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Aggarwal P, Sinha SK, Khanra D, Nath RK, Gujral J, Reddy KK, Mukherjee A. Comparison of original and modified Q risk 2 risk score with Framingham risk score - An Indian perspective. Indian Heart J 2021; 73:353-358. [PMID: 34154755 PMCID: PMC8322747 DOI: 10.1016/j.ihj.2021.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE No study among Indian population has proposed modification of existing cardiovascular disease (CVD) risk scores or novel risk scores as risk estimation using conventional risk calculators can't be generalized because of epidemiological differences. MATERIAL AND METHODS A single center observational study was performed at a tertiary care center among participants having no evidence of CVD. Prevalence of various cardiac risk factors were analysed and 10-year risk was estimated using Framingham risk score (FRS), Q risk 2 score calculator (QRISK2) and Modified Q risk 2 (mQRISK2) which included smokeless tobacco consumption. QRISK2 and mQRISK2 were compared with FRS and participant's eligibility for statin therapy as primary preventive measure was assessed. RESULTS Total of 4045 participants were enrolled from August 2016 to July 2019. 3520(87%) had no history of smoking in their lifetime while smokeless tobacco consumption was seen in 1153(28.5%), diabetes in 422(10.4%), hypertension in 1096(27.1%), obesity in 2035(50.3%), and family history of CVD in 353(8.7%) participants. High risk participants were found to be 826(20.4%), 627(15.5%), and 509(12.6%) by using FRS, mQRISK2 and QRISK2, whereas those eligible for statin therapy were maximum by mQRISK2 among 1323(32.7%) participants compared to QRISK2 (n = 1191; 29.4%) and FRS (n = 826; 20.4%) model. Krippendorff's alpha for mQRISK2 was in better agreement with body mass index (BMI) and lipid FRS CVD scoring system as compared to QRISK2 risk model. CONCLUSION CVD risk stratification based on smokeless tobacco use is first of its kind from this part of world and should be part of CV risk assessment.
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Allen JC, Halaand B, Shirore RM, Jafar TH. Statistical analysis plan for management of hypertension and multiple risk factors to enhance cardiovascular health in Singapore: the SingHypertension pragmatic cluster randomized controlled trial. Trials 2021; 22:66. [PMID: 33468225 PMCID: PMC7814171 DOI: 10.1186/s13063-020-05016-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 12/31/2020] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (O'Lone E, Viecelli AK, Craig JC, Tong A, Sautenet B, Herrington WG, et al., Am J Kidney Dis 76(1):109-20, 2020) remains the leading cause of death in Singapore. Uncontrolled hypertension confers the highest attributable risk of CVD and remains a significant public health issue with sub-optimal blood pressure (BP) control rates. The aim of the trial is to evaluate the effectiveness and cost-effectiveness of a multicomponent intervention (MCI) versus usual care on lowering BP among adults with uncontrolled hypertension visiting primary care clinics in Singapore. This article describes the statistical analysis plan for the primary and secondary objectives related to intervention effectiveness. METHODS The study is a cluster randomized trial enrolling 1000 participants with uncontrolled hypertension aged ≥ 40 years from eight primary care clinics in Singapore. The unit of randomization is the clinic, with eight clusters (clinics) randomized in a 1:1 ratio to either MCI or usual care. All participants will be assessed at baseline, 12 months, and 24 months with measurements of systolic and diastolic BP, antihypertensive and statin medication use, medication adherence, physical activity level, anthropometric parameters, smoking status, and dietary habits. The primary objective of this study is to assess the effectiveness of MCI versus usual care on mean SBP at the 2-year follow-up. The primary outcome is SBP at 24 months. SBP at baseline, 12, and 24 months will be modeled at the subject level using a likelihood-based, linear mixed-effects model repeated measures (MMRM) analysis with treatment group and follow-up as fixed effects, random cluster (clinic) effects, Gaussian error distribution, and adjustment to degrees of freedom using the Satterthwaite approximation. Secondary outcomes will be analyzed using a similar modeling approach incorporating generalized techniques appropriate for the type of outcome. DISCUSSION The trial will allow us to determine whether the MCI has an impact on BP and cardiovascular risk factors over a 2-year follow-up period and inform recommendations for health planners in scaling up these strategies for the benefit of society at large. A pre-specified and pre-published statistical analysis plan mitigates reporting bias and data driven approaches. TRIAL REGISTRATION ClinicalTrials.gov NCT02972619 . Registered on 23 November 2016.
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Affiliation(s)
- John C Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Level 6, Academia, 20 College Road, Singapore, Singapore.
| | - Benjamin Halaand
- Centre for Quantitative Medicine, Duke-NUS Medical School, Level 6, Academia, 20 College Road, Singapore, Singapore.,Division of Biostatistics, Population Health Sciences, University of Utah, Salt Lake City, USA
| | - Rupesh M Shirore
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - Tazeen H Jafar
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, Singapore.
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Peri-Okonny PA, Patel S, Spertus JA, Jackson EA, Malik AO, Provance J, Mena-Hurtado C, Shishehbor MH, Hijjaji V, Gosch KL, Smolderen KG. Physical Activity After Treatment for Symptomatic Peripheral Artery Disease. Am J Cardiol 2021; 138:107-113. [PMID: 33065083 DOI: 10.1016/j.amjcard.2020.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 02/01/2023]
Abstract
The association of invasive versus noninvasive treatment and physical activity level in patients with claudication remains unclear. Participants with claudication were enrolled from US vascular clinics. Treatment was categorized as invasive (surgical or endovascular treatment <3 months of initial visit) versus noninvasive. Self-reported leisure time (LTPA) and work related physical activity (WRPA) (sedentary, mild, moderate/strenuous), and health status (peripheral artery questionnaire summary score [PAQ SS]) was measured at baseline and 12 months. Change in PA was also categorized as increased, decreased, persistent sedentary [reference] and persistent active based on activity status at baseline and 12 months. Multivariable logistic regression assessed the association of treatment with 12-month LTPA and WRPA. Multivariable linear regression examined the association between 12-month change in PA with a 12-month change in PAQ. A total of 196of 656 patients (29.9%) underwent invasive treatment. There was no association between treatment and 12-month LTPA (p = 0.77) or WRPA (p = 0.26). Compared with being persistently sedentary, increased LTPA was associated with increased PAQ SS (OR 11.1 95% CI [4.4 to 17.7], p <0.01). In conclusion, there was no association between invasive treatment and physical activity at follow up despite a greater health status change in the invasive group. As increased physical activity was associated with more health status gains than remaining sedentary, additional ways to improve physical activity levels could potentially improve PAD outcomes.
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Affiliation(s)
- Poghni A Peri-Okonny
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri.
| | - Sarthak Patel
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Ali O Malik
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Jeremy Provance
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Carlos Mena-Hurtado
- Yale University School of Medicine, Vascular Medicine Outcomes lab, New Haven, Connecticut
| | - Mehdi H Shishehbor
- University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vittal Hijjaji
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri; University of Missouri-Kansas City, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kim G Smolderen
- Yale University School of Medicine, Vascular Medicine Outcomes lab, New Haven, Connecticut
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Bansal M, Ranjan S, Kasliwal RR. Cardiovascular Risk Calculators and their Applicability to South Asians. Curr Diabetes Rev 2021; 17:e100120186497. [PMID: 33023452 DOI: 10.2174/1573399816999201001204020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/17/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Estimation of absolute cardiovascular disease (CVD) risk and tailoring therapies according to the estimated risk is a fundamental concept in the primary prevention of CVD is assessed in this study. Numerous CVD risk scores are currently available for use in various populations but unfortunately, none exist for South Asians who have much higher CVD risk as compared to their western counterparts. METHODS A literature search was done using PubMed and Google search engines to prepare a narrative review on this topic. RESULTS Various currently available CVD risk scores and their pros and cons are summarized. The studies performed in native as well as migrant South Asians evaluating the accuracy of these risk scores for estimation of CVD risk are also summarized. The findings of these studies have generally been inconsistent, but it appears that the British risk scores (e.g. QRISK versions) may be more accurate because of inclusion of migrant South Asians in the derivation of these risk scores. However, the lack of any prospective study precludes our ability to draw any firm conclusions. Finally, the potential solution to these challenges, including the role of recalibration and subclinical atherosclerosis imaging, is also discussed. CONCLUSION This review highlights the need to develop large, representative, prospectively followed databases of South Asians providing information on various CVD risk factors and their contribution to incident CVD. Such databases will not only allow the development of validated CVD risk scores for South Asians but will also enable application of machine-learning approaches to provide personalized solutions to CVD risk assessment and management in these populations.
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Affiliation(s)
- Manish Bansal
- Clinical and Preventive Cardiology, Medanta- The Medicity, Gurgaon, Haryana, India
| | - Shraddha Ranjan
- Department of Cardiology, Medanta- The Medicity, Gurgaon, India
| | - Ravi R Kasliwal
- Clinical and Preventive Cardiology, Medanta- The Medicity, Gurgaon, Haryana, India
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Wang M, Wang C, Zhao M, Li Y, Yao S, Wu S, Xue H. Uric Acid Variability and All-Cause Mortality: A Prospective Cohort Study in Northern China. J Nutr Health Aging 2021; 25:1235-1241. [PMID: 34866151 DOI: 10.1007/s12603-021-1706-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Uric acid(UA) is related with cardiovascular disease, but the association of UA variability with all-cause mortality is rarely known. This study aimed to investigate the relationship between UA variability and all-cause mortality in Kailuan cohort study in northern China. DESIGN Cohort study. SETTING Kailuan community hospitals in Tangshan, Hebei province, Northern China. PARTICIPANTS A total of 55717 participants from Kailuan Study were enrolled, and our study followed up biennially from 2006 to 2010. MEASUREMENTS Clinical records of the participants enrolled were analyzed. UA variation independent of mean (UAVIM) values were calculated and all the participants were quartile grouped into four groups as: Q1(UAVIM<0.68), Q2(0.68≤UAVIM<1.10), Q3(1.10≤UAVIM<1.67) and Q4(UAVIM≥1.67). The endpoint event was all-cause death. Cox regression model was performed to evaluate the hazard ratios(HRs) of all-cause mortality based on UAVIM groups. RESULTS During a median follow-up of 6.83 years, 2926 deaths occurred. The accumulated mortality rates were 4.6%, 4.8%, 5.4% and 6.1% in group Q1, Q2, Q3 and Q4 respectively. When adjusted potential confounders, the highest risk for all-cause mortality was in group Q4 and the adjusted HRs and 95% confidence intervals(CIs) of group Q2-Q4 for all-cause death were 1.044(0.937, 1.164), 1.182(1.064, 1.314) and 1.353(1.220, 1.501) compared with group Q1, respectively. Further analysis showed that the risk for all-cause death increased as UAVIM value increased. Sensitive analysis still showed the similar results when excluding participants with hyperuricemia or severe chronic kidney diseases. Sub-group analysis by age, gender, BMI or hypertension history also indicated analogous results. CONCLUSION Elevated UAVIM was related with increased all-cause mortality and UAVIM was an independent risk factor for all-cause mortality in the community cohort study.
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Affiliation(s)
- M Wang
- Shouling Wu, Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China, E-mail: ; Hao Xue, Department of Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China, E-mail:
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Ndejjo R, Wanyenze RK, Nuwaha F, Bastiaens H, Musinguzi G. Barriers and facilitators of implementation of a community cardiovascular disease prevention programme in Mukono and Buikwe districts in Uganda using the Consolidated Framework for Implementation Research. Implement Sci 2020; 15:106. [PMID: 33298098 PMCID: PMC7726905 DOI: 10.1186/s13012-020-01065-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/29/2020] [Indexed: 12/01/2022] Open
Abstract
Background In low- and middle-income countries, there is an increasing attention towards community approaches to deal with the growing burden of cardiovascular disease (CVD). However, few studies have explored the implementation processes of such interventions to inform their scale up and sustainability. Using the consolidated framework for implementation research (CFIR), we examined the barriers and facilitators influencing the implementation of a community CVD programme led by community health workers (CHWs) in Mukono and Buikwe districts in Uganda. Methods This qualitative study is a process evaluation of an ongoing type II hybrid stepped wedge cluster trial guided by the CFIR. Data for this analysis were collected through regular meetings and focus group discussions (FGDs) conducted during the first cycle (6 months) of intervention implementation. A total of 20 CHWs participated in the implementation programme in 20 villages during the first cycle. Meeting reports and FGD transcripts were analysed following inductive thematic analysis with the aid of Nvivo 12.6 to generate emerging themes and sub-themes and thereafter deductive analysis was used to map themes and sub-themes onto the CFIR domains and constructs. Results The barriers to intervention implementation were the complexity of the intervention (complexity), compatibility with community culture (culture), the lack of an enabling environment for behaviour change (patient needs and resources) and mistrust of CHWs by community members (relative priority). In addition, the low community awareness of CVD (tension for change), competing demands (other personal attributes) and unfavourable policies (external policy and incentives) impeded intervention implementation. On the other hand, facilitators of intervention implementation were availability of inputs and protective equipment (design quality and packaging), training of CHWs (Available resources), working with community structures including leaders and groups (process—opinion leaders), frequent support supervision and engagements (process—formally appointed internal implementation leaders) and access to quality health services (process—champions). Conclusion Using the CFIR, we identified drivers of implementation success or failure for a community CVD prevention programme in a low-income context. These findings are key to inform the design of impactful, scalable and sustainable CHW programmes for non-communicable diseases prevention and control. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-020-01065-0.
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Affiliation(s)
- Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. .,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Boudreau F, Dagenais GR, de Vries H, Walthouwer MJL, Côté J, Turbide G, Bourlaud AS, Poirier P. Effectiveness of a web-based computer-tailored intervention promoting physical activity for adults from Quebec City: a randomized controlled trial. Health Psychol Behav Med 2020; 8:601-622. [PMID: 34040888 PMCID: PMC8114390 DOI: 10.1080/21642850.2020.1850287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background The primary objective of this study was to determine the effectiveness of a 3-month web-based computer-tailored intervention on moderate-to-vigorous physical activity (MVPA) in adults. Methods A total of 242 Canadian adults aged between 35 and 70 years were randomized to an experimental group receiving the intervention or a waiting list control group. The fully automated web-based computer-tailored physical activity intervention consists of seven 10- to 15-min sessions over an 8-week period. The theoretical underpinning of the intervention is based on the I-Change Model. Results A repeated-measures ANOVA using a linear mixed model showed a significant 'group-by-time' interaction favoring the intervention group in self-reported MVPA (p = .02). The MVPA was similar in both groups at baseline (mean ± SD; 176 ± 13 vs. 172 ± 15 min/week, p = .72) and higher in the intervention than in the control group at a 3-month follow-up (259 ± 21 vs. 201 ± 22 min/week, p = .04). This finding was comparable across women and men (group-by-sex, p = .57) and across participants meeting or not physical activity guidelines at baseline (group-by-baseline physical activity, p = .43). Although engagement to the web-based sessions declined over time, participants completing more web sessions achieved higher self-reported MVPA (p < .05). Conclusion These findings suggest that this intervention is effective in enhancing self-reported MVPA in this adult population in the short term; however, this needs to be confirmed in a larger trial with better engagement to the web-based sessions.
