551
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Anand SS, Hawkes C, de Souza RJ, Mente A, Dehghan M, Nugent R, Zulyniak MA, Weis T, Bernstein AM, Krauss RM, Kromhout D, Jenkins DJA, Malik V, Martinez-Gonzalez MA, Mozaffarian D, Yusuf S, Willett WC, Popkin BM. Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System: A Report From the Workshop Convened by the World Heart Federation. J Am Coll Cardiol 2015; 66:1590-1614. [PMID: 26429085 PMCID: PMC4597475 DOI: 10.1016/j.jacc.2015.07.050] [Citation(s) in RCA: 281] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/16/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023]
Abstract
Major scholars in the field, on the basis of a 3-day consensus, created an in-depth review of current knowledge on the role of diet in cardiovascular disease (CVD), the changing global food system and global dietary patterns, and potential policy solutions. Evidence from different countries and age/race/ethnicity/socioeconomic groups suggesting the health effects studies of foods, macronutrients, and dietary patterns on CVD appear to be far more consistent though regional knowledge gaps is highlighted. Large gaps in knowledge about the association of macronutrients to CVD in low- and middle-income countries particularly linked with dietary patterns are reviewed. Our understanding of foods and macronutrients in relationship to CVD is broadly clear; however, major gaps exist both in dietary pattern research and ways to change diets and food systems. On the basis of the current evidence, the traditional Mediterranean-type diet, including plant foods and emphasis on plant protein sources provides a well-tested healthy dietary pattern to reduce CVD.
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Affiliation(s)
- Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Corinna Hawkes
- Centre for Food Policy, City University, London, United Kingdom
| | - Russell J de Souza
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Mente
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Rachel Nugent
- Department of Global Health, University of Washington, Seattle, Washington
| | | | - Tony Weis
- Department of Geography, University of Western Ontario, London, Ontario, Canada
| | - Adam M Bernstein
- Center for Lifestyle Medicine, Cleveland Clinic, Lyndhurst, Ohio
| | - Ronald M Krauss
- Children's Hospital Oakland Research Institute, Oakland, California
| | - Daan Kromhout
- Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands
| | - David J A Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Clinical Nutrition & Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Vasanti Malik
- Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
| | | | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, Boston, Massachusetts
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Walter C Willett
- Departamento de Medicina Preventiva y Salud Publica, Universidad de Navarra-CIBEROBN, Pamplona, Spain
| | - Barry M Popkin
- Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, North Carolina.
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552
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Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, Mentzelopoulos SD, Nolan JP, Van de Voorde P, Xanthos TT, Georgiou M, Lippert FK, Steen PA. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:302-11. [DOI: 10.1016/j.resuscitation.2015.07.033] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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553
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Heart failure in low- and middle-income countries: background, rationale, and design of the INTERnational Congestive Heart Failure Study (INTER-CHF). Am Heart J 2015; 170:627-634.e1. [PMID: 26386785 DOI: 10.1016/j.ahj.2015.07.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 07/02/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although heart failure (HF) has been referred to as a global epidemic, most HF information comes from high-income countries, with little information about low-income countries (LIC) and middle-income countries (MIC) in Africa, Asia, the Middle East, and South America, which make up the majority of the world's population. METHODS The INTERnational Congestive Heart Failure Study is a cohort study of 5,813 HF patients enrolled in 108 centers in 16 LIC and MIC. At baseline, data were recorded on sociodemographic and clinical risk factors, HF etiology, laboratory variables, management, and barriers to evidence-based HF care at the patient, physician, and system levels. We sought to enroll consecutive and consenting patients ≥18 years of age with a clinical diagnosis of HF seen in outpatient clinics (2/3 of patients) or inpatient hospital wards (1/3 of patients). Patients were followed up at 6 and 12 months post-enrollment to record clinical status, treatments, and clinical outcomes such as death and hospitalizations. In the 5,813 enrolled HF patients, the mean age was 59 ± 15 years, 40% were female, 62% had a history of hypertension, 30% had diabetes, 21% had prior myocardial infarction, 64% were recruited from outpatient clinics, 36% lived in rural areas, and 29% had HF with preserved left ventricular ejection fraction. CONCLUSIONS This unique HF registry aims to systematically gather information on sociodemographic and clinical risk factors, etiologies, treatments, barriers to evidence-based care, and outcomes of HF in LIC and MIC. This information will help improve the management of HF globally.
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554
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Global prevention and control of NCDs: Limitations of the standard approach. J Public Health Policy 2015; 36:408-25. [PMID: 26377446 DOI: 10.1057/jphp.2015.29] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The five-target '25 × 25' strategy for tackling the emerging global epidemic of non-communicable diseases (NCDs) focuses on four diseases (CVD, diabetes, cancer, and chronic respiratory disease), four risk factors (tobacco, diet and physical activity, dietary salt, and alcohol), and one cardiovascular preventive drug treatment. The goal is to decrease mortality from NCDs by 25 per cent by the year 2025. The 'standard approach' to the '25 × 25' strategy has the benefit of simplicity, but also has major weaknesses. These include lack of recognition of: (i) the fundamental drivers of the NCD epidemic; (ii) the 'missing NCDs', which are major causes of morbidity; (iii) the 'missing causes' and the 'causes of the causes'; and (iv) the role of health care and the need for integration of interventions.
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555
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Lee SD, Tontonoz P. Liver X receptors at the intersection of lipid metabolism and atherogenesis. Atherosclerosis 2015; 242:29-36. [PMID: 26164157 PMCID: PMC4546914 DOI: 10.1016/j.atherosclerosis.2015.06.042] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/19/2015] [Accepted: 06/22/2015] [Indexed: 12/14/2022]
Affiliation(s)
- Stephen D Lee
- Howard Hughes Medical Institute, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095, USA
| | - Peter Tontonoz
- Howard Hughes Medical Institute, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA 90095, USA.
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556
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Brola W, Sobolewski P, Fudala M, Goral A, Kasprzyk M, Szczuchniak W, Pejas-Dulewicz R, Przybylski W. Metabolic Syndrome in Polish Ischemic Stroke Patients. J Stroke Cerebrovasc Dis 2015; 24:2167-72. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022] Open
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557
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Tu JV, Chu A, Rezai MR, Guo H, Maclagan LC, Austin PC, Booth GL, Manuel DG, Chiu M, Ko DT, Lee DS, Shah BR, Donovan LR, Sohail QZ, Alter DA. The Incidence of Major Cardiovascular Events in Immigrants to Ontario, Canada: The CANHEART Immigrant Study. Circulation 2015; 132:1549–1559. [PMID: 26324719 PMCID: PMC4606988 DOI: 10.1161/circulationaha.115.015345] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Immigrants from ethnic minority groups represent an increasing proportion of the population in many high-income countries, but little is known about the causes and amount of variation between various immigrant groups in the incidence of major cardiovascular events.
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Affiliation(s)
- Jack V Tu
- Institute for Clinical Evaluative Sciences; Schulich Heart Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, Ontario, Canada
| | - Anna Chu
- Institute for Clinical Evaluative Sciences & University of Toronto, Toronto, Ontario, Canada
| | - Mohammad R Rezai
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Helen Guo
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Laura C Maclagan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Peter C Austin
- Institute for Clinical Evaluative Sciences & University of Toronto, Toronto, Ontario, Canada
| | - Gillian L Booth
- Institute for Clinical Evaluative Sciences; University of Toronto; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Douglas G Manuel
- Institute for Clinical Evaluative Sciences, Toronto; University of Toronto, Toronto; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Maria Chiu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Dennis T Ko
- Institute for Clinical Evaluative Sciences; Schulich Heart Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, Ontario, Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences; University of Toronto; Peter Munk Cardiac Centre and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
| | - Baiju R Shah
- Institute for Clinical Evaluative Sciences; University of Toronto; Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda R Donovan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - David A Alter
- Institute for Clinical Evaluative Sciences; University of Toronto; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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558
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Kayima J, Nankabirwa J, Sinabulya I, Nakibuuka J, Zhu X, Rahman M, Longenecker CT, Katamba A, Mayanja-Kizza H, Kamya MR. Determinants of hypertension in a young adult Ugandan population in epidemiological transition-the MEPI-CVD survey. BMC Public Health 2015; 15:830. [PMID: 26315787 PMCID: PMC4552375 DOI: 10.1186/s12889-015-2146-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 08/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High blood pressure is the principal risk factor for stroke, heart failure and kidney failure in the young population in Africa. Control of hypertension is associated with a larger reduction in morbidity and mortality in younger populations compared with the elderly; however, blood pressure control efforts in the young are hampered by scarcity of data on prevalence and factors influencing awareness, treatment and control of hypertension. We aimed to describe the prevalence of prehypertension and hypertension among young adults in a peri-urban district of Uganda and the factors associated with occurrence of hypertension in this population. METHODS This cross-sectional study was conducted between August, 2012 and May 2013 in Wakiso district, a suburban district that that encircles Kampala, Uganda's capital city. We collected data on socio-demographic characteristics and hypertension status using a modified STEPs questionnaire from 3685 subjects aged 18-40 years selected by multistage cluster sampling. Blood pressure and anthropometric measurements were performed using standardized protocols. Fasting blood sugar and HIV status were determined using a venous blood sample. Association between hypertension status and various biosocial factors was assessed using logistic regression. RESULTS The overall prevalence of hypertension was 15% (95% CI 14.2 - 19.6) and 40% were pre-hypertensive. Among the 553 hypertensive participants, 76 (13.7%) were aware of their diagnosis and all these participants had initiated therapy with target blood pressure control attained in 20% of treated subjects. Hypertension was significantly associated with the older age-group, male sex and obesity. There was a significantly lower prevalence of hypertension among participants with HIV OR 0.6 (95% CI 0.4-0.8, P = 0.007). CONCLUSION There is a high prevalence of high blood pressure in this young periurban population of Uganda with sub-optimal diagnosis and control. There is previously undocumented high rate of treatment, a unique finding that may be exploited to drive efforts to control hypertension. Specific programs for early diagnosis and treatment of hypertension among the young should be developed to improve control of hypertension. The relationship between HIV infection and blood pressure requires further clarification by longitudinal studies.
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Affiliation(s)
- James Kayima
- Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Joaniter Nankabirwa
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Isaac Sinabulya
- Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Jane Nakibuuka
- Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Xiaofeng Zhu
- Department of Epidemiology, Case Western Reserve University School of Medicine Cleveland, Cleveland, OH, USA.
| | - Mahboob Rahman
- Clinical Hypertension Program, University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Christopher T Longenecker
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Achilles Katamba
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Harriet Mayanja-Kizza
- Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Moses R Kamya
- Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
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559
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Noubiap JJN, Nansseu JRN. Are the current recommendations for the use of aspirin in primary prevention of cardiovascular disease applicable in low-income countries? Vasc Health Risk Manag 2015; 11:503-6. [PMID: 26345154 PMCID: PMC4556041 DOI: 10.2147/vhrm.s87398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although evidence has accumulated that long-term aspirin therapy is beneficial in secondary prevention of cardiovascular disease (CVD), a lot of controversies persist regarding the benefit of aspirin use in primary prevention of CVD. In low-income countries (LIC) specifically, the decision to prescribe aspirin for primary CVD prevention is more problematic, as there is a dearth of evidence in this regard. Aspirin has been shown to have relative beneficial effects in preventing a first myocardial infarction, but not stroke. However, as stroke is the prevailing CVD in many LIC, especially in Africa, the benefit of aspirin in these settings is therefore questionable. Indeed, there is no published trial that has evaluated the benefits and risks of continuous aspirin therapy in populations of LIC. Furthermore, though cardiovascular risk assessment is crucial in decision-making for the use of aspirin in primary prevention of CVD, there are no risk assessment tools that have been validated in African populations. Studies are urgently warranted, to determine the usefulness of aspirin in primary prevention of CVD in low-income settings where the drug is highly available and affordable, as CVD is becoming the leading cause of deaths in LIC.
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Affiliation(s)
- Jean Jacques N Noubiap
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa ; Medical Diagnostic Center, Yaoundé, Cameroon
| | - Jobert Richie N Nansseu
- Sickle Cell Disease Unit, Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon ; Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
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560
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Quispe R, Bazo-Alvarez JC, Burroughs Peña MS, Poterico JA, Gilman RH, Checkley W, Bernabé-Ortiz A, Huffman MD, Miranda JJ. Distribution of Short-Term and Lifetime Predicted Risks of Cardiovascular Diseases in Peruvian Adults. J Am Heart Assoc 2015; 4:e002112. [PMID: 26254303 PMCID: PMC4599468 DOI: 10.1161/jaha.115.002112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Short-term risk assessment tools for prediction of cardiovascular disease events are widely recommended in clinical practice and are used largely for single time-point estimations; however, persons with low predicted short-term risk may have higher risks across longer time horizons. METHODS AND RESULTS We estimated short-term and lifetime cardiovascular disease risk in a pooled population from 2 studies of Peruvian populations. Short-term risk was estimated using the atherosclerotic cardiovascular disease Pooled Cohort Risk Equations. Lifetime risk was evaluated using the algorithm derived from the Framingham Heart Study cohort. Using previously published thresholds, participants were classified into 3 categories: low short-term and low lifetime risk, low short-term and high lifetime risk, and high short-term predicted risk. We also compared the distribution of these risk profiles across educational level, wealth index, and place of residence. We included 2844 participants (50% men, mean age 55.9 years [SD 10.2 years]) in the analysis. Approximately 1 of every 3 participants (34% [95% CI 33 to 36]) had a high short-term estimated cardiovascular disease risk. Among those with a low short-term predicted risk, more than half (54% [95% CI 52 to 56]) had a high lifetime predicted risk. Short-term and lifetime predicted risks were higher for participants with lower versus higher wealth indexes and educational levels and for those living in urban versus rural areas (P<0.01). These results were consistent by sex. CONCLUSIONS These findings highlight potential shortcomings of using short-term risk tools for primary prevention strategies because a substantial proportion of Peruvian adults were classified as low short-term risk but high lifetime risk. Vulnerable adults, such as those from low socioeconomic status and those living in urban areas, may need greater attention regarding cardiovascular preventive strategies.
