-reviewed international journals, presented at national and international conferences, and summarised as research and policy briefs.
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Affiliation(s)
- Karen Charlton
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Lisa J Ware
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Elias Menyanu
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | | | | | - Chiné Pieterse
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | | | - Jeannine Baumgartner
- Centre of Excellence for Nutrition, North-West University, Potchefstroom, South Africa
| | - George A Asare
- Chemical Pathology Unit, Department of Medical Laboratory Sciences, University of Ghana, Legon, Ghana
| | | | - Aletta E Schutte
- Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
- MRC Research Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Paul Kowal
- World Health Organization (WHO), Geneva, Switzerland
- University of Newcastle Research Centre for Generational Health and Ageing, Newcastle, New South Wales, Australia
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489
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Lee H, Oh SH, Cho H, Cho HJ, Kang HY. Prevalence and socio-economic burden of heart failure in an aging society of South Korea. BMC Cardiovasc Disord 2016; 16:215. [PMID: 27832754 PMCID: PMC5103434 DOI: 10.1186/s12872-016-0404-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Heart failure (HF) is one of the leading causes of morbidity and mortality in South Korea. With the rapidly aging population in the country, the prevalence of HF and its associated costs are expected to rise continuously. This study was carried out to estimate the prevalence and economic burden of HF in order to understand its impact on our society. METHODS A prevalence-based, cost-of-illness study was conducted using the 2014 Health Insurance Review and Assessment Service-National Patients Sample (HIRA-NPS) data. Adult HF patients were defined as those aged ≥19 years who had at least one insurance claim record with a primary or secondary diagnosis of HF (ICD-10 codes of I11.0, I13.0, I13.2, and I50.x). The costs consist of direct costs (i.e., medical and non-medical costs) and indirect costs (i.e., productivity loss cost due to morbidity and premature death). Subgroup analyses were conducted by age group, history of HF hospitalization, and type of universal health security program enrolled in. RESULTS A total of 475,019 adults were identified to have HF in 2014. The estimated prevalence rate of HF was 12.4 persons per 1,000 adults. According to the base cases and the extended definition of the cases, the annual economic burden of HF from a societal perspective ranges from USD 1,414.0 to 1,560.5 for individual patients, and from USD 752.8 million to 1,085.6 million for the country. A high percentage (68.5 %) of this socioeconomic burden consist of medical costs, followed by caregiver's cost (13.2 %), productivity loss costs due to premature death (10.8 %) and morbidity (4.2 %), and transportation costs (3.4 %). The HF patients with prior hospitalization due to HF annually spent 9.7 times more for National-Health-Insurance-covered medical costs compared to HF patients who were not previously hospitalized. CONCLUSIONS In the present study, HF patients who were older and had a history of prior hospitalization for HF as well as an indigent status were shown at high risk of spending more for healthcare to treat their HF. An effective disease management protocol should be employed to target this patient group.
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Affiliation(s)
- Hankil Lee
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Sung-Hee Oh
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Hyeonseok Cho
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, South Korea
| | - Hye-Young Kang
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea.
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490
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Goulart AC. "EMMA Study: a Brazilian community-based cohort study of stroke mortality and morbidity". SAO PAULO MED J 2016; 134:543-554. [PMID: 28076632 DOI: 10.1590/1516-3180.2016.024227092016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/27/2016] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity). DESIGN AND SETTINGS: Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014. METHODS: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses. RESULTS: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55). CONCLUSION: Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system.
