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Nuotio J, Vähämurto L, Pahkala K, Magnussen CG, Hutri-Kähönen N, Kähönen M, Laitinen T, Taittonen L, Tossavainen P, Lehtimäki T, Jokinen E, Viikari JSA, Raitakari O, Juonala M. CVD risk factors and surrogate markers - Urban-rural differences. Scand J Public Health 2019; 48:752-761. [PMID: 31464561 DOI: 10.1177/1403494819869816] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: Disparity in cardiovascular disease (CVD) mortality and risk factor levels between urban and rural regions has been confirmed worldwide. The aim of this study was to examine how living in different community types (urban-rural) in childhood and adulthood are related to cardiovascular risk factors and surrogate markers of CVD such as carotid intima-media thickness (IMT) and left ventricular mass (LVM). Methods: The study population comprised 2903 participants (54.1% female, mean age 10.5 years in 1980) of the Cardiovascular Risk in Young Finns Study who had been clinically examined in 1980 (age 3-18 years) and had participated in at least one adult follow-up (2001-2011). Results: In adulthood, urban residents had lower systolic blood pressure (-1 mmHg), LDL-cholesterol (-0.05 mmol/l), lower body mass index (-1.0 kg/m2) and glycosylated haemoglobin levels (-0.05 mmol/mol), and lower prevalence of metabolic syndrome (19.9 v. 23.7%) than their rural counterparts. In addition, participants continuously living in urban areas had significantly lower IMT (-0.01 mm), LVM (1.59 g/m2.7) and pulse wave velocity (-0.22 m/s) and higher carotid artery compliance (0.07%/10 mmHg) compared to persistently rural residents. The differences in surrogate markers of CVD were only partially attenuated when adjusted for cardiovascular risk factors. Conclusions: Participants living in urban communities had a more favourable cardiovascular risk factor profile than rural residents. Furthermore, participants continuously living in urban areas had less subclinical markers related to CVD compared with participants living in rural areas. Urban-rural differences in cardiovascular health might provide important opportunities for optimizing prevention by targeting areas of highest need.
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Affiliation(s)
- Joel Nuotio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Heart Centre, Turku University Hospital and University of Turku, Finland
| | - Lauri Vähämurto
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Paavo Nurmi Centre, Department of Physical Activity and Health, University of Turku, Finland
| | - Costan G Magnussen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Menzies Research Institute Tasmania, University of Tasmania, Australia
| | - Nina Hutri-Kähönen
- Department of Paediatrics, University of Tampere and Tampere University Hospital, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, University of Tampere School of Medicine and Tampere University Hospital, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland and Kuopio University Hospital, Finland
| | | | | | - Terho Lehtimäki
- Fimlab Laboratories and Finnish Cardiovascular Research Centre-Tampere, University of Tampere, Finland
| | - Eero Jokinen
- Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Finland
| | | | - Olli Raitakari
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
| | - Markus Juonala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland.,Department of Medicine, University of Turku, Finland.,Murdoch Children's Research Institute, Melbourne, Australia
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302
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Gupta R, Wood DA. Primary prevention of ischaemic heart disease: populations, individuals, and health professionals. Lancet 2019; 394:685-696. [PMID: 31448740 DOI: 10.1016/s0140-6736(19)31893-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 12/24/2022]
Abstract
Ischaemic heart disease has a multifactorial aetiology and can be prevented from developing in populations primordially, and in individuals at high risk by primary prevention. The primordial approach focuses on social determinants of health in populations: political, economic, and social factors, principally unplanned urbanisation, illiteracy, poverty, and working and living conditions. Implementation of the UN Sustainable Development Goals can lead to major improvements in cardiovascular health, and adequate health-care financing and universal health care are important for achieving these goals. Population-level interventions should focus on tobacco control, promotion of healthy foods (fruits, vegetables, legumes, and nuts), curbing unhealthy foods (saturated fats, trans fats, refined carbohydrates, excessive salt, and alcohol), promotion of physical activity in everyday living, and control of ambient and indoor pollution. At the individual level, identification of people at high multifactorial risk and guideline-driven management of hypertension, LDL cholesterol, and diabetes is required. Strategies to improve adherence to healthy lifestyles and drug therapies are essential and can be implemented at health system, health care, and patient levels with use of education, technology, and personalised approaches. Improving quality of medical education with a focus on ischaemic heart disease prevention for physicians, nurses, allied health workers, and the public is required.
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Affiliation(s)
- Rajeev Gupta
- Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India; Department of Preventive Cardiology and Internal Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, Rajasthan, India.
| | - David A Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland Galway, Galway, Ireland; National Heart and Lung Institute, Imperial College, London, UK
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303
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Mkuu RS, Gilreath TD, Wekullo C, Reyes GA, Harvey IS. Social determinants of hypertension and type-2 diabetes in Kenya: A latent class analysis of a nationally representative sample. PLoS One 2019; 14:e0221257. [PMID: 31425539 PMCID: PMC6699668 DOI: 10.1371/journal.pone.0221257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/03/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Cardiovascular disease is among the leading causes of death in Kenya and type II diabetes (T2D) is a growing chronic health concern in the country. However, a gap exists in examining how demographic and social characteristics coalesce to identify individuals at high risk for hypertension and/or T2D in Kenya. The current study examined demographic typologies associated with self-report diagnoses. Methods Nationally representative cross-sectional study using 43,898 individuals from the Kenya Demographic and Health Survey 2014. Main Outcome Measures were self-reported Hypertension and Type 2 Diabetes diagnosis. Descriptive analyses were conducted using STATA 14. Latent class analysis (LCA) was conducted using Mplus 7.4. Results Approximately 5% reported hypertension and 1% reported T2D. Latent class analysis suggested a 4-class solution. The class with the highest likelihood to report previous diagnosis of hypertension (10.4%), consisted of high proportion of married adult women. The second highest prevalence of previous diagnosis of hypertension (4.4%) consisted of a high proportion of married middle aged men with high probability of being smokers. The results suggest that Kenyan women over 30 years may be at increased risk of hypertension compared to men. Future studies should include additional socio-demographic and behavioral characteristics to better understand gender differences in correlates for hypertension to be used for targeted and tailored health promotion-interventions.
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Affiliation(s)
- Rahma S. Mkuu
- Transdisciplinary Center for Health Equity Research, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
- * E-mail:
| | - Tamika D. Gilreath
- Transdisciplinary Center for Health Equity Research, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
| | - Caroline Wekullo
- Post Graduate Studies, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Gabriela A. Reyes
- Colorado School of Public Health, Colorado University, Denver-Anschutz Medical Campus, Denver, Colorado, United States of America
| | - Idethia S. Harvey
- Transdisciplinary Center for Health Equity Research, Department of Health & Kinesiology, Texas A&M University, College Station, Texas, United States of America
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304
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Jallow E, Al Hail H, Han TS, Sharma S, Deleu D, Ali M, Al Hussein H, Abuzaid HO, Sharif K, Khan FY, Sharma P. Current status of stroke in Qatar: Including data from the BRAINS study. JRSM Cardiovasc Dis 2019; 8:2048004019869160. [PMID: 31452875 PMCID: PMC6700866 DOI: 10.1177/2048004019869160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 06/06/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background Qatar is located on the north-eastern coast of the Arabian Peninsula. Qatari natives account for less than 15% of the population while the largest migrant group comprising 60% derives from South Asia. Despite projections that stroke burden in Qatar will increase with population ageing, epidemiological studies focusing on stroke in Qatar are relatively scarce. Method We reviewed the available epidemiological publications relating to Qatar. In addition, we have added to this knowledge by incorporating Qatari data from the on-going Bio-Repository of DNA in Stroke, an independent multinational database of stroke patients. Results Qatar has low reported incidence and mortality rates of 58 and 9.17 per 100,000 per year, respectively, which may be explained by its middle-aged migrant worker majority population. Correspondingly, South Asian migrants in Qatar suffered younger strokes than Qatari natives (48.7 vs 63.4 years, P < 0.001). Among the most common risk factors identified in stroke patients were hypertension (77.9%), diabetes (43.8%) and hypercholesterolemia (28.5%). Ischaemic stroke was the most frequent subtype amongst migrant South Asians (71.1%). The majority of stroke cases had computed tomography and/or magnetic resonance imaging scans, but only 11.1% of ischaemic strokes were thrombolysed. Qataris on one-year follow up were more often found to have died (6.5% vs 0.3%) and had further stroke/transient ischaemic attack events (17.4% vs 6.4%, P = 0.009) compared to South Asians. Conclusion The burden of stroke is increasing in Qatar, and considerable disparities are observed between the native and migrant populations which likely will require different approaches to management by its healthcare system.
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Affiliation(s)
- Ebrima Jallow
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | | | - Thang S Han
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | - Sapna Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK
| | | | - Musab Ali
- Hamad Medical Corporation, Doha, Qatar
| | | | | | | | | | - Pankaj Sharma
- Institute of Cardiovascular Research, Royal Holloway University of London , London, UK.,Ashford & St Peters Hospital NHS Foundation Trust, Surrey, UK.,Imperial College Healthcare NHS Trust, London, UK
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305
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Prabhakaran D, Singh K, Roth GA, Banerjee A, Pagidipati NJ, Huffman MD. Cardiovascular Diseases in India Compared With the United States. J Am Coll Cardiol 2019; 72:79-95. [PMID: 29957235 DOI: 10.1016/j.jacc.2018.04.042] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 04/11/2018] [Accepted: 04/25/2018] [Indexed: 01/01/2023]
Abstract
This review describes trends in the burden of cardiovascular diseases (CVDs) and risk factors in India compared with the United States; provides potential explanations for these differences; and describes strategies to improve cardiovascular health behaviors, systems, and policies in India. The prevalence of CVD in India has risen over the past 2 decades due to population growth, aging, and a stable age-adjusted CVD mortality rate. Over the same time period, the United States has experienced an overall decline in age-adjusted CVD mortality, although the trend has begun to plateau. These improvements in CVD mortality in the United States are largely due to favorable population-level risk factor trends, specifically with regard to tobacco use, cholesterol, and blood pressure, although improvements in secondary prevention and acute care have also contributed. To realize similar gains in reducing premature death and disability from CVD, India needs to implement population-level policies while strengthening and integrating its local, regional, and national health systems. Achieving universal health coverage that includes financial risk protection should remain a goal to help all Indians realize their right to health.
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Affiliation(s)
- Dorairaj Prabhakaran
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India; London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Kavita Singh
- Public Health Foundation of India and Centre for Chronic Disease Control, Gurgaon, India
| | - Gregory A Roth
- Institute for Health Metrics and Evaluation and the Division of Cardiology at the University of Washington School of Medicine, Seattle, Washington
| | - Amitava Banerjee
- Farr Institute of Health Informatics, University College London, London, United Kingdom
| | - Neha J Pagidipati
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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306
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Nagraj S, Hinton L, Praveen D, Kennedy S, Norton R, Hirst J. Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study. BJOG 2019; 126 Suppl 4:34-42. [PMID: 31257668 PMCID: PMC6771686 DOI: 10.1111/1471-0528.15847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 12/27/2022]
Abstract
Objectives A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long‐term risks. Design Qualitative study using modified grounded theory. Setting Two states in rural India: Haryana and Andhra Pradesh. Population Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. Methods In‐depth interviews and focus group discussions explored: (1) priorities for high‐risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long‐term sequelae of high‐risk conditions. A thematic analysis was undertaken. Results Seven focus group discussions and 11 in‐depth interviews (n = 71 participants) were performed. The key priority area for high‐risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long‐term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long‐term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. Conclusions There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. Funding SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. Tweetable abstract Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long‐term risks. Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long‐term risks.
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Affiliation(s)
- S Nagraj
- The George Institute for Global Health, University of Oxford, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - L Hinton
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - D Praveen
- The George Institute for Global Health, Hyderabad, India
| | - S Kennedy
- Nuffield Department of Women's & Reproductive Health, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - R Norton
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - J Hirst
- The George Institute for Global Health, University of Oxford, Oxford, UK.,Nuffield Department of Women's & Reproductive Health, Level 3 Women's Centre, John Radcliffe Hospital, University of Oxford, Oxford, UK
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307
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Tromp J, Ferreira JP, Janwanishstaporn S, Shah M, Greenberg B, Zannad F, Lam CS. Heart failure around the world. Eur J Heart Fail 2019; 21:1187-1196. [DOI: 10.1002/ejhf.1585] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/23/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jasper Tromp
- National Heart Centre Singapore Singapore
- Duke‐NUS Medical School Singapore
- Department of Cardiology University Medical Centre Groningen, University of Groningen Groningen The Netherlands
| | - João Pedro Ferreira
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - Satit Janwanishstaporn
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand
| | | | - Barry Greenberg
- Division of Cardiovascular Medicine UC San Diego Health System La Jolla NC USA
| | - Faiez Zannad
- Université de Lorraine, Inserm, Centre d'Investigations Cliniques‐ Plurithématique 14‐33, and Inserm U1116, CHRU, F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists) Nancy France
| | - Carolyn S.P. Lam
- National Heart Centre Singapore Singapore
- Duke‐NUS Medical School Singapore
- Department of Cardiology University Medical Centre Groningen, University of Groningen Groningen The Netherlands
- The George Institute for Global Health Sydney Australia
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308
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Keetile M, Navaneetham K, Letamo G, Rakgoasi SD. Socioeconomic inequalities in non-communicable disease risk factors in Botswana: a cross-sectional study. BMC Public Health 2019; 19:1060. [PMID: 31391020 PMCID: PMC6686547 DOI: 10.1186/s12889-019-7405-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The debate on socioeconomic inequalities in health dominates the research and policy agenda of many countries. The prevalence of non-communicable diseases (NCDs) is on the rise in recent years in Botswana. As a prevention and policy effort, the study provided an empirical evidence on socioeconomic inequalities in NCD risk factors in Botswana. METHODS Data used in this study was derived from a cross sectional survey on chronic non communicable diseases in Botswana conducted in 2016. The survey adopted a multistage sampling design and a sample of 1178 participants (males and females) aged 15 years and above was selected in both urban and rural areas of Botswana. The inequality analysis was conducted employing decomposition analysis using ADePT software version 6. Logistic regression models were used to show the association between NCD risk factors and socioeconomic status using SPSS version 25. RESULTS Concentration indices showed that poor physical activity (CI = 0.0546), alcohol consumption (CI = 0.1859) and overweight/obesity (CI = 0.038) were more concentrated among the non-poor while daily smoking (CI = - 0.0308) and poor fruit/vegetable consumption (CI = - 0.1909) were more concentrated among the poor. Wealth status was observed to be the leading contributor to socioeconomic inequality for daily smoking, poor fruit/vegetable consumption, overweight/obesity and poor physical activity. Education was the leading contributor to socioeconomic inequality for alcohol consumption. CONCLUSIONS Findings in this study indicate the need for concerted differential efforts to address the needs of the poor and non-poor in order to reduce NCD risk factor inequalities.
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Affiliation(s)
- Mpho Keetile
- Department of Population Studies, University of Botswana, Gaborone, Botswana.
| | - Kannan Navaneetham
- Department of Population Studies, University of Botswana, Gaborone, Botswana
| | - Gobopamang Letamo
- Department of Population Studies, University of Botswana, Gaborone, Botswana
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309
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Advances in tissue engineering of nanocellulose-based scaffolds: A review. Carbohydr Polym 2019; 224:115144. [PMID: 31472870 DOI: 10.1016/j.carbpol.2019.115144] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/08/2019] [Accepted: 07/29/2019] [Indexed: 01/12/2023]
Abstract
Scaffolds based on nanocellulose (NC) have crucial applications in tissue engineering (TE) owing to the biocompatibility, water absorption, water retention, optical transparency, and chemo-mechanical properties. In this review, we summarize the scaffolds based on nanocellulose, including nanocrystalline cellulose and nanofibrillated cellulose. We compare four representative methods to prepare NC-based scaffolds, containing electrospinning, freeze-drying, 3D printing, and solvent casting. We outline the characteristics of scaffolds obtained by different methods. Our focus is on the applications of NC-based scaffolds to repair, improve or replace damaged tissues and organs, including skin, blood vessel, nerve, skeletal muscle, heart, liver, and ophthalmology. NC-based scaffolds are attractive materials for regeneration of different tissues and organs due to the remarkable features. Finally, we propose the challenges and potentials of NC-based TE scaffolds.
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310
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Özlek B, Özlek E, Zencirkıran Ağuş H, Tekinalp M, Kahraman S, Çelik O, Çil C, Başaran Ö, Doğan V, Kaya BC, Rencüzoğulları İ, Ösken A, Bekar L, Çakır MO, Çelik Y, Mert KU, Memiç Sancar K, Sevinç S, Mert GÖ, Biteker M. Geographical Variations in Patients with Heart Failure and Preserved Ejection Fraction: A Sub-Group Analysis of the APOLLON Registry. Balkan Med J 2019; 36:235-244. [PMID: 30945522 PMCID: PMC6636651 DOI: 10.4274/balkanmedj.galenos.2019.2019.2.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: Clinical characteristics of patients with heart failure may vary geographically. However, limited data are available regarding the geographical differences of patients with heart failure and preserved ejection fraction. Aims: The present subgroup analysis aims to investigate the geographical differences in clinical characteristics, management, and primary etiology of patients with heart failure and preserved ejection fraction in Turkey. Study Design: A cross-sectional study. Methods: A comPrehensive, ObservationaL registry of heart faiLure with mid-range and preserved ejection fractiON (APOLLON) is a multicenter and observational study conducted in seven regions of Turkey (NCT03026114). The present study is a post-hoc analysis of the APOLLON registry. In this substudy, we compared the clinical characteristics of 819 consecutive patients with heart failure and preserved ejection fraction (mean age, 67 years; 57.8% women) admitted to cardiology outpatient units in different geographical regions. Results: Based on the geographical distribution of the entire Turkish population, the highest number of patients enrolled were from Marmara (271 patients, 33.1%). All demographical characteristics, clinical and laboratory findings, comorbidities, primary etiology, and medications prescribed were significantly different between the regions. Furthermore, inter-regional gender differences were identified. Comparatively, the Aegean and Mediterranean regions had older patients with heart failure and preserved ejection fraction (p<0.001), and the Black Sea, Southeast, and East Anatolia regions had predominantly male patients (51.2, 54.5, and 56.9%, respectively; p=0.002). Notably, the Mediterranean and Southeast Anatolia had more symptomatic patients, and history of hospitalization for heart failure was more prevalent in Southeast Anatolia (33.3%, p<0.001). Prevalence of atrial fibrillation was higher in the Mediterranean and Southeast Anatolia regions (51 and 48.5%, p<0.001), and patients with heart failure and preserved ejection fraction had a higher prevalence of hypertension in the Mediterranean, Southeast Anatolia, and Black Sea regions (p=0.002). Angiotensin-converting enzyme inhibitors were more frequently prescribed in East Anatolia (52.3%, p=0.001), and the prevalence of patients with heart failure and preserved ejection fraction using loop diuretics (48.8%, p=0.003) was higher in the Black Sea region. Conclusion: This study was the first to show geographical differences in clinical characteristics of patients with heart failure and preserved ejection fraction in Turkey. Determination of the clinical characteristics of the heart failure and preserved ejection fraction population based on the geographical region may enables physicians to adopt a region-specific clinical approach toward heart failure and preserved ejection fraction.
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Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Hicaz Zencirkıran Ağuş
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Tekinalp
- Clinic of Cardiology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Serkan Kahraman
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
| | - Bedri Caner Kaya
- Clinic of Cardiology, Şanlıurfa Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
| | | | - Altuğ Ösken
- Clinic of Cardiology, İstanbul Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Lütfü Bekar
- Clinic of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
| | - Mustafa Ozan Çakır
- Department of Cardiology, Zonguldak Bülent Ecevit Universiy School of Medicine, Zonguldak, Turkey
| | - Yunus Çelik
- Clinic of Cardiology, Yüksek İhtisas Hospital, Kırıkkale, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Kadriye Memiç Sancar
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Samet Sevinç
- Clinic of Cardiology, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Gurbet Özge Mert
- Clinic of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Training and Research Hospital, Muğla, Turkey
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311
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Hong P, Gu RN, Li FX, Xiong XX, Liang WB, You ZJ, Zhang HF. NLRP3 inflammasome as a potential treatment in ischemic stroke concomitant with diabetes. J Neuroinflammation 2019; 16:121. [PMID: 31174550 PMCID: PMC6554993 DOI: 10.1186/s12974-019-1498-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023] Open
Abstract
The NLRP3 (nucleotide-binding oligomerization domain-like receptor [NLR] family pyrin domain-containing 3) inflammasome is a member of the NLR family of innate immune cell sensors. These are crucial regulators of cytokine secretions, which promote ischemic cell death and insulin resistance. This review summarizes recent progress regarding the NLRP3 inflammasome as a potential treatment for ischemic stroke in patients with diabetes, two complicated diseases that often occur together. Stroke worsens glucose metabolism abnormalities, and the outcomes after stroke are more serious for diabetic patients compared with those without diabetes. Inflammation contributes to organ injury after ischemic stroke and diabetes. Recent research has focused on inhibiting the activation of inflammasomes and thus reducing the maturation of proinflammatory cytokines such as interleukin (IL)-1β and IL-18. Studies suggest that inhibition of NLRP3 prevents or alleviates both ischemic stroke and diabetes. Targeting against the assembly and activity of the NLRP3 inflammasome is a potential and novel therapy for inflammasome-associated diseases, including ischemic stroke concomitant with diabetes.
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Affiliation(s)
- Pu Hong
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Ruo-Nan Gu
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Feng-Xian Li
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xiao-Xing Xiong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, People's Republic of China
| | - Wen-Bin Liang
- Cardiac Electrophysiology Lab, University of Ottawa Heart Institute, Ottawa, Ontario, K1Y 4 W7, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, K1Y 4 W7, Canada
| | - Zhi-Jian You
- Department of Anesthesiology, Shenzhen SAMII Medical Center, Shenzhen, Guangdong, People's Republic of China.
| | - Hong-Fei Zhang
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
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312
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2017 Roadmap for Innovation-ACC Health Policy Statement on Healthcare Transformation in the Era of Digital Health, Big Data, and Precision Health: A Report of the American College of Cardiology Task Force on Health Policy Statements and Systems of Care. J Am Coll Cardiol 2019; 70:2696-2718. [PMID: 29169478 DOI: 10.1016/j.jacc.2017.10.018] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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313
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Cainzos-Achirica M, Fedeli U, Sattar N, Agyemang C, Jenum AK, McEvoy JW, Murphy JD, Brotons C, Elosua R, Bilal U, Kanaya AM, Kandula NR, Martinez-Amezcua P, Comin-Colet J, Pinto X. Epidemiology, risk factors, and opportunities for prevention of cardiovascular disease in individuals of South Asian ethnicity living in Europe. Atherosclerosis 2019; 286:105-113. [PMID: 31128454 DOI: 10.1016/j.atherosclerosis.2019.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 01/22/2023]
Abstract
South Asian (SA) individuals represent a large, growing population in a number of European countries. These individuals, particularly first-generation SA immigrants, are at higher risk of developing type 2 diabetes, atherogenic dyslipidaemia, and coronary heart disease than most other racial/ethnic groups living in Europe. SAs also have an increased risk of stroke compared to European-born individuals. Despite a large body of conclusive evidence, SA-specific cardiovascular health promotion and preventive interventions are currently scarce in most European countries, as well as at the European Union level. In this narrative review, we aim to increase awareness among clinicians and healthcare authorities of the public health importance of cardiovascular disease among SAs living in Europe, as well as the need for tailored interventions targeting this group - particularly, in countries where SA immigration is a recent phenomenon. To this purpose, we review key studies on the epidemiology and risk factors of cardiovascular disease in SAs living in the United Kingdom, Italy, Spain, Denmark, Norway, Sweden, and other European countries. Building on these, we discuss potential opportunities for multi-level, targeted, tailored cardiovascular prevention strategies. Because lifestyle interventions often face important cultural barriers in SAs, particularly for first-generation immigrants; we also discuss features that may help maximise the effectiveness of those interventions. Finally, we evaluate knowledge gaps, currently available risk stratification tools such as QRISK-3, and future directions in this important field.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain.
| | - Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Italy
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, University of Oslo, Institute of Health and Society, Norway
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; National University of Ireland and National Institute for Preventive Cardiology, Galway, Ireland; Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland
| | - Jack D Murphy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carlos Brotons
- Casernes Primary Care Center, Àmbit D'Atenció Primària Barcelona Ciutat, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, Mar Institute of Medical Research, Barcelona, Spain; Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Barcelona, Spain; School of Medicine, Universitat de Vic-Central de Catalunya, Vic, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | | | - Namratha R Kandula
- Northwestern University, Departments of Medicine and Preventive Medicine, Chicago, IL, USA
| | - Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine, University of Barcelona, Barcelona, Spain
| | - Xavier Pinto
- School of Medicine, University of Barcelona, Barcelona, Spain; Cardiovascular Risk Unit, Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Biomedical Research Network in Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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314
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Prediction of 24-hour sodium excretion from spot urine samples in South African adults: a comparison of four equations. J Hum Hypertens 2019; 34:24-33. [PMID: 31076654 DOI: 10.1038/s41371-019-0210-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 01/29/2023]
Abstract
Repeated 24-hour urine collection is considered to be the gold standard for assessing salt intake. This is often impractical in large-population studies, especially in low-middle-income countries. Equations to estimate 24-hour urinary salt excretion from a spot urine sample have been developed, but have not been widely validated in African populations. This study aimed to systematically assess the validity of four existing equations to predict 24-hour urinary sodium excretion (24UNa) from spot urine samples in a nationally representative sample of South Africans. Spot and 24-hour urine samples were collected in a subsample (n = 438) of participants from the World Health Organisation Study on global AGEing and adult health (SAGE) Wave 2 in South Africa in 2015. Measured 24UNa values were compared with predicted 24UNa values from the Kawasaki, Tanaka, INTERSALT and Mage equations using Bland-Altman plots. In this subsample (mean age 52.8 ± 16.4 years; body mass index 30.2 ± 8.2 kg/m2; 76% female; 73% black African; 42% hypertensive), all four equations produced a significantly different population estimate compared with the measured median value of 6.7 g salt/day (IQR 4.4-10.5). Although INTERSALT underestimated salt intake (-3.77 g/d; -1.64 to -7.09), the other equations overestimated by 1.28 g/d (-3.52; 1.97), 6.24 g/d (2.22; 9.45), and 17.18 g/d (8.42; 31.96) for Tanaka, Kawasaki, and Mage, respectively. Bland-Altman curves indicated unacceptably wide levels of agreement. Use of these equations to estimate population level salt intake from spot urine samples in South Africans is not recommended.
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315
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Dodd R, Ramanathan S, Angell B, Peiris D, Joshi R, Searles A, Webster J. Strengthening and measuring research impact in global health: lessons from applying the FAIT framework. Health Res Policy Syst 2019; 17:48. [PMID: 31060617 PMCID: PMC6501392 DOI: 10.1186/s12961-019-0451-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/04/2019] [Indexed: 12/27/2022] Open
Abstract
Background To date, efforts to measure impact have largely focused on health research in high-income countries, reflecting where the majority of health research funding is spent. Nevertheless, there is a growing body of health and medical research being undertaken in low- and middle-income countries (LMICs), supported by both development aid and established research funders. The Framework to Assess the Impact of Translational health research (FAIT) combines three approaches to measuring research impact (Payback, economic assessment and case study narrative). Its aim is to strengthen the focus on translation and impact measurement in health research. FAIT has been used by several Australian research initiatives; however, it has not been used in LMICs. Our aim was to apply FAIT in an LMIC context and evaluate its utility. Methods We retrospectively applied all three FAIT methods to two LMIC studies using available data, supplemented with group discussion and further economic analyses. Results were presented in a scorecard format. Results FAIT helped clarify pathways of impact for the projects and provided new knowledge on areas of impact in several domains, including capacity-building for research, policy development and economic impact. However, there were constraints, particularly associated with calculating the return on investment in the LMIC context. The case study narrative provided a layperson’s summary of the research that helped to explain outcomes and succinctly communicate lessons learnt. Conclusion Use of FAIT to assess the impact of LMIC research was both feasible and useful. We make recommendations related to prospective use, identification of metrics to support use of the Payback framework, and simplification of the economic assessment, which may facilitate further application in LMIC environments. Electronic supplementary material The online version of this article (10.1186/s12961-019-0451-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rebecca Dodd
- The George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, 2042, Australia.
| | - Shanthi Ramanathan
- Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia.,School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Blake Angell
- The George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, 2042, Australia
| | - David Peiris
- The George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, 2042, Australia
| | - Rohina Joshi
- The George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, 2042, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia.,School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Jacqui Webster
- The George Institute for Global Health, University of New South Wales, 1 King Street, Newtown, Sydney, 2042, Australia
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316
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Xuan Y, Zuo J, Zheng S, Ji J, Qian Y. Association of Hemoglobin and Blood Pressure in a Chinese Community-Dwelling Population. Pulse (Basel) 2019; 6:154-160. [PMID: 31049315 DOI: 10.1159/000494735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/20/2018] [Indexed: 12/31/2022] Open
Abstract
This study investigated the relationship between hemoglobin (Hb) level and blood pressure in a Chinese community-dwelling population with normal glucose metabolism. Hb, fasting plasma glucose, glycated Hb A1c, hepatic and renal function, lipid, electrolytes, and anthropometric parameters were measured. Hb level was found to be positively correlated with systolic (SBP; r = 0.075, p < 0.001) and diastolic (DBP; r = 0.272, p < 0.001) blood pressure in the cohort. The relationship was not affected by age, BMI, serum creatinine (Cr), and low-density lipoprotein (LDL) in both males and females. Multivariate stepwise regression showed that age (β = 0.556, p < 0.001), BMI (β = 1.107, < 0.001), Hb (β = 0.082, p < 0.001), Cr (β = -0.032, p < 0.001), and LDL (β = 1.023, p < 0.001) were independent factors for SBP, and Hb (β = 0.168, p < 0.001), BMI (β = 0.519, p = 0.001), and LDL (β = 0.331, p < 0.001) for DBP. Hb level is positively associated with both SBP and DBP in a Chinese community-dwelling population with normal glucose metabolism.
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Affiliation(s)
- Yan Xuan
- Department of Geriatrics, Ruijin Hospital North, Shanghai Jiaotong University Medicine School, Shanghai, China
| | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital North, Shanghai Jiaotong University Medicine School, Shanghai, China
| | - Shuping Zheng
- Jiading District Jiangqiao Community Health Service Center, Shanghai, China
| | - Jinbao Ji
- Jiading District Jiangqiao Community Health Service Center, Shanghai, China
| | - Yi Qian
- Department of Respiratory Medicine, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, China
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317
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Aspirin for primary prevention: Is this the end of the road? Indian Heart J 2019; 71:113-117. [PMID: 31280821 PMCID: PMC6620426 DOI: 10.1016/j.ihj.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/28/2019] [Accepted: 04/15/2019] [Indexed: 01/23/2023] Open
Abstract
Aspirin is one of the oldest and most commonly used cardiovascular drugs. Despite there being high-quality evidence supporting the use of aspirin for patients with known cardiovascular disease, a definitive consensus regarding its use for patients at risk for cardiovascular disease (and without established cardiovascular disease) has never been reached. Many randomized control trials have produced conflicting results, and consequently, society guidelines have issued differring recommendations. Three major trials were published in 2018, which supplement the existing data on aspirin's role in primary prevention and provide further guidance on this contentious issue. This article reviews the history of aspirin through the last two decades, with special emphasis on these new trials.
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318
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Serón P, Lanas F. The Americas: a region that ages with disparity. THE LANCET GLOBAL HEALTH 2019; 7:e540-e541. [DOI: 10.1016/s2214-109x(19)30168-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/22/2019] [Indexed: 10/27/2022] Open
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319
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Hystad P, Duong M, Brauer M, Larkin A, Arku R, Kurmi OP, Fan WQ, Avezum A, Azam I, Chifamba J, Dans A, du Plessis JL, Gupta R, Kumar R, Lanas F, Liu Z, Lu Y, Lopez-Jaramillo P, Mony P, Mohan V, Mohan D, Nair S, Puoane T, Rahman O, Lap AT, Wang Y, Wei L, Yeates K, Rangarajan S, Teo K, Yusuf S. Health Effects of Household Solid Fuel Use: Findings from 11 Countries within the Prospective Urban and Rural Epidemiology Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2019; 127:57003. [PMID: 31067132 PMCID: PMC6791569 DOI: 10.1289/ehp3915] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 05/19/2023]
Abstract
BACKGROUND Household air pollution (HAP) from solid fuel use for cooking affects 2.5 billion individuals globally and may contribute substantially to disease burden. However, few prospective studies have assessed the impact of HAP on mortality and cardiorespiratory disease. OBJECTIVES Our goal was to evaluate associations between HAP and mortality, cardiovascular disease (CVD), and respiratory disease in the prospective urban and rural epidemiology (PURE) study. METHODS We studied 91,350 adults 35–70 y of age from 467 urban and rural communities in 11 countries (Bangladesh, Brazil, Chile, China, Colombia, India, Pakistan, Philippines, South Africa, Tanzania, and Zimbabwe). After a median follow-up period of 9.1 y, we recorded 6,595 deaths, 5,472 incident cases of CVD (CVD death or nonfatal myocardial infarction, stroke, or heart failure), and 2,436 incident cases of respiratory disease (respiratory death or nonfatal chronic obstructive pulmonary disease, pulmonary tuberculosis, pneumonia, or lung cancer). We used Cox proportional hazards models adjusted for individual, household, and community-level characteristics to compare events for individuals living in households that used solid fuels for cooking to those using electricity or gas. RESULTS We found that 41.8% of participants lived in households using solid fuels as their primary cooking fuel. Compared with electricity or gas, solid fuel use was associated with fully adjusted hazard ratios of 1.12 (95% CI: 1.04, 1.21) for all-cause mortality, 1.08 (95% CI: 0.99, 1.17) for fatal or nonfatal CVD, 1.14 (95% CI: 1.00, 1.30) for fatal or nonfatal respiratory disease, and 1.12 (95% CI: 1.06, 1.19) for mortality from any cause or the first incidence of a nonfatal cardiorespiratory outcome. Associations persisted in extensive sensitivity analyses, but small differences were observed across study regions and across individual and household characteristics. DISCUSSION Use of solid fuels for cooking is a risk factor for mortality and cardiorespiratory disease. Continued efforts to replace solid fuels with cleaner alternatives are needed to reduce premature mortality and morbidity in developing countries. https://doi.org/10.1289/EHP3915.
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Affiliation(s)
- Perry Hystad
- School of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - MyLinh Duong
- Population Health Research Institute, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Michael Brauer
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Larkin
- School of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Raphael Arku
- University of Massachusetts at Amherst, Amherst, Massachusetts, USA
| | - Om P. Kurmi
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Center, Hamilton, Ontario, Canada
| | - Wen Qi Fan
- University of Toronto, Toronto, Ontario, Canada
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, Santo Amaro, São Paulo, Brazil
| | - Igbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Jephat Chifamba
- Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Antonio Dans
- Section of Adult Medicine, Medical Research Unit, University of the Philippines College of Medicine, Manila, Philippines
| | - Johan L. du Plessis
- Occupational Hygiene and Health Research Initiative, North-West University, Potchefstroom, South Africa
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Rajesh Kumar
- Post Graduate Institute of Medical Education and Research School of Public Health, Chandigarh, India
| | | | - Zhiguang Liu
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yin Lu
- 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
| | | | - Prem Mony
- Division of Epidemiology, Biostatistics and Population Health, St John’s Medical College and Research Institute, Bangalore, India
| | | | - Deepa Mohan
- Madras Diabetes Research Foundation, Chennai, India
| | - Sanjeev Nair
- Health Action by People, Thiruvananthapuram, Kerala, India
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Omar Rahman
- School of Public Health, Independent University, Dhaka, Bangladesh
| | - Ah Tse Lap
- Jockey Club School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yanga 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
| | - Li Wei
- 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
| | - Karen Yeates
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Center, Hamilton, Ontario, Canada
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Center, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Center, Hamilton, Ontario, Canada
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320
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Akbari M, Lankarani KB, Naghibzadeh-Tahami A, Tabrizi R, Honarvar B, Kolahdooz F, Borhaninejad V, Asemi Z. The effects of mobile health interventions on lipid profiles among patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Syndr 2019; 13:1949-1955. [PMID: 31235120 DOI: 10.1016/j.dsx.2019.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 04/11/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The current systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to summarize the effect of mobile health (m-health) interventions on lipid profiles among patients with metabolic syndrome and related disorders. METHODS Cochrane Library, EMBASE, PubMed, and Web of Science databases were searched to indentify the relevant randomized clinical trials published up April 30th, 2018. Two reviewers examined study eligibility, extracted data, and assessed risk of bias of included clinical trials, individually. Heterogeneity was measured using I-square (I2) statistic and Cochran's Q test. Data were pooled the standardized mean difference (SMD) effect size by the random-effect model. RESULTS 18 trials of 1681 citations were identified to be appropriate for the current meta-analysis. Findings random-effects model indicated that m-health interventions significantly decreased total- (SMD -0.54; 95% CI, -1.05, -0.03) and LDL-cholesterol levels (SMD -0.66; 95% CI, -1.18, -0.15). M-health interventions had no significant effect on triglycerides (SMD -0.14; 95% CI, -0.56, 0.28) and HDL-cholesterol levels (SMD -0.35; 95% CI, -0.81, 0.11). CONCLUSION Overall, the current meta-analysis demonstrated that m-health interventions resulted in an improvement in total- and LDL-cholesterol, but did not affect triglycerides and HDL-cholesterol levels.
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Affiliation(s)
- Maryam Akbari
- Health Policy Research Center, Institute of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran B Lankarani
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmad Naghibzadeh-Tahami
- Physiology Research Center, Institute of Basic and Clinical Physiology Sciences, 3Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Tabrizi
- Health Policy Research Center, Institute of Health, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behnam Honarvar
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fariba Kolahdooz
- Indigenous and Global Health Research, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Vahidreza Borhaninejad
- Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Zatollah Asemi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, I.R, Iran.
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321
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Boateng D, Galbete C, Nicolaou M, Meeks K, Beune E, Smeeth L, Osei-Kwasi HA, Bahendeka S, Agyei-Baffour P, Mockenhaupt FP, Spranger J, Grobbee DE, Schulze MB, Stronks K, Agyemang C, Danquah I, Klipstein-Grobusch K. Dietary Patterns Are Associated with Predicted 10-Year Risk of Cardiovascular Disease Among Ghanaian Populations: the Research on Obesity and Diabetes in African Migrants (RODAM) Study. J Nutr 2019; 149:755-769. [PMID: 31050745 PMCID: PMC6533550 DOI: 10.1093/jn/nxz002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/13/2018] [Accepted: 01/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Sub-Saharan African populations are disproportionately affected by cardiovascular disease (CVD). Although diet is an important lifestyle factor associated with CVD, evidence on the relation between dietary patterns (DPs) and CVD risk among sub-Saharan African populations is limited. OBJECTIVE We assessed the associations of DPs with estimated 10-y atherosclerotic cardiovascular disease (ASCVD) risk in Ghanaian adults in Ghana and Europe. METHODS Three DPs ('mixed'; 'rice, pasta, meat, and fish'; and 'roots, tubers, and plantain') were derived by principal component analysis (PCA) based on intake frequencies obtained by a self-administered Food Propensity Questionnaire in the multi-center, cross-sectional RODAM (Research on Obesity and Diabetes among African Migrants) study. The 10-y ASCVD risk was estimated using the Pooled Cohort Equations (PCE) for 2976 subjects, aged 40-70 y; a risk score ≥7.5% was defined as 'elevated' ASCVD risk. The associations of DPs with 10-y ASCVD risk were determined using Poisson regression with robust variance. RESULTS Stronger adherence to a 'mixed' DP was associated with a lower predicted 10-y ASCVD in urban and rural Ghana and a higher 10-y ASCVD in Europe. The observed associations were attenuated after adjustment for possible confounders with the exception of urban Ghana (prevalence ratio [PR] for Quintile 5 compared with 1: 0.70; 95% CI: 0.53, 0.93, P-trend = 0.013). The 'rice, pasta, meat, and fish' DP was inversely associated with 10-y ASCVD across all study sites, with the adjusted effect being significant only in urban Ghana. A 'roots, tubers, and plantain' DP was directly associated with increased 10-y ASCVD risk. CONCLUSIONS Adherence to 'mixed' and 'rice, pasta, meat, and fish' DPs appears to reduce predicted 10-y ASCVD risk in adults in urban Ghana. Further investigations are needed to understand the underlying contextual-level mechanisms that influence dietary habits and to support context-specific dietary recommendations for CVD prevention among sub-Saharan African populations.
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Affiliation(s)
- Daniel Boateng
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,Address correspondence to DB (e-mail: )
| | - Cecilia Galbete
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Mary Nicolaou
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Karlijn Meeks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Erik Beune
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Hibbah Araba Osei-Kwasi
- Public Health Section, School of Health and Related Research–ScHARR, University of Sheffield, Sheffield, United Kingdom,Department of Clinical Sciences and Nutrition, University of Chester, Chester, United Kingdom
| | | | - Peter Agyei-Baffour
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité – University Medicine Berlin, Berlin, Germany
| | - Joachim Spranger
- Charité Center for Cardiovascular Research (CCR), Berlin, Germany
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Matthias B Schulze
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Karien Stronks
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ina Danquah
- Department of Molecular Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ray KK, Kendall DM, Zhao Z, Peng X, Caballero AE, Polonsky WH, Nordstrom BL, Fan L, Curtis BH, Davies MJ. A multinational observational study assessing insulin use: Understanding the determinants associated with progression of therapy. Diabetes Obes Metab 2019; 21:1101-1110. [PMID: 30565369 PMCID: PMC6590265 DOI: 10.1111/dom.13622] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 11/27/2022]
Abstract
AIMS To describe global patterns of insulin treatment and to assess the impact of patient, provider, health system and economic influences on treatment decisions for patients with insulin-treated type 2 diabetes (T2D). METHODS This prospective cohort study of insulin-treated patients with T2D was conducted across 18 countries categorized as high, upper-middle or lower-middle income regions. Information collected from patients included knowledge of diabetes, experiences and interactions with their healthcare provider. Physician information included specialty, practice size, availability of diabetes support services, volume of diabetes patients treated and time spent per patient. Physicians determined an individualized haemoglobin A1c (HbA1c) target for each patient by the start of the study. Changes in T2D therapies and HbA1c were recorded for 2 years. RESULTS Complete treatment data were available for 2528 patients. Median age was 61 years and median duration of diabetes was 11.4 years. Changes to treatment regimen occurred in 90.0% of patients, but changes were less common in countries with a higher economic status (P < 0.001). Most treatment changes involved insulin, with changes in dose the most common. Overall predictors of change in insulin therapy included younger age, use of any insulin regimen other than basal only, higher mean baseline HbA1c and longer duration of T2D. HbA1c levels remained constant regardless of regional economic status. At baseline, 20.6% of patients were at their HbA1c target; at 2 years this was 26.8%. CONCLUSIONS Among insulin-treated patients with T2D, treatment changes were common; however, only approximately one-fourth of individuals achieved their HbA1c target.
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Affiliation(s)
- Kausik K. Ray
- Faculty of MedicineSchool of Public Health, Imperial CollegeLondonUK
| | - David M. Kendall
- Global Health Outcomes, Eli Lilly and CompanyIndianapolisIndiana
| | - Zhenxiang Zhao
- Global Health Outcomes, Eli Lilly and CompanyIndianapolisIndiana
| | - Xiaomei Peng
- Global Health Outcomes, Eli Lilly and CompanyIndianapolisIndiana
| | | | | | | | - Ludi Fan
- Global Health Outcomes, Eli Lilly and CompanyIndianapolisIndiana
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323
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Khunti K, Jung H, Dans AL, Held C, Dagenais GR, Yusuf S, Lonn E. Statin Use in Primary Prevention: A Simple Trial-Based Approach Compared With Guideline-Recommended Risk Algorithms for Selection of Eligible Patients. Can J Cardiol 2019; 35:644-652. [PMID: 31030865 DOI: 10.1016/j.cjca.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiovascular disease risk assessment tools help identify individuals likely to benefit from preventative therapies. In this study we compared outcomes using the American College of Cardiology/American Heart Association (ACC/AHA) risk algorithm and the Framingham Risk Score (FRS) tool in the Heart Outcomes Prevention Evaluation (HOPE)-3 study. METHODS We compared outcomes using the ACC/AHA algorithm and the FRS with those seen in HOPE-3, which randomized participants to 10 mg rosuvastatin or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; second coprimary outcome additionally included heart failure, cardiac arrest, and revascularization. RESULTS Relative risks using risk scores were similar to those observed in the HOPE-3. Hazards ratios for the first coprimary outcome according to risk categories of ≤ 10%, 10%-20%, and ≥ 20% using the ACC/AHA algorithm were 0.82 (95% confidence interval [CI], 0.53-1.28), 0.72 (95% CI, 0.53-0.96), and 0.72 (95% CI, 0.55-0.93), and absolute risk reduction (ARR) of 0.18%, 1.33%, and 1.85%, respectively, over a median of 5.6 years. Corresponding results using the FRS were 0.69 (95% CI, 0.36-1.35), 0.73 (95% CI, 0.52-1.01), and 0.75 (95% CI, 0.60- 0.94); and ARR of 1.32%, 0.61%, and 1.43%. Hazard ratios for the second coprimary outcome were 0.77 (95% CI, 0.51-1.14), 0.73 (95% CI, 0.56-0.95), and 0.74 (95% CI, 0.58-0.94); and ARR of 0.36%, 1.49%, and 1.85%, using the ACC/AHA algorithm and 0.76 (95% CI, 0.41-1.41), 0.70 (95% CI, 0.52-0.95), and 0.76 (95% CI, 0.62-0.94); and ARR of 1.08%, 0.83%, and 1.56% using the FRS. CONCLUSIONS The pragmatic HOPE-3 trial approach identifies in an ethnically diverse primary prevention population individuals at intermediate risk who benefit from statin therapy using simple clinical characteristics without the need for complex, currently used risk assessment tools.
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Affiliation(s)
- Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom.
| | - Hyejung Jung
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Antonio L Dans
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala, Sweden
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, Quebec City, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Medicine and Population Health Research Institute, Hamilton Health Sciences General Site, McMaster University, Hamilton, Ontario, Canada
| | - Eva Lonn
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Medicine and Population Health Research Institute, Hamilton Health Sciences General Site, McMaster University, Hamilton, Ontario, Canada
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324
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Gu T, Fu C, Shen Z, Guo H, Zou M, Chen M, Rockwood K, Song X. Age-Related Whole-Brain Structural Changes in Relation to Cardiovascular Risks Across the Adult Age Spectrum. Front Aging Neurosci 2019; 11:85. [PMID: 31105550 PMCID: PMC6492052 DOI: 10.3389/fnagi.2019.00085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/26/2019] [Indexed: 12/11/2022] Open
Abstract
Background: The brain atrophy and lesion index (BALI) has been developed to assess whole-brain structural deficits that are commonly seen on magnetic resonance imaging (MRI) in aging. It is unclear whether such changes can be detected at younger ages and how they might relate to other exposures. Here, we investigate how BALI scores, and the subcategories that make the total score, compare across adulthood and whether they are related to the level of cardiovascular risks, in both young and old adulthood. Methods: Data were from 229 subjects (72% men; 24-80 years of age) whose annual health evaluation included a routine anatomical MRI examination. A BALI score was generated for each subject from T2-weighted MRI. Differences in the BALI total score and categorical subscores were examined by age and by the level of cardiovascular risk factors (CVRFs). Regression analysis was used to evaluate relationships between continuous variables. Relative risk ratios (RRRs) of CVRF on BALI were examined using a multinomial logistic regression. The area under the receiver operating characteristic (ROC) curve was used to estimate the classification accuracy. Results: Nearly 90% of the participants had at least one CVRF. Mean CVRF scores increased with age (slope = 0.03; r = 0.36, 95% confidence intervals: 0.23-0.48; p < 0.001). The BALI total score was closely related to age (slope = 0.18; r = 0.69, 95% confidence intervals: 0.59-0.78; p < 0.001), as so were the categorical subscores (r's = 0.41-0.61, p < 0.001); each differed by the number of CVRF (t-test: 4.16-14.83, χ 2: 6.9-43.9, p's < 0.050). Multivariate analyses adjusted for age and sex suggested an independent impact of age and the CVRF on the BALI score (for each year of advanced age, RRR = 1.20, 95% CI = 1.11-1.29; for each additional CVRF, RRR = 3.63, 95% CI = 2.12-6.23). The CVRF and BALI association remained significant even in younger adults. Conclusion: The accumulation of MRI-detectable structural brain deficits can be evident from young adulthood. Age and the number of CVFR are independently associated with BALI score. Further research is needed to understand the extent to which other age-related health deficits can increase the risk of abnormalities in brain structure and function, and how these, with BALI scores, relate to cognition.
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Affiliation(s)
- Tao Gu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
- Health Research and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada
- SFU ImageTech Lab, Surrey Memorial Hospital, Surrey, BC, Canada
| | - Chunyi Fu
- Department of Emergency Medicine, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Zhengyin Shen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Hui Guo
- Health Research and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada
- Department of Diagnostic Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Meicun Zou
- Health Research and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada
| | - Min Chen
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Kenneth Rockwood
- Department of Medicine (Geriatric Medicine & Neurology), Dalhousie University, Halifax, NS, Canada
- Centre for Healthcare of the Elderly, QEII Sciences Centre, Halifax, NS, Canada
| | - Xiaowei Song
- Health Research and Innovation, Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada
- SFU ImageTech Lab, Surrey Memorial Hospital, Surrey, BC, Canada
- Department of Medicine (Geriatric Medicine & Neurology), Dalhousie University, Halifax, NS, Canada
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325
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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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326
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Villela PB, Klein CH, de Oliveira GMM. Socioeconomic factors and mortality due to cerebrovascular and hypertensive disease in Brazil. Rev Port Cardiol 2019; 38:205-212. [PMID: 31028004 DOI: 10.1016/j.repc.2018.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 06/25/2018] [Accepted: 07/15/2018] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE Socioeconomic factors may affect mortality due to cerebrovascular diseases (CBVDs), hypertensive diseases (HYPDs), and circulatory system diseases (CSDs). This study aimed to assess the association between the Human Development Index (HDI) and the extent of supplementary health coverage and mortality due to these diseases in the Brazilian Federative Units (FUs) between 2004 and 2013. METHODS The Municipal HDI (MHDI) scores of each FU for 2000 and 2010 were retrieved from the Atlas Brasil website, and supplementary health coverage data for the period 2004-2013 were obtained from the national regulatory agency for private health insurance. Population and mortality data were obtained from the website of the Department of Information Technology of the Unified Health System (DATASUS). Mortality rates were weighted by ill-defined causes of death and standardized by age. RESULTS The MHDI increased between 2000 and 2010 in all FUs, in half of which it was 0.7 or higher. Supplementary health coverage increased in the country during the study period and was inversely associated with mortality due to CSDs and CBVDs between 2004 and 2013. Mortality due to CBVDs and HYPD in 2013 showed an inverse linear association with the MHDI in 2000. CONCLUSION Mortality due to CSDs, CBVDs, and HYPDs was influenced by socioeconomic factors. There was a significant inverse association between socioeconomic factors and mortality due to CSDs, CBVDs, and HYPDs. Plans to reduce mortality due to these diseases should include measures to foster economic development and reduce inequality.
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Affiliation(s)
- Paolo Blanco Villela
- Federal University of Rio de Janeiro, Edson Saad Heart Institute, Rio de Janeiro, Brazil.
| | - Carlos Henrique Klein
- Department of Epidemiology and Quantitative Methods in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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327
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Zheng X, Spatz ES, Bai X, Huo X, Ding Q, Horak P, Wu X, Guan W, Chow CK, Yan X, Sun Y, Wang X, Zhang H, Liu J, Li J, Li X, Spertus JA, Masoudi FA, Krumholz HM. Effect of Text Messaging on Risk Factor Management in Patients With Coronary Heart Disease. Circ Cardiovasc Qual Outcomes 2019; 12:e005616. [DOI: 10.1161/circoutcomes.119.005616] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Erica S. Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (E.S.S., Q.D., H.M.K.)
| | - Xueke Bai
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Xiqian Huo
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Qinglan Ding
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (E.S.S., Q.D., H.M.K.)
| | - Paul Horak
- Stanford University School of Medicine, CA (P.H.)
| | - Xuekun Wu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Wenchi Guan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Clara K. Chow
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney and The George Institute for Global Health, Australia (C.K.C.)
| | - Xiaofang Yan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Ying Sun
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Xiuling Wang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Jiamin Liu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Z., X.B., X.H., X.W., W.G., X.Y., Y.S., X.W., H.Z., J. Liu, J. Li., X.L.)
| | - John A. Spertus
- Health Outcomes Research, Saint Luke’s Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, MO (J.A.S.)
| | - Frederick A. Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (E.S.S., Q.D., H.M.K.)
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (H.M.K.)
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Yao H, Ekou A, Hadéou A, N'Djessan JJ, Kouamé I, N'Guetta R. Medium and long-term follow-up after ST-segment elevation myocardial infarction in a sub-Saharan Africa population: a prospective cohort study. BMC Cardiovasc Disord 2019; 19:65. [PMID: 30894133 PMCID: PMC6425633 DOI: 10.1186/s12872-019-1043-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/14/2019] [Indexed: 11/26/2022] Open
Abstract
Background Major in-hospital mortality rate in patients with ST-segment Elevation Myocardial Infarction (STEMI) in Sub-Saharan Africa has been reported. Data on follow-up in these patients with STEMI are scarce. We aimed to assess medium and long-term prognosis in patients with STEMI admitted to Abidjan Heart Institute. Methods Prospective cohort study including 260 patients admitted for STEMI to Abidjan Heart Institute, from January 1, 2012 to December 31, 2015. We compared mortality and nonfatal cardiovascular complications in revascularized and non-revascularized groups. Survival curve was generated with the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression. Results Of the 260 patients followed up on a median period of 39 months [28–68 months], 94 patients (36.1%) were revascularized and 166 (63.8%) were non-revascularized. Crude all-cause mortality was 10.4%. It was significantly higher in non-revascularized patients (p = 0.04). There was no difference in the occurrence of nonfatal cardiovascular complications in the 2 groups. In multivariable Cox regression, age ≥ 70 years, female gender and heart failure were the predictive factors for death after adjustment. Conclusions STEMI remains an important cause of mortality in our practice. Healthcare policies should be developed to improve patient care and long-term outcomes.
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Affiliation(s)
- Hermann Yao
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire.
| | - Arnaud Ekou
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Aurore Hadéou
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Jean-Jacques N'Djessan
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Isabelle Kouamé
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Roland N'Guetta
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
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Al Abdi RM, Alshraideh H, Hijazi HH, Jarrah M, Alyahya MS. The use of echocardiographic and clinical data recorded on admission to simplify decision making for elective percutaneous coronary intervention: a prospective cohort study. BMC Med Inform Decis Mak 2019; 19:46. [PMID: 30885191 PMCID: PMC6421658 DOI: 10.1186/s12911-019-0797-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD), a leading cause of mortality, affects patient health-related quality of life (HRQoL). Elective percutaneous coronary interventions (ePCIs) are usually performed to improve HRQoL of CAD patients. The aim of this study was to design models using admission data to predict the outcomes of the ePCI treatments on the patients' HRQoL. METHODS This prospective cohort study was conducted with CAD patients who underwent ePCIs at the King Abdullah University Hospital in Jordan from January 2014 through May 2015. Six months after their ePCI procedures, the participants completed the improved MacNew (QLMI-2) questionnaire, which was used for evaluating three domains (physical, emotional and social) of HRQoL. Multivariate linear regression was used to design models to predict the three domains of HRQoL from echocardiographic findings and clinical data that are routinely measured on admission. RESULTS The study included 239 patients who underwent ePCIs and responded to the QLMI-2 questionnaire. The mean age (± standard deviation) of the participants was 55.74 ± 11.84 years, 54.58 ± 11.37 years for males (n = 174) and 59.11 ± 12.49 years for females (n = 65). The average scores for physical, emotional and social HRQoL were 4.38 ± 1.27, 4.4 ± 1.11, and 4.37 ± 1.32, respectively. Out of the 42 factors inputted to the models to predict HRQoL scores, 10, 9, and 9 factors were found to be significant determinants for physical, emotional and social domains, respectively, with adjusted coefficients of determination of 0.630, 0.604 and 0.534, respectively. Basophil levels on admission showed a significant positive correlation with the three domains of HRQoL, while aortic root diameter showed a negative correlation. Scores for the three domains were significantly lower in women than in men. Hypertensive and diabetic patients had significantly lower HRQoL scores than patients without hypertension and diabetes. CONCLUSION The prediction of HRQoL scores 6 months after an ePCI is possible based on data acquired on admission. The models developed here can be used as decision-making tools to guide physicians in identifying the efficacy of ePCIs for individual patients, hence decreasing the rate of inappropriate ePCIs and reducing costs and complications.
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Affiliation(s)
- Rabah M Al Abdi
- Biomedical Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan.
| | - Hussam Alshraideh
- Industrial Engineering Department, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba H Hijazi
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohamad Jarrah
- Division of Cardiology, Internal Medicine Department, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad S Alyahya
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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330
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Increases in statin eligibility to reduce cardiovascular risk according to the 2013 ACC/AHA cholesterol guidelines in the Africa Middle East region: a sub-analysis of the Africa Middle East Cardiovascular Epidemiological (ACE) study. BMC Cardiovasc Disord 2019; 19:61. [PMID: 30876390 PMCID: PMC6420771 DOI: 10.1186/s12872-019-1034-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/27/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND With development of cholesterol management guidelines by the American College of Cardiology/American Heart Association (ACC/AHA), more individuals at risk of cardiovascular disease may be eligible for statin therapy. It is not known how this affects statin eligibility in the Africa and Middle East Region. METHODS Data were used from the Africa Middle East Cardiovascular Epidemiological (ACE) study. The percentage of subjects eligible for statins per the ACC/AHA 2013 cholesterol guidelines and the 2002 National Cholesterol Education Program-Adult Treatment Panel (NCEP-ATP III) recommendations were compared. Analyses were carried out according to age, gender, community (urban/rural), and country income categories based on World Bank definitions. RESULTS According to the ACC/AHA recommendations, 1695 out of 4378 subjects (39%; 95% confidence interval [CI], 37-40%) satisfied statin eligibility criteria vs. 1043/4378 (24%; 95% CI, 23-25%) per NCEP-ATP recommendations, representing a 63% increase in statin eligibility. Consistent increases in eligibility for statin therapy were seen according to the ACC/AHA vs. NCEP-ATP guidelines across sub-groups of age, gender, community, and country income. Notable increases for statin eligibility according to ACC/AHA vs. NCEP-ATP were seen, respectively, in subjects aged ≥65 years (86% vs. 39%), in males (46% vs. 25%), in low-income countries (28% vs. 14%), and rural communities (37% vs. 19%). CONCLUSION An increase in statin eligibility was seen applying ACC/AHA cholesterol guidelines compared with previous NCEP-ATP recommendations in the Africa Middle East region. The economic consequences of these guideline recommendations will need further research. TRIAL REGISTRATION The ACE trial is registered under NCT01243138 .
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331
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O'Donnell M, Mente A, Rangarajan S, McQueen MJ, O'Leary N, Yin L, Liu X, Swaminathan S, Khatib R, Rosengren A, Ferguson J, Smyth A, Lopez-Jaramillo P, Diaz R, Avezum A, Lanas F, Ismail N, Yusoff K, Dans A, Iqbal R, Szuba A, Mohammadifard N, Oguz A, Yusufali AH, Alhabib KF, Kruger IM, Yusuf R, Chifamba J, Yeates K, Dagenais G, Wielgosz A, Lear SA, Teo K, Yusuf S. Joint association of urinary sodium and potassium excretion with cardiovascular events and mortality: prospective cohort study. BMJ 2019; 364:l772. [PMID: 30867146 PMCID: PMC6415648 DOI: 10.1136/bmj.l772] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults. DESIGN International prospective cohort study. SETTING 18 high, middle, and low income countries, sampled from urban and rural communities. PARTICIPANTS 103 570 people who provided morning fasting urine samples. MAIN OUTCOME MEASURES Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category variable for joint sodium and potassium was generated: sodium excretion (low (<3 g/day), moderate (3-5 g/day), and high (>5 g/day) sodium intakes) by potassium excretion (greater/equal or less than median 2.1 g/day). RESULTS Mean estimated sodium and potassium urinary excretion were 4.93 g/day and 2.12 g/day, respectively. After a median follow-up of 8.2 years, 7884 (6.1%) participants had died or experienced a major cardiovascular event. Increasing urinary sodium excretion was positively associated with increasing potassium excretion (unadjusted r=0.34), and only 0.002% had a concomitant urinary excretion of <2.0 g/day of sodium and >3.5 g/day of potassium. A J-shaped association was observed of sodium excretion and inverse association of potassium excretion with death and cardiovascular events. For joint sodium and potassium excretion categories, the lowest risk of death and cardiovascular events occurred in the group with moderate sodium excretion (3-5 g/day) and higher potassium excretion (21.9% of cohort). Compared with this reference group, the combinations of low potassium with low sodium excretion (hazard ratio 1.23, 1.11 to 1.37; 7.4% of cohort) and low potassium with high sodium excretion (1.21, 1.11 to 1.32; 13.8% of cohort) were associated with the highest risk, followed by low sodium excretion (1.19, 1.02 to 1.38; 3.3% of cohort) and high sodium excretion (1.10, 1.02 to 1.18; 29.6% of cohort) among those with potassium excretion greater than the median. Higher potassium excretion attenuated the increased cardiovascular risk associated with high sodium excretion (P for interaction=0.007). CONCLUSIONS These findings suggest that the simultaneous target of low sodium intake (<2 g/day) with high potassium intake (>3.5 g/day) is extremely uncommon. Combined moderate sodium intake (3-5 g/day) with high potassium intake is associated with the lowest risk of mortality and cardiovascular events.
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Affiliation(s)
- Martin O'Donnell
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Andrew Mente
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Matthew J McQueen
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Neil O'Leary
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Lu Yin
- Medical Research & Biometrics Centre, National Centre for Cardiovascular Diseases Cardiovascular, Fengcunxili, Mentougou District, Beijing, China
| | - Xiaoyun Liu
- Medical Research & Biometrics Centre, National Centre for Cardiovascular Diseases Cardiovascular, Fengcunxili, Mentougou District, Beijing, China
| | - Sumathi Swaminathan
- Division of Nutrition, St John's Research Institute, Bangalore, Karnataka, India
| | - Rasha Khatib
- Departments of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John Ferguson
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Andrew Smyth
- HRB-Clinical Research Facility, Galway University Hospital, NUI Galway, Galway, Ireland
| | - Patricio Lopez-Jaramillo
- Fundacion Oftalmologica de Santander (FOSCAL), Medical School, Universidad de Santander, Floridablanca-Santander, Colombia
| | - Rafael Diaz
- Estudios Clinicos Latinoamerica ECLA, Instituto Cardiovascular de Rosario, Rosario, Santa Fe, Argentina
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology, Sao Paulo, Brazil
| | | | - Noorhassim Ismail
- Department of Community Health. University Kebangsaan Malaysia Medical Centre, Malaysia
| | - Khalid Yusoff
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Antonio Dans
- University of the Philippines-Manila, Ermita, Manila, Philippines
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Andrzej Szuba
- Division of Angiology, Wroclaw Medical University, Wroclaw, Poland
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atyekin Oguz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Afzal Hussein Yusufali
- Hatta Hospital, Dubai Medical University, Dubai Health Authority. Dubai, United Arab Emirates
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Centre, College of Medicine, King Saud University. Riyadh, Saudi Arabia
| | - Iolanthe M Kruger
- Faculty of Health Science, North-West University, Potchefstroom campus, Potchefstroom, South Africa
| | - Rita Yusuf
- School of Life Sciences and The Centre for Health, Population and Development. Independent University, Bangladesh, Dhaka, Bangladesh
| | - Jephat Chifamba
- University of Zimbabwe, College of Health Sciences, Physiology Department, Harare, Zimbabwe
| | - Karen Yeates
- Department of Medicine, Division of Nephrology, Queen's University, Kingston, Canada
| | - Gilles Dagenais
- Laval University Heart and Lungs Institute, Quebec City, QC, Canada
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, and Division of Cardiology, Providence Health Care, BC, Canada
| | - Koon Teo
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
| | - Salim Yusuf
- Population Health Research Institute, DBCVS Research Institute, McMaster University, 237 Barton St East, Hamilton, ON L8L 2X2, Canada
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332
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Rukn SA, Mazya MV, Hentati F, Sassi SB, Nabli F, Said Z, Faouzi B, Hashim H, Abd-Allah F, Mansouri B, Kesraoui S, Gebeily S, Abdulrahman H, Akhtar N, Ahmed N, Wahlgren N, Aref H, Almekhlafi M, Moreira T. Stroke in the Middle-East and North Africa: A 2-year prospective observational study of stroke characteristics in the region-Results from the Safe Implementation of Treatments in Stroke (SITS)-Middle-East and North African (MENA). Int J Stroke 2019; 14:715-722. [PMID: 30860454 DOI: 10.1177/1747493019830331] [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: 11/16/2022]
Abstract
BACKGROUND AND METHODS Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. RESULTS Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20-13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4-13) and age was 65 years (56-76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed an onset-to-door time of 5:50 h (2:00-18:45), a median of NIHSS 6 (3-14), and a median age of 66 (56-76), with other large vessel disease and cardiac embolism as the main ischemic stroke etiologies. Hemorrhagic strokes (10%) were less common compared to non-MENA countries (13.9%). In MENA, only a low proportion of patients (21%) was admitted to stroke units. CONCLUSIONS MENA patients are slightly younger, have a higher prevalence of diabetes and slightly more severe ischemic strokes, commonly of atherosclerotic or microvascular etiology. Admission into stroke units and long-term follow-up need to be improved. It is suspected that cardiac embolism and atrial fibrillation are currently underdiagnosed in MENA countries.
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Affiliation(s)
- Suhail Al Rukn
- Department of Neurology, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - Michael V Mazya
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Faycal Hentati
- Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Samia Ben Sassi
- Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Fatma Nabli
- Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Zakharia Said
- Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Belahsen Faouzi
- Department of Neurology, Hassan II University Hospital, Fez, Morocco
| | - Husnain Hashim
- Department of Neurology, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | | | | | | | - Souheil Gebeily
- Neurosciences Research Center, Faculty of Medical Sciences, The Lebanese University, Hadath, Lebanon
| | - Husen Abdulrahman
- Department of Neurology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nils Wahlgren
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hany Aref
- Stroke unit, Ain Shams University, Cairo, Egypt
| | | | - Tiago Moreira
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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333
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Strategies for reducing cardiovascular mortality should go beyond control of classic risk factors. Rev Port Cardiol 2019; 38:213-214. [DOI: 10.1016/j.repc.2019.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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334
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Gómez JF, Camacho PA, López-López J, López-Jaramillo P. Control y tratamiento de la hipertensión arterial: Programa 20-20. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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335
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Editorial: Culture, treatment paradigms, and advanced heart failure. Curr Opin Support Palliat Care 2019; 13:1-2. [DOI: 10.1097/spc.0000000000000415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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336
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Strategies for reducing cardiovascular mortality should go beyond control of classic risk factors. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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337
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Villela PB, Klein CH, de Oliveira GMM. Socioeconomic factors and mortality due to cerebrovascular and hypertensive disease in Brazil. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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338
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Ke C, Gupta R, Xavier D, Prabhakaran D, Mathur P, Kalkonde YV, Kolpak P, Suraweera W, Jha P. Divergent trends in ischaemic heart disease and stroke mortality in India from 2000 to 2015: a nationally representative mortality study. THE LANCET GLOBAL HEALTH 2019; 6:e914-e923. [PMID: 30012272 PMCID: PMC6942542 DOI: 10.1016/s2214-109x(18)30242-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/15/2018] [Accepted: 04/27/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction India accounts for about a fifth of cardiovascular deaths globally, but nationally representative data on mortality trends are not yet available. In this nationwide mortality study, we aimed to assess the trends in ischaemic heart disease and stroke mortality over 15 years using the Million Death Study. Methods We determined national and subnational cardiovascular mortality rates and trends by sex and birth cohort using cause of death ascertained by verbal autopsy from 2001 to 2013 among 2·4 million households. We derived mortality rates for ischaemic heart disease and stroke by applying mortality proportions to UN mortality estimates for India and projected the rates from 2000 to 2015. Findings Cardiovascular disease caused more than 2·1 million deaths in India in 2015 at all ages, or more than a quarter of all deaths. At ages 30–69 years, of 1·3 million cardiovascular deaths, 0·9 million (68·4%) were caused by ischaemic heart disease and 0·4 million (28·0%) by stroke. At these ages, the probability of dying from ischaemic heart disease increased during 2000–15, from 10·4% to 13·1% in men and 4·8% to 6·6% in women. Ischaemic heart disease mortality rates in rural areas increased rapidly and surpassed those in urban areas. By contrast, the probability of dying from stroke decreased from 5·7% to 5·0% in men and 5·0% to 3·9% in women. A third of premature stroke deaths occurred in the northeastern states, inhabited by a sixth of India’s population, where rates increased significantly and were three times higher than the national average. The increased mortality rates of ischaemic heart disease nationally and stroke in the northeastern states were higher in the cohorts of adults born in the 1970s onwards, than in earlier decades. A large and growing proportion of the ischaemic heart disease nationally and stroke deaths in high-burden states reported earlier diagnosis of cardiovascular disease, but low medication use. Interpretation The unexpectedly diverse patterns of cardiovascular mortality require investigation to identify the role of established and new cardiovascular risk factors. Secondary prevention with effective and inexpensive long-term treatment and adult smoking cessation could prevent substantial numbers of premature deaths. Without progress against the control of cardiovascular disease in India, global goals to reduce non-communicable diseases by 2030 will be difficult to achieve. Funding Fogarty International Center of the US National Institutes of Health, Dalla Lana School of Public Health, University of Toronto, Indian Council of Medical Research, and the Disease Control Priorities.
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Affiliation(s)
- Calvin Ke
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Centre for Global Health Research, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Rajeev Gupta
- Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, Rajasthan, India
| | - Denis Xavier
- St John's Medical College and Research Institute, Bangalore, India
| | | | - Prashant Mathur
- National Centre for Diseases Informatics & Research, Indian Council of Medical Research, Bangalore, India
| | - Yogeshwar V Kalkonde
- Society for Education, Action and Research in Community Health, Gadchiroli, Maharashtra, India
| | - Patrycja Kolpak
- Centre for Global Health Research, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wilson Suraweera
- Centre for Global Health Research, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Zahid FM, Ramzan S, Faisal S, Hussain I. Gender based survival prediction models for heart failure patients: A case study in Pakistan. PLoS One 2019; 14:e0210602. [PMID: 30779736 PMCID: PMC6380566 DOI: 10.1371/journal.pone.0210602] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The objective of this study was to build and assess the performance of survival prediction models using the gender-specific informative risk factors for patients with left ventricular systolic dysfunction. METHODS A lasso approach was used to decide the informative predictors for building semi-parametric proportional hazards Cox model. Separate models were built for all patients [N = 299], male patients [Nmale = 194 (64.88%)], and female patients [Nfemale = 105 (35.12%)], to observe the risk factors associated with the individual's risk of death. The likelihood- ratio test was used to test the goodness of fit of the selected model, and the C-index was used to assess the predictive performance of the selected model(s) with respect to the overall model with all observed risk factors. RESULTS The survival prediction model for females is notably different from that for males. For males, smoking, diabetes, and anaemia, whereas for females, ejection fraction, sodium, and platelets count are non-informative with zero regression coefficients. The goodness of fit of the selected models with respect to the general model with all observed risk factors is tested using the likelihood-ratio test. The results are in favor of the selected models with p-values 0.51,0.61, and 0.70 for all patients, male patients, and female patients, respectively. The same values of C-index for the full model and the selected models for overall data, for males, and for females (0.72, 0.73, and 0.77 for overall data, male data, and female data, respectively) indicate that the selected models are as good as the corresponding overall models regarding their predictive performance. CONCLUSION There is a substantial difference in the survival prediction models for heart failure (HF) of male and female patients in this study. More studies are needed in Pakistan for confirming this striking male-female difference regarding the potential risk factors to predict survival with heart failure.
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Affiliation(s)
| | - Shakeela Ramzan
- Faisalabad Medical University, Allied Hospital, Faisalabad, Pakistan
| | - Shahla Faisal
- Department of Statistics / Government College University, Faisalabad, Pakistan
| | - Ijaz Hussain
- Department of Statistics / Quaid-i-Azam University, Islamabad, Pakistan
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340
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Casper EA, El Wakeel LM, Saleh MA, El-Hamamsy MH. Management of pharmacotherapy-related problems in acute coronary syndrome: Role of clinical pharmacist in cardiac rehabilitation unit. Basic Clin Pharmacol Toxicol 2019; 125:44-53. [PMID: 30739389 DOI: 10.1111/bcpt.13210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 01/29/2019] [Indexed: 11/30/2022]
Abstract
Acute coronary syndrome (ACS) is one of the leading causes of mortality worldwide and negatively impacts healthcare costs, productivity and quality of life. Polymorbidity and polypharmacy predispose ACS patients to medication discrepancies between cardiologist-prescribed medication and drug use by the patient, drug-related problems (DRPs) and inadequate drug adherence. This study aimed to evaluate the impact of clinical pharmacist-provided services on the outcome of ACS patients. This was a prospective, randomized, controlled study on ACS patients participating in a cardiac rehabilitation programme. Forty ACS patients were randomly assigned to either control group, who received standard medical care, or intervention group, who received standard medical care plus clinical pharmacist-provided services. Services included DRP management, clinical assessment and enforcing the patient education and adherence. For both groups, the following were assessed at baseline and after 3 months: DRPs, adherence (assessed by 8-item Morisky Adherence Questionnaire), patient's knowledge (assessed by Coronary Artery Disease Questionnaire), 36-Short Form Health Survey (SF-36), heart rate, systolic and diastolic blood pressure, low-density lipoprotein (LDL), total cholesterol (TC) and fasting blood glucose (FBG). After 3 months, there was a significant difference between the intervention and control groups in the per cent change of DRPs (median: -100 vs 5.882, P = 0.0001), patient's adherence score (median: 39.13 vs -14.58, P = 0.0001), knowledge score (median: 30.28 vs -5.196, P = 0.0001), SF-36 scores, heart rate (mean: -10.04 vs 6.791, P = 0.0001), diastolic blood pressure (mean: -17.87 vs 10.45, P = 0.0001), systolic blood pressure (mean: -16.22 vs 4.751, P = 0.0001), LDL (median: -25.73 vs -0.2538, P = 0.0071), TC (median: -14.62 vs 4.123, P = 0.0005) and FBG (median: -11.42 vs 5.422, P = 0.0098). Clinical pharmacists can play an important role as part of a cardiac rehabilitation team through patient education and interventions to minimize DRPs.
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Affiliation(s)
- Eman Ahmed Casper
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Ayman Saleh
- Department of Cardiology, Faculty of Medicine, Cardiac Rehabilitation Unit, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt
| | - Manal Hamed El-Hamamsy
- Department of Clinical Pharmacy, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia Kingdom
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Adherence to self-care recommendations and associated factors among adult heart failure patients. From the patients' point of view. PLoS One 2019; 14:e0211768. [PMID: 30730931 PMCID: PMC6366768 DOI: 10.1371/journal.pone.0211768] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background Nowadays, heart failure (HF) related morbidity and mortality rate is increasing globally. Younger populations happen to be more affected by HF in sub- Saharan African than the western countries. Even though medications, low sodium diet, regular exercise, and weight monitoring are essential to control heart failure symptoms and its exacerbation, poor adherence to these self-care recommendations is contributing to an increased in hospitalization, morbidity, and mortality. Therefore, this study aimed to assess heart failure patients’ adherence to self-care recommendations and its associated factors. Methods A hospital-based cross-sectional study was conducted on 310 adult heart failure patients attending Gondar University referral hospital from February to May 2017. The participants were selected by systematic random sampling technique. Data were collected through face to face interview and from the patients’ medical records. The data were analyzed using SPSS version 20. A binary logistic regression model was used to check the effect of different factors on the patients’ adherence level. Results Of 310 study participants only 22.3% (95% CI, 17.4%-26.8%) of heart failure patients reported good adherence to their self-care recommendations. Adherence to self-care recommendation was positively associated with being male in gender (AOR = 2.34, 95% CI: 1.18–4.62), good level of heart failure knowledge (AOR = 2.49, 95% CI: 1.276–4.856) and free from chronic comorbid diseases (AOR = 2.57, 95% CI: 1.28–5.14). Conclusion Overall, heart failure patients’ adherence to self-care recommendations is poor and selective. Being male in gender, had no chronic comorbidity, and a good level of heart failure knowledge were positively associated with adherence to self-care recommendations. It is therefore strategic to plan improving heart failure patients’ knowledge about heart failure signs, symptoms and its management approaches, to improve the patients’ adherence level.
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de Groot R, van den Hurk K, Schoonmade LJ, de Kort WLAM, Brug J, Lakerveld J. Urban-rural differences in the association between blood lipids and characteristics of the built environment: a systematic review and meta-analysis. BMJ Glob Health 2019; 4:e001017. [PMID: 30740247 PMCID: PMC6347938 DOI: 10.1136/bmjgh-2018-001017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 12/28/2022] Open
Abstract
Introduction The built environment defines opportunities for healthy eating and physical activity and may thus be related to blood lipids. The aim of this study is to systematically analyse the scientific evidence on associations between built-environment characteristics and blood lipid levels in adults. Methods PubMed, EMBASE and Web of Science were searched for peer-reviewed papers on population-based studies up to 9 October 2017. We included studies that reported on built-environment characteristics and blood lipid levels in adult populations (≥18 years). Two reviewers independently screened titles/abstracts and full-texts of papers and appraised the risk of bias of included studies using an adapted version of the Quality Assessment Tool for Quantitative Studies. We performed meta-analyses when five or more studies had sufficient homogeneity in determinant and outcome. Results After screening 6902 titles/abstracts and 141 potentially relevant full-text articles, we included 50 studies. Forty-seven studies explored associations between urban versus rural areas with blood lipid levels. Meta-analyses on urban versus rural areas included 133 966 subjects from 36 studies in total. Total cholesterol levels were significantly and consistently higher in urban areas as compared with rural areas (mean difference 0.37 mmol/L, 95% CI 0.27 to 0.48). Urban/rural differences in high density lipoprotein cholesterol were inconsistent across studies and the pooled estimate showed no difference (0.00 mmol/L 95% CI −0.03 to 0.04). Low density lipoprotein (LDL) cholesterol and triglyceride levels were higher in urban than in rural areas (mean difference 0.28, 95% CI 0.17 to 0.39 and 0.09, 95% CI 0.03 to 0.14, respectively). Conclusions Total and LDL cholesterol levels and triglycerides were consistently higher in residents of urban areas than those of rural areas. These results indicate that residents of urban areas generally have less favourable lipid profiles as compared with residents of rural areas. Prospero registration number CRD42016043226.
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Affiliation(s)
- Rosa de Groot
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Linda J Schoonmade
- Department of Medical Library, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Wim L A M de Kort
- Department of Donor Medicine – Donor Studies, Sanquin Research, Amsterdam, The Netherlands
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes Brug
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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Bardach AE, Elorriaga N, Alcaraz AO, Rubinstein AL, Tavella JM. Community-based cardiovascular health promotion in Argentina. A systematic review. Health Promot Int 2019; 33:695-712. [PMID: 28137729 DOI: 10.1093/heapro/daw107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In Argentina, cardiovascular disease (CVD) accounts for 30% of deaths and more than 600 000 disability-adjusted life years. However, no reviews describing local studies on interventions to address CVD risk factors have been identified. The purpose of this study is to characterize those population-based interventions and public policies implemented in Argentina to reduce the burden of cardiovascular disease with an adequate evaluation of their impact on population health. We conducted a systematic review of studies that assessed interventions in health promotion and/or primary prevention conducted in adult populations of Argentina, addressing specific CVD factors, from 1999 to 2016. We searched major bibliographic databases, grey literature, ministries and secretariats of health, and academic national libraries. Key informants, non-governmental organizations, universities, hospitals and experts were also contacted. We applied specific inclusion criteria. We assessed the methodological quality of the studies and reported the effectiveness and impact of population interventions and policies, as well as process evaluations' characteristics. After removing duplicates we identified 1686 references from databases. After reviewing title and abstracts 18 studies were selected, five of them corresponded to evaluations of public policies-all addressing tobacco smoking. We presented a structured review of each experience. Most of the studies were deemed to entail moderate or high risk of bias. We summarized the findings and characteristics of these studies, including implementation strategies, process and impact evaluation. This is the first systematic review of interventions focused on primary prevention and health promotion to counter CVD and diabetes in Argentina.
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Affiliation(s)
- Ariel Esteban Bardach
- Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.,National Scientific and Technical Research Council - Argentina (CONICET), Buenos Aires, Argentina
| | - Natalia Elorriaga
- Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Andrea Olga Alcaraz
- Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina
| | - Adolfo Luis Rubinstein
- Institute for Clinical Effectiveness and Health Policy, Dr. Emilio Ravignani 2024 (C1414CPV), Buenos Aires, Argentina.,National Scientific and Technical Research Council - Argentina (CONICET), Buenos Aires, Argentina
| | - Julio Marcelo Tavella
- Infarction Prevention Program (PROPIA), National University of La Plata, Avenida 7 776, La Plata, Argentina
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Hertz JT, Fu T, Vissoci JR, Rocha TAH, Carvalho E, Flanagan B, de Andrade L, Limkakeng AT, Staton CA. The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access. PLoS One 2019; 14:e0210502. [PMID: 30629670 PMCID: PMC6328143 DOI: 10.1371/journal.pone.0210502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality. METHODS AND RESULTS Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables. CONCLUSIONS The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.
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Affiliation(s)
- Julian T. Hertz
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Tommy Fu
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Joao Ricardo Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Medicine, Centro Universitario Inga, Maringa, Brazil
| | | | - Elias Carvalho
- Department of Computer Science, Pontifical University Catholic of Parana, Curitiba, Brazil
- Data Processing Department, State University of Maringa, Maringa, Brazil
| | - Brendan Flanagan
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Alex T. Limkakeng
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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Miranda-Machado P, Salcedo-Mejía F, Wilches JP, Fernandez-Mercado J, De la Hoz-Restrepo F, Alvis-Guzmán N. First cardiovascular event in patients with type 2 diabetes mellitus of a cardiovascular risk management program of a poor Colombian population: a cohort study. BMC Cardiovasc Disord 2019; 19:8. [PMID: 30621603 PMCID: PMC6323759 DOI: 10.1186/s12872-018-0993-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 12/26/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND According to several studies in population of high-income countries (HIC), patients with Type 2 diabetes mellitus (DM) have a considerably higher risk of cardiovascular morbidity and mortality. However, it is not clear if the magnitude of this association can be widespread in other populations. The objective of this study was to determine the independent association between Type 2 DM and first cardiovascular event in Colombian Caribbean poor population with no records of previous cardiovascular events reported. METHODS We retrospectively reviewed the individual records from the hospitalizations database of 64,668 patients of cardiovascular risk management program from July 2014 to December 2015. We used a propensity score matching cohort analysis for this study. The Kaplan-Meier curves were constructed for the cardiovascular events related endpoints and matched Cox-regression analysis to estimate associations of a history of Type 2 DM with cardiovascular outcomes during 1.5 years of follow-up. A formal sensitivity analysis using The Breslow-Day and Tarone Homogeneity tests was conducted. RESULTS Out of 56,351 patients with no previous cardiovascular events records, 19,368 (34.4%) patients were found to suffer Type 2 DM. Using propensity scores for Type 2 DM, we gathered a cohort of 18,449 pairs of patients with and without Type 2 DM who were balanced on 22 baseline characteristics. A first cardiovascular event occurred in 650 (3.5%) and 403 (2.1%) matched patients with and without Type 2 DM, respectively, during 1.5 years of follow-up. Type 2 DM was associated with first cardiovascular event (HR 1.69; 95% CI 1.43-2.00; p = 0.000), AMI (HR 1.79; 95% CI 1.45-2.20; p = 0.000) and stroke (HR 1.54; 95% CI 1.18-2.02; p = 0.001). Hazard ratios (95% CIs) for the association of Type 2 DM with all-cause mortality, cardiovascular mortality and all-cause hospitalization were 1.36 (1.21-1.53; p < 0.001), 1.52 (1.12-2.08; p 0.004), and 1.20 (1.21-1.53; p < 0.001), respectively. CONCLUSION Type 2 DM resulted to be a significant independent risk factor for first cardiovascular event in Colombian Caribbean poor population with no previous records of cardiovascular events.
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Bijker R, Jiamsakul A, Uy E, Kumarasamy N, Ditango R, Chaiwarith R, Wong WW, Avihingsanon A, Sun LP, Yunihastuti E, Pujari S, Do CD, Merati TP, Kantipong P, Nguyen KV, Kamarulzaman A, Zhang F, Lee MP, Choi JY, Tanuma J, Ng OT, Sim B, Ross J, Kiertiburanakul S. Cardiovascular disease-related mortality and factors associated with cardiovascular events in the TREAT Asia HIV Observational Database (TAHOD). HIV Med 2019; 20:183-191. [PMID: 30620108 DOI: 10.1111/hiv.12687] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES With aging of the HIV-positive population, cardiovascular disease (CVD) increasingly contributes to morbidity and mortality. We investigated CVD-related and other causes of death (CODs) and factors associated with CVD in a multi-country Asian HIV-positive cohort. METHODS Patient data from 2003-2017 were obtained from the Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD). We included patients on antiretroviral therapy (ART) with > 1 day of follow-up. Cumulative incidences were plotted for CVD-related, AIDS-related, non-AIDS-related, and unknown CODs, and any CVD (i.e. fatal and nonfatal). Competing risk regression was used to assess risk factors of any CVD. RESULTS Of 8069 patients with a median follow-up of 7.3 years [interquartile range (IQR) 4.4-10.7 years], 378 patients died [incidence rate (IR) 6.2 per 1000 person-years (PY)], and this total included 22 CVD-related deaths (IR 0.36 per 1000 PY). Factors significantly associated with any CVD event (IR 2.2 per 1000 PY) were older age [sub-hazard ratio (sHR) 2.21; 95% confidence interval (CI) 1.36-3.58 for age 41-50 years; sHR 5.52; 95% CI 3.43-8.91 for ≥ 51 years, compared with < 40 years], high blood pressure (sHR 1.62; 95% CI 1.04-2.52), high total cholesterol (sHR 1.89; 95% CI 1.27-2.82), high triglycerides (sHR 1.55; 95% CI 1.02-2.37) and high body mass index (BMI) (sHR 1.66; 95% CI 1.12-2.46). CVD crude IRs were lower in the later ART initiation period and in lower middle- and upper middle-income countries. CONCLUSIONS The development of fatal and nonfatal CVD events in our cohort was associated with older age, and treatable risk factors such as high blood pressure, triglycerides, total cholesterol and BMI. Lower CVD event rates in middle-income countries may indicate under-diagnosis of CVD in Asian-Pacific resource-limited settings.
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Affiliation(s)
- R Bijker
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Jiamsakul
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - E Uy
- Research Institute for Tropical Medicine, Manila, Philippines
| | | | - R Ditango
- Research Institute for Tropical Medicine, Manila, Philippines
| | - R Chaiwarith
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - W W Wong
- Taipei Veterans General Hospital, Taipei, Taiwan
| | - A Avihingsanon
- HIV-NAT/The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - L P Sun
- National Center for HIV/AIDS, Dermatology & STDs, University of Health Sciences, Phnom Penh, Cambodia
| | - E Yunihastuti
- Working Group on AIDS, Faculty of Medicine, University of Indonesia/CiptoMangunkusumo Hospital, Jakarta, Indonesia
| | - S Pujari
- Institute of Infectious Diseases, Pune, India
| | - C D Do
- Bach Mai Hospital, Hanoi, Vietnam
| | - T P Merati
- Faculty of Medicine, Sanglah Hospital, Udayana University, Bali, Indonesia
| | - P Kantipong
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - K V Nguyen
- National Hospital for Tropical Diseases, Hanoi, Vietnam
| | - A Kamarulzaman
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - F Zhang
- Beijing Ditan Hospital, Capital Medical University, Bejing, China
| | - M P Lee
- Queen Elizabeth Hospital, Kowloon, Hong Kong SAR
| | - J Y Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - J Tanuma
- National Center for Global Health and Medicine, Tokyo, Japan
| | - O T Ng
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore
| | - Blh Sim
- Hospital Sungai Buloh, Sungai Buloh, Malaysia
| | - J Ross
- TREAT Asia, amfAR - The Foundation for AIDS Research, Bangkok, Thailand
| | - S Kiertiburanakul
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Połtyn-Zaradna K, Zatońska K, Basiak A, Sozańska B, Gaweł-Dąbrowska D, Wołyniec M, Szuba A, Zatoński W. Sociodemographic characteristic of changes in smoking patterns in rural and urban population of PURE Poland study: findings from 6-year follow up. BMC Public Health 2019; 19:6. [PMID: 30606160 PMCID: PMC6318843 DOI: 10.1186/s12889-018-6354-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022] Open
Abstract
Background Tobacco smoking is one of the most serious modern civilization threats. According to WHO identifying patterns of tobacco use is essential for implementing effective preventive policies. The aim of the paper was to assess changes in smoking patterns among the PURE study population over 6 years. Methods The study sample comprised of 1784 adult participants from PURE Poland study, who were assessed at baseline (2007–2010) and then at 6-year follow-up. Participants were classified into current smokers, ex-smokers and never smokers. Smoking patterns were analyzed according to sex, age/birth cohort, place of residence (urban vs rural setting), and education level. Results Overall, a significant decrease of 3.1% in current smokers was observed (from 20.0% in baseline to 16.9 at follow-up). However, 0.8% of never smokers and 6.2% of ex-smokers at baseline were classified as current smokers at 6-year follow-up. Despite overall decrease in percentage of current smokers in both rural and urban area, in fact significantly more ex-smokers from rural area became current smokers after 6 years. Living in the rural area was associated with nearly two-fold increase in current smoking, and almost two-fold decline in chances to quit smoking. The highest percentage of current smokers was observed in birth year cohort 1961–1979. Conclusion Despite a small but significant decline in overall smoking rates, important differences in smoking and quitting patterns emerged between rural and urban areas, as well as sexes. A less favorable smoking patterns were observed among women, and rural populations, suggesting that these are important targets of future tobacco control interventions in Poland.
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Affiliation(s)
| | - Katarzyna Zatońska
- Department of Social Medicine, Wroclