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Impact of β-thalassemia trait carrier state on cardiovascular risk factors and metabolic profile in patients with newly diagnosed hypertension. J Hum Hypertens 2013; 28:328-32. [DOI: 10.1038/jhh.2013.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 09/07/2013] [Accepted: 09/09/2013] [Indexed: 11/09/2022]
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Gunnell AS, Einarsdóttir K, Galvão DA, Joyce S, Tomlin S, Graham V, McIntyre C, Newton RU, Briffa T. Lifestyle factors, medication use and risk for ischaemic heart disease hospitalisation: a longitudinal population-based study. PLoS One 2013; 8:e77833. [PMID: 24147088 PMCID: PMC3797723 DOI: 10.1371/journal.pone.0077833] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/09/2013] [Indexed: 01/22/2023] Open
Abstract
Background Lifestyle factors have been implicated in ischaemic heart disease (IHD) development however a limited number of longitudinal studies report results stratified by cardio-protective medication use. Purpose This study investigated the influence of self-reported lifestyle factors on hospitalisation for IHD, stratified by blood pressure and/or lipid-lowering therapy. Methods A population-based cohort of 14,890 participants aged 45+ years and IHD-free was identified from the Western Australian Health and wellbeing Surveillance System (2004 to 2010 inclusive), and linked with hospital administrative data. Adjusted hazard ratios for future IHD-hospitalisation were estimated using Cox regression. Results Current smokers remained at higher risk for IHD-hospitalisation (adjusted HR=1.57; 95% CI: 1.22-2.03) after adjustment for medication use, as did those considered overweight (BMI=25-29 kg/m2; adjusted HR=1.28; 95% CI: 1.04-1.57) or obese (BMI of ≥30kg/m2; adjusted HR=1.31; 95% CI: 1.03-1.66). Weekly leisure-time physical activity (LTPA) of 150 minutes or more and daily intake of 3 or more fruit/vegetable servings reduced risk by 21% (95% CI: 0.64-0.97) and 26% (95% CI: 0.58-0.96) respectively. Benefits of LTPA appeared greatest in those on blood pressure lowering medication (adjusted HR=0.50; 95% CI: 0.31-0.82 [for LTPA<150 mins], adjusted HR=0.64; 95% CI: 0.42-0.96 [for LTPA>=150 mins]). IHD risk in smokers was most pronounced in those taking neither medication (adjusted HR=2.00; 95% CI: 1.41-2.83). Conclusion This study confirms the contribution of previously reported lifestyle factors towards IHD hospitalisation, even after adjustment for antihypertensive and lipid-lowering medication use. Medication stratified results suggest that IHD risks related to LTPA and smoking may differ according to medication use.
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Affiliation(s)
- Anthony S. Gunnell
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Edith Cowan University Survey Research Centre, Edith Cowan University, Joondalup, Western Australia, Australia
- * E-mail:
| | - Kristjana Einarsdóttir
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Subiaco, Western Australia, Australia
| | - Daniel A. Galvão
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Sarah Joyce
- Epidemiology Branch, Western Australian Department of Health, East Perth, Western Australia, Australia
| | - Stephania Tomlin
- Epidemiology Branch, Western Australian Department of Health, East Perth, Western Australia, Australia
| | - Vicki Graham
- Edith Cowan University Survey Research Centre, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Caroline McIntyre
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U. Newton
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Tom Briffa
- School of Population Health, University of Western Australia, Crawley, Western Australia, Australia
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Assessment of cardiovascular disease risk in South asian populations. Int J Vasc Med 2013; 2013:786801. [PMID: 24163770 PMCID: PMC3791806 DOI: 10.1155/2013/786801] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 08/14/2013] [Indexed: 11/21/2022] Open
Abstract
Although South Asian populations have high cardiovascular disease (CVD) burden in the world, their patterns of individual CVD risk factors have not been fully studied. None of the available algorithms/scores to assess CVD risk have originated from these populations. To explore the relevance of CVD risk scores for these populations, literature search and qualitative synthesis of available evidence were performed. South Asians usually have higher levels of both “classical” and nontraditional CVD risk factors and experience these at a younger age. There are marked variations in risk profiles between South Asian populations. More than 100 risk algorithms are currently available, with varying risk factors. However, no available algorithm has included all important risk factors that underlie CVD in these populations. The future challenge is either to appropriately calibrate current risk algorithms or ideally to develop new risk algorithms that include variables that provide an accurate estimate of CVD risk.