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Affiliation(s)
- Alessandra Carvalho Goulart
- MD, PhD. Clinical Epidemiologist and Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo (SP), Brazil
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491
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Zhong Y, Rosengren A, Fu M, Welin L, Welin C, Caidahl K, Mandalenakis Z, Dellborg M, Svärdsudd K, Hansson PO. Secular changes in cardiovascular risk factors in Swedish 50-year-old men over a 50-year period: The study of men born in 1913, 1923, 1933, 1943, 1953 and 1963. Eur J Prev Cardiol 2016; 24:612-620. [DOI: 10.1177/2047487316676905] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- You Zhong
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Beijing Hospital, Beijing, PR China
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lennart Welin
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Lidköping Hospital, Lidköping, Sweden
| | - Catharina Welin
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kenneth Caidahl
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kurt Svärdsudd
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine Section, Uppsala University, Uppsala, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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492
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Secondary CV Prevention in South America in a Community Setting: The PURE Study. Glob Heart 2016; 12:305-313. [PMID: 27773540 DOI: 10.1016/j.gheart.2016.06.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/11/2016] [Accepted: 06/15/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Despite the availability of evidence-based therapies, there is no information on the use of medications for the secondary prevention of cardiovascular disease in urban and rural community settings in South America. OBJECTIVES This study sought to assess the use, and its predictors, of effective secondary prevention therapies in individuals with a history of coronary heart disease (CHD) or stroke. METHODS In the PURE (Prospective Urban Rural Epidemiological) study, we enrolled 24,713 individuals from South America ages 35 to 70 years from 97 rural and urban communities in Argentina, Brazil, Chile, and Colombia. We assessed the use of proven therapies with standardized questionnaires. We report estimates of drug use at national, community, and individual levels and the independent predictors of their utilization through a multivariable analysis model. RESULTS Of 24,713 individuals, 910 had a self-reported CHD event (at a median of 5 years earlier) and 407 had stroke (6 years earlier). The proportions of individuals with CHD who received antiplatelet medications (30.1%), beta-blockers (34.2%), angiotensin-converting enzyme inhibitors, or angiotensin-receptor blockers (36.0%), or statins (18.0%) were low; with even lower proportions among stroke patients (antiplatelets 24.3%, angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 37.6%, statins 9.8%). A substantial proportion of patients did not receive any proven therapy (CHD 31%, stroke 54%). A minority of patients received either all 4 (4.1%) or 3 proven therapies (3.3%). Male sex, age >60 years, better education, more wealth, urban location, diabetes, and obesity were associated with higher rates of medication use. In a multivariable model, markers of wealth had the largest impact in secondary prevention. CONCLUSIONS There are large gaps in the use of proven medications for secondary prevention of cardiovascular disease in South America. Strategies to improve the sustained use of these medications will likely reduce cardiovascular disease burden substantially.
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493
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Zhang X, Khan AA, Haq EU, Rahim A, Hu D, Attia J, Oldmeadow C, Ma X, Ding R, Boyle AJ. Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 3:47-52. [DOI: 10.1093/ehjqcco/qcw041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Indexed: 12/18/2022]
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494
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Jurca SJ, Elliott WJ. Common Substances That May Contribute to Resistant Hypertension, and Recommendations for Limiting Their Clinical Effects. Curr Hypertens Rep 2016; 18:73. [DOI: 10.1007/s11906-016-0682-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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495
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Ramírez-Vélez R, Correa-Bautista JE, Lobelo F, Izquierdo M, Alonso-Martínez A, Rodríguez-Rodríguez F, Cristi-Montero C. High muscular fitness has a powerful protective cardiometabolic effect in adults: influence of weight status. BMC Public Health 2016; 16:1012. [PMID: 27663845 PMCID: PMC5035511 DOI: 10.1186/s12889-016-3678-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 09/19/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Low levels of muscular fitness (MF) are recognized as an important marker of nutritional status and a predictor of metabolic complications, cardiovascular disease and death, however, the relationship between MF, body mass index (BMI) and the subsequent cardiometabolic protective effects has been less studied among Latin American populations. This study identified an association between MF and the cardiometabolic risk score index (CMRSI) and the lipid-metabolic cardiovascular risk index (LMCRI) in a wide sample of university students grouped according to their BMI. METHODS Six thousand ninety five healthy males (29.6 ± 11.7 year-old) participated in the study. Absolute strength was measured using a T.K.K. analogue dynamometer (handgrip), and the participant's strength was then calculated relative to their body mass (MF/BM). The LMCRI was derived from the levels of triglycerides, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and glucose levels in a blood sample. The CMRSI was calculated by summing the standardized residuals (z-score) for waist circumference, total cholesterol, LDL-c, triglycerides, HDL-c, and median blood pressure. Subjects were divided into six subgroups according to BMI (normal vs. overweight/obese) and MF/BM tertiles (unfit, average, fit). RESULTS The group of participants with low and moderate levels of MF/BM showed higher CMRSI values independent of BMI (P < 0.001). The group with normal BMI and high MF/BM had the highest levels of cardiometabolic protection. All overweight/obese BMI groups had significantly higher LMCRI values independent of the level of MF/BM (P < 0.001). CONCLUSIONS Participants with high MF/BM showed reduced cardiometabolic risk, which increased significantly when they were within normal parameters.