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Affiliation(s)
- François Boudreau
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
| | - Hein de Vries
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Michel Jean Louis Walthouwer
- School for Public Health and Primary Care (CAPHRI), Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - José Côté
- Faculté des sciences infirmières, Centre de recherche du Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Ginette Turbide
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Anne-Sophie Bourlaud
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada.,Faculté de Pharmacie, Université Laval, Québec, Canada
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Hall RE, Tusevljak N, Wu CF, Ibrahim Q, Schulze K, Khan AM, Desai D, Awadalla P, Broet P, Dummer TJ, Hicks J, Tardif JC, Teo KK, Vena J, Lee D, Friedrich M, Anand SS, Tu JV. The Canadian Alliance for Healthy Hearts and Minds: How Well Does It Reflect the Canadian Population? CJC Open 2020; 2:599-609. [PMID: 33305220 PMCID: PMC7711015 DOI: 10.1016/j.cjco.2020.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The intent of the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort is to understand the early determinants of subclinical cardiac and vascular disease and progression in adults selected from existing cohorts-the Canadian Partnership for Tomorrow's Health, the Prospective Urban and Rural Evaluation (PURE) cohort, and the Montreal Heart Institute Biobank. We evaluated how well the CAHHM-Health Services Research (CAHHM-HSR) subcohort reflects the Canadian population. METHODS A cross-sectional design was used among a prospective cohort of community-dwelling adults aged 35-69 years who met the CAHHM inclusion criteria, and a cohort of adults aged 35-69 years who responded to the 2015 Canadian Community Health Survey-Rapid Response module. The INTERHEART risk score was calculated at the individual level with means and proportions reported at the overall and provincial level. RESULTS There are modest differences between CAHHM-HSR study participants and the 2015 Canadian Community Health Survey-Rapid Response respondents in age (56.3 vs 51.7 mean years), proportion of men (44.9% vs 49.3%), and mean INTERHEART risk score (9.7 vs 10.1). Larger differences were observed in postsecondary education (86.8% vs 70.2%), Chinese ethnicity (11.0% vs 3.3%), obesity (23.2% vs 29.3%), current smoker status (6.1% vs 18.4%), and having no cardiac testing (30.4% vs 55.9%). CONCLUSIONS CAHHM-HSR participants are older, of higher socioeconomic status, and have a similar mean INTERHEART risk score, compared with participants in the Canadian Community Health Survey. Differing sampling strategies and missing data may explain some differences between the CAHHM-HSR cohort and Canadian community-dwelling adults and should be considered when using the CAHHM-HSR for scientific research.
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Affiliation(s)
- Ruth E. Hall
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Quazi Ibrahim
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Karleen Schulze
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Philip Awadalla
- Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, Toronto, Ontario, Canada
| | - Philippe Broet
- Department of Preventive and Social Medicine, School of Public Health, Montré University, Montreal, Quebec, Canada
- Research Centre, CHU Sainte Justine, Montreal, Quebec, Canada
| | - Trevor J.B. Dummer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jason Hicks
- Atlantic PATH, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
| | - Koon K. Teo
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer Vena
- Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Douglas Lee
- ICES, Toronto, Ontario, Canada
- Institute for Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada
| | - Matthias Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jack V. Tu
- ICES, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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Yebyo HG, Zappacosta S, Aschmann HE, Haile SR, Puhan MA. Global variation of risk thresholds for initiating statins for primary prevention of cardiovascular disease: a benefit-harm balance modelling study. BMC Cardiovasc Disord 2020; 20:418. [PMID: 32942999 PMCID: PMC7495829 DOI: 10.1186/s12872-020-01697-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/31/2020] [Indexed: 11/29/2022] Open
Abstract
Background We previously showed that the 10-year cardiovascular disease (CVD) risk threshold to initiate statins for primary prevention depends on the baseline CVD risk, age, sex, and the incidence of statin-related harm outcome and competing risk for non-CVD death. As these factors appear to vary across countries, we aimed in this study to determine country-specific thresholds and provide guidelines a quantitative benefit-harm assessment method for local adaptation. Methods For each of the 186 countries included, we replicated the benefit-harm balance analysis using an exponential model to determine the thresholds to initiate statin use for populations aged 40 to 75 years, with no history of CVD. The analyses took data inputs from a priori studies, including statin effect estimates (network meta-analysis), patient preferences (survey), and baseline incidence of harm outcomes and competing risk for non-CVD (global burden of disease study). We estimated the risk thresholds above which the benefits of statins were more likely to outweigh the harms using a stochastic approach to account for statistical uncertainty of the input parameters. Results The 5th and 95th percentiles of the 10-year risk thresholds above which the benefits of statins outweigh the harms across 186 countries ranged between 14 and 20% in men and 19–24% in women, depending on age (i.e., 90% of the country-specific thresholds were in the ranges stated). The median risk thresholds varied from 14 to 18.5% in men and 19 to 22% in women. The between-country variability of the thresholds was slightly attenuated when further adjusted for age resulting, for example, in a 5th and 95th percentiles of 14–16% for ages 40–44 years and 17–21% for ages 70–74 years in men. Some countries, especially the islands of the Western Pacific Region, had higher thresholds to achieve net benefit of statins at 25–36% 10-year CVD risks. Conclusions This extensive benefit-harm analysis modeling shows that a single CVD risk threshold, irrespective of age, sex and country, is not appropriate to initiate statin use globally. Instead, countries need to carefully determine thresholds, considering the national or subnational contexts, to optimize benefits of statins while minimizing related harms and economic burden.
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Affiliation(s)
- Henock G Yebyo
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland.
| | - Sofia Zappacosta
- School of Public Health, Mekelle University, Ayder, Mekelle, Ethiopia.,Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig Maximilians Universität, Marchioninistrasse 15, 81377, Munich, Germany
| | - Hélène E Aschmann
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Sarah R Haile
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Milo A Puhan
- Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
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Arku RE, Brauer M, Duong M, Wei L, Hu B, Ah Tse L, Mony PK, Lakshmi PVM, Pillai RK, Mohan V, Yeates K, Kruger L, Rangarajan S, Koon T, Yusuf S, Hystad P. Adverse health impacts of cooking with kerosene: A multi-country analysis within the Prospective Urban and Rural Epidemiology Study. ENVIRONMENTAL RESEARCH 2020; 188:109851. [PMID: 32798956 PMCID: PMC7748391 DOI: 10.1016/j.envres.2020.109851] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/09/2020] [Accepted: 06/17/2020] [Indexed: 06/06/2023]
Abstract
BACKGROUND Kerosene, which was until recently considered a relatively clean household fuel, is still widely used in low- and middle-income countries for cooking and lighting. However, there is little data on its health effects. We examined cardiorespiratory effects and mortality in households using kerosene as their primary cooking fuel within the Prospective Urban Rural Epidemiology (PURE) study. METHODS We analyzed baseline and follow-up data on 31,490 individuals from 154 communities in China, India, South Africa, and Tanzania where there was at least 10% kerosene use for cooking at baseline. Baseline comorbidities and health outcomes during follow-up (median 9.4 years) were compared between households with kerosene versus clean (gas or electricity) or solid fuel (biomass and coal) use for cooking. Multi-level marginal regression models adjusted for individual, household, and community level covariates. RESULTS Higher rates of prevalent respiratory symptoms (e.g. 34% [95% CI:15-57%] more dyspnea with usual activity, 44% [95% CI: 21-72%] more chronic cough or sputum) and lower lung function (differences in FEV1: -46.3 ml (95% CI: -80.5; -12.1) and FVC: -54.7 ml (95% CI: -93.6; -15.8)) were observed at baseline for kerosene compared to clean fuel users. The odds of hypertension was slightly elevated but no associations were observed for blood pressure. Prospectively, kerosene was associated with elevated risks of all-cause (HR: 1.32 (95% CI: 1.14-1.53)) and cardiovascular (HR: 1.34 (95% CI: 1.00-1.80)) mortality, as well as major fatal and incident non-fatal cardiovascular (HR: 1.34 (95% CI: 1.08-1.66)) and respiratory (HR: 1.55 (95% CI: 0.98-2.43)) diseases, compared to clean fuel use. Further, compared to solid fuel users, those using kerosene had 20-47% higher risks for the above outcomes. CONCLUSIONS Kerosene use for cooking was associated with higher rates of baseline respiratory morbidity and increased risk of mortality and cardiorespiratory outcomes during follow-up when compared to either clean or solid fuels. Replacing kerosene with cleaner-burning fuels for cooking is recommended.
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Affiliation(s)
- Raphael E Arku
- Department of Environmental Health Sciences, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA; School of Population and Public Health, The University of British Columbia, Vancouver, Canada.
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - MyLinh Duong
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Li Wei
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, China
| | - Lap Ah Tse
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Prem K Mony
- Division of Epidemiology & Population Health, St John's Medical College & Research Institute, Bangalore, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rajamohanan K Pillai
- School of Health Policy, Kerala University of Health Sciences, Trivandrum, India
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Lanthe Kruger
- North-West University, Africa Unit for Transdisciplinary Health Research (AUTHeR), South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Teo Koon
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, Hamilton, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, USA
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61
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Alhabib KF, Batais MA, Almigbal TH, Alshamiri MQ, Altaradi H, Rangarajan S, Yusuf S. Demographic, behavioral, and cardiovascular disease risk factors in the Saudi population: results from the Prospective Urban Rural Epidemiology study (PURE-Saudi). BMC Public Health 2020; 20:1213. [PMID: 32770968 PMCID: PMC7414714 DOI: 10.1186/s12889-020-09298-w] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 07/26/2020] [Indexed: 12/23/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the major cause of death in Saudi Arabia. We aimed to assess associated demographic, behavioral, and CVD risk factors as part of the Prospective Urban Rural Epidemiology (PURE) study. Methods PURE is a global cohort study of adults ages 35–70 years in 20 countries. PURE-Saudi study participants were recruited from 19 urban and 6 rural communities randomly selected from the Central province (Riyadh and Alkharj) between February 2012 and January 2015. Data were stratified by age, sex, and urban vs rural and summarized as means and standard deviations for continuous variables and as numbers and percentages for categorical variables. Proportions and means were compared between men and women, among age groups, and between urban and rural areas, using Chi-square test and t-tests, respectively. Results The PURE-Saudi study enrolled 2047 participants (mean age, 46.5 ± 9.12 years; 43.1% women; 24.5% rural). Overall, 69.4% had low physical activity, 49.6% obesity, 34.4% unhealthy diet, 32.1% dyslipidemia, 30.3% hypertension, and 25.1% diabetes. In addition, 12.2% were current smokers, 15.4% self-reported feeling sad, 16.9% had a history of periods of stress, 6.8% had permanent stress, 1% had a history of stroke, 0.6% had heart failure, and 2.5% had coronary heart disease (CHD). Compared to women, men were more likely to be current smokers and have diabetes and a history of CHD. Women were more likely to be obese, have central obesity, self-report sadness, experience stress, feel permanent stress, and have low education. Compared to participants in urban areas, those in rural areas had higher rates of diabetes, obesity, and hypertension, and lower rates of unhealthy diet, self-reported sadness, stress (several periods), and permanent stress. Compared to middle-aged and older individuals, younger participants more commonly reported an unhealthy diet, permanent stress, and feeling sad. Conclusion These results of the PURE-Saudi study revealed a high prevalence of unhealthy lifestyle and CVD risk factors in the adult Saudi population, with higher rates in rural vs urban areas. National public awareness programs and multi-faceted healthcare policy changes are urgently needed to reduce the future burden of CVD risk and mortality.
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Affiliation(s)
- Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed A Batais
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Turky H Almigbal
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Q Alshamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hani Altaradi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sumathy Rangarajan
- Population Health Research Institute, DBCVS Research Institute, McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, DBCVS Research Institute, McMaster University, Hamilton, Canada
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62
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Peri-Okonny PA, Gosch K, Patel S, Heyligers JMM, Mena-Hurtado C, Shishebor M, Malik A, Provance J, Hejjaji V, Spertus JA, Smolderen KG. Physical Activity in Patients with Symptomatic Peripheral Artery Disease: Insights from the PORTRAIT Registry. Eur J Vasc Endovasc Surg 2020; 60:889-895. [PMID: 32709469 DOI: 10.1016/j.ejvs.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 05/23/2020] [Accepted: 06/07/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE A physically active lifestyle reduces the risk of cardiovascular events and functional impairment in patients with peripheral artery disease (PAD). There are limited data on the patterns of physical activity in patients with PAD compared between countries. METHODS Self reported physical activity (sedentary vs. not) was obtained at enrolment, 3, 6, and 12 months in the US and Netherlands' cohorts of the Patient-centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry of patients with new or worsening claudication. Multivariable repeated measures using modified Poisson regression analysis compared the proportion of sedentary participants over time between countries to identify factors that attenuate intercountry differences. RESULTS Of 1 098 participants, 743 (67.7%) and 355 (32.3%) were recruited from the USA and the Netherlands respectively. Compared with the Netherlands, participants from the US were older (mean age 68.6 vs. 65.3 years; p < .001), more obese (41.3% vs. 20.5%; p < .001), and more likely to be female (41.3% vs. 31.4%; p = .002). There were fewer current smokers (30.1% vs. 52.8%; p < .001) and supervised exercise referrals (1.6% vs. 63.9%; p < .001) in the US compared with the Netherlands. US participants were more sedentary at baseline (43.7% vs. 34.1%; p < .001). Sedentary behaviour decreased after three months in both countries, then diverged with an increase in sedentary participants in the USA. Risk of sedentary behaviour was significantly greater in the USA compared with the Netherlands at 12 months, after adjustment of sociodemographic, lifestyle factors, and comorbidities (relative risk [RR] 1.56, 95% confidence interval [CI] 1.08-2.25; p = .020) but was attenuated after accounting for referral to supervised exercise (RR 1.20, 95% CI 0.67-2.16; p = .54). CONCLUSION Referral to supervised exercise was key in explaining the observed difference in the physical activity levels between patients with PAD in the USA and the Netherlands. Further promotion of supervised exercise for PAD may improve physical activity in patients with PAD and modify cultural norms of inactivity in the US.
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Affiliation(s)
- Poghni A Peri-Okonny
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri-Kansas City, Kansas City, MO, USA.