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Affiliation(s)
- Renato Quispe
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (R.Q., J.C.B.A., M.S.B.P., J.A.P., A.B.O., J.M.)
| | - Juan Carlos Bazo-Alvarez
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (R.Q., J.C.B.A., M.S.B.P., J.A.P., A.B.O., J.M.)
| | - Melissa S Burroughs Peña
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (R.Q., J.C.B.A., M.S.B.P., J.A.P., A.B.O., J.M.) Duke University Research Institute, Duke University, Durham, NC (M.S.B.P.)
| | - Julio A Poterico
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (R.Q., J.C.B.A., M.S.B.P., J.A.P., A.B.O., J.M.)
| | - Robert H Gilman
- Asociación Benéfica PRISMA, Lima, Peru (R.H.G.) Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (R.H.G., W.C.)
| | - William Checkley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (R.H.G., W.C.) Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD (W.C.)
| | - Antonio Bernabé-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (R.Q., J.C.B.A., M.S.B.P., J.A.P., A.B.O., J.M.)
| | - Mark D Huffman
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL (M.D.H.)
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru (R.Q., J.C.B.A., M.S.B.P., J.A.P., A.B.O., J.M.) Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru (J.M.)
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561
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Estol CJ. Letter by Estol Regarding Article, "New Strategy to Reduce the Global Burden of Stroke". Stroke 2015; 46:e194. [PMID: 26089333 DOI: 10.1161/strokeaha.115.010034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Conrado J Estol
- Heart and Brain Medicine, Av Callao 875, CABA 1023, Argentina
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562
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Yusuf S, Wood D, Ralston J, Reddy KS. The World Heart Federation's vision for worldwide cardiovascular disease prevention. Lancet 2015; 386:399-402. [PMID: 25892680 DOI: 10.1016/s0140-6736(15)60265-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
| | - David Wood
- International Centre for Circulatory Health, Imperial College, London, UK
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563
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Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A, Seron P, Ahmed SH, Rosengren A, Kelishadi R, Rahman O, Swaminathan S, Iqbal R, Gupta R, Lear SA, Oguz A, Yusoff K, Zatonska K, Chifamba J, Igumbor E, Mohan V, Anjana RM, Gu H, Li W, Yusuf S. Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 2015; 386:266-73. [PMID: 25982160 DOI: 10.1016/s0140-6736(14)62000-6] [Citation(s) in RCA: 1116] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual's risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries. METHODS The Prospective Urban-Rural Epidemiology (PURE) study is a large, longitudinal population study done in 17 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years and if household members intended to stay at that address for another 4 years. Participants were assessed for grip strength, measured using a Jamar dynamometer. During a median follow-up of 4.0 years (IQR 2.9-5.1), we assessed all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, hospital admission for pneumonia or chronic obstructive pulmonary disease (COPD), hospital admission for any respiratory disease (including COPD, asthma, tuberculosis, and pneumonia), injury due to fall, and fracture. Study outcomes were adjudicated using source documents by a local investigator, and a subset were adjudicated centrally. FINDINGS Between January, 2003, and December, 2009, a total of 142,861 participants were enrolled in the PURE study, of whom 139,691 with known vital status were included in the analysis. During a median follow-up of 4.0 years (IQR 2.9-5.1), 3379 (2%) of 139,691 participants died. After adjustment, the association between grip strength and each outcome, with the exceptions of cancer and hospital admission due to respiratory illness, was similar across country-income strata. Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1.16, 95% CI 1.13-1.20; p<0.0001), cardiovascular mortality (1.17, 1.11-1.24; p<0.0001), non-cardiovascular mortality (1.17, 1.12-1.21; p<0.0001), myocardial infarction (1.07, 1.02-1.11; p=0.002), and stroke (1.09, 1.05-1.15; p<0.0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. We found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, injury from fall, or fracture. In high-income countries, the risk of cancer and grip strength were positively associated (0.916, 0.880-0.953; p<0.0001), but this association was not found in middle-income and low-income countries. INTERPRETATION This study suggests that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease. Further research is needed to identify determinants of muscular strength and to test whether improvement in strength reduces mortality and cardiovascular disease. FUNDING Full funding sources listed at end of paper (see Acknowledgments).
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Affiliation(s)
- Darryl P Leong
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Koon K Teo
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo University, Brazil
| | - Andres Orlandini
- ECLA Foundation, Instituto Cardiovascular de Rosario, Rosario, Argentina
| | | | - Suad H Ahmed
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
| | - Aytekin Oguz
- Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Khalid Yusoff
- Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia; UCSI University, Cheras, Kuala Kumpur, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Medical University of Wrocław, Wrocław, Poland
| | | | - Ehimario Igumbor
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | | | | | - Hongqiu Gu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & 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 & Peking Union Medical College, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Hamilton Health Sciences, Hamilton, ON, Canada
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564
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Affiliation(s)
- Avan Aihie Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK; Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK.
| | - Thomas B L Kirkwood
- Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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565
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Gijsberts CM, Seneviratna A, Hoefer IE, Agostoni P, Rittersma SZH, Pasterkamp G, Hartman M, Pinto de Carvalho L, Richards AM, Asselbergs FW, de Kleijn DPV, Chan MY. Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients. PLoS One 2015; 10:e0131977. [PMID: 26147437 PMCID: PMC4492790 DOI: 10.1371/journal.pone.0131977] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic "synergy between percutaneous coronary intervention (PCI) with taxus and cardiac surgery" (SYNTAX) score quantifies CAD severity and predicts outcomes. We studied CAD severity and all-cause mortality in four globally populous ethnic groups: Caucasians, Chinese, Indians and Malays. METHODS We quantified SYNTAX scores of 1,000 multi-ethnic patients undergoing PCI in two tertiary hospitals in the Netherlands (Caucasians) and Singapore (Chinese, Indians and Malays). Within each ethnicity we studied 150 patients with stable CAD and 100 with ST-elevated myocardial infarction (STEMI). We made inter-ethnic comparisons of SYNTAX scores and all-cause mortality. RESULTS Despite having a younger age (mean age Indians: 56.8 and Malays: 57.7 vs. Caucasians: 63.7 years), multivariable adjusted SYNTAX scores were significantly higher in Indians and Malays than Caucasians with stable CAD: 13.4 [11.9-14.9] and 13.4 [12.0-14.8] vs. 9.4 [8.1-10.8], p<0.001. Among STEMI patients, SYNTAX scores were highest in Chinese and Malays: 17.7 [15.9-19.5] and 18.8 [17.1-20.6] vs. 15.5 [13.5-17.4] and 12.7 [10.9-14.6] in Indians and Caucasians, p<0.001. Over a median follow-up of 709 days, 67 deaths (stable CAD: 37, STEMI: 30) occurred. Among STEMI patients, the SYNTAX score independently predicted all-cause mortality: HR 2.5 [1.7-3.8], p<0.001 for every 10-point increase. All-cause mortality was higher in Indian and Malay STEMI patients than Caucasians, independent of SYNTAX score (adjusted HR 7.2 [1.5-34.7], p=0.01 and 5.8 [1.2-27.2], p=0.02). CONCLUSION Among stable CAD and STEMI patients requiring PCI, CAD is more severe in Indians and Malays than in Caucasians, despite having a younger age. Moreover, Indian and Malay STEMI patients had a greater adjusted risk of all-cause mortality than Caucasians, independent of SYNTAX score.