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Affiliation(s)
- Robinson Ramírez-Vélez
- Center for Studies on Measurement of Physical Activity, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, D.C, Colombia
| | - Jorge E Correa-Bautista
- Center for Studies on Measurement of Physical Activity, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, D.C, Colombia
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mikel Izquierdo
- GICAEDS Group, Faculty of Physical Culture, Sport and Recreation, Universidad Santo Tomás, Bogotá, D.C, Colombia. .,Department of Health Sciences, Public University of Navarra (Navarra) SPAIN, Campus of Tudela, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain.
| | - Alicia Alonso-Martínez
- Department of Health Sciences, Public University of Navarra (Navarra) SPAIN, Campus of Tudela, Av. de Tarazona s/n. 31500, Tudela, Navarra, Spain
| | | | - Carlos Cristi-Montero
- IRyS Group. School of Physical Education. Pontificia Universidad Católica de Valparaíso, Valparaiso, Chile
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496
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Banerjee A, Khandelwal S, Nambiar L, Saxena M, Peck V, Moniruzzaman M, Faria Neto JR, Quinto KC, Smyth A, Leong D, Werba JP. Health system barriers and facilitators to medication adherence for the secondary prevention of cardiovascular disease: a systematic review. Open Heart 2016; 3:e000438. [PMID: 27738515 PMCID: PMC5030589 DOI: 10.1136/openhrt-2016-000438] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/13/2022] Open
Abstract
Background Secondary prevention is cost-effective for cardiovascular disease (CVD), but uptake is suboptimal. Understanding barriers and facilitators to adherence to secondary prevention for CVD at multiple health system levels may inform policy. Objectives To conduct a systematic review of barriers and facilitators to adherence/persistence to secondary CVD prevention medications at health system level. Methods Included studies reported effects of health system level factors on adherence/persistence to secondary prevention medications for CVD (coronary artery or cerebrovascular disease). Studies considered at least one of β blockers, statins, angiotensin–renin system blockers and aspirin. Relevant databases were searched from 1 January 1966 until 1 October 2015. Full texts were screened for inclusion by 2 independent reviewers. Results Of 2246 screened articles, 25 studies were included (12 trials, 11 cohort studies, 1 cross-sectional study and 1 case–control study) with 132 140 individuals overall (smallest n=30, largest n=63 301). 3 studies included upper middle-income countries, 1 included a low middle-income country and 21 (84%) included high-income countries (9 in the USA). Studies concerned established CVD (n=4), cerebrovascular disease (n=7) and coronary heart disease (n=14). Three studies considered persistence and adherence. Quantity and quality of evidence was limited for adherence, persistence and across drug classes. Studies were concerned with governance and delivery (n=19, including 4 trials of fixed-dose combination therapy, FDC), intellectual resources (n=1), human resources (n=1) and health system financing (n=4). Full prescription coverage, reduced copayments, FDC and counselling were facilitators associated with higher adherence. Conclusions High-quality evidence on health system barriers and facilitators to adherence to secondary prevention medications for CVD is lacking, especially for low-income settings. Full prescription coverage, reduced copayments, FDC and counselling may be effective in improving adherence and are priorities for further research.