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Sarthak Patel
- Kansas City University of Medicine and Biosciences, Kansas City, MO, USA
| | | | | | - Mehdi Shishebor
- University Hospitals Cleveland Medical Centre and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ali Malik
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri-Kansas City, Kansas City, MO, USA
| | - Jeremy Provance
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri-Kansas City, Kansas City, MO, USA
| | - Vittal Hejjaji
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri-Kansas City, Kansas City, MO, USA
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kim G Smolderen
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
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63
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Walli-Attaei M, Joseph P, Rosengren A, Chow CK, Rangarajan S, Lear SA, AlHabib KF, Davletov K, Dans A, Lanas F, Yeates K, Poirier P, Teo KK, Bahonar A, Camilo F, Chifamba J, Diaz R, Didkowska JA, Irazola V, Ismail R, Kaur M, Khatib R, Liu X, Mańczuk M, Miranda JJ, Oguz A, Perez-Mayorga M, Szuba A, Tsolekile LP, Prasad Varma R, Yusufali A, Yusuf R, Wei L, Anand SS, Yusuf S. Variations between women and men in risk factors, treatments, cardiovascular disease incidence, and death in 27 high-income, middle-income, and low-income countries (PURE): a prospective cohort study. Lancet 2020; 396:97-109. [PMID: 32445693 DOI: 10.1016/s0140-6736(20)30543-2] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Some studies, mainly from high-income countries (HICs), report that women receive less care (investigations and treatments) for cardiovascular disease than do men and might have a higher risk of death. However, very few studies systematically report risk factors, use of primary or secondary prevention medications, incidence of cardiovascular disease, or death in populations drawn from the community. Given that most cardiovascular disease occurs in low-income and middle-income countries (LMICs), there is a need for comprehensive information comparing treatments and outcomes between women and men in HICs, middle-income countries, and low-income countries from community-based population studies. METHODS In the Prospective Urban Rural Epidemiological study (PURE), individuals aged 35-70 years from urban and rural communities in 27 countries were considered for inclusion. We recorded information on participants' sociodemographic characteristics, risk factors, medication use, cardiac investigations, and interventions. 168 490 participants who enrolled in the first two of the three phases of PURE were followed up prospectively for incident cardiovascular disease and death. FINDINGS From Jan 6, 2005 to May 6, 2019, 202 072 individuals were recruited to the study. The mean age of women included in the study was 50·8 (SD 9·9) years compared with 51·7 (10) years for men. Participants were followed up for a median of 9·5 (IQR 8·5-10·9) years. Women had a lower cardiovascular disease risk factor burden using two different risk scores (INTERHEART and Framingham). Primary prevention strategies, such as adoption of several healthy lifestyle behaviours and use of proven medicines, were more frequent in women than men. Incidence of cardiovascular disease (4·1 [95% CI 4·0-4·2] for women vs 6·4 [6·2-6·6] for men per 1000 person-years; adjusted hazard ratio [aHR] 0·75 [95% CI 0·72-0·79]) and all-cause death (4·5 [95% CI 4·4-4·7] for women vs 7·4 [7·2-7·7] for men per 1000 person-years; aHR 0·62 [95% CI 0·60-0·65]) were also lower in women. By contrast, secondary prevention treatments, cardiac investigations, and coronary revascularisation were less frequent in women than men with coronary artery disease in all groups of countries. Despite this, women had lower risk of recurrent cardiovascular disease events (20·0 [95% CI 18·2-21·7] versus 27·7 [95% CI 25·6-29·8] per 1000 person-years in men, adjusted hazard ratio 0·73 [95% CI 0·64-0·83]) and women had lower 30-day mortality after a new cardiovascular disease event compared with men (22% in women versus 28% in men; p<0·0001). Differences between women and men in treatments and outcomes were more marked in LMICs with little differences in HICs in those with or without previous cardiovascular disease. INTERPRETATION Treatments for cardiovascular disease are more common in women than men in primary prevention, but the reverse is seen in secondary prevention. However, consistently better outcomes are observed in women than in men, both in those with and without previous cardiovascular disease. Improving cardiovascular disease prevention and treatment, especially in LMICs, should be vigorously pursued in both women and men. FUNDING Full funding sources are listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Marjan Walli-Attaei
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clara K Chow
- The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kairat Davletov
- The Faculty of Medicine, Health Research Institute, Kazakh National University, Almaty, Kazakhstan
| | - Antonio Dans
- Department of Medicine, University of Philippines, Manila, Philippines
| | - Fernando Lanas
- Department of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec City, QC, Canada
| | - Koon K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Ahmad Bahonar
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Felix Camilo
- Facultad de Ciencias Medicas Eugenio Espejo, Universidad Universidad Tecnológica Equinoccial, Quito, Ecuador
| | - Jephat Chifamba
- Physiology Department, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica, Rosario, Argentina
| | - Joanna A Didkowska
- Department of Epidemiology and Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute, Warsaw, Poland
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; South American Center of Excellence for Cardiovascular Health, Buenos Aires, Argentina
| | - Rosnah Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Medical Center, Kuala Lumpur, Malaysia
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Xiaoyun Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Marta Mańczuk
- Department of Epidemiology and Cancer Prevention, The Maria Sklodowska-Curie Memorial Cancer Center and Institute, Warsaw, Poland
| | - J Jaime Miranda
- Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Aytekin Oguz
- Department of Internal Medicine, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Maritza Perez-Mayorga
- Facultad de Medicina, Universidad Nueva Granada and Clinica de Marly, Bogota, Colombia
| | - Andrzej Szuba
- Wroclaw Medical University, Department of Angiology, Diabetology and Hypertension, Wroclaw, Poland
| | - Lungiswa P Tsolekile
- University of the Western Cape, School of Public Health, Cape Town, South Africa
| | - Ravi Prasad Varma
- Health Action by People, Thiruvananthapuram, India; Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Afzalhussein Yusufali
- Department of Medicine, Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Li Wei
- National Centre for Cardiovascular Diseases, Cardiovascular Institute & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sonia S Anand
- 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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Milà C, Ranzani O, Sanchez M, Ambrós A, Bhogadi S, Kinra S, Kogevinas M, Dadvand P, Tonne C. Land-Use Change and Cardiometabolic Risk Factors in an Urbanizing Area of South India: A Population-Based Cohort Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2020; 128:47003. [PMID: 32243204 PMCID: PMC7228094 DOI: 10.1289/ehp5445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Land-use changes in city fringes due to urbanization can lead to a reduction of greenspace that may reduce its associated health benefits. OBJECTIVES We evaluated the association between changes in residential surrounding built-up land use and cardiometabolic risk factors in an urbanizing peri-urban area of south India and explored the mediating roles of air pollution, physical activity, and stress in these associations. METHODS We analyzed data on 6,039 adults from the third follow-up of the Andhra Pradesh Children and Parent Study (APCAPS) cohort (2010-2012). We generated trajectories of change in residential surrounding built-up land use (buffer areas) from 1995-2009 (stable, slow increase, fast increase) using remote sensing data and image classification methods. We estimated associations between built-up land use trajectories and natural log-transformed blood pressure, waist circumference, triglycerides, fasting glucose, and non-high-density lipoprotein (non-HDL) cholesterol using linear mixed models. We accounted for multiple mediators and the multilevel structure of the data in mediation analyses. RESULTS We observed positive associations between a fast increase in built-up land use within 300m of the home and all cardiometabolic risk factors. Compared with participants with stable trajectories, those with the largest increase in built-up land use had 1.5% (95% CI: 0.1, 2.9) higher systolic blood pressure, 2.4% (95% CI: 0.6, 4.3) higher diastolic blood pressure, 2.1% (95% CI: 0.5, 3.8) higher waist circumference, and 1.6% (95% CI: -0.6, 3.8) higher fasting glucose in fully adjusted models. Associations were positive, but not statistically significant, for triglycerides, fasting glucose, and non-HDL cholesterol. Physical activity and ambient particulate matter ≤2.5μm in aerodynamic diameter (PM2.5) partially mediated the estimated associations. Associations between fast build-up and all cardiometabolic risk factors except non-HDL cholesterol were stronger in women than men. DISCUSSION Increases in built-up land use surrounding residences were consistently associated with higher levels of cardiometabolic risk factors. Our findings support the need for better integration of health considerations in urban planning in rapidly urbanizing settings. https://doi.org/10.1289/EHP5445.
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Affiliation(s)
- Carles Milà
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Otavio Ranzani
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Margaux Sanchez
- Vieillissement et Maladies chroniques, Institut national de la santé et de la recherche médicale, Paris, France
| | - Albert Ambrós
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | | | - Sanjay Kinra
- London School of Hygiene and Tropical Medicine, London, UK
| | - Manolis Kogevinas
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Payam Dadvand
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
| | - Cathryn Tonne
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Madrid, Spain
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65
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Anand SS, Friedrich MG, Desai D, Schulze KM, Awadalla P, Busseuil D, Dummer TJ, Jacquemont S, Dick A, Kelton D, Kirpalani A, Lear SA, Leipsic J, Noseworthy MD, Parker L, Parraga G, Poirier P, Robson P, Tardif JC, Teo K, Vena J, Yusuf S, Moody AR, Black SE, Smith EE. Reduced Cognitive Assessment Scores Among Individuals With Magnetic Resonance Imaging–Detected Vascular Brain Injury. Stroke 2020; 51:1158-1165. [DOI: 10.1161/strokeaha.119.028179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background and Purpose—
Little is known about the association between covert vascular brain injury and cognitive impairment in middle-aged populations. We investigated if scores on a cognitive screen were lower in individuals with higher cardiovascular risk, and those with covert vascular brain injury.
Methods—
Seven thousand five hundred forty-seven adults, aged 35 to 69 years, free of cardiovascular disease underwent a cognitive assessment using the Digital Symbol Substitution test and Montreal Cognitive Assessment, and magnetic resonance imaging (MRI) to detect covert vascular brain injury (high white matter hyperintensities, lacunar, and nonlacunar brain infarctions). Cardiovascular risk factors were quantified using the INTERHEART (A Global Study of Risk Factors for Acute Myocardial Infarction) risk score. Multivariable mixed models tested for independent determinants of reduced cognitive scores. The population attributable risk of risk factors and MRI vascular brain injury on low cognitive scores was calculated.
Results—
The mean age of participants was 58 (SD, 9) years; 55% were women. Montreal Cognitive Assessment and Digital Symbol Substitution test scores decreased significantly with increasing age (
P
<0.0001), INTERHEART risk score (
P
<0.0001), and among individuals with high white matter hyperintensities, nonlacunar brain infarction, and individuals with 3+ silent brain infarctions. Adjusted for age, sex, education, ethnicity covariates, Digital Symbol Substitution test was significantly lowered by 1.0 (95% CI, −1.3 to −0.7) point per 5-point cardiovascular risk score increase, 1.9 (95% CI, −3.2 to −0.6) per high white matter hyperintensities, 3.5 (95% CI, −6.4 to −0.7) per nonlacunar stroke, and 6.8 (95% CI, −11.5 to −2.2) when 3+ silent brain infarctions were present. No postsecondary education accounted for 15% (95% CI, 12–17), moderate and high levels of cardiovascular risk factors accounted for 19% (95% CI, 8–30), and MRI vascular brain injury accounted for 10% (95% CI, −3 to 22) of low test scores.
Conclusions—
Among a middle-aged community-dwelling population, scores on a cognitive screen were lower in individuals with higher cardiovascular risk factors or MRI vascular brain injury. Much of the population attributable risk of low cognitive scores can be attributed to lower educational attainment, higher cardiovascular risk factors, and MRI vascular brain injury.
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Affiliation(s)
- Sonia S. Anand
- From the Department of Medicine, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.M.S., K.T., S.Y.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.T., S.Y.)
- Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.A., D.D., K.M.S, K.T., S.Y.)
| | - Matthias G. Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada (M.G.F.)
| | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.A., D.D., K.M.S, K.T., S.Y.)
| | - Karleen M. Schulze
- From the Department of Medicine, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.M.S., K.T., S.Y.)
- Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.A., D.D., K.M.S, K.T., S.Y.)
| | - Philip Awadalla
- Department of Electrical and Computer Engineering, School of Biomedical Engineering, Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, Canada (P.A.)
| | - David Busseuil
- Research Centre, Montreal Heart Institute, Université de Montréal, Quebec, Canada (D.B., J.-C.T)
| | - Trevor J.B. Dummer
- School of Population and Public Health, University of British Columbia, and BC Cancer Agency, Vancouver, Canada (T.J.B.D.)
| | - Sébastien Jacquemont
- Department of Medicine and Pediatrics, Université de Montréal, CHU Sainte Justine, Quebec, Canada (S.J.)
| | - Alexander Dick
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ontario, Canada (A.D.)
| | - David Kelton
- Diagnostic Imaging, Brampton Civic Hospital, William Osler Health System, Brampton, Ontario, Canada (D.K.)
| | - Anish Kirpalani
- Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Ontario, Canada (A.K.)
| | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (S.A.L.)
| | - Jonathan Leipsic
- Department of Radiology, University of British Columbia, St. Paul’s Hospital, Vancouver, British Columbia, Canada (J.L.)
| | - Michael D. Noseworthy
- Department of Electrical and Computer Engineering, School of Biomedical Engineering, McMaster University, and Diagnostic Imaging, St. Joseph’s Health Care, Hamilton, Ontario, Canada (M.D.N.)
| | - Louise Parker
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (L.P.)
| | - Grace Parraga
- Department of Medical Biophysics, and Robarts Research Institute, Western University, London, Ontario, Canada (G.P.)
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Canada (P.P.)
| | - Paula Robson
- Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Edmonton, Canada (P.R.)
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, Quebec, Canada (D.B., J.-C.T)
| | - Koon Teo
- From the Department of Medicine, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.M.S., K.T., S.Y.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.T., S.Y.)
- Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.A., D.D., K.M.S, K.T., S.Y.)
| | - Jennifer Vena
- Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Richmond Road Diagnostic and Treatment Centre, Calgary, Canada (J.V.)
| | - Salim Yusuf
- From the Department of Medicine, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.M.S., K.T., S.Y.)
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (S.S.A., K.T., S.Y.)
- Population Health Research Institute, Hamilton Health Sciences, Ontario, Canada (S.S.A., D.D., K.M.S, K.T., S.Y.)
| | - Alan R. Moody
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (A.R.M.)
| | - Sandra E. Black
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (A.R.M.)
- Department of Medicine (Neurology) and Hurvitz Brain Sciences Research Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada (S.E.B.)
| | - Eric E. Smith
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada (E.E.S.)
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Dagenais GR, Leong DP, Rangarajan S, Lanas F, Lopez-Jaramillo P, Gupta R, Diaz R, Avezum A, Oliveira GBF, Wielgosz A, Parambath SR, Mony P, Alhabib KF, Temizhan A, Ismail N, Chifamba J, Yeates K, Khatib R, Rahman O, Zatonska K, Kazmi K, Wei L, Zhu J, Rosengren A, Vijayakumar K, Kaur M, Mohan V, Yusufali A, Kelishadi R, Teo KK, Joseph P, Yusuf S. Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study. Lancet 2020; 395:785-794. [PMID: 31492501 DOI: 10.1016/s0140-6736(19)32007-0] [Citation(s) in RCA: 354] [Impact Index Per Article: 88.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches. METHODS The PURE study is a prospective, population-based cohort study of individuals aged 35-70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years. FINDINGS This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5-10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs. INTERPRETATION Among adults aged 35-70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care. FUNDING Full funding sources are listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Gilles R Dagenais
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, QC, Canada
| | - Darryl P Leong
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Fernando Lanas
- Department of Medicine, Universidad de La Frontera, Temuco, Chile
| | - Patricio Lopez-Jaramillo
- Medical School, Fundación Oftalmológica de Santander, Universidad de Santander, Bucaramanga, Colombia
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India; Department of Medicine, Rajasthan University of Health Sciences, Jaipur, India
| | - Rafael Diaz
- Estudios Clinicos Latinoamérica, Rosario, Argentina
| | - Alvaro Avezum
- Department of Medicine, Hospital Alemão Oswaldo Cruz, Universidade de Santo Amaro, São Paulo, Brazil
| | | | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Shameena R Parambath
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Prem Mony
- St John's Research Institute, St John's Medical College, Bangalore, India
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ahmet Temizhan
- Department of Cardiology, Faculty of Medicine, Saglik Bilimleri University, Ankara, Turkey
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Jephat Chifamba
- Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Karen Yeates
- Pamoja Tunaweza Women's Centre, Moshi, Tanzania; Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine; Advocate Research Institute, Advocate Health Care, Chicago, IL, USA
| | | | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Khawar Kazmi
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Li Wei
- National Centre for Cardiovascular Diseases, Cardiovascular Institute, Beijing, China; Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Zhu
- Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - K Vijayakumar
- Health Action by People, Trivandrum, India; Amrita Institute of Medical Sciences, Kochi, India
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation, Chennai, India; Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - AfzalHussein Yusufali
- Department of Medicine, Hatta Hospital, Dubai Medical University, Dubai Health Authority, Dubai, United Arab Emirates
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Koon K Teo
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Philip Joseph
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, ON, Canada.