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Mahanta TG, Joshi R, Mahanta BN, Xavier D. Prevalence of modifiable cardiovascular risk factors among tea garden and general population in Dibrugarh, Assam, India. J Epidemiol Glob Health 2013; 3:147-56. [PMID: 23932057 PMCID: PMC3741672 DOI: 10.1016/j.jegh.2013.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Revised: 04/11/2013] [Accepted: 04/12/2013] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Risk factors for cardiovascular disease (CVD) are multifactorial. Previous research has reported a high prevalence of CVD risk factors in tea-garden workers. This study was conducted to assess prevalence and level of modifiable cardiovascular risk factors among tea-garden and general population in Dibrugarh, Assam. METHODS A community-based cross-sectional study using the World Health Organization's (WHO) Stepwise methodology was conducted in Dibrugarh District of Assam. A multistep random sampling was done to include adults aged 35 years and above, with an intended equal sampling from tea-garden and general population. INTERHEART modifiable non-laboratory based risk score was estimated. Salt consumption was estimated using questionnaire-based methods in both subgroups. RESULTS A total of 2826 individuals participated in the study (1231 [43.6%] tea-garden workers; 1595 [56.4%] general population). Tobacco consumption was higher in tea-garden workers as compared with general population (85.2% vs. 41.7% (p < 0.0001). Mean daily per-capita salt consumption was also significantly higher among tea-garden workers (29.60 vs. 22.89 g, p = 0.0001). Overall prevalence of hypertension was similar (44.4% vs. 45.2%), but among those who had hypertension, prevalence of undiagnosed hypertension was higher in tea-garden workers (82.8% vs. 74.4%, p < 0.0001). Tea-garden workers had lower BMI, were more physically active, and had a lower prevalence of diabetes mellitus and metabolic syndrome. Their INTERHEART modifiable risk score was also lower (1.44 [2.5] vs. 1.79 [2.8], p = 0.001). CONCLUSION High prevalence of modifiable risk factors like tobacco consumption, high salt intake and high prevalence of hypertension indicates the need for early implementation of preventive actions in this population.
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Samaan Z, Schulze KM, Middleton C, Irvine J, Joseph P, Mente A, Shah BR, Pare G, Desai D, Anand SS. South Asian Heart Risk Assessment (SAHARA): Randomized Controlled Trial Design and Pilot Study. JMIR Res Protoc 2013; 2:e33. [PMID: 23965279 PMCID: PMC3757993 DOI: 10.2196/resprot.2621] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 07/01/2013] [Accepted: 07/29/2013] [Indexed: 01/24/2023] Open
Abstract
Background People of South Asian origin suffer a high burden of premature myocardial infarction (MI). South Asians form a growing proportion of the Canadian population and preventive strategies to mitigate the risk of MI in this group are needed. Prior studies have shown that multimedia interventions are effective and feasible in inducing health behavior changes among the obese, smokers, and among those who are sedentary. Objective Among at-risk South Asians living in Canada, our objectives are to determine: (1) the feasibility of a culturally tailored multimedia intervention to induce positive behavioral changes associated with reduced MI risk factors, and (2) the effectiveness and acceptability of information communicated by individualized MI and genetic risk score (GRS) reports. Methods The South Asian HeArt Risk Assessment (SAHARA) pilot study enrolled 367 individuals of South Asian origin recruited from places of worship and community centers in Ontario, Canada. MI risk factors including the 9p21 genetic variant status were provided to all participants after the baseline visit. Participants were randomly allocated to receive a multimedia intervention or control. The intervention group selected health goals and received personalized health messages to promote adherence to their selected goals. After 6 months, all participants had their MI risk factors repeated. The methods and results of this study are reported based on the CONSORT-EHEALTH guidelines. Results The mean age of participants was 53.8 years (SD 11.4), 52.0% (191/367) were women, and 97.5% (358/367) were immigrants to Canada. The mean INTERHEART risk score was 13.0 (SD 5.8) and 73.3% (269/367) had one or two copies of the risk allele for the 9p21 genetic variant. Both the intervention and control groups made some progress in health behavior changes related to diet and physical activity over 6 months. Participants reported that their risk score reports motivated behavioral changes, although half of the participants could not recall their risk scores at the end of study evaluation. Some components of the multimedia intervention were not widely used such as logging onto the website to set new health goals, and participants requested having more personal interactions with the study team. Conclusions Some, but not all, components of the multimedia intervention are feasible and have the potential to induce positive health behavior changes. MI and GRS reports are desired by participants although their impact on inducing sustained health behavior change requires further evaluation. Information generated from this pilot study has directly informed the design of another randomized trial designed to reduce MI risk among South Asians. Trial Registration ClinicalTrials.gov NCT01577719; http://clinicaltrials.gov/ct2/show/NCT01577719 (Archived by WebCite at http://www.webcitation.org/6J11uYXgJ).