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Affiliation(s)
- Crystel M. Gijsberts
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands
| | | | - Imo E. Hoefer
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Leonardo Pinto de Carvalho
- Cardiac Department, National University Hospital, Singapore
- Department of Cardiology, Albert Einstein Hospital, Sao Paulo, Brazil
| | - A. Mark Richards
- Cardiac Department, National University Hospital, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
| | - Folkert W. Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
- Institute of Cardiovascular Science, faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Dominique P. V. de Kleijn
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, the Netherlands
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
| | - Mark Y. Chan
- Cardiac Department, National University Hospital, Singapore
- Cardiovascular Research Institute (CVRI), National University Heart Centre (NUHCS), National University Health System, Singapore
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566
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Noubiap JJN, Essouma M, Bigna JJR. Targeting Household Air Pollution for Curbing the Cardiovascular Disease Burden: A Health Priority in Sub-Saharan Africa. J Clin Hypertens (Greenwich) 2015; 17:825-9. [PMID: 26140428 DOI: 10.1111/jch.12610] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/06/2015] [Accepted: 05/18/2015] [Indexed: 01/10/2023]
Abstract
Household air pollution (HAP) is a major public health problem, particularly in sub-Saharan Africa where most of the populations still rely on solid fuels for cooking, heating, and lighting. This narrative review highlights the direct and indirect evidence of the important role of HAP in cardiovascular disease, especially in sub-Saharan African countries where highest rates of major cardiovascular disease and death are observed, and thus provides ample reason for promotion of preventive interventions to reduce HAP exposures in the region. There is an urgent need for efficient strategies to educate populations on the health issues associated with this health hazard, to provide affordable clean cooking energy for poor people and to promote improved household ventilation. High-quality data on household energy practices and patterns of HAP and related health issues are still needed for efficient policy making in this region.
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Affiliation(s)
- Jean Jacques N Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.,Medical Diagnostic Center, Yaoundé, Cameroon
| | - Mickael Essouma
- Internal Medicine Unit, Sangmelima Reference Hospital, Sangmelima, Cameroon
| | - Jean Joel R Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Yaoundé, Member of International Network of the Pasteur Institutes, Yaoundé, Cameroon
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567
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Gupta R. Convergence in urban–rural prevalence of hypertension in India. J Hum Hypertens 2015; 30:79-82. [DOI: 10.1038/jhh.2015.48] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 11/09/2022]
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568
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Fernando E, Razak F, Lear SA, Anand SS. Cardiovascular Disease in South Asian Migrants. Can J Cardiol 2015; 31:1139-50. [PMID: 26321436 DOI: 10.1016/j.cjca.2015.06.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/11/2015] [Accepted: 06/11/2015] [Indexed: 02/09/2023] Open
Abstract
Cardiovascular disease (CVD) represents a significant cause of global mortality and morbidity. South Asians (SAs) have a particularly high burden of coronary artery disease (CAD). This review describes current literature regarding the prevalence, incidence, etiology, and prognosis of CVD in SA migrants to high-income nations. We conducted a narrative review of CVD in the SA diaspora through a search of MEDLINE and PubMed. We included observational studies, randomized clinical trials, nonsystematic reviews, systematic reviews, and meta-analyses written in English. Of 15,231 articles identified, 827 articles were screened and 124 formed the basis for review. SA migrants have a 1.5-2 times greater prevalence of CAD than age- and sex-adjusted Europids. Increased abdominal obesity and body fat and increased burden of type 2 diabetes mellitus and dyslipidemia appear to be primary drivers of the excess CAD burden in SAs. Sedentary lifestyle and changes in diet after immigration are important contributors to weight gain and adiposity. Early life factors, physical activity patterns and, in some cases, reduced adherence to medical therapy may contribute to increased CVD risks in SAs. Novel biomarkers like leptin and adipokines may show distinct patterns in SAs and provide insights into cardiometabolic risk determinants. In conclusion, SAs have distinct CVD risk predispositions, with a complex relationship to cultural, innate, and acquired factors. Although CVD risk factor management and treatment among SAs is improving, opportunities exist for further advances.
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Affiliation(s)
- Eshan Fernando
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Harvard Center for Population and Development Studies, Boston, Massachusetts, USA
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada; Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Sonia S Anand
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Epidemiology, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Chanchlani Research Centre, McMaster University, Hamilton, Ontario, Canada.
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569
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Krishnadath IS, Smits CC, Jaddoe VW, Hofman A, Toelsie JR. A National Surveillance Survey on Noncommunicable Disease Risk Factors: Suriname Health Study Protocol. JMIR Res Protoc 2015; 4:e75. [PMID: 26085372 PMCID: PMC4526944 DOI: 10.2196/resprot.4205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/03/2015] [Indexed: 11/24/2022] Open
Abstract
Background Noncommunicable diseases (NCDs) are the leading cause of death in low- and middle-income countries. Therefore, the surveillance of risk factors has become an issue of major importance for planning and implementation of preventive measures. Unfortunately, in these countries data on NCDs and their risk factors are limited. This also prevails in Suriname, a middle-income country of the Caribbean, with a multiethnic/multicultural population living in diverse residential areas. For these reasons, “The Suriname Health Study” was designed. Objective The main objective of this study is to estimate the prevalence of NCD risk factors, including metabolic syndrome, hypertension, and diabetes in Suriname. Differences between specific age groups, sexes, ethnic groups, and geographical areas will be emphasized. In addition, risk groups will be identified and targeted actions will be designed and evaluated. Methods In this study, several methodologies were combined. A stratified multistage cluster sample was used to select the participants of 6 ethnic groups (Hindustani, Creole, Javanese, Maroon, Chinese, Amerindians, and mixed) divided into 5 age groups (between 15 and 65 years) who live in urban/rural areas or the hinterland. A standardized World Health Organization STEPwise approach to surveillance questionnaire was adapted and used to obtain information about demographic characteristics, lifestyle, and risk factors. Physical examinations were performed to measure blood pressure, height, weight, and waist circumference. Biochemical analysis of collected blood samples evaluated the levels of glucose, high-density-lipoprotein cholesterol, total cholesterol, and triglycerides. Statistical analysis will be used to identify the burden of modifiable and unmodifiable risk factors in the aforementioned subgroups. Subsequently, tailor-made interventions will be prepared and their effects will be evaluated. Results The data as collected allow for national inference and valid analysis of the age, sex, and ethnicity subgroups in the Surinamese population. A publication of the basic survey results is anticipated in mid-2015. Secondary results on the effect of targeted lifestyle interventions are anticipated in late 2017. Conclusions Using the data collected in this study, the national prevalence of NCD risk factors will be approximated and described in a diverse population. This study is an entry point for formulating the structure of NCD prevention and surveillance.
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Affiliation(s)
- Ingrid Sk Krishnadath
- Department of Public Health, Faculty of Medical Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname.