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Gao L, Li SC, Moodie M. How Does Preterm Delivery Contribute to the Increased Burden of Cardiovascular Disease? Quantifying the Economic Impact of Cardiovascular Disease in Women with a History of Preterm Delivery. J Womens Health (Larchmt) 2020; 29:1392-1400. [PMID: 32150481 DOI: 10.1089/jwh.2019.7995] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: The association between preterm delivery (PTD) and maternal risk of cardiovascular disease (CVD) was demonstrated, but the economic burden of CVD in these women was unknown. Methods: A Markov microsimulation model, comprising no event, postacute coronary event (ACE, including acute myocardial infarction and unstable angina), poststroke, post-ACE and stroke, postheart failure, and death, was constructed to quantify the CVD burden in women with PTD from 2017 to 2066 using the Australian health care system perspective. Both first-ever and recurrent CVD events were accounted for in the model. Population with PTD histories was sourced from Australian Bureau of Statistics and costs of acute hospitalization and long-term management from government websites. Nonmonetary burden as years of life lost (YLL) was compared between women with and without PTD histories. Both dynamic (i.e., new cohort added every cycle) and static (i.e., population was stabilized) approaches were used to measure the CVD burden, with sensitivity analyses examining the robustness of results. Results: The dynamic model showed the total CVD burden caused by PTD as AUD11.4 billion for the next 50 years and the YLL as 0.34/capita, while the static model generated a cost of AUD4.5 billion and the YLL as 0.52/capita. Long-term management cost was the primary cost determinant (AUD9.4 billion and AUD3.7 billion, respectively) in the two models, with the results most sensitive to the discount rate and time horizon. Conclusions: Considering the substantial economic burden, recognizing PTD as a potential risk factor and encouraging women with PTD histories to participate in primary prevention programs would potentially curb the ever-increasing CVD burden.
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Affiliation(s)
- Lan Gao
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.,School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia
| | - Shu-Chuen Li
- School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Australia.,Global Obesity Centre, Institute for Health Transformation, Geelong, Australia
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Montalvan Sanchez EE, Urrutia SA, Rodriguez AA, Duarte G, Murillo A, Rivera R, Paredes Henriquez AA, Montalvan Sanchez DM, Ordoñez E, Norwood DA, Dominguez LB, Dominguez RL, Torres K, Reyes Fajardo EM, Godoy CA. Cardiovascular risk assessment in the resource limited setting of Western Honduras: An epidemiological perspective. IJC HEART & VASCULATURE 2020; 27:100476. [PMID: 32309530 PMCID: PMC7154315 DOI: 10.1016/j.ijcha.2020.100476] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/08/2020] [Accepted: 01/21/2020] [Indexed: 12/15/2022]
Abstract
Cardiovascular Disease (CVD) epidemiology varies significantly among Low and Middle-Income Countries. Honduras is the Central American country with the highest Ischemic Heart Disease and CVD mortality rates. The aim of this study was to assess the individual CVD risk factors and calculate Cardiovascular Risk Assessment Scores (CVRAS) from the population. Methods: A cross-sectional study in western Honduras. Estimation of CV risk was performed using Framingham, MESA, ACC/AHA-PCEs and ESC SCORE calculators. Results: 38% were male. For men and women respectively; 49% and 48% had self-reported hypertension (HTN), on measured blood pressure only 18% and 30% had normal readings. Diabetes Mellitus was reported in 19% and 22%. Tobacco use was 14% and 3%. Self-reported regular exercise was 39.9% and 25%. Obesity was diagnosed in 24% and 24%. Lipid profile; total cholesterol was ≥200 mg/dl in 63% of subjects. LDL-C was elevated (>100 mg/dl) in 74% of participants, 9% had LDL-C levels higher than 190 mg/dl. Triglycerides were high (>160 mg/dl) in 60%, of these subjects 22% were taking lipid-lowering medications. 52% reported family-history of CVD. The risk calculation for men and women respectively for each CVRAS were; AHA/ACC-PCEs high risk (score ≥ 7.5%) in 62% and 30%, FRS high risk (score ≥ 20%) 46% and 15%, MESA high risk (Score ≥ 7.5%) in 70.6% and 17.7%, ESC SCORE high risk (score ≥ 5% in 32.4% and 11.8%). Conclusions: CV risk calculations revealed higher than rates than expected with consequently reflected on higher than estimated CVRAS. This represents the first report of its kind in Honduras.
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Affiliation(s)
| | | | - Aida Argentina Rodriguez
- Western Honduras Gastric Cancer Prevention Initiative, Hospital de Occidente, Santa Rosa de Copan 41101, Honduras
| | - Gabriela Duarte
- Western Honduras Gastric Cancer Prevention Initiative, Hospital de Occidente, Santa Rosa de Copan 41101, Honduras
| | - Axel Murillo
- Western Honduras Gastric Cancer Prevention Initiative, Hospital de Occidente, Santa Rosa de Copan 41101, Honduras
| | - Ricardo Rivera
- Western Honduras Gastric Cancer Prevention Initiative, Hospital de Occidente, Santa Rosa de Copan 41101, Honduras
| | | | | | - Eva Ordoñez
- Western Honduras Gastric Cancer Prevention Initiative, Hospital de Occidente, Santa Rosa de Copan 41101, Honduras
| | - Dalton Argean Norwood
- Western Honduras Gastric Cancer Prevention Initiative, Hospital de Occidente, Santa Rosa de Copan 41101, Honduras
| | - Lucia Belem Dominguez
- Western Honduras Gastric Cancer Prevention Initiative, Hospital de Occidente, Santa Rosa de Copan 41101, Honduras
| | - Ricardo Leonel Dominguez
- Western Honduras Gastric Cancer Prevention Initiative, Hospital de Occidente, Santa Rosa de Copan 41101, Honduras
| | - Karla Torres
- Universidad Nacional Autonoma de Honduras, Santa Rosa de Copan 41101, Honduras
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Gerstein HC, Paré G, McQueen MJ, Lee SF, Bangdiwala SI, Kannt A, Hess S. Novel Biomarkers for Change in Renal Function in People With Dysglycemia. Diabetes Care 2020; 43:433-439. [PMID: 31727687 DOI: 10.2337/dc19-1604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a major risk factor for renal function decline and failure. The availability of multiplex panels of biochemical markers provides the opportunity to identify novel biomarkers that can better predict changes in renal function than routinely available clinical markers. RESEARCH DESIGN AND METHODS The concentration of 239 biochemical markers was measured in stored serum from participants in the biomarker substudy of Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial. Repeated-measures mixed-effects models were used to compute the annual change in eGFR (measured as mL/min/1.73 m2/year) for the 7,482 participants with a recorded baseline and follow-up eGFR. Linear regression models using forward selection were used to identify the independent biomarker determinants of the annual change in eGFR after accounting for baseline HbA1c, baseline eGFR, and routinely measured clinical risk factors. The incidence of the composite renal outcome (i.e., renal replacement therapy, renal death, renal failure, albuminuria progression, doubling of serum creatinine) and death within each fourth of change in eGFR predicted from these models was also estimated. RESULTS During 6.2 years of median follow-up, the median annual change in eGFR was -0.18 mL/min/1.73 m2/year. Fifteen biomarkers independently predicted eGFR decline after accounting for cardiovascular risk factors, as did 12 of these plus 1 additional biomarker after accounting for renal risk factors. Every 0.1 mL/min/1.73 m2 predicted annual fall in eGFR predicted a 13% (95% CI 12, 14%) higher mortality. CONCLUSIONS Adding up to 16 biomarkers to routinely measured clinical risk factors improves the prediction of annual change in eGFR in people with dysglycemia.
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Affiliation(s)
- Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Guillaume Paré
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.,Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Matthew J McQueen
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Shrikant I Bangdiwala
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Aimo Kannt
- Sanofi Aventis Deutschland GmbH Research and Development, Frankfurt, Germany
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Jarab AS, Rababa'h AM, Almousa A, Mukattash TL, Bsoul R. Non‐adherence to pharmacotherapy and its associated factors among patients with angina in Jordan. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2020. [DOI: 10.1111/jphs.12341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Anan S. Jarab
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| | - Abeer M. Rababa'h
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| | - Abdullah Almousa
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
| | - Razan Bsoul
- Department of Clinical Pharmacy Faculty of Pharmacy Jordan University of Science and Technology IrbidJordan
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71
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Johnson A, Gnanaselvam N, Gomes S, Jeskezia JV, Chandran N, Bajaj S. Assessment of 5-year risk of cardiovascular events among adults residing in an urban underprivileged area of Bangalore city: A community-based cross-sectional study. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_60_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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72
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Jarab AS, Almousa A, Rababa'h AM, Mukattash TL, Farha RA. Health-related quality of life and its associated factors among patients with angina in Jordan. Qual Life Res 2019; 29:1027-1035. [PMID: 31823184 DOI: 10.1007/s11136-019-02383-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite the negative impact of angina and its worsening symptoms on the quality of life of the affected patients, little research has evaluated the factors associated with poor health-related quality of life (HRQOL) among patients with angina. OBJECTIVE The study aim was to evaluate HRQOL and to explore factors associated with poor HRQOL in patients with angina in Jordan. SETTING The present study used data collected for patients attending the cardiology clinic at the Royal Medical Services (RMS) Hospital in Amman. METHODS In addition to collecting sociodemographic and clinical data, the EQ-5D questionnaire was used to assess HRQOL in outpatients with angina in the present study. Multiple linear regression analysis was conducted to build a model with variables that are significantly and independently associated with poor HRQOL. MAIN OUTCOME MEASURE HRQOL quantified using the EQ-5D. RESULTS The mean of the total EQ-5D score of the 500 participants was 0.392. Most of the patients reported 'some problems' through the five dimensions, with the highest percentage (66.6%) related to mobility domain. Regression analysis identified female gender (B = - 0.232; P < 0.05) elevated fasting blood sugar (FBS) (P < 0.05; B = - 0.219), and low high density lipoprotein (HDL) (B = - 0.183; P < 0.05) as being significantly associated with poor HRQOL. CONCLUSIONS The HRQOL has considerable scope for improvement for patients with angina in Jordan. Female gender, elevated FBS, and decreased HDL levels were significantly associated with poor HRQoL in the present study.
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Affiliation(s)
- Anan S Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan.
| | - Abdullah Almousa
- Department of Clinical Pharmacy, Jordanian Royal Medical Services, P.O. Box 855122, Amman, 11855, Jordan
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Rana Abu Farha
- Department of Clinical Pharmacy, Faculty of Pharmacy, Applied Sciences Private University, P.O. Box 166, Amman, 11931, Jordan
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Anand SS, Abonyi S, Arbour L, Balasubramanian K, Brook J, Castleden H, Chrisjohn V, Cornelius I, Davis AD, Desai D, de Souza RJ, Friedrich MG, Harris S, Irvine J, L'Hommecourt J, Littlechild R, Mayotte L, McIntosh S, Morrison J, Oster RT, Picard M, Poirier P, Schulze KM, Toth EL. Explaining the variability in cardiovascular risk factors among First Nations communities in Canada: a population-based study. Lancet Planet Health 2019; 3:e511-e520. [PMID: 31868600 DOI: 10.1016/s2542-5196(19)30237-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Historical, colonial, and racist policies continue to influence the health of Indigenous people, and they continue to have higher rates of chronic diseases and reduced life expectancy compared with non-Indigenous people. We determined factors accounting for variations in cardiovascular risk factors among First Nations communities in Canada. METHODS Men and women (n=1302) aged 18 years or older from eight First Nations communities participated in a population-based study. Questionnaires, physical measures, blood samples, MRI of preclinical vascular disease, and community audits were collected. In this cross-sectional analysis, the main outcome was the INTERHEART risk score, a measure of cardiovascular risk factor burden. A multivariable model was developed to explain the variations in INTERHEART risk score among communities. The secondary outcome was MRI-detected carotid wall volume, a measure of subclinical atherosclerosis. FINDINGS The mean INTERHEART risk score of all communities was 17·2 (SE 0·2), and more than 85% of individuals had a risk score in the moderate to high risk range. Subclinical atherosclerosis increased significantly across risk score categories (p<0·0001). Socioeconomic advantage (-1·4 score, 95% CI -2·5 to -0·3; p=0·01), trust between neighbours (-0·7, -1·2 to -0·3; p=0·003), higher education level (-1·9, -2·9 to -0·8, p<0·001), and higher social support (-1·1, -2·0 to -0·2; p=0·02) were independently associated with a lower INTERHEART risk score; difficulty accessing routine health care (2·2, 0·3 to 4·1, p=0·02), taking prescription medication (3·5, 2·8 to 4·3; p<0·001), and inability to afford prescription medications (1·5, 0·5 to 2·6; p=0·003) were associated with a higher INTERHEART risk score. Collectively, these factors explained 28% variation in the cardiac risk score among communities. Communities with higher socioeconomic advantage and greater trust, and individuals with higher education and social support, had a lower INTERHEART risk score. Communities with difficulty accessing health care, and individuals taking or unable to afford prescription medications, had a higher INTERHEART risk score. INTERPRETATION Cardiac risk factors are lower in communities with high socioeconomic advantage, greater trust, social support and educational opportunities, and higher where it is difficult to access health care or afford prescription medications. Strategies to optimise the protective factors and reduce barriers to health care in First Nations communities might contribute to improved health and wellbeing. FUNDING Heart and Stroke Foundation of Canada, Canadian Partnership Against Cancer, Canadian Institutes for Health Research.
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Affiliation(s)
- Sonia S Anand
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Health Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada.
| | - Sylvia Abonyi
- Faculty of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; Division of Biomedical Sciences, University of Victoria, Victoria, BC, Canada
| | - Kumar Balasubramanian
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada
| | - Jeffrey Brook
- Dalla Lana School of Public Health and Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, ON, Canada
| | - Heather Castleden
- Department of Geogrophy and Planning, Queens University, Kingston, ON, Canada
| | - Vicky Chrisjohn
- Oneida Health Centre, Oneida Nation of the Thames, Southwold, ON, Canada
| | - Ida Cornelius
- Oneida Health Centre, Oneida Nation of the Thames, Southwold, ON, Canada
| | | | - Dipika Desai
- Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada
| | - Russell J de Souza
- Department of Health Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada
| | - Matthias G Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montréal, QC, Canada
| | - Stewart Harris
- Department of Family Medicine, Western University, London, ON, Canada
| | - James Irvine
- Department of Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Randy Littlechild
- Maskwacis Health Services, Maskwacis First Nation, Maskwacis, AB, Canada
| | - Lisa Mayotte
- Health Services, Lac La Ronge Indian Band, La Ronge, SK, Canada
| | - Sarah McIntosh
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | | | - Richard T Oster
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Manon Picard
- Health Services, Wendake Reserve, Wendake, QC, Canada
| | - Paul Poirier
- Institut universitaire de cardiologie et de pneumologie de Quebec, Université Laval, QC, Canada
| | - Karleen M Schulze
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamiliton Health Sciences, Hamilton, ON, Canada
| | - Ellen L Toth
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Umer A, Lilly C, Hamilton C, Cottrell L, Lefeber T, Hulsey T, John C. Updating a Perinatal Risk Scoring System to Predict Infant Mortality. Am J Perinatol 2019; 36:1278-1287. [PMID: 30593081 PMCID: PMC6599540 DOI: 10.1055/s-0038-1676631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The Birth Score Project (Project WATCH) began in the rural state of West Virginia (WV) in the United States in 1984. The project is intended to identify newborns with a greater risk of infant mortality. The primary objective of this study was to update the current Birth Score based on current literature and rigorous statistical methodology. STUDY DESIGN The study merged data from the Birth Score, Birth Certificate (birth years 2008-2013), and Infant Mortality Data (N = 121,640). The merged data were randomly divided into developmental (N = 85,148) and validation (N = 36,492) datasets. Risk scoring system was developed using the weighted multivariate risk score functions and consisted of infant and maternal factors. RESULTS The updated score ranged from 0 to 86. Infants with a score of ≥17 were categorized into the high score group (n = 15,387; 18.1%). The odds of infant mortality were 5.6 times higher (95% confidence interval: 4.4, 7.1) among those who had a high score versus low score. CONCLUSION The updated score is a better predictor of infant mortality than the current Birth Score. This score has practical relevance for physicians in WV to identify newborns at the greatest risk of infant mortality and refer the infants to primary pediatric services and case management for close follow-up.