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Affiliation(s)
- Zainab Samaan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
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Rab A, Rowe SM, Raju SV, Bebok Z, Matalon S, Collawn JF. Cigarette smoke and CFTR: implications in the pathogenesis of COPD. Am J Physiol Lung Cell Mol Physiol 2013; 305:L530-41. [PMID: 23934925 DOI: 10.1152/ajplung.00039.2013] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disorder consisting of chronic bronchitis and/or emphysema. COPD patients suffer from chronic infections and display exaggerated inflammatory responses and a progressive decline in respiratory function. The respiratory symptoms of COPD are similar to those seen in cystic fibrosis (CF), although the molecular basis of the two disorders differs. CF is a genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene encoding a chloride and bicarbonate channel (CFTR), leading to CFTR dysfunction. The majority of COPD cases result from chronic oxidative insults such as cigarette smoke. Interestingly, environmental stresses including cigarette smoke, hypoxia, and chronic inflammation have also been implicated in reduced CFTR function, and this suggests a common mechanism that may contribute to both the CF and COPD. Therefore, improving CFTR function may offer an excellent opportunity for the development of a common treatment for CF and COPD. In this article, we review what is known about the CF respiratory phenotype and discuss how diminished CFTR expression-associated ion transport defects may contribute to some of the pathological changes seen in COPD.
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Affiliation(s)
- Andras Rab
- Dept. of Cell, Developmental and Integrative Biology, Univ. of Alabama at Birmingham, 1918 Univ. Blvd., MCLM 395, Birmingham, AL 35294.
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Fathima FN, Joshi R, Agrawal T, Hegde S, Xavier D, Misquith D, Chidambaram N, Kalantri SP, Chow C, Islam S, Devereaux PJ, Gupta R, Pais P, Yusuf S. Rationale and design of the Primary pREvention strategies at the community level to Promote Adherence of treatments to pREvent cardiovascular diseases trial number (CTRI/2012/09/002981). Am Heart J 2013; 166:4-12. [PMID: 23816015 PMCID: PMC3750498 DOI: 10.1016/j.ahj.2013.03.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/25/2013] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality in low-income countries including India. There is a need for effective, low-cost methods to prevent CVDs in rural India. One strategy is to identify and implement interventions at high-risk individuals using community health workers (CHWs). There is a paucity of CHW-based CVD intervention trials from low-income countries. METHODS We designed a multicenter, household-level, cluster-randomized trial with 1:1 allocation to intervention and control arms. The CHWs undertook a door-to-door survey and screened 5,699 households in 28 villages from 3 rural regions in India to identify at-risk households. The households were defined as those with ≥1 individual aged ≥35 years and at moderate or high risk for CVD based on the non-laboratory-based National Health and Nutrition Examination Survey score. All at-risk individuals were invited to attend a physician-led village clinic that provided a CVD risk reduction prescription and education about target risk factor levels for CVD control. All households in which at least 1 member at moderate to high risk for CVD had received a risk reduction prescription were eligible for randomization. Households randomized to the CHW-based intervention will receive 1 household visit by a CHW every 2 months, for 12 months. During these visits, CHWs will measure blood pressure, ascertain and reinforce adherence to prescribed therapies, and modify therapy to meet targets. Households randomized to the control arm do not receive CHW visits. At 12 months after randomization, we will evaluate 2 primary outcomes of systolic blood pressure and adherence to antihypertensive drugs and secondary outcomes of INTERHEART risk score, body mass index, and waist-to-hip ratios. At 18 to 24 months after randomization and 6 to 12 months after the last intervention, we will record these outcomes to evaluate sustainability of intervention. RESULTS Community health workers screened a total of 5,033 households that included 9,248 individuals and identified 2,571 households with 3,784 at-risk individuals. We randomized 2,438 households (1,219 to intervention and 1,219 to control groups). CONCLUSION Our large trial of CHWs in rural India will provide important information regarding a promising approach to primary prevention of CVDs.