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570
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Hajifathalian K, Ueda P, Lu Y, Woodward M, Ahmadvand A, Aguilar-Salinas CA, Azizi F, Cifkova R, Di Cesare M, Eriksen L, Farzadfar F, Ikeda N, Khalili D, Khang YH, Lanska V, León-Muñoz L, Magliano D, Msyamboza KP, Oh K, Rodríguez-Artalejo F, Rojas-Martinez R, Shaw JE, Stevens GA, Tolstrup J, Zhou B, Salomon JA, Ezzati M, Danaei G. A novel risk score to predict cardiovascular disease risk in national populations (Globorisk): a pooled analysis of prospective cohorts and health examination surveys. Lancet Diabetes Endocrinol 2015; 3:339-55. [PMID: 25819778 PMCID: PMC7615120 DOI: 10.1016/s2213-8587(15)00081-9] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/07/2015] [Accepted: 01/09/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND Treatment of cardiovascular risk factors based on disease risk depends on valid risk prediction equations. We aimed to develop, and apply in example countries, a risk prediction equation for cardiovascular disease (consisting here of coronary heart disease and stroke) that can be recalibrated and updated for application in different countries with routinely available information. METHODS We used data from eight prospective cohort studies to estimate coefficients of the risk equation with proportional hazard regressions. The risk prediction equation included smoking, blood pressure, diabetes, and total cholesterol, and allowed the effects of sex and age on cardiovascular disease to vary between cohorts or countries. We developed risk equations for fatal cardiovascular disease and for fatal plus non-fatal cardiovascular disease. We validated the risk equations internally and also using data from three cohorts that were not used to create the equations. We then used the risk prediction equation and data from recent (2006 or later) national health surveys to estimate the proportion of the population at different levels of cardiovascular disease risk in 11 countries from different world regions (China, Czech Republic, Denmark, England, Iran, Japan, Malawi, Mexico, South Korea, Spain, and USA). FINDINGS The risk score discriminated well in internal and external validations, with C statistics generally 70% or more. At any age and risk factor level, the estimated 10 year fatal cardiovascular disease risk varied substantially between countries. The prevalence of people at high risk of fatal cardiovascular disease was lowest in South Korea, Spain, and Denmark, where only 5-10% of men and women had more than a 10% risk, and 62-77% of men and 79-82% of women had less than a 3% risk. Conversely, the proportion of people at high risk of fatal cardiovascular disease was largest in China and Mexico. In China, 33% of men and 28% of women had a 10-year risk of fatal cardiovascular disease of 10% or more, whereas in Mexico, the prevalence of this high risk was 16% for men and 11% for women. The prevalence of less than a 3% risk was 37% for men and 42% for women in China, and 55% for men and 69% for women in Mexico. INTERPRETATION We developed a cardiovascular disease risk equation that can be recalibrated for application in different countries with routinely available information. The estimated percentage of people at high risk of fatal cardiovascular disease was higher in low-income and middle-income countries than in high-income countries. FUNDING US National Institutes of Health, UK Medical Research Council, Wellcome Trust.
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Affiliation(s)
- Kaveh Hajifathalian
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA; Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Peter Ueda
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Yuan Lu
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA
| | - Mark Woodward
- The George Institute for Global Health, Nuffield Department of Population 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
| | - 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
| | - Carlos A Aguilar-Salinas
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Fereidoun Azizi
- Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Renata Cifkova
- Department of Preventive Cardiology, Thomayer Teaching 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
| | - 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
| | - Nayu Ikeda
- Center for International Collaboration and Partnership, National Institute of Health and Nutrition, Tokyo, Japan
| | - Davood Khalili
- 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, Madrid, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Dianna Magliano
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | | | - Kyungwon Oh
- Division of Health and Nutrition Survey, Korea Centers for Disease Control and Prevention, Cheongwon-gun, South Korea
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/Idipaz, Madrid, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain
| | - Rosalba Rojas-Martinez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Publica, Mexico City, Mexico
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Gretchen A Stevens
- Department of Health Statistics and Information Systems, WHO, Geneva, Switzerland
| | - Janne Tolstrup
- Department of Preventive Cardiology, Thomayer Teaching Hospital, Prague, Czech Republic
| | - 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
| | - 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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571
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Preiss D, Kristensen SL. The New Pooled Cohort Equations Risk Calculator. Can J Cardiol 2015; 31:613-9. [DOI: 10.1016/j.cjca.2015.02.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/02/2015] [Accepted: 02/02/2015] [Indexed: 11/29/2022] Open
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572
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Ningyan W, Chee Tang C, Ping Sing T, Lay Wai K, Koh AS, Shern KY, Terence, Chieh TW, Jack. Risk factors for cardiovascular events among Asian patients without pre-existing cardiovascular disease on the renal transplant wait list. ACTA ACUST UNITED AC 2015; 23:1. [PMID: 26316667 PMCID: PMC4544482 DOI: 10.7603/s40602-015-0001-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: For suitable end-stage renal failure (ESRF) patients, renal transplantation gives better long term survival and quality of life as compared to dialysis. Prior to entry into the renal transplant wait list, potential candidates are screened for the presence of cardiovascular disease. However, the waiting time on the transplant list is long, and interval screening for cardiac fitness for surgery is not well defined. We aim to study the risk factors for the development of a cardiovascular event (CVE) and the time interval from recruitment to onset of a CVE that resulted in their removal from the transplant wait list. Methods: A retrospective study of all patients registered under the cadaveric renal transplant waiting list in Singapore General Hospital (SGH) from 16th April 1987 to 31st October 2010. We identified patients who developed a CVE among this cohort. We compared the demographics and clinical characteristics of patients who experienced a CVE versus those who did not. Univariable and multivariable cox regression were performed to investigate the significant variables for the development of a CVE. The time to development of CVE was estimated using Kaplan Meier estimation and log-rank test was used to compare the time to CVE between those with diabetes mellitus and those without. Results: 1265 patients were enrolled in this study. 273 patients dropped out of the wait list due to medical reasons or death, of which 38.8% were due to CVE. The mean and median time duration from recruitment into the waiting list to development of a CVE was 14.42 (95% CI 13.72 to 15.11) and 15.69 (95% CI 13.86 to 17.51) years respectively. For patients with diabetes mellitus, this was 8.22 (95% CI 6.30 to 10.14) and 8.16 (95% CI 4.95 to 11.36) years respectively. Factors associated with an increased risk of developing a CVE included male gender (adjusted HR 2.21, 95% CI 1.43 to 3.41, p<0.001), presence of diabetes mellitus (adjusted HR 5.13, 95% CI 2.85 to 9.24, p<0.001) and patients who were either not working or working part-time as compared to their full-time counterparts (adjusted HR 1.76, 95% CI 1.14 to 2.72, p=0.010). In addition, hazard ratio for CVE significantly increased with advancing age quartile (p<0.001 by log rank test for trend). Conclusion: A significant proportion of patients exited from the renal transplant wait list due to a CVE. Being male, age 37 years old or more, presence of diabetes mellitus and non-working or part-time workers as compared to full-time workers were found to increase the risk of developing a CVE during the wait period for transplantation. The presence of diabetes mellitus significantly shortened the time to development of a CVE.
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Affiliation(s)
- Wong Ningyan
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Chin Chee Tang
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore ; Duke-National University Singapore Graduate Medical School, Singapore, Singapore
| | - Tee Ping Sing
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Khin Lay Wai
- Investigational Medical Unit, Dean's Office, Singapore, Singapore
| | - Angela S Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore ; Duke-National University Singapore Graduate Medical School, Singapore, Singapore
| | - Kee Yi Shern
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore ; Duke-National University Singapore Graduate Medical School, Singapore, Singapore
| | - Terence
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore ; Duke-National University Singapore Graduate Medical School, Singapore, Singapore
| | - Tan Wei Chieh
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore ; Duke-National University Singapore Graduate Medical School, Singapore, Singapore
| | - Jack
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore ; Duke-National University Singapore Graduate Medical School, Singapore, Singapore
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573
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Riesgo cardiovascular e ingresos. Semergen 2015; 41:168-9. [DOI: 10.1016/j.semerg.2014.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/08/2014] [Indexed: 11/22/2022]
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574
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Anand S, Shivashankar R, Ali MK, Kondal D, Binukumar B, Montez-Rath ME, Ajay VS, Pradeepa R, Deepa M, Gupta R, Mohan V, Narayan KMV, Tandon N, Chertow GM, Prabhakaran D. Prevalence of chronic kidney disease in two major Indian cities and projections for associated cardiovascular disease. Kidney Int 2015; 88:178-85. [PMID: 25786102 PMCID: PMC4490055 DOI: 10.1038/ki.2015.58] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 12/23/2015] [Accepted: 01/15/2015] [Indexed: 12/15/2022]
Abstract
India is experiencing an alarming rise in the burden of non-communicable diseases, but data on the incidence of chronic kidney disease (CKD) are sparse. Using the Center for Cardiometabolic Risk Reduction in South Asia surveillance study (a population-based survey of Delhi and Chennai, India) we estimated overall, and age-, sex-, city-, and diabetes-specific prevalence of CKD, and defined the distribution of the study population by the Kidney Disease Improving Global Outcomes (KDIGO) classification scheme. The likelihood of cardiovascular events in participants with and without CKD was estimated by the Framingham and Interheart Modifiable Risk Scores. Of 12,271 participants, 80% had complete data on serum creatinine and albuminuria. The prevalence of CKD and albuminuria, age standardized to the World Bank 2010 world population, were 8.7% (95% confidence interval: 7.9 to 9.4%) and 7.1% (6.4 to 7.7%) respectively. Nearly 80% of patients with CKD had an abnormally high hemoglobin A1c (5.7 and above). Based on KDIGO guidelines, 6.0, 1.0, and 0.5% of study participants are at moderate, high, or very high risk for experiencing CKD-associated adverse outcomes. The cardiovascular risk scores placed a greater proportion of patients with CKD in the high-risk categories for experiencing cardiovascular events, when compared with participants without CKD. Thus one in 12 persons living in two of India’s largest cities have evidence of CKD, with features that put them at high risk for adverse outcomes.
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Affiliation(s)
- Shuchi Anand
- 1] CoE-CARRS, Public Health Foundation of India, New Delhi, India [2] Centre for Chronic Disease Control, New Delhi, India [3] Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Roopa Shivashankar
- 1] CoE-CARRS, Public Health Foundation of India, New Delhi, India [2] Centre for Chronic Disease Control, New Delhi, India
| | - Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Dimple Kondal
- 1] CoE-CARRS, Public Health Foundation of India, New Delhi, India [2] Centre for Chronic Disease Control, New Delhi, India
| | - B Binukumar
- 1] CoE-CARRS, Public Health Foundation of India, New Delhi, India [2] Centre for Chronic Disease Control, New Delhi, India
| | - Maria E Montez-Rath
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Vamadevan S Ajay
- 1] CoE-CARRS, Public Health Foundation of India, New Delhi, India [2] Centre for Chronic Disease Control, New Delhi, India
| | - R Pradeepa
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - M Deepa
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Ruby Gupta
- 1] CoE-CARRS, Public Health Foundation of India, New Delhi, India [2] Centre for Chronic Disease Control, New Delhi, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - K M Venkat Narayan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Dorairaj Prabhakaran
- 1] CoE-CARRS, Public Health Foundation of India, New Delhi, India [2] Centre for Chronic Disease Control, New Delhi, India
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575
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Reddy KS. Cardiovascular Health. J Am Coll Cardiol 2015; 65:1026-8. [DOI: 10.1016/j.jacc.2015.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 10/23/2022]
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576
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Enas EA, Dharmarajan TS, Varkey B. Consensus statement on the management of dyslipidemia in Indian subjects: A different perspective. Indian Heart J 2015; 67:95-102. [PMID: 26071285 PMCID: PMC4475838 DOI: 10.1016/j.ihj.2015.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/31/2022] Open
Affiliation(s)
- Enas A Enas
- Executive Director, Coronary Artery Disease among Asian Indians (CADI) Research Foundation, USA.
| | - T S Dharmarajan
- Professor of Clinical Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Basil Varkey
- Professor Emeritus of Medicine, Medical College of Wisconsin, USA
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577
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Abstract
Heart failure is a global problem with an estimated prevalence of 38 million patients worldwide, a number that is increasing with the ageing of the population. It is the most common diagnosis in patients aged 65 years or older admitted to hospital and in high-income nations. Despite some progress, the prognosis of heart failure is worse than that of most cancers. Because of the seriousness of the condition, a declaration of war on five fronts has been proposed for heart failure. Efforts are underway to treat heart failure by enhancing myofilament sensitivity to Ca(2+); transfer of the gene for SERCA2a, the protein that pumps calcium into the sarcoplasmic reticulum of the cardiomyocyte, seems promising in a phase 2 trial. Several other abnormal calcium-handling proteins in the failing heart are candidates for gene therapy; many short, non-coding RNAs--ie, microRNAs (miRNAs)--block gene expression and protein translation. These molecules are crucial to calcium cycling and ventricular hypertrophy. The actions of miRNAs can be blocked by a new class of drugs, antagomirs, some of which have been shown to improve cardiac function in animal models of heart failure; cell therapy, with autologous bone marrow derived mononuclear cells, or autogenous mesenchymal cells, which can be administered as cryopreserved off the shelf products, seem to be promising in both preclinical and early clinical heart failure trials; and long-term ventricular assistance devices are now used increasingly as a destination therapy in patients with advanced heart failure. In selected patients, left ventricular assistance can lead to myocardial recovery and explantation of the device. The approaches to the treatment of heart failure described, when used alone or in combination, could become important weapons in the war against heart failure.
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Affiliation(s)
- Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA.
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578
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Berezin A, Zulli A, Kerrigan S, Petrovic D, Kruzliak P. Predictive role of circulating endothelial-derived microparticles in cardiovascular diseases. Clin Biochem 2015; 48:562-8. [PMID: 25697107 DOI: 10.1016/j.clinbiochem.2015.02.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 02/03/2015] [Accepted: 02/05/2015] [Indexed: 12/31/2022]
Abstract
Endothelial-derived microparticles (EMPs) are a novel biological marker of endothelium injury and vasomotion disorders that are involved in pathogenesis of cardiovascular, metabolic, and inflammatory diseases. Circulating levels of EMPs are thought to reflect a balance between cell stimulation, proliferation, apoptosis, and cell death. Increased EMPs may be defined in several cardiovascular diseases, such as stable and unstable coronary artery disease, acute and chronic heart failure, hypertension, arrhythmias, thromboembolism, asymptomatic atherosclerosis as well as renal failure, metabolic disorders (including type two diabetes mellitus, abdominal obesity, metabolic syndrome, insulin resistance) and dyslipidemia. This review highlights the controversial opinions regarding impact of circulating EMPs in major cardiovascular and metabolic diseases and summarizes the perspective implementation of the EMPs in risk stratification models.
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Affiliation(s)
- Alexander Berezin
- Internal Medicine Department, State Medical University, Zaporozhye, Ukraine
| | - Anthony Zulli
- Centre for Chronic Disease Prevention and Management, College of Health and Biomedicine, Victoria University, St Albans, Australia
| | - Steve Kerrigan
- Molecular and Cellular Therapeutics Department, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Daniel Petrovic
- Department of Histology and Embryology, School of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Kruzliak
- International Clinical Research Center, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic.
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579
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Patel P, DiPette DJ. Hypertension-related congestive heart failure in west Africa: a framework for global blood pressure control. J Clin Hypertens (Greenwich) 2015; 17:260-2. [PMID: 25688849 DOI: 10.1111/jch.12494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Pragna Patel
- Global Noncommunicable Diseases Unit, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA
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580
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Gupta R, Sharma KK, Gupta BK, Gupta A, Gupta RR, Deedwania PC. Educational status-related disparities in awareness, treatment and control of cardiovascular risk factors in India. HEART ASIA 2015; 7:1-6. [PMID: 27326202 DOI: 10.1136/heartasia-2014-010551] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Revised: 09/07/2014] [Accepted: 12/18/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To determine association of socioeconomic status, defined by educational status (ES), with awareness, treatment and control of cardiovascular risk factors. METHODS We performed an epidemiological study at 11 cities in India using cluster sampling. 6198 subjects (3426 men, 2772 women, response 62%, age 48±10 years) were evaluated for sociodemographic, lifestyle, anthropometric and biochemical factors. ES was categorised according to years of schooling into low (≤10 years), medium (11-15 years) and high (>15 years). Risk factors were diagnosed according to current guidelines. Awareness, treatment and control status were determined for hypertension, diabetes and hypercholesterolaemia. For smoking/tobacco use, quit rate was determined. Descriptive statistics are reported. RESULTS Age-adjusted and sex-adjusted prevalence (%) of various risk factors in low, medium and high ES subjects was hypertension 31.8, 29.5 and 34.1, diabetes 14.5, 15.3 and 14.3, hypercholesterolaemia 24.0, 23.9 and 27.3, and smoking/tobacco use 24.3, 14.4 and 19.0. Significantly increasing trends with low, medium and high ES were observed for hypertension awareness (30.7, 37.8, 47.0), treatment (24.3, 29.2, 35.5) and control (7.8, 11.6, 15.5); diabetes awareness (47.2, 51.5, 56.4), treatment (38.3, 41.3, 46.0) and control (18.3, 15.3, 22.8); hypercholesterolaemia awareness (8.9, 22.4, 18.4), treatment (4.1, 6.2, 7.9) and control (2.8, 3.2, 6.9), as well as for smoking/tobacco quit rates (1.6, 2.8, 5.5) (χ(2) for trend, p<0.05). CONCLUSIONS Low ES subjects in India have lower awareness, treatment and control of hypertension, diabetes and hypercholesterolaemia and smoking quit rates.
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Affiliation(s)
- Rajeev Gupta
- Department of Medicine , Fortis Escorts Hospital , Jaipur, Rajasthan , India
| | | | | | - Arvind Gupta
- Jaipur Diabetes Research Centre , Jaipur , India
| | | | - Prakash C Deedwania
- Department of Cardiology , University of California San Francisco , Fresno, California , USA
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581
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Norheim OF, Jha P, Admasu K, Godal T, Hum RJ, Kruk ME, Gómez-Dantés O, Mathers CD, Pan H, Sepúlveda J, Suraweera W, Verguet S, Woldemariam AT, Yamey G, Jamison DT, Peto R. Avoiding 40% of the premature deaths in each country, 2010-30: review of national mortality trends to help quantify the UN sustainable development goal for health. Lancet 2015; 385:239-52. [PMID: 25242039 DOI: 10.1016/s0140-6736(14)61591-9] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The UN will formulate ambitious Sustainable Development Goals for 2030, including one for health. Feasible goals with some quantifiable, measurable targets can influence governments. We propose, as a quatitative health target, "Avoid in each country 40% of premature deaths (under-70 deaths that would be seen in the 2030 population at 2010 death rates), and improve health care at all ages". Targeting overall mortality and improved health care ignores no modifiable cause of death, nor any cause of disability that is treatable (or also causes many deaths). 40% fewer premature deaths would be important in all countries, but implies very different priorities in different populations. Reinforcing this target for overall mortality in each country are four global subtargets for 2030: avoid two-thirds of child and maternal deaths; two-thirds of tuberculosis, HIV, and malaria deaths; a third of premature deaths from non-communicable diseases (NCDs); and a third of those from other causes (other communicable diseases, undernutrition, and injuries). These challenging subtargets would halve under-50 deaths, avoid a third of the (mainly NCD) deaths at ages 50-69 years, and so avoid 40% of under-70 deaths. To help assess feasibility, we review mortality rates and trends in the 25 most populous countries, in four country income groupings, and worldwide. METHODS UN sources yielded overall 1970-2010 mortality trends. WHO sources yielded cause-specific 2000-10 trends, standardised to country-specific 2030 populations; decreases per decade of 42% or 18% would yield 20-year reductions of two-thirds or a third. RESULTS Throughout the world, except in countries where the effects of HIV or political disturbances predominated, mortality decreased substantially from 1970-2010, particularly in childhood. From 2000-10, under-70 age-standardised mortality rates decreased 19% (with the low-income and lower-middle-income countries having the greatest absolute gains). The proportional decreases per decade (2000-10) were: 34% at ages 0-4 years; 17% at ages 5-49 years; 15% at ages 50-69 years; 30% for communicable, perinatal, maternal, or nutritional causes; 14% for NCDs; and 13% for injuries (accident, suicide, or homicide). INTERPRETATION Moderate acceleration of the 2000-10 proportional decreases in mortality could be feasible, achieving the targeted 2030 disease-specific reductions of two-thirds or a third. If achieved, these reductions avoid about 10 million of the 20 million deaths at ages 0-49 years that would be seen in 2030 at 2010 death rates, and about 17 million of the 41 million such deaths at ages 0-69 years. Such changes could be achievable by 2030, or soon afterwards, at least in areas free of war, other major effects of political disruption, or a major new epidemic. FUNDING UK Medical Research Council, Norwegian Agency for Development Cooperation, Centre for Global Health Research, and Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ole F Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Norway.
| | - Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, ON, Canada
| | | | - Tore Godal
- Ministry of Foreign Affairs, Oslo, Norway
| | - Ryan J Hum
- Centre for Global Engineering, University of Toronto, ON, Canada
| | - Margaret E Kruk
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Colin D Mathers
- WHO Mortality and Burden of Disease Unit, Geneva, Switzerland
| | - Hongchao Pan
- Nuffield Department of Population Health Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK
| | - Jaime Sepúlveda
- Global Health Sciences, University of California, San Francisco, USA
| | - Wilson Suraweera
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, ON, Canada
| | - Stéphane Verguet
- Department of Global Health, University of Washington, Seattle, USA
| | | | - Gavin Yamey
- Global Health Sciences, University of California, San Francisco, USA
| | - Dean T Jamison
- Global Health Sciences, University of California, San Francisco, USA
| | - Richard Peto
- Nuffield Department of Population Health Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), University of Oxford, Oxford, UK.