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Affiliation(s)
- Amna Umer
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Christa Lilly
- Department of Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Candice Hamilton
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Lesley Cottrell
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Timothy Lefeber
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Thomas Hulsey
- Department of Epidemiology, School of Public Health, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
| | - Collin John
- Department of Pediatrics, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown, West Virginia
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Nansseu JR, Assah F, Petnga SJ, Kameni BS, Tene HDF, Nang FT, Wouna DLA, Noubiap JJ, Kamgno J. Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon. BMJ Open 2019; 9:e030594. [PMID: 31542752 PMCID: PMC6756422 DOI: 10.1136/bmjopen-2019-030594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe the global cardiovascular disease (CVD) risk distribution in a young adult-aged population living in Yaoundé, Cameroon and depict factors likely influencing this risk distribution. DESIGN A cross-sectional study between May and July 2017. SETTING The University of Yaoundé I, Cameroon. PARTICIPANTS Any university student aged 18 years and above, with no known history of CVD, found at the campus during recruitment and who voluntarily agreed to be included in the study. PRIMARY AND SECONDARY OUTCOME MEASURES The global risk of CVD was measured with the non-laboratory-based INTERHEART Modifiable Risk Score. RESULTS A total of 949 participants (54% males) were recruited; the median age was 23 (IQR 21-26) years. The CVD risk varied between 2 and 21, with a median of 9 (IQR 7-12); 51.2% of students had a low risk of CVD, 43.7% had a moderate risk and 5.1% presented a high risk of CVD. The number of years since first registration at the university (β=0.08), history of sudden death among biological parents (β=1.28), history of hypertension among brothers/sisters (β=1.33), history of HIV infection (β=4.34), the Alcohol Use Disorder Identification Test-Consumption score (β=0.13), regular exposure to firewood smoke (β=1.29), eating foods/drinks with too much sugar ≥1 time/day (β=0.96), eating foods/snacks with too much oil ≥3 times/week (β=1.20) and eating dairy products≥1 time/day (β=0.61) were the independent factors likely influencing participants' global risk of CVD. CONCLUSION Almost 50% of participants had moderate or high risk of CVD. Specific interventions targeting major CVD risk factors should be put in place among young adults to prevent or reduce this upcoming overburdened picture of CVD.
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Affiliation(s)
- Jobert Richie Nansseu
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
- Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon
| | - Felix Assah
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
| | - Saint-Just Petnga
- Kousseri Regional Hospital, Far-North Regional Delegation, Ministry of Public Health, Kousseri, Cameroon
| | - Bibiane Siaheu Kameni
- HIV Care Unit, Ngaoundéré Regional Hospital and Regional Technical Group for the Fight Against HIV/AIDS, Adamawa Regional Delegation, Ministry of Public Health, Ngaoundere, Cameroon
| | | | | | | | - Jean Jacques Noubiap
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Joseph Kamgno
- Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
- Centre for Research on Filariasis and other Tropical Diseases, Yaoundé, Cameroon
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Prevalence, awareness, treatment and control of hypertension in rural and urban communities in Latin American countries. J Hypertens 2019; 37:1813-1821. [DOI: 10.1097/hjh.0000000000002108] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Rosengren A, Smyth A, Rangarajan S, Ramasundarahettige C, Bangdiwala SI, AlHabib KF, Avezum A, Bengtsson Boström K, Chifamba J, Gulec S, Gupta R, Igumbor EU, Iqbal R, Ismail N, Joseph P, Kaur M, Khatib R, Kruger IM, Lamelas P, Lanas F, Lear SA, Li W, Wang C, Quiang D, Wang Y, Lopez-Jaramillo P, Mohammadifard N, Mohan V, Mony PK, Poirier P, Srilatha S, Szuba A, Teo K, Wielgosz A, Yeates KE, Yusoff K, Yusuf R, Yusufali AH, Attaei MW, McKee M, Yusuf S. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. LANCET GLOBAL HEALTH 2019; 7:e748-e760. [PMID: 31028013 DOI: 10.1016/s2214-109x(19)30045-2] [Citation(s) in RCA: 285] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/28/2018] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status-wealth and education-differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management. METHODS In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics. Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family. FINDINGS Recruitment to the study began on Jan 12, 2001, with most participants enrolled between Jan 6, 2005, and Dec 4, 2014. 160 299 (87·9%) of 182 375 participants with baseline data had available follow-up event data and were eligible for inclusion. After exclusion of 6130 (3·8%) participants without complete baseline or follow-up data, 154 169 individuals remained for analysis, from five low-income, 11 middle-income, and four high-income countries. Participants were followed-up for a mean of 7·5 years. Major cardiovascular events were more common among those with low levels of education in all types of country studied, but much more so in low-income countries. After adjustment for wealth and other factors, the HR (low level of education vs high level of education) was 1·23 (95% CI 0·96-1·58) for high-income countries, 1·59 (1·42-1·78) in middle-income countries, and 2·23 (1·79-2·77) in low-income countries (pinteraction<0·0001). We observed similar results for all-cause mortality, with HRs of 1·50 (1·14-1·98) for high-income countries, 1·80 (1·58-2·06) in middle-income countries, and 2·76 (2·29-3·31) in low-income countries (pinteraction<0·0001). By contrast, we found no or weak associations between wealth and these two outcomes. Differences in outcomes between educational groups were not explained by differences in risk factors, which decreased as the level of education increased in high-income countries, but increased as the level of education increased in low-income countries (pinteraction<0·0001). Medical care (eg, management of hypertension, diabetes, and secondary prevention) seemed to play an important part in adverse cardiovascular disease outcomes because such care is likely to be poorer in people with the lowest levels of education compared to those with higher levels of education in low-income countries; however, we observed less marked differences in care based on level of education in middle-income countries and no or minor differences in high-income countries. INTERPRETATION Although people with a lower level of education in low-income and middle-income countries have higher incidence of and mortality from cardiovascular disease, they have better overall risk factor profiles. However, these individuals have markedly poorer health care. Policies to reduce health inequities globally must include strategies to overcome barriers to care, especially for those with lower levels of education. FUNDING Full funding sources are listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Andrew Smyth
- HRB Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology and University Santo Amaro, São Paulo, Brazil
| | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Sadi Gulec
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Ehi U Igumbor
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Norhassim Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Philip Joseph
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rasha Khatib
- Public Health Sciences, Stritch School of Medicine, Maywood, IL, USA
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Pablo Lamelas
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chuangshi Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Deren Quiang
- Wujin District Center for Disease Control and Prevention, Changzhou, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Patricio Lopez-Jaramillo
- Research Institute, FOSCAL International Clinic, Bucaramanga, Colombia; Eugenio Espejo Medical School, Universidad UTE, Quito, Ecuador
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, QC, Canada
| | | | - Andrzej Szuba
- Division of Angiology, Wroclaw Medical University, Wroclaw, Poland
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia; UCSI University, Kuala Lumpur, Malaysia
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afzalhusein H Yusufali
- Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Marjan W Attaei
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
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Lianov LS, Fredrickson BL, Barron C, Krishnaswami J, Wallace A. Positive Psychology in Lifestyle Medicine and Health Care: Strategies for Implementation. Am J Lifestyle Med 2019; 13:480-486. [PMID: 31523213 DOI: 10.1177/1559827619838992] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Prevention and treatment of lifestyle-related diseases are realized through leading a healthy lifestyle. Activities supporting positive psychology can facilitate healthy behaviors and improve physiological health. Adding such activities to clinical care promotes attainment of the physical, social, and emotional elements of health, as defined by the World Health Organization-leading to (1) prolonged lifespan and quality of life, (2) lowered costs of care, and (3) reduced rates of provider burnout. A key challenge remains the translation of positive psychology-based practices into practical, implementable strategies by health care providers. An essential step is collaboration of positive psychology and health care researchers and practitioners to develop standards, terms, and measures and arrive at evidence-based clinical approaches addressing total well-being. The first Summit on Happiness Science in Healthcare enabled national experts and stakeholders in lifestyle medicine, medical education, health care administration, psychology, and community welfare to convene and identify best practices for practical implementation of positive psychology science into health care. This article draws on the summit discussions to address the gap between positive psychology theory and practical implementation in health care. We briefly summarize the positive psychology-health outcomes relationship and present key strategies needed to bridge this gap.
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Affiliation(s)
- Liana S Lianov
- American College of Lifestyle Medicine, Chesterfield, MO (LSL).,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, North Carolina (BLF).,Dell Medical School, DMS Department of Psychiatry, Austin, Texas (CB).,University of Texas Rio Grande Valley School of Medicine, McAllen, Texas (JK).,Beech Acres Parenting Center, Cincinnati, Ohio (AW)
| | - Barbara L Fredrickson
- American College of Lifestyle Medicine, Chesterfield, MO (LSL).,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, North Carolina (BLF).,Dell Medical School, DMS Department of Psychiatry, Austin, Texas (CB).,University of Texas Rio Grande Valley School of Medicine, McAllen, Texas (JK).,Beech Acres Parenting Center, Cincinnati, Ohio (AW)
| | - Carrie Barron
- American College of Lifestyle Medicine, Chesterfield, MO (LSL).,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, North Carolina (BLF).,Dell Medical School, DMS Department of Psychiatry, Austin, Texas (CB).,University of Texas Rio Grande Valley School of Medicine, McAllen, Texas (JK).,Beech Acres Parenting Center, Cincinnati, Ohio (AW)
| | - Janani Krishnaswami
- American College of Lifestyle Medicine, Chesterfield, MO (LSL).,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, North Carolina (BLF).,Dell Medical School, DMS Department of Psychiatry, Austin, Texas (CB).,University of Texas Rio Grande Valley School of Medicine, McAllen, Texas (JK).,Beech Acres Parenting Center, Cincinnati, Ohio (AW)
| | - Anne Wallace
- American College of Lifestyle Medicine, Chesterfield, MO (LSL).,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, North Carolina (BLF).,Dell Medical School, DMS Department of Psychiatry, Austin, Texas (CB).,University of Texas Rio Grande Valley School of Medicine, McAllen, Texas (JK).,Beech Acres Parenting Center, Cincinnati, Ohio (AW)
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Hammoudeh AJ, Al-Bayyari N, Obeidat O, Al-Mousa EN, Tabbalat RA, Alhaddad IA. Incidence and impact on prognosis of impaired kidney function in Middle Eastern patients undergoing percutaneous coronary intervention: results from the first Jordanian PCI Registry. ASIAINTERVENTION 2019; 5:18-26. [PMID: 36483935 PMCID: PMC9706756 DOI: 10.4244/aij-d-17-00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/06/2018] [Indexed: 06/17/2023]
Abstract
AIMS The aim of this study was to evaluate the impact on prognosis of renal impairment (RI) in Middle Eastern patients after percutaneous coronary intervention (PCI). METHODS AND RESULTS PCI patients (N=2,426) were divided into three groups according to the estimated glomerular filtration rate (eGFR, ml/min/1.73 m2): normal renal function (eGFR ≥90), mild RI (eGFR 60-89), or moderate to severe RI (eGFR <60). Mean age of participants was 56±11 years. Normal renal function was present in 41.6%, mild RI in 44.2%, and moderate to severe RI in 14.2%. Patients with moderate to severe RI were older and had higher prevalence of hypertension and diabetes mellitus compared with other patients (p≤0.002). At one year, patients with moderate to severe RI had a higher incidence of cardiac mortality (3.78%) compared with patients with mild (1.77%) or no RI (1.49%), p=0.03. In multivariate analysis, moderate to severe RI was associated with higher one-year cardiac mortality compared to mild or no RI (odds ratio=3.7; 95% CI: 2.8-5.0, p=0.001). CONCLUSIONS Impaired renal function was present in about six out of 10 Middle Eastern patients undergoing PCI. Moderate to severe RI carries a higher risk of cardiac mortality at one year compared with mild or no RI.
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Affiliation(s)
| | - Nahla Al-Bayyari
- Department of Nutrition and Food Technology, Faculty of Al-Huson University College, Al-Balqa Applied University, Al-Salt, Jordan
| | - Omar Obeidat
- Division of Cardiology, Department of Internal Medicine, Jordan University Hospital, Amman, Jordan
| | | | | | - Imad A Alhaddad
- Division of Cardiology, Department of Internal Medicine, Jordan Hospital Medical Center, Amman, Jordan
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Joseph P, Pais P, Dans AL, Bosch J, Xavier D, Lopez-Jaramillo P, Yusoff K, Santoso A, Talukder S, Gamra H, Yeates K, Lopez PC, Tyrwhitt J, Gao P, Teo K, Yusuf S. The International Polycap Study-3 (TIPS-3): Design, baseline characteristics and challenges in conduct. Am Heart J 2018; 206:72-79. [PMID: 30342297 PMCID: PMC6299262 DOI: 10.1016/j.ahj.2018.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/18/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND It is hypothesized that in individuals without clinical cardiovascular disease (CVD), but at increased CVD risk, a 50% to 60% reduction in CVD risk could be achieved using fixed dose combination (FDC) therapy (usually comprised of multiple blood-pressure agents and a statin [with or without aspirin]) in a single "polypill". However, the impact of a polypill in preventing clinical CV events has not been evaluated in a large randomized controlled trial. METHODS TIPS-3 is a 2x2x2 factorial randomized controlled trial that will examine the effect of a FDC polypill on major CV outcomes in a primary prevention population. This study aims to determine whether the Polycap (comprised of atenolol, ramipril, hydrochlorothiazide, and a statin) reduces CV events in persons without a history of CVD, but who are at least at intermediate CVD risk. Additional interventions in the factorial design of the study will compare the effect of (1) aspirin versus placebo on CV events (and cancer), (2) vitamin D versus placebo on the risk of fractures, and (3) the combined effect of aspirin and the Polycap on CV events. RESULTS The study has randomized 5713 participants across 9 countries. Mean age of the study population is 63.9 years, and 53% are female. Mean INTERHEART risk score is 16.8, which is consistent with a study population at intermediate CVD risk. CONCLUSION Results of the TIP-3 study will be key to determining the appropriateness of FDC therapy as a strategy in the global prevention of CVD.
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Affiliation(s)
- Philip Joseph
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Prem Pais
- St. John's Medical College, Bangalore, India
| | - Antonio L Dans
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Jackie Bosch
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada; School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Patricio Lopez-Jaramillo
- Research Institute and Clinic of Metabolic Syndrome and Diabetes, Fundacion Oftalmologica de Santander FOSCAL, Universidad de Santander UDES, Bucaramanga, Colombia
| | - Khalid Yusoff
- UiTM Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Anwar Santoso
- Universitas Indonesia and Department of Cardiology - Vascular Medicine, National Cardiovascular Centre, Harapan Kita Hospital, Jakarta, Indonesia
| | | | - Habib Gamra
- Fattouma Bourguiba University Hospital and University of Monastir, Tunisia
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Paul Camacho Lopez
- Research Institute and Clinic of Metabolic Syndrome and Diabetes, Fundacion Oftalmologica de Santander FOSCAL, Universidad de Santander UDES, Bucaramanga, Colombia
| | - Jessica Tyrwhitt
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Peggy Gao
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada.
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Gandhi M, Assam PN, Turner EL, Morisky DE, Chan E, Jafar TH. Statistical analysis plan for the control of blood pressure and risk attenuation-rural Bangladesh, Pakistan, Sri Lanka (COBRA-BPS) trial: a cluster randomized trial for a multicomponent intervention versus usual care in hypertensive patients. Trials 2018; 19:658. [PMID: 30486858 PMCID: PMC6263546 DOI: 10.1186/s13063-018-3022-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 10/25/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In rural south Asia, hypertension remains a significant public health issue with sub-optimal blood pressure (BP) control rates. The goal of the trial is to evaluate the effectiveness and cost-effectiveness of a multicomponent intervention (MCI) compared to usual care on lowering BP among adults with hypertension in rural south-Asian communities. This article describes the statistical analysis plan for the primary and secondary objectives related to intervention effectiveness based on clinical and patient-reported endpoints. METHODS/DESIGN The study is a cluster randomized trial which will enroll 2550 participants aged ≥ 40 years with hypertension from rural communities in Bangladesh, Pakistan, and Sri Lanka. The unit of randomization is a cluster defined by 250-300 households. Thirty clusters, 10 from each country, are randomized in a 1:1 ratio to either MCI or usual care, stratified by country and their distance from the clinic. All participants will be assessed every six months over a two-year period after baseline with measurements of systolic and diastolic BP, antihypertensive and statin medication use, medication adherence, physical activity level, anthropometric parameters, smoking status, and dietary habits. The primary objective is to assess the effectiveness of MCI as compared with usual care in terms of mean change in systolic BP from baseline to final follow-up at two years. The primary outcome will be modelled using a generalized linear mixed-model for repeated measures based on a participant-level analysis. The model will include cluster random-effects and will use a non-independence residual correlation matrix to account for repeated measures on the same participant. Sensitivity analyses for the primary endpoint will be based on multiple imputation as well as pattern mixture model tipping point analyses. Secondary outcomes will be analyzed using the same modeling approach as for the primary outcome, with appropriate distributions within the exponential family and corresponding link functions. DISCUSSION The a priori statistical analysis plan will avoid reporting bias and data-driven analysis for the primary and key secondary outcomes. The results of the study will provide evidence of the benefits and risks of the MCI for BP control in rural communities in south Asian countries with low-resourced public health infrastructure. TRIAL REGISTRATION Clinicaltrials.gov, NCT02657746 . Registered on 14 January 2016.
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Affiliation(s)
- Mihir Gandhi
- Department of Biostatistics, Singapore Clinical Research Institute, #02-01, Nanos, 31 Biopolis Way, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Leve 6, Academia, 20 College Road, Singapore, Singapore
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Arvo Building, Lääkärinkatu 1, Tampere, Finland
| | - Pryseley Nkouibert Assam
- Department of Biostatistics, Singapore Clinical Research Institute, #02-01, Nanos, 31 Biopolis Way, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Leve 6, Academia, 20 College Road, Singapore, Singapore
| | - Elizabeth L. Turner
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC USA
- Duke Global Health Institute, Duke University, Trent Hall, 310 Trent Drive, Durham, NC USA
| | - Donald E. Morisky
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California USA
| | - Edwin Chan
- Department of Epidemiology, Singapore Clinical Research Institute, #02-01, Nanos, 31 Biopolis Way, Singapore, Singapore
| | - Tazeen H. Jafar
- Duke Global Health Institute, Duke University, Trent Hall, 310 Trent Drive, Durham, NC USA
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
| | - on behalf of the COBRA-BPS Study Group
- Department of Biostatistics, Singapore Clinical Research Institute, #02-01, Nanos, 31 Biopolis Way, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Leve 6, Academia, 20 College Road, Singapore, Singapore
- Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, Arvo Building, Lääkärinkatu 1, Tampere, Finland
- Department of Biostatistics and Bioinformatics, Duke University, 2424 Erwin Road, Durham, NC USA
- Duke Global Health Institute, Duke University, Trent Hall, 310 Trent Drive, Durham, NC USA
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California USA
- Department of Epidemiology, Singapore Clinical Research Institute, #02-01, Nanos, 31 Biopolis Way, Singapore, Singapore
- Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, Singapore
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82
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Cardiovascular Diseases and Long-term Self-reported Exposure to Pollution: RESULTS OF A NATIONAL EPIDEMIOLOGICAL STUDY IN LEBANON. J Cardiopulm Rehabil Prev 2018; 39:43-49. [PMID: 30418257 DOI: 10.1097/hcr.0000000000000378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are linked to high mortality and morbidity, particularly in developing countries. Some studies have linked indoor and outdoor pollution to CVD, but results are inconsistent. Our objective was to assess this association in Lebanon, a Middle Eastern country. METHODS A national cross-sectional study was conducted across Lebanon. CVD prevalence, which included prevalent ischemic heart and cerebrovascular diseases, was assessed. Moreover, in addition to self-reported items of pollution exposure, we assessed potential predictors of CVD, including sociodemographic characteristics, self-reported health information, and biological measurements. RESULTS We assessed the dose-effect relationship of pollution items in relation with CVD. Self-reported indoor and outdoor pollution exposures were associated with CVD, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease (44% increase in risk of CVD for every additional pollution exposure item), after adjustment for sociodemographic and biological characteristics. CONCLUSION Although additional studies would be necessary to confirm these findings, interventions should start to sensitize the population about the effect of pollution on chronic diseases and the work of reducing pollution and improving air quality should be implemented to decrease the disease burden on the population and health system.
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83
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Rehman H, Samad Z, Mishra SR, Merchant AT, Narula JP, Mishra S, Virani SS. Epidemiologic studies targeting primary cardiovascular disease prevention in South Asia. Indian Heart J 2018; 70:721-730. [PMID: 30392513 PMCID: PMC6204454 DOI: 10.1016/j.ihj.2018.01.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 12/12/2017] [Accepted: 01/16/2018] [Indexed: 01/02/2023] Open
Abstract
South Asia has experienced a 73% increase in healthy life years lost due to ischemic heart disease between 1990 and 2010. There is a lack of quality data relating to cardiovascular risk factors and disease from this region. Several observational and prospective cohorts in South Asia have been established in recent times to evaluate the burden of cardiovascular disease and their risk factors. The Prospective Rural Urban Epidemiology (PURE) study is the largest of these studies that has provided data on social, environmental, behavioral and biologic risk factors that influence heart disease and diabetes. Some studies have also borrowed data from large datasets to provide meaningful insights. These studies have allowed a better understanding of cardiovascular disease risk factors indigenous to the South Asian population along with conventional risk factors. Culturally sensitive interventions geared towards treating risk factors identified in these studies are needed to fully realize the true potential of these epidemiologic studies.
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Affiliation(s)
| | - Zainab Samad
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Shiva Raj Mishra
- Nepal Development Society, Bharatpur-10, Chitwan, Nepal; Center for Longitudinal and Lifecourse Research, Faculty of Medicine, University of Queensland, Herston, QLD 4006, Australia
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Jagat P Narula
- Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Mount Sinai School of Medicine, USA
| | - Sundeep Mishra
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Salim S Virani
- Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
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84
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Itsiopoulos C, Kucianski T, Mayr HL, van Gaal WJ, Martinez-Gonzalez MA, Vally H, Kingsley M, Kouris-Blazos A, Radcliffe J, Segal L, Brazionis L, Salim A, Tierney AC, O'Dea K, Wilson A, Thomas CJ. The AUStralian MEDiterranean Diet Heart Trial (AUSMED Heart Trial): A randomized clinical trial in secondary prevention of coronary heart disease in a multiethnic Australian population: Study protocol. Am Heart J 2018; 203:4-11. [PMID: 29966802 DOI: 10.1016/j.ahj.2018.05.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/21/2018] [Indexed: 11/27/2022]
Abstract
The Mediterranean diet was first characterized as a heart-protective diet in the 1960s. The significant cardioprotective effects of the Mediterranean diet in comparison to the standard-care low-fat diet have been established in the primary prevention of cardiovascular disease (CVD); however, there is insufficient evidence in secondary prevention research to influence the current standard of care. Opportunity exists to assess the Mediterranean diet as a therapeutic target for secondary CVD prevention within Australia's ethnoculturally diverse communities. The AUSMED Heart Trial is a multisite randomized controlled trial that will evaluate the efficacy of the Mediterranean diet for secondary prevention of CVD in the Australian health care setting. This trial aims to evaluate the effect of a 6-month Mediterranean diet intervention (delivered by dietitians) versus a "standard-care" low-fat diet in reducing the composite incidence of cardiovascular events at 12 months and at trial end in participants with documented evidence of a previous acute myocardial infarction at trial entry. The quality of the diet at baseline and follow-up will be assessed using comprehensive dietary questionnaires and diaries as well as relevant dietary biomarkers (such as urinary polyphenols and erythrocyte fatty acids). Cardiovascular risk markers, including novel measures of immune and inflammatory status, endothelial function, vascular compliance, platelet activity, and body composition, will be collected to explore possible mechanisms for treatment effect. Cost-effectiveness will also be estimated to support policy translation. We plan to recruit 1,032 participants (516 per arm) from cardiology clinics in major Australian hospitals in Melbourne, Adelaide, and Brisbane.
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85
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Apoloni RC, Zerati AE, Wolosker N, Saes GF, Wolosker M, Curado T, Puech-Leão P, De Luccia N. Analysis of the Correlation Between Central Obesity and Abdominal Aortic Diseases. Ann Vasc Surg 2018; 54:176-184. [PMID: 30103051 DOI: 10.1016/j.avsg.2018.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/23/2018] [Accepted: 06/11/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Atherosclerosis and abdominal aortic aneurysms (AAAs) have several similar risk factors but different pathogenesis. Inflammation of the arteries is common to both. Central obesity can act as an endocrine organ through the secretion of inflammatory cytokines, and the perivascular fat has a local effect that could contribute to diseases of the abdominal aorta. Although the relation between central obesity and atherosclerosis occlusive arterial disease has been demonstrated, the correlation with AAA has conflicting results. The aim of this study was to analyze the correlation between central obesity and the presence of abdominal aortic diseases using computed tomography. METHODS Six hundred thirty-nine consecutive patients classified into 3 groups (AAA, aortic atherosclerotic occlusive disease (AAOD), and without aortic disease [control group]) who underwent computed tomography had the aorta diameter, the visceral fat area (VFA), and the subcutaneous fat area (SFA) measured at the level of third and fourth lumbar vertebrae. RESULTS VFA showed no difference between the groups. SFA was lower in atherosclerotic group (AAOD) than control (P < 0.01 in general and P < 0.04 in male). In AAA group, we found in men that the first tertile of aorta diameter had higher VFA than third tertile (P = 0.02). CONCLUSIONS There was no difference in VFA between patients in AAA, AAOD, and without aortic disease groups. In men with aneurysm, there was an inverse relationship between VFA and aortic diameter. In AAOD, visceral to subcutaneous ratio is higher due to lower SFA.
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Affiliation(s)
- Rafael Correa Apoloni
- Department of Vascular Surgery, Hospital das Clinicas University of Sao Paulo, Sao Paulo, SP, Brazil.
| | - Antonio Eduardo Zerati
- Department of Vascular Surgery, Hospital das Clinicas University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Nelson Wolosker
- Department of Vascular Surgery, Hospital das Clinicas University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Glauco Fernandes Saes
- Department of Vascular Surgery, Hospital das Clinicas University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Marina Wolosker
- Department of Vascular Surgery, Hospital das Clinicas University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Taina Curado
- Department of Vascular Surgery, Hospital das Clinicas University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Pedro Puech-Leão
- Department of Vascular Surgery, Hospital das Clinicas University of Sao Paulo, Sao Paulo, SP, Brazil
| | - Nelson De Luccia
- Department of Vascular Surgery, Hospital das Clinicas University of Sao Paulo, Sao Paulo, SP, Brazil
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86
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Fowokan A, Black J, Holmes E, Seto D, Lear S. Examining risk factors for cardiovascular disease among food bank members in Vancouver. Prev Med Rep 2018; 10:359-362. [PMID: 29868392 PMCID: PMC5984241 DOI: 10.1016/j.pmedr.2018.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/07/2018] [Accepted: 04/21/2018] [Indexed: 11/30/2022] Open
Abstract
Food banks provide supplemental food to low-income households, yet little is known about the cardiovascular health of food banks members. This study therefore described cardiovascular disease (CVD) risk factors among food bank members and explored associations between food insecurity and CVD risk. Adults ≥18 years (n = 77) from three food bank sites in metro Vancouver, British Columbia completed surveys and physical assessments examining a range of socio-demographic variables and CVD risk factors. A composite measure of myocardial infarction (MI) risk called the INTERHEART score was assessed and household food insecurity was measured using the Household Food Security Survey Module. Regression models were used to explore associations between food insecurity and CVD risk measures, including the INTERHEART score. Ninety-seven percent of food bank members reported experiencing food insecurity, 65% were current smokers, 53% reported either chronic or several periods of stress in the past year, 55% reported low physical activity levels and 80% reported consuming fewer than five servings of fruit and vegetables daily. Prevalence of self-reported diabetes and hypertension were 13% and 29% respectively. Fifty-two percent of the sample were at high risk of non-fatal MI. No statistically significant associations were found between increased severity of food insecurity and CVD risk factors among this sample where both severe food insecurity and high CVD risks were prevalent. Food bank members were at elevated risk for CVD compared with the general population. Strategies are needed to reduce prevalence of food insecurity and CVD risk factors, both of which disproportionately affected food bank members.
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Affiliation(s)
- A.O. Fowokan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
| | - J.L. Black
- Faculty of Land and Food Systems, Food Nutrition and Health, University of British Columbia, 2205 East Mall, Vancouver V6T 1Z4, BC, Canada
| | - E. Holmes
- Faculty of Land and Food Systems, Food Nutrition and Health, University of British Columbia, 2205 East Mall, Vancouver V6T 1Z4, BC, Canada
| | - D. Seto
- Greater Vancouver Food Bank, Vancouver, BC, Canada
| | - S.A. Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby V5A 1S6, BC, Canada
- Division of Cardiology, Providence Health Care, Vancouver V6Z 1Y6, BC, Canada
- Corresponding author at: Healthy Heart Program, St. Paul's Hospital, 180-1081 Burrard St, Vancouver V6Z 1Y6, BC, Canada.
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87
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Ilic M, Grujicic Sipetic S, Ristic B, Ilic I. Myocardial infarction and alcohol consumption: A case-control study. PLoS One 2018; 13:e0198129. [PMID: 29864160 PMCID: PMC5986147 DOI: 10.1371/journal.pone.0198129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 05/14/2018] [Indexed: 12/13/2022] Open
Abstract
Background Although epidemiological evidence for the beneficial effect of low alcohol consumption on myocardial infarction is strong, the impact of heavy drinking episodes is less clear. Objectives The aim of this study was to investigate a possible association between the risk for acute myocardial infarction occurrence and alcohol consumption. Methods Our hospital-based case-control study comprised 374 participants (187 newly diagnosed patients with myocardial infarction and 187 controls, individually matched by gender, age, and place of residence). This study was performed in Kragujevac (a city in Serbia) during 2010. Logistic regression analysis was used to determine odds ratio (OR) with 95% confidence intervals (95% CI). Results The history of alcohol consumption in patients with acute myocardial infarction and their controls did not differ significantly: the percentage of those that were consuming alcohol was slightly higher in cases (54.5%) than in controls (50.3%). The habit of binge drinking during the previous 12 months was significantly more common in cases (25.1%) than in controls (12.8%): adjusted OR = 2.2 (95%CI = 1.2–4.2, p = 0.017), p for trend = 0.015. Analysis of binge drinking by age, gender and place of residence revealed that the increase in risk for acute myocardial infarction was associated with older age (adjusted OR = 5.1, 95%CI = 1.7–15.1, p for trend = 0.010), male gender (adjusted OR = 2.3, 95%CI = 1.1–5.2, p for trend = 0.028) and rural place of residence (adjusted OR = 4.8, 95%CI = 1.3–18.5, p for trend = 0.033). Conclusion Our results suggest that binge drinking is associated with twice the risk for myocardial infarction compared to not drinking. Since consumption of alcohol is very common in the Serbian population, the effect of binge drinking on myocardial infarction should be considered an important public health issue.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- * E-mail:
| | | | - Branko Ristic
- Clinic for Orthopedic Surgery and Traumatology, Clinical Center Kragujevac, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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88
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Cherfan M, Blacher J, Asmar R, Chahine MN, Zeidan RK, Farah R, Salameh P. Prevalence and risk factors of hypertension: A nationwide cross-sectional study in Lebanon. J Clin Hypertens (Greenwich) 2018; 20:867-879. [PMID: 29604167 DOI: 10.1111/jch.13268] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/21/2018] [Accepted: 02/28/2018] [Indexed: 11/26/2022]
Abstract
There is limited epidemiologic data on hypertension (HTN) in Lebanon. This study aimed to determine the prevalence and associated risk factors of HTN in the adult Lebanese population and evaluate the association between dietary and psychological factors on systolic blood pressure (SBP). Cross-sectional analyses were conducted using a multistage cluster sample across Lebanon. A total of 2014 participants were included. The prevalence and control rates of HTN were 31.2% and 28.7%, respectively. In women, educational level and physical activity were negatively associated with HTN (P < .05 for both) and adherence to the Lebanese Mediterranean diet was associated with a lower SBP. Other factors were associated with HTN in men. There was no relationship with SBP and psychological distress. Of the modifiable risk factors, body mass index persisted as the only contributory factor in both sexes (P < .01). Accordingly, prevention of HTN at the population level should focus mainly on overweight prevention.
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Affiliation(s)
- Michelle Cherfan
- Nutritional Epidemiology Research Unit (EREN), Galilee Doctoral School of Sciences, Technology and Health, Centre of Research in Epidemiology and Biostatistics (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University Sorbonne Paris Cite, Bobibny, France.,Faculty of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Jacques Blacher
- Nutritional Epidemiology Research Unit (EREN), Galilee Doctoral School of Sciences, Technology and Health, Centre of Research in Epidemiology and Biostatistics (CRESS), Inserm U1153, Inra U1125, Cnam, Paris 13 University Sorbonne Paris Cite, Bobibny, France.,Faculty of Medicine, Diagnosis and Therapeutic Center, Hôtel-Dieu Hospital, Paris-Descartes University, AP-HP, Paris, France
| | - Roland Asmar
- Foundation-Medical Research Institutes, F-MRI®, Geneva, Switzerland
| | - Mirna N Chahine
- Foundation-Medical Research Institutes, F-MRI®, Beirut, Lebanon.,Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Rouba K Zeidan
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Rita Farah
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
| | - Pascale Salameh
- Faculty of Public Health, Lebanese University, Fanar, Lebanon.,Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
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89
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Yingst JM, Veldheer S, Hrabovsky S, Hammett E, Nicholson J, Berg A, Foulds J. Pilot Randomized Trial of an Automated Smoking Cessation Intervention via Mobile Phone Text Messages as an Adjunct to Varenicline in Primary Care. JOURNAL OF HEALTH COMMUNICATION 2018; 23:370-378. [PMID: 29578832 PMCID: PMC11181465 DOI: 10.1080/10810730.2018.1453890] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Varenicline is a safe and effective aid to smoking cessation but most trials have involved frequent visits or intensive behavioral support unlike that typically provided in primary care. The current study examined if motivational text messages, sent via cellphone, would increase quit rates in smokers being treated with varenicline and 3 brief sessions in a family practice setting. METHODS This study was a randomized controlled, parallel-group smoking cessation trial. Intervention group participants (n = 74) received daily motivational text messages, additional texted tips in response to keywords, and weekly study questions while control group participants (n = 76) received only weekly study questions. Both groups received individualized counseling. Self-reported non-smoking and exhaled breath CO <10ppm were used to validate smoking abstinence at 3 weeks and 12 weeks. RESULTS Overall, 30.7% (46/150) of participants were abstinent at the 12 week follow-up and the abstinence rate did not differ between groups (INT 31.1% v. CON 30.3%, p = .91). The only predictor of abstinence at 12 weeks was use of varenicline during a previous quit attempt (p = .01). Intervention group participants were more likely to rate the text messaging program as good or excellent (p < .01), to recommend a similar program to family or friends (p < .01), and to complete positive smoking cessation activities (p = .04), when compared with the control group. CONCLUSION Although there were no differences in quit rates between the intervention and control group, intervention group participants rated the text messaging system more favorably, were more likely to recommend the program to others, and were more likely to complete positive smoking cessation activities.
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Affiliation(s)
- Jessica M Yingst
- a Penn State University College of Medicine , Department of Public Health Sciences , Hershey , Pennsylvania USA
| | - Susan Veldheer
- a Penn State University College of Medicine , Department of Public Health Sciences , Hershey , Pennsylvania USA
| | - Shari Hrabovsky
- a Penn State University College of Medicine , Department of Public Health Sciences , Hershey , Pennsylvania USA
| | - Erin Hammett
- a Penn State University College of Medicine , Department of Public Health Sciences , Hershey , Pennsylvania USA
| | - James Nicholson
- b Penn State Hershey Medical Center , Department of Family and Community Medicine , Hershey , Pennsylvania USA
| | - Arthur Berg
- a Penn State University College of Medicine , Department of Public Health Sciences , Hershey , Pennsylvania USA
| | - Jonathan Foulds
- a Penn State University College of Medicine , Department of Public Health Sciences , Hershey , Pennsylvania USA
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90
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Prevalence of Asymptomatic Coronary Heart Disease in the Siblings of Young Myocardial Infarction Patients as Detected by Coronary Computer Tomography Angiography: A Pilot Study. Heart Lung Circ 2018; 27:205-211. [DOI: 10.1016/j.hlc.2017.03.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/16/2017] [Accepted: 03/16/2017] [Indexed: 11/18/2022]
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91
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Wu P, Gulati M, Kwok CS, Wong CW, Narain A, O'Brien S, Chew-Graham CA, Verma G, Kadam UT, Mamas MA. Preterm Delivery and Future Risk of Maternal Cardiovascular Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2018; 7:JAHA.117.007809. [PMID: 29335319 PMCID: PMC5850169 DOI: 10.1161/jaha.117.007809] [Citation(s) in RCA: 114] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Preterm delivery (<37 weeks gestational age) affects 11% of all pregnancies, but data are conflicting whether preterm birth is associated with long‐term adverse maternal cardiovascular outcomes. We aimed to systematically evaluate and summarize the evidence on the relationship between preterm birth and future maternal risk of cardiovascular diseases. Methods and Results A systematic search of MEDLINE and EMBASE was performed to identify relevant studies that evaluated the association between preterm birth and future maternal risk of composite cardiovascular disease, coronary heart disease, stroke, and death caused by cardiovascular or coronary heart disease and stroke. We quantified the associations using random effects meta‐analysis. Twenty‐one studies with over 5.8 million women, including over 338 000 women with previous preterm deliveries, were identified. Meta‐analysis of studies that adjusted for potential confounders showed that preterm birth was associated with an increased risk of maternal future cardiovascular disease (risk ratio [RR] 1.43, 95% confidence interval [CI], 1.18, 1.72), cardiovascular disease death (RR 1.78, 95% CI, 1.42, 2.21), coronary heart disease (RR 1.49, 95% CI, 1.38, 1.60), coronary heart disease death (RR 2.10, 95% CI, 1.87, 2.36), and stroke (RR 1.65, 95% CI, 1.51, 1.79). Sensitivity analysis showed that the highest risks occurred when the preterm deliveries occurred before 32 weeks gestation or were medically indicated. Conclusions Preterm delivery is associated with an increase in future maternal adverse cardiovascular outcomes, including a 2‐fold increase in deaths caused by coronary heart disease. These findings support the assessment of preterm delivery in cardiovascular risk assessment in women.
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Affiliation(s)
- Pensée Wu
- Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom .,Academic Unit of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, AZ
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.,The Heart Centre, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Chun Wai Wong
- Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.,The Heart Centre, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Aditya Narain
- Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.,The Heart Centre, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Shaughn O'Brien
- Academic Unit of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom.,Institute for Applied Clinical Sciences, Keele University School of Medicine, Stoke-on-Trent, United Kingdom
| | - Carolyn A Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Stoke-on-Trent, United Kingdom.,NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) West Midlands, Keele University, Stoke-on-Trent, United Kingdom
| | - Ganga Verma
- Academic Unit of Obstetrics and Gynaecology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
| | - Umesh T Kadam
- College of Life Sciences, University of Leicester, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Institute for Applied Clinical Sciences and Centre for Prognosis Research, Institute of Primary Care and Health Sciences, University of Keele, Stoke-on-Trent, United Kingdom.,The Heart Centre, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom
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92
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Therapeutic Approaches to Acquired Cystic Fibrosis Transmembrane Conductance Regulator Dysfunction in Chronic Bronchitis. Ann Am Thorac Soc 2018; 13 Suppl 2:S169-76. [PMID: 27115953 DOI: 10.1513/annalsats.201509-601kv] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chronic obstructive pulmonary disease is a common cause of morbidity and a rising cause of mortality worldwide. Its rising impact indicates the ongoing unmet need for novel and effective therapies. Previous work has established a pathophysiological link between the chronic bronchitis phenotype of chronic obstructive pulmonary disease and cystic fibrosis as well as phenotypic similarities between these two airways diseases. An extensive body of evidence has established that cigarette smoke and its constituents contribute to acquired dysfunction of the cystic fibrosis transmembrane conductance regulator (CFTR) protein in the airways, pointing to a mechanistic link with smoking-related and chronic bronchitis. Recent interest surrounding new drugs that target both mutant and wild-type CFTR channels has paved the way for a new treatment opportunity addressing the mucus defect in chronic bronchitis. We review the clinical and pathologic evidence for modulating CFTR to address acquired CFTR dysfunction and pragmatic issues surrounding clinical trials as well as a discussion of other ion channels that may represent alternative therapeutic targets.
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93
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Duong M, Rangarajan S, Zhang X, Killian K, Mony P, Swaminathan S, Bharathi AV, Nair S, Vijayakumar K, Mohan I, Gupta R, Mohan D, Rani S, Mohan V, Iqbal R, Kazmi K, Rahman O, Yusuf R, Pinnaka LVM, Kumar R, O'Byrne P, Yusuf S. Effects of bidi smoking on all-cause mortality and cardiorespiratory outcomes in men from south Asia: an observational community-based substudy of the Prospective Urban Rural Epidemiology Study (PURE). LANCET GLOBAL HEALTH 2017; 5:e168-e176. [PMID: 28104186 DOI: 10.1016/s2214-109x(17)30004-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 11/14/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Bidis are minimally regulated, inexpensive, hand-rolled tobacco products smoked in south Asia. We examined the effects of bidi smoking on baseline respiratory impairment, and prospectively collected data for all-cause mortality and cardiorespiratory events in men from this region. METHODS This substudy of the international, community-based Prospective Urban Rural Epidemiology (PURE) study was done in seven centres in India, Pakistan, and Bangladesh. Men aged 35-70 years completed spirometry testing and standardised questionnaires at baseline and were followed up yearly. We used multilevel regression to compare cross-sectional baseline cardiorespiratory symptoms, spirometry measurements, and follow-up events (all-cause mortality, cardiovascular events, respiratory events) adjusted for socioeconomic status and baseline risk factors between non-smokers, light smokers of bidis or cigarettes (≤10 pack-years), heavy smokers of cigarettes only (>10 pack-years), and heavy smokers of bidis (>10 pack-years). FINDINGS 14 919 men from 158 communities were included in this substudy (8438 non-smokers, 3321 light smokers, 959 heavy cigarette smokers, and 2201 heavy bidi smokers). Mean duration of follow-up was 5·6 years (range 1-13). The adjusted prevalence of self-reported chronic wheeze, cough or sputum, dyspnoea, and chest pain at baseline increased across the categories of non-smokers, light smokers, heavy cigarette smokers, and heavy bidi smokers (p<0·0001 for association). Adjusted cross-sectional age-related changes in forced expiratory volume in 1 s (FEV1) and FEV1/forced vital capacity (FVC) ratio were larger for heavy bidi smokers than for the other smoking categories. Hazard ratios (relative to non-smokers) showed increasing hazards for all-cause mortality (light smokers 1·28 [95% CI 1·02-1·62], heavy cigarette smokers 1·59 [1·13-2·24], heavy bidi smokers 1·56 [1·22-1·98]), cardiovascular events (1·45 [1·13-1·84], 1·47 [1·05-2·06], 1·55 [1·17-2·06], respectively) and respiratory events (1·30 [0·91-1·85], 1·21 [0·70-2·07], 1·73 [1·23-2·45], respectively) across the smoking categories. INTERPRETATION Bidi smoking is associated with severe baseline respiratory impairment, all-cause mortality, and cardiorespiratory outcomes. Stricter controls and regulation of bidis are needed to reduce the tobacco-related disease burden in south Asia. FUNDING Population Health Research Institute, Canadian Institutes of Health Research, and Heart and Stroke Foundation of Ontario.
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Affiliation(s)
- MyLinh Duong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada.
| | - Sumathy Rangarajan
- 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
| | - Kieran Killian
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Prem Mony
- Division of Epidemiology and Population Health, St John's Research Institute, Bengaluru, India
| | - Sumathi Swaminathan
- Division of Epidemiology and Population Health, St John's Research Institute, Bengaluru, India
| | | | - Sanjeev Nair
- Department of Pulmonary Medicine, Medical College, Thiruvananthapuram, Kerala, India; Health Action by People, Thiruvananthapuram, Kerala, India
| | - Krishnapillai Vijayakumar
- Health Action by People, Thiruvananthapuram, Kerala, India; Dr Somervell Memorial CSI Medical College, Karakonam, Thiruvananthapuram, Kerala, India
| | - Indu Mohan
- Fortis Escorts Hospitals, JLN Marg, Jaipur, India
| | - Rajeev Gupta
- Fortis Escorts Hospitals, JLN Marg, Jaipur, India
| | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Shanthi Rani
- Madras Diabetes Research Foundation, Chennai, India
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Khawar Kazmi
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | | | - Rajesh Kumar
- Post Graduate Institute of Medical Education and Research (PGIMER) School of Public Health, Chandigarh, India
| | - Paul O'Byrne
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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Sanin V, Pfetsch V, Koenig W. Dyslipidemias and Cardiovascular Prevention: Tailoring Treatment According to Lipid Phenotype. Curr Cardiol Rep 2017; 19:61. [PMID: 28528455 DOI: 10.1007/s11886-017-0869-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This study aimed to present the current information on the genetic background of dyslipidemias and provide insights into the complex pathophysiological role of several plasma lipids/lipoproteins in the pathogenesis of atherosclerotic cardiovascular disease. Furthermore, we aim to summarize established therapies and describe the scientific rationale for the development of novel therapeutic strategies. RECENT FINDINGS Evidence from genetic studies suggests that besides lowering low-density lipoprotein cholesterol, pharmacological reduction of triglyceride-rich lipoproteins, or lipoprotein(a) will reduce risk for coronary heart disease. Dyslipidemia, in particular hypercholesterolemia, is a common clinical condition and represents an important determinant of atherosclerotic vascular disease. Treatment decisions are currently guided by the causative lipid phenotype and the presence of other risk factors suggesting a very high cardiovascular risk. Therefore, the identification of lipid disorders and the optimal combination of therapeutic strategies provide an outstanding opportunity for reducing the onset and burden of cardiovascular disease.
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Affiliation(s)
- Veronika Sanin
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Vanessa Pfetsch
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany. .,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
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95
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Joseph P, Yusuf S, Lee SF, Ibrahim Q, Teo K, Rangarajan S, Gupta R, Rosengren A, Lear SA, Avezum A, Lopez-Jaramillo P, Gulec S, Yusufali A, Chifamba J, Lanas F, Kumar R, Mohammadifard N, Mohan V, Mony P, Kruger A, Liu X, Guo B, Zhao W, Yang Y, Pillai R, Diaz R, Krishnapillai A, Iqbal R, Yusuf R, Szuba A, Anand SS. Prognostic validation of a non-laboratory and a laboratory based cardiovascular disease risk score in multiple regions of the world. Heart 2017; 104:581-587. [PMID: 29066611 PMCID: PMC5861396 DOI: 10.1136/heartjnl-2017-311609] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 01/07/2023] Open
Abstract
Objective To evaluate the performance of the non-laboratory INTERHEART risk score (NL-IHRS) to predict incident cardiovascular disease (CVD) across seven major geographic regions of the world. The secondary objective was to evaluate the performance of the fasting cholesterol-based IHRS (FC-IHRS). Methods Using measures of discrimination and calibration, we tested the performance of the NL-IHRS (n=100 475) and FC-IHRS (n=107 863) for predicting incident CVD in a community-based, prospective study across seven geographic regions: South Asia, China, Southeast Asia, Middle East, Europe/North America, South America and Africa. CVD was defined as the composite of cardiovascular death, myocardial infarction, stroke, heart failure or coronary revascularisation. Results Mean age of the study population was 50.53 (SD 9.79) years and mean follow-up was 4.89 (SD 2.24) years. The NL-IHRS had moderate to good discrimination for incident CVD across geographic regions (concordance statistic (C-statistic) ranging from 0.64 to 0.74), although recalibration was necessary in all regions, which improved its performance in the overall cohort (increase in C-statistic from 0.69 to 0.72, p<0.001). Regional recalibration was also necessary for the FC-IHRS, which also improved its overall discrimination (increase in C-statistic from 0.71 to 0.74, p<0.001). In 85 078 participants with complete data for both scores, discrimination was only modestly better with the FC-IHRS compared with the NL-IHRS (0.74 vs 0.73, p<0.001). Conclusions External validations of the NL-IHRS and FC-IHRS suggest that regionally recalibrated versions of both can be useful for estimating CVD risk across a diverse range of community-based populations. CVD prediction using a non-laboratory score can provide similar accuracy to laboratory-based methods.
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Affiliation(s)
- Philip Joseph
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Quazi Ibrahim
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Rajasthan University of Health Sciences, and Fortis Escorts Hospital, Jaipur, India
| | - Annika Rosengren
- Sahlgrenska University Hospital/Ã-stra Hospital, Goteborg, Sweden
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology and UNISA, São Paulo, Brazil
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander (FOSCAL) and Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Sadi Gulec
- School of Medicine, Ankara University, Ankara, Turkey
| | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Fernando Lanas
- Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile
| | - Rajesh Kumar
- Department of Community Medicine & School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Prem Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Annamarie Kruger
- Faculty of Health Science, North-West University, Potchefstroom, South Africa
| | - Xu Liu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Beijing, China
| | - Baoxia Guo
- Shenyang Red Cross Hospital, Shenyang, China
| | - Wenqi Zhao
- Chinese Center for Disease Control and Prevention, Xi'ning, China
| | | | - Rajamohanan Pillai
- Health Action by People, and SMCSI Medical College Karakonam, Trivandrum, India
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica ECLA, Rosario, Argentina
| | | | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Rita Yusuf
- Independent University, Bangladesh (IUB), Dhaka, Bangladesh
| | | | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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96
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A novel cardiovascular death prediction model for Chinese individuals: A prospective cohort study of 381,963 study participants. Atherosclerosis 2017; 264:19-28. [DOI: 10.1016/j.atherosclerosis.2017.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/16/2017] [Accepted: 07/13/2017] [Indexed: 11/22/2022]
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97
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Ho CLB, Sanders S, Doust J, Breslin M, Reid CM, Nelson MR. Legacy Effect of Delayed Blood Pressure-Lowering Pharmacotherapy in Middle-Aged Individuals Stratified by Absolute Cardiovascular Disease Risk: Protocol for a Systematic Review. JMIR Res Protoc 2017; 6:e177. [PMID: 28864428 PMCID: PMC5600968 DOI: 10.2196/resprot.8362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Many national and international guidelines recommend that the initiation of blood pressure (BP)-lowering drug treatment for the primary prevention of cardiovascular disease (CVD) should no longer be based on BP level alone, but on absolute cardiovascular risk. While BP-lowering drug treatment is beneficial in high-risk individuals at any level of elevated BP, clinicians are concerned about legacy effects on patients with low-to-moderate risk and mildly elevated BP who remain "untreated". OBJECTIVE We aim to investigate the legacy effect of delayed BP-lowering pharmacotherapy in middle-aged individuals (45-65 years) with mildly elevated BP (systolic BP 140-159 mmHg and/or diastolic BP 90-99 mmHg) stratified by absolute risk for primary prevention of CVD, but particularly in the low-risk (<10% five-year absolute risk) group. METHODS Randomized trials of BP-lowering therapy versus placebo or pretreated subjects in active comparator studies with posttrial follow-up will be identified using a 2-step process. First, randomized trials of BP-lowering therapy will be identified by (1) retrieving the references of trials included in published systematic reviews of BP-lowering therapy, (2) retrieving studies published by the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC), and (3) checking studies referenced in the 1993 World Health Organization/International Society of Hypertension meeting memorandum on BP management. Posttrial follow-up studies will then be identified by forward citation searching the randomized trials identified in step 1 through Web of Science. The search will include randomized controlled trials with at least 1-year in-trial period and a posttrial follow-up phase. Age is the major determinant of absolute cardiovascular risk, so the participants in our review will be restricted to middle-aged adults who are more likely to have a lower cardiovascular risk profile. The primary outcome will be all-cause mortality. Secondary outcomes will include cardiovascular mortality, fatal stroke, fatal myocardial infarction, and death due to heart failure. RESULTS The searches for existing systematic reviews and BPLTTC studies were piloted and modified. The study is expected to be completed before June 2018. CONCLUSIONS The findings of this study will contribute to the body of knowledge concerning the beneficial, neutral, or harmful effects of delayed BP-lowering drug treatment on the primary prevention of CVD in patients with mildly elevated BP and low-to-moderate CVD risk. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews: CRD42017058414; https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42017058414 (Archived by WebCite® at http://www.webcitation.org/6t6sa8O2Q).
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Affiliation(s)
- Chau Le Bao Ho
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Sharon Sanders
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Jenny Doust
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD, Australia
| | - Monique Breslin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, Australia
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark Raymond Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- Centre of Cardiovascular Research & Education in Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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98
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Murphy A, Faria-Neto JR, Al-Rasadi K, Blom D, Catapano A, Cuevas A, Lopez-Jimenez F, Perel P, Santos R, Sniderman A, Sy R, Watts GF, Zhao D, Yusuf S, Wood D. World Heart Federation Cholesterol Roadmap. Glob Heart 2017; 12:179-197.e5. [PMID: 28765036 DOI: 10.1016/j.gheart.2017.03.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The World Heart Federation has undertaken an initiative to develop a series of Roadmaps. OBJECTIVES The aim of these is to promote development of national policies and health systems approaches and identify potential roadblocks on the road to effective prevention, detection and management of cardiovascular disease (CVD) in low-and middle-income countries (LMIC), and strategies for overcoming these. This Roadmap focuses on elevated blood cholesterol, a leading risk factor for myocardial infarction, stroke, and peripheral arterial disease. METHODS Through a review of published guidelines and research papers, and consultation with a committee composed of experts in clinical management of cholesterol and health systems research in LMIC, this Roadmap identifies (1) key interventions for primordial, primary and secondary prevention of CVD through detection, treatment, and management of elevated cholesterol and familial hypercholesterolemia (FH); (2) gaps in implementation of these interventions (knowledge-practice gaps); (3) health system roadblocks to treatment of elevated cholesterol in LMIC; and (4) potential strategies for overcoming these. RESULTS Despite strong evidence of the importance of cholesterol levels in primary or secondary prevention of CVD, and the effectiveness of statin therapy for cholesterol lowering and reduction of CVD risk, gaps exist in the detection, treatment, and management of high cholesterol globally. Some potential roadblocks include poor access to laboratory facilities or trained professionals for cholesterol management, low awareness of FH among the general population and health professionals, unaffordability of statins for patient households, and low awareness of the importance of persistent adherence to lipid-lowering medication. Potential solutions include point-of-care testing, provision of free or subsidized lipid-lowering medication, and treatment adherence support using text message reminders. CONCLUSIONS Known effective strategies for detection, treatment, and management of elevated cholesterol and FH exist, but there are barriers to their implementation in many low-resource settings. Priorities for health system intervention should be identified at the national level, and the feasibility and effectiveness of proposed solutions should be assessed in specific contexts. Many solutions proposed in this Roadmap may apply to other cardiovascular conditions and present opportunities for integration of CVD care in LMIC.
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Affiliation(s)
- Adrianna Murphy
- Centre for Health and Social Change, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jose R Faria-Neto
- School of Medicine, Pontificia Universidade Catolica do Parana, Curitiba, Brazil
| | - Khalid Al-Rasadi
- Department of Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Dirk Blom
- Division of Lipidology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Alberico Catapano
- Department of Pharmacology, Center of Epidemiology and Preventive Pharmacology, University of Milan, Milan, Italy; Laboratory of Lipoproteins, Immunity and Atherosclerosis, Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; Center for the Study of Atherosclerosis at Bassini Hospital, University of Milan, Milan, Italy
| | - Ada Cuevas
- Nutrition Department, Clinica Las Condes, Santiago, Chile
| | - Francisco Lopez-Jimenez
- Department of Medicine, Mayo Medical School, Division of Preventive Cardiology, Mayo Clinic, Rochester, Minnesota, USA; Department of Research, Dan Abraham Healthy Living Center, Rochester, Minnesota, USA
| | - Pablo Perel
- World Heart Federation, Geneva, Switzerland; London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Raul Santos
- Lipid Clinic Heart Institute, University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil; Preventive Medicine Center and Cardiology Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Allan Sniderman
- Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Rody Sy
- Section of Cardiology, Department of Medicine, University of the Phillipines College of Medicine, Manila, Philippines; Cardiovascular Institute, Cardinal Santos Medical Center, San Juan, Philippines
| | - Gerald F Watts
- Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia; School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Dong Zhao
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing Anzhen Hospital, Beijing, China
| | - Salim Yusuf
- World Heart Federation, Geneva, Switzerland; Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada; Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - David Wood
- World Heart Federation, Geneva, Switzerland; Department of Cardiovascular Medicine, Imperial College London, London, United Kingdom; National Heart and Lung Institute, Bethesda, MD, USA
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99
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Gerstein HC, Paré G, McQueen MJ, Lee SF, Hess S. Validation of the ORIGIN Cardiovascular Biomarker Panel and the Value of Adding Troponin I in Dysglycemic People. J Clin Endocrinol Metab 2017; 102:2251-2257. [PMID: 28368516 DOI: 10.1210/jc.2017-00273] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/20/2017] [Indexed: 02/13/2023]
Abstract
BACKGROUND Analyses of stored blood from the Outcomes Reduction with an Initial Glargine Intervention (ORIGIN) trial identified biomarkers that supplemented clinical risk factors for cardiovascular (CV) events or death. Their performance in participants with diabetes in the Heart Outcomes Prevention Evaluation (HOPE) study and the incremental value of adding high-sensitivity assays of serum troponin I (hsTnI) in the ORIGIN study were assessed. METHODS Levels of the 10 ORIGIN biomarkers for the composite CV outcome of myocardial infarction, stroke, or CV death were measured in 350 HOPE study participants with diabetes and stored serum that included all 77 who experienced this outcome. The effect of adding hsTnI levels to this panel, and the previously identified ORIGIN biomarkers for this composite outcome, this outcome, or revascularization or heart failure, and for mortality was also analyzed. RESULTS Within the HOPE cohort, the ORIGIN biomarker panel increased the C statistic from 0.63 for clinical risk factors alone to 0.67 with the addition of the 10 biomarkers, and the net reclassification improvement was 0.14 (95% confidence interval, 0.01, 0.28). Within the ORIGIN cohort, hsTnI levels predicted all three outcomes during follow-up both alone, and independently of the other biomarkers, which all remained independent predictors of outcomes after inclusion of the hsTnI levels. The hsTnI level interacted with follow-up time such that it was a stronger predictor of earlier vs later events. CONCLUSION The ORIGIN biomarkers predicted CV outcomes in the independent HOPE cohort. Adding hsTnI levels to the previously identified models in ORIGIN modestly improved their performance.
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Affiliation(s)
- Hertzel C Gerstein
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Guillaume Paré
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario L8S 4K1, Canada
- Thrombosis and Atherosclerosis Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Matthew J McQueen
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Shun Fu Lee
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario L8S 4K1, Canada
| | - Sibylle Hess
- Sanofi Aventis Deutschland GmbH, Research and Development Division, Translational Medicine and Early Development, Biomarkers and Clinical Bioanalyses, Frankfurt 65926, Germany
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100
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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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