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Affiliation(s)
- Farah N. Fathima
- St John’s Medical College and Research Institute, Bengaluru, India
| | - Rajnish Joshi
- St John’s Medical College and Research Institute, Bengaluru, India
- All India Institute of Medical Sciences, Bhopal, India
| | - Twinkle Agrawal
- St John’s Medical College and Research Institute, Bengaluru, India
| | - Shailendra Hegde
- St John’s Medical College and Research Institute, Bengaluru, India
| | - Denis Xavier
- St John’s Medical College and Research Institute, Bengaluru, India
| | - Dominic Misquith
- St John’s Medical College and Research Institute, Bengaluru, India
| | | | - S. P. Kalantri
- Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | - Clara Chow
- George Institute of Global Health, Sydney, Australia
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - P. J. Devereaux
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | - Prem Pais
- St John’s Medical College and Research Institute, Bengaluru, India
| | - Salim Yusuf
- Population Health Research Institute, Hamilton, Ontario, Canada
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McDonald SD, Ray J, Teo K, Jung H, Salehian O, Yusuf S, Lonn E. Measures of cardiovascular risk and subclinical atherosclerosis in a cohort of women with a remote history of preeclampsia. Atherosclerosis 2013; 229:234-9. [DOI: 10.1016/j.atherosclerosis.2013.04.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/05/2013] [Accepted: 04/13/2013] [Indexed: 11/17/2022]
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Vyssoulis GP, Liakos CI, Karpanou EA, Triantafyllou AI, Michaelides AP, Tzamou VE, Markou MI, Stefanadis CI. Impaired glucose homeostasis in non-diabetic Greek hypertensives with diabetes family history. Effect of the obesity status. ACTA ACUST UNITED AC 2013; 7:294-304. [DOI: 10.1016/j.jash.2013.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/14/2013] [Accepted: 02/18/2013] [Indexed: 11/29/2022]
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McDonald SD, Yusuf S, Walsh MW, Lonn E, Teo K, Anand SS, Pogue J, Islam S, Devereaux PJ, Gerstein HC. Increased cardiovascular risk after pre-eclampsia in women with dysglycaemia. Diabet Med 2013; 30:e1-7. [PMID: 23050859 DOI: 10.1111/dme.12033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 08/29/2012] [Accepted: 10/05/2012] [Indexed: 11/30/2022]
Abstract
AIMS Compared with women with uncomplicated pregnancies, women with a history of pre-eclampsia have two to five times the risk of cardiovascular disease. It is not known whether this risk is related to albuminuria, a known cardiovascular risk factor that is part of the definition of pre-eclampsia and that often persists after delivery. Our objective was to determine if the high risk of cardiovascular disease in women with pre-eclampsia is accounted for by known cardiovascular risk factors including albuminuria. METHODS We performed a cross-sectional analysis of 4080 dysglycaemic women enrolled in a large randomized controlled trial who provided an obstetric history and had at least one delivery. Blood pressure, height, weight, waist circumference and hip circumference were measured. An oral glucose tolerance test, lipids, an electrocardiogram and an albumin/creatinine ratio from a first morning urine sample were obtained. RESULTS There were 3613 women with no history of pre-eclampsia during their pregnancies, 108 with severe pre-eclampsia and 359 with non-severe pre-eclampsia. Women with a history of severe pre-eclampsia had higher rates of previous cardiovascular disease than women with non-severe pre-eclampsia or women without pre-eclampsia (87, 72 and 72%, P = 0.0019). The high risk of previous cardiovascular disease in women with a history of severe pre-eclampsia (odds ratio 2.67, 95% CI 1.52-4.70) persisted after adjustment for albuminuria (odds ratio 2.74, 95% CI 1.55-4.83) and also after adjusting for other covariates including albuminuria (odds ratio 3.03, 95% CI 1.69-5.44). CONCLUSION Even after accounting for cardiovascular risk factors including albuminuria, a history of severe pre-eclampsia is independently associated with a threefold higher risk of cardiovascular disease.
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Affiliation(s)
- S D McDonald
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, Canada
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Sanz J, Moreno PR, Fuster V. The year in atherothrombosis. J Am Coll Cardiol 2012; 60:932-42. [PMID: 22935466 DOI: 10.1016/j.jacc.2012.04.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 04/18/2012] [Accepted: 04/23/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Javier Sanz
- Zena and Michael A. Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, NY, USA
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Dong C, Rundek T, Wright CB, Anwar Z, Elkind MSV, Sacco RL. Ideal cardiovascular health predicts lower risks of myocardial infarction, stroke, and vascular death across whites, blacks, and hispanics: the northern Manhattan study. Circulation 2012; 125:2975-84. [PMID: 22619283 DOI: 10.1161/circulationaha.111.081083] [Citation(s) in RCA: 281] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Evidence of the relationship of cardiovascular health (CVH), defined by the American Heart Association, and specific cardiovascular outcomes is lacking, particularly among Hispanics. This study sought to evaluate the relationship between the number of ideal CVH metrics and cardiovascular risk, overall and by event subtype, in a multiethnic community-based prospective cohort. METHODS AND RESULTS A total of 2981 subjects (mean age, 69±10 years; 54% Caribbean Hispanic, 25% black, 21% white) free of myocardial infarction and stroke at baseline in the Northern Manhattan Study were prospectively followed up (median follow-up, 11 years). The relationship between the number of ideal CVH metrics and the risk of cardiovascular disease, including myocardial infarction, stroke, and vascular death, was investigated. Overall, a strong gradient relationship was observed between the adjusted hazard ratios for cardiovascular disease and the number of ideal CVH metrics: 0.73 (95% confidence interval, 0.60-0.89), 0.61 (95% confidence interval, 0.50-0.76), 0.49 (95% confidence interval, 0.38-0.63), and 0.41 (95% confidence interval, 0.26-0.63) for those having 2, 3, 4, and 5 to 6 ideal CVH metrics, respectively, compared with those having 0 to 1 ideal CVH metrics (P for trend <0.0001). Similar graded relationships were found between the number of ideal CVH metrics and the adjusted incidence rate for each specific outcome and among whites, blacks, and Caribbean Hispanics. CONCLUSIONS Our findings demonstrated a steep gradient relationship between ideal CVH and individual cardiovascular disease end points, including stroke, that was similar for whites, blacks, and Caribbean Hispanics. This evidence supports the application of the AHA ideal cardiovascular health metrics for cardiovascular disease risk assessment and health promotion for all Americans regardless of race-ethnic background.
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Affiliation(s)
- Chuanhui Dong
- Department of Neurology, University of Miami, CRB 13, 1120 NW 14th St, Miami, FL 33136, USA
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Bernal DDL, Stafford L, Bereznicki LRE, Castelino RL, Davidson PM, Peterson GM. Home medicines reviews following acute coronary syndrome: study protocol for a randomized controlled trial. Trials 2012; 13:30. [PMID: 22463733 PMCID: PMC3349589 DOI: 10.1186/1745-6215-13-30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/02/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite continual improvements in the management of acute coronary syndromes, adherence to guideline-based medications remains suboptimal. We aim to improve adherence with guideline-based therapy following acute coronary syndrome using an existing service that is provided by specifically trained pharmacists, called a Home Medicines Review. We have made two minor adjustments to target the focus of the existing service including an acute coronary syndrome specific referral letter and a training package for the pharmacists providing the service. METHODS/DESIGN We will be conducting a randomized controlled trial to compare the directed home medicines review service to usual care following acute coronary syndromes. All patients aged 18 to 80 years and with a working diagnosis of acute coronary syndrome, who are admitted to two public, acute care hospitals, will be screened for enrolment into the trial. Exclusion criteria will include: not being discharged home, documented cognitive decline, non-Medicare eligibility, and presence of a terminal malignancy. Randomization concealment and sequence generation will occur through a centrally-monitored computer program. Patients randomized to the control group will receive usual post-discharge care. Patients randomized to receive the intervention will be offered usual post-discharge care and a directed home medicines review at two months post-discharge. The study endpoints will be six and twelve months post-discharge. The primary outcome will be the proportion of patients who are adherent to a complete, guideline-based medication regimen. Secondary outcomes will include hospital readmission rates, length of hospital stays, changes in quality of life, smoking cessation rates, cardiac rehabilitation completion rates, and mortality. DISCUSSION As the trial is closely based on an existing service, any improvements observed should be highly translatable into regular practice. Possible limitations to the success of the trial intervention include general practitioner approval of the intervention, general practitioner acceptance of pharmacists' recommendations, and pharmacists' ability to make appropriate recommendations. A detailed monitoring process will detect any barriers to the success of the trial. Given that poor medication persistence following acute coronary syndrome is a worldwide problem, the findings of our study may have international implications for the care of this patient group. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12611000452998.