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Affiliation(s)
- Amitava Banerjee
- Farr Institute of Health Informatics Research, University College London , London , UK
| | | | | | | | - Victoria Peck
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
| | | | | | - Katherine Curi Quinto
- Instituto de Nutrición y Tecnología de los Alimentos, Asociación Kausasunchis-ADEK Perú, Lima , Peru
| | - Andrew Smyth
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
| | - Darryl Leong
- Population Health Research Institute, McMaster University , Hamilton, Ontario , Canada
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497
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Healthcare Professional Shortage and Task-Shifting to Prevent Cardiovascular Disease: Implications for Low- and Middle-Income Countries. Curr Cardiol Rep 2016; 17:115. [PMID: 26482758 DOI: 10.1007/s11886-015-0672-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular diseases (CVD) account for 18 million of annual global deaths with more than three quarters of these deaths occurring in low- and middle-income countries (LMIC). In LMIC, the distribution of risk factors is heterogeneous, with urban areas being the worst affected. Despite the availability of effective CVD interventions in developed countries, many poor countries still struggle to provide care due to lack of resources. In addition, many LMIC suffer from staff shortages which pose additional burden to the healthcare system. Regardless of these challenges, there are potentially effective strategies such as task-shifting which have been used for chronic conditions such as HIV to address the human resource crisis. We propose that through task-shifting, certain tasks related to prevention be shifted to non-physician health workers as well as non-nurse health workers such as community health workers. Such steps will allow better coverage of segments of the underserved population. We recognise that for task-shifting to be effective, issues such as clearly defined roles, evaluation, on-going training, and supervision must be addressed.
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498
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Feigin VL, Norrving B, George MG, Foltz JL, Roth GA, Mensah GA. Prevention of stroke: a strategic global imperative. Nat Rev Neurol 2016; 12:501-12. [PMID: 27448185 PMCID: PMC8114177 DOI: 10.1038/nrneurol.2016.107] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, School of Rehabilitation and Occupation Studies, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Studies, Auckland University of Technology, North Shore Campus, AA254, 90 Akoranga Drive, Northcote 0627, Private Bag 92006, Auckland 1142, New Zealand
| | - Bo Norrving
- Department of Clinical Sciences, Neurology, Lund University, Paradisgatan 2, Lund, Sweden
| | - Mary G George
- Division for Heart Disease &Stroke Prevention, Centers for Disease Control and Prevention, 600 Clifton Road, Atlanta, Georgia 30333, USA
| | - Jennifer L Foltz
- Division for Heart Disease &Stroke Prevention, Centers for Disease Control and Prevention, 600 Clifton Road, Atlanta, Georgia 30333, USA
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation and the Division of Cardiology, School of Medicine, University of Washington, 2301 5th Avenue Suite 600, Seattle, Washington 98121, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS) and Division of Cardiovascular Sciences; National Heart, Lung, and Blood Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, Maryland 20892, USA
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499
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Abstract
Patients with chronic heart failure (CHF) living in rural areas face an increased risk of adverse cardiovascular events. Even in countries with universal access to health care, rural areas are characteristically underserved, with reduced health care providers supply, greater distance to health care centers, decreased physician density with higher reliance on generalists, and high health care staff turnover. On the other hand, patient-related characteristics vary widely among published data. This review describes the epidemiology of CHF in rural or remote settings, organizational and patient-related factors involved in cardiovascular outcomes, and the role of interventions to improve rural health care.
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Affiliation(s)
- Hugo E Verdejo
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases FONDAP ACCDis, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, CP 8330024, Santiago, Chile.
| | - Catterina Ferreccio
- Advanced Center for Chronic Diseases FONDAP ACCDis, Division of Public Health and Family Medicine, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 434, CP 8330073, Santiago, Chile
| | - Pablo F Castro
- Division of Cardiovascular Diseases, Advanced Center for Chronic Diseases FONDAP ACCDis, Facultad de Medicina, Pontificia Universidad Catolica de Chile, Marcoleta 367, CP 8330024, Santiago, Chile
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O'Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, Rao-Melacini P, Zhang X, Pais P, Agapay S, Lopez-Jaramillo P, Damasceno A, Langhorne P, McQueen MJ, Rosengren A, Dehghan M, Hankey GJ, Dans AL, Elsayed A, Avezum A, Mondo C, Diener HC, Ryglewicz D, Czlonkowska A, Pogosova N, Weimar C, Iqbal R, Diaz R, Yusoff K, Yusufali A, Oguz A, Wang X, Penaherrera E, Lanas F, Ogah OS, Ogunniyi A, Iversen HK, Malaga G, Rumboldt Z, Oveisgharan S, Al Hussain F, Magazi D, Nilanont Y, Ferguson J, Pare G, Yusuf S. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet 2016; 388:761-75. [PMID: 27431356 DOI: 10.1016/s0140-6736(16)30506-2] [Citation(s) in RCA: 1216] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. METHODS We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals. FINDINGS Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72-3·28; PAR 47·9%, 99% CI 45·1-50·6), regular physical activity (0·60, 0·52-0·70; 35·8%, 27·7-44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65-2·06 for highest vs lowest tertile; 26·8%, 22·2-31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53-0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2-28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27-1·64 for highest vs lowest tertile; 18·6%, 13·3-25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78-2·72; 17·4%, 13·1-22·6), current smoking (1·67, 1·49-1·87; 12·4%, 10·2-14·9), cardiac causes (3·17, 2·68-3·75; 9·1%, 8·0-10·2), alcohol consumption (2·09, 1·64-2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4-9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05-1·30; 3·9%, 1·9-7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001). INTERPRETATION Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke. FUNDING Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.
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Affiliation(s)
- Martin J O'Donnell
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Health Research Board Clinical Research Facility, Department of Medicine, NUI Galway, Galway, Ireland.
| | - Siu Lim Chin
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Denis Xavier
- St John's Medical College and Research Institute, Bangalore, India
| | - Lisheng Liu
- National Center of Cardiovascular Disease, Beijing, China
| | - Hongye Zhang
- Beijing Hypertension League Institute, Beijing, China
| | - Purnima Rao-Melacini
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Xiaohe Zhang
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Prem Pais
- St John's Medical College and Research Institute, Bangalore, India
| | - Steven Agapay
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Patricio Lopez-Jaramillo
- Instituto de Investigaciones FOSCAL, Escuela de Medicina, Universidad de Santander, Bucaramanga, Colombia
| | | | - Peter Langhorne
- Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
| | - Matthew J McQueen
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Annika Rosengren
- Sahlgrenska University Hospital and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Graeme J Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
| | - Antonio L Dans
- College of Medicine, University of Philippines, Manila, Philippines
| | | | - Alvaro Avezum
- Instituto Dante Pazzanese de Cardiologia, Sao Paulo, Brazil
| | - Charles Mondo
- Uganda Heart Institute, Mulago Hospital, Kampala, Uganda
| | | | | | | | - Nana Pogosova
- National Research Center for Preventive Medicine of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | | | - Romaina Iqbal
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selayang, Selangor, Malaysia; UCSI University, Cheras, Kuala Lumpur, Malaysia
| | | | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Xingyu Wang
- Beijing Hypertension League Institute, Beijing, China
| | | | - Fernando Lanas
- Faculty of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Okechukwu S Ogah
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Division of Cardiovascular Medicine, Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Helle K Iversen
- Stroke Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Denmark
| | | | | | - Shahram Oveisgharan
- Rush Alzheimer Disease Research Center, Rush University Medical Center, Chicago, IL, USA
| | | | - Daliwonga Magazi
- Department of Medicine, University of Limpopo, Pretoria, South Africa
| | - Yongchai Nilanont
- Neurology Division, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - John Ferguson
- Health Research Board Clinical Research Facility, Department of Medicine, NUI Galway, Galway, Ireland
| | - Guillaume Pare
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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