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583
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Brant LCC, Hamburg NM, Barreto SM, Benjamin EJ, Ribeiro ALP. Relations of digital vascular function, cardiovascular risk factors, and arterial stiffness: the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) cohort study. J Am Heart Assoc 2014; 3:e001279. [PMID: 25510401 PMCID: PMC4338719 DOI: 10.1161/jaha.114.001279] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Vascular dysfunction is an early expression of atherosclerosis and predicts cardiovascular (CV) events. Peripheral arterial tonometry (PAT) evaluates basal pulse amplitude (BPA), endothelial function (PAT ratio), and wave reflection (PAT‐AIx) in the digital microvessels. In Brazilian adults, we investigated the correlations of PAT responses to CV risk factors and to carotid‐femoral pulse wave velocity (PWV), a measure of arterial stiffness. Methods and Results In a cross‐sectional study, 1535 participants of the ELSA‐Brasil cohort underwent PAT testing (52±9 years; 44% women). In multivariable analyses, more‐impaired BPA and PAT ratios were associated with male sex, higher body mass index (BMI), and total cholesterol/high‐density lipoprotein. Higher age and triglycerides were related to higher BPA, whereas lower systolic blood pressure, hypertension (HTN) treatment, and prevalent CV disease (CVD) were associated with lower PAT ratio. PAT‐AIx correlated positively with female sex, advancing age, systolic and diastolic blood pressures, and smoking and inversely to heart rate, height, BMI, and prevalent CVD. Black race was associated with lower BPA, higher PAT ratio, and PAT‐AIx. Microvessel vasodilator function was not associated with PWV. Higher PAT‐AIx was modestly correlated to higher PWV and PAT ratio and inversely correlated to BPA. Conclusion Metabolic risk factors are related to impaired microvessel vasodilator function in Brazil. However, in contrast to studies from the United States, black race was not associated with an impaired microvessel vasodilator response, implying that vascular function may vary by race across populations. PAT‐AIx relates to HTN, may be a valid measure of wave reflection, and provides distinct information from arterial stiffness.
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Affiliation(s)
- Luisa C C Brant
- Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.C.B., S.M.B., A.P.R.)
| | - Naomi M Hamburg
- Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA (N.M.H., E.J.B.)
| | - Sandhi M Barreto
- Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.C.B., S.M.B., A.P.R.)
| | - Emelia J Benjamin
- Whitaker Cardiovascular Institute, School of Medicine, Boston University, Boston, MA (N.M.H., E.J.B.)
| | - Antonio L P Ribeiro
- Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) Hospital das Clínicas and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.C.B., S.M.B., A.P.R.)
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584
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Parmar P, Krishnamurthi R, Ikram MA, Hofman A, Mirza SS, Varakin Y, Kravchenko M, Piradov M, Thrift AG, Norrving B, Wang W, Mandal DK, Barker-Collo S, Sahathevan R, Davis S, Saposnik G, Kivipelto M, Sindi S, Bornstein NM, Giroud M, Béjot Y, Brainin M, Poulton R, Narayan KMV, Correia M, Freire A, Kokubo Y, Wiebers D, Mensah G, BinDhim NF, Barber PA, Pandian JD, Hankey GJ, Mehndiratta MM, Azhagammal S, Ibrahim NM, Abbott M, Rush E, Hume P, Hussein T, Bhattacharjee R, Purohit M, Feigin VL. The Stroke Riskometer(TM) App: validation of a data collection tool and stroke risk predictor. Int J Stroke 2014; 10:231-44. [PMID: 25491651 PMCID: PMC4335600 DOI: 10.1111/ijs.12411] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/28/2014] [Indexed: 11/26/2022]
Abstract
Background The greatest potential to reduce the burden of stroke is by primary prevention of first-ever stroke, which constitutes three quarters of all stroke. In addition to population-wide prevention strategies (the ‘mass’ approach), the ‘high risk’ approach aims to identify individuals at risk of stroke and to modify their risk factors, and risk, accordingly. Current methods of assessing and modifying stroke risk are difficult to access and implement by the general population, amongst whom most future strokes will arise. To help reduce the burden of stroke on individuals and the population a new app, the Stroke Riskometer™, has been developed. We aim to explore the validity of the app for predicting the risk of stroke compared with current best methods. Methods 752 stroke outcomes from a sample of 9501 individuals across three countries (New Zealand, Russia and the Netherlands) were utilized to investigate the performance of a novel stroke risk prediction tool algorithm (Stroke Riskometer™) compared with two established stroke risk score prediction algorithms (Framingham Stroke Risk Score [FSRS] and QStroke). We calculated the receiver operating characteristics (ROC) curves and area under the ROC curve (AUROC) with 95% confidence intervals, Harrels C-statistic and D-statistics for measure of discrimination, R2 statistics to indicate level of variability accounted for by each prediction algorithm, the Hosmer-Lemeshow statistic for calibration, and the sensitivity and specificity of each algorithm. Results The Stroke Riskometer™ performed well against the FSRS five-year AUROC for both males (FSRS = 75·0% (95% CI 72·3%–77·6%), Stroke Riskometer™ = 74·0(95% CI 71·3%–76·7%) and females [FSRS = 70·3% (95% CI 67·9%–72·8%, Stroke Riskometer™ = 71·5% (95% CI 69·0%–73·9%)], and better than QStroke [males – 59·7% (95% CI 57·3%–62·0%) and comparable to females = 71·1% (95% CI 69·0%–73·1%)]. Discriminative ability of all algorithms was low (C-statistic ranging from 0·51–0·56, D-statistic ranging from 0·01–0·12). Hosmer-Lemeshow illustrated that all of the predicted risk scores were not well calibrated with the observed event data (P < 0·006). Conclusions The Stroke Riskometer™ is comparable in performance for stroke prediction with FSRS and QStroke. All three algorithms performed equally poorly in predicting stroke events. The Stroke Riskometer™ will be continually developed and validated to address the need to improve the current stroke risk scoring systems to more accurately predict stroke, particularly by identifying robust ethnic/race ethnicity group and country specific risk factors.
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585
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Reddy KS. Polypill opens a path for improving adherence. J Am Coll Cardiol 2014; 64:2083-5. [PMID: 25457397 DOI: 10.1016/j.jacc.2014.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 09/10/2014] [Indexed: 11/25/2022]
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586
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Spencer S. Lessons from the PURE study. Glob Cardiol Sci Pract 2014; 2014:379-81. [PMID: 25780792 PMCID: PMC4355512 DOI: 10.5339/gcsp.2014.52] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 12/11/2014] [Indexed: 11/03/2022] Open
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