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Affiliation(s)
- Daniel DL Bernal
- Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania (UTAS), Sandy Bay Campus, Tasmania 7001, Australia
| | - Leanne Stafford
- Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania (UTAS), Sandy Bay Campus, Tasmania 7001, Australia
| | - Luke RE Bereznicki
- Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania (UTAS), Sandy Bay Campus, Tasmania 7001, Australia
| | - Ronald L Castelino
- Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania (UTAS), Sandy Bay Campus, Tasmania 7001, Australia
| | - Patricia M Davidson
- Centre for Cardiovascular and Chronic Care, Faculty of Nursing, Midwifery and Health, University of Technology Sydney (UTS), Sydney 2007, Australia
| | - Gregory M Peterson
- Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy, University of Tasmania (UTAS), Sandy Bay Campus, Tasmania 7001, Australia
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Cardiovascular disease risk factor patterns and their implications for intervention strategies in Vietnam. Int J Hypertens 2012; 2012:560397. [PMID: 22500217 PMCID: PMC3303616 DOI: 10.1155/2012/560397] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Revised: 10/20/2011] [Accepted: 11/01/2011] [Indexed: 11/18/2022] Open
Abstract
Background. Data on cardiovascular disease risk factors (CVDRFs) in Vietnam are limited. This study explores the prevalence of each CVDRF and how they cluster to evaluate CVDRF burdens and potential prevention strategies.
Methods. A cross-sectional survey in 2009 (2,130 adults) was done to collect data on behavioural CVDRF, anthropometry and blood pressure, lipidaemia profiles, and oral glucose tolerance tests. Four metabolic CVDRFs (hypertension, dyslipidaemia, diabetes, and obesity) and five behavioural CVDRFs (smoking, excessive alcohol intake, unhealthy diet, physical inactivity, and stress) were analysed to identify their prevalence, cluster patterns, and social predictors. Framingham scores were applied to estimate the global 10-year CVD risks and potential benefits of CVD prevention strategies. Results. The age-standardised prevalence of having at least 2/4 metabolic, 2/5 behavioural, or 4/9 major CVDRF was 28%, 27%, 13% in women and 32%, 62%, 34% in men. Within-individual clustering of metabolic factors was more common among older women and in urban areas. High overall CVD risk (≥20% over 10 years) identified 20% of men and 5% of women—especially at higher ages—who had coexisting CVDRF. Conclusion. Multiple CVDRFs were common in Vietnamese adults with different clustering patterns across sex/age groups. Tackling any single risk factor would not be efficient.
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Erne P, Gutzwiller F, Urban P, Maggiorini M, Keller PF, Radovanovic D. Characteristics and Outcome in Acute Coronary Syndrome Patients with and without Established Modifiable Cardiovascular Risk Factors: Insights from the Nationwide AMIS Plus Registry 19972010. Cardiology 2012; 121:228-36. [DOI: 10.1159/000337324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 01/27/2012] [Indexed: 01/23/2023]
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Goto S, Ikeda Y, Shimada K, Uchiyama S, Origasa H, Kobayashi H. One-year cardiovascular event rates in Japanese outpatients with myocardial infarction, stroke, and atrial fibrillation. -Results From the Japan Thrombosis Registry for Atrial Fibrillation, Coronary, or Cerebrovascular Events (J-TRACE).-. Circ J 2011; 75:2598-604. [PMID: 21857143 DOI: 10.1253/circj.cj-11-0378] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There remains uncertainty about the risk of cardiovascular events in stable outpatients with a history of myocardial infarction (MI), stroke, and atrial fibrillation in Japan. METHODS AND RESULTS In the Japan Thrombosis Registry for Atrial Fibrillation, Coronary, or Cerebrovascular Events (J-TRACE), a nationwide prospective cohort of stable outpatients with a history of MI (n=2,291), stroke (n=3,554), and/or atrial fibrillation (n=2,242), 1-year follow-up data were available for 7,513 of 8,087 patients (follow-up rate: 92.9%). The primary endpoint (death/MI/stroke) was reported in 3.53 events per 100 person-years (95% confidence interval [CI]: 3.11-3.99) within 1 year. The rates of all-cause death, death from stroke, and death from MI within 1 year were 1.35 (95%CI: 1.10-1.65), 0.15 (95%CI: 0.08-0.27), and 0.06 (95%CI: 0.02-0.14) per 100 person-years, respectively. The rate of non-fatal stroke was 1.85 (95%CI: 1.55-2.19), while that of non-fatal MI was 0.33 (95%CI: 0.21-0.49). The rate of non-fatal stroke was highest among stroke patients (2.95; 95%CI: 2.39-3.60 per 100 person-years), while that of non-fatal MI was similar across all disease categories. Investigator-decided serious non-fatal bleeding events occurred in 0.21 events (95%CI: 0.12-0.34) per 100 person-years. CONCLUSIONS In this large, nationwide Japanese registry, the highest stroke event rate was seen in patients with a history of stroke.
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Affiliation(s)
- Shinya Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Japan.
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167
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Goto S, Ikeda Y, Chan JCN, Wilson PWF, Yeo TC, Liau CS, Abola MT, Salette G, Steg PG, Bhatt DL. Risk-factor profile, drug usage and cardiovascular events within a year in patients with and at high risk of atherothrombosis recruited from Asia as compared with those recruited from non-Asian regions: a substudy of the REduction of Atherothrombosis for Continued Health (REACH) registry. HEART ASIA 2011; 3:93-8. [PMID: 27326003 DOI: 10.1136/ha.2010.002691] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 07/11/2011] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To clarify the differences in the baseline characteristics, prevalence and incidence of atherothrombosis in patients recruited from Asia versus non-Asian regions. DESIGN International Prospective Cohort Study. SETTING Region focused substudy. PATIENTS The Reduction of Atherothrombosis for Continued Health (REACH) Registry recruited 68 236 stable outpatients with established atherothrombosis or ≥3 atherothrombotic risk factors from 44 countries. INTERVENTIONS No intervention. MAIN OUTCOME MEASURES Risk factors, use of medications, vascular disease bed location, and 1-year cardiovascular (CV) outcomes (CV death, myocardial infarction, stroke). RESULTS The percentages of patients recruited with CVD (Cerebrovascular Disease) were higher in Asia (41.0%) than in non-Asian regions (25.1%) (p<0.0001). The prevalence of diabetes mellitus was higher in Asia (46.6%) than in non-Asian regions (43.3%) (p<0.0001) despite the former having a lower body mass index (BMI) (24.4±3.9 vs 28.8±5.6) (p<0.0001). The combined endpoint of CV death/myocardial infarction/stroke of patients recruited from non-Asian regions of 4.38% (95% CI 4.20 to 4.56) is equivalent to those from the Asian region excluding Japan of 4.65% (95% CI 4.04 to 5.25), but that is significantly lower in patients recruited from Japan of 3.40% (95% CI 2.76 to 4.04, p<0.05). CONCLUSIONS There is a higher prevalence of CVD and higher prevalence of diabetus mellitus with lower body mass index in patients recruited from the Asian region as compared those recruited from non-Asian regions. The CV event rate in patients recruited from non-Asian regions is equivalent to that of patients recruited from the Asian region excluding Japan, but significantly lower in patients recruited from Japan.
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Affiliation(s)
- S Goto
- Department of Medicine (Cardiology), Tokai University School of Medicine, Isehara, Japan
| | - Y Ikeda
- Department of Life Science and Medical Bioscience, Waseda University, Tokyo, Japan
| | - J C N Chan
- Department of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - P W F Wilson
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - T Cheng Yeo
- Department of General Medicine, National University Hospital, Singapore
| | - C S Liau
- Department of Cardiology, Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - M T Abola
- Section of Vascular Medicine, Division of Clinical Cardiology, Philippine Heart Center, Quezon City, Philippines
| | | | - P G Steg
- Department of Cardiology, Hôpital Bichat-Claude Bernard, Université Paris, Paris, France
| | - D L Bhatt
- 10VA Boston Healthcare System and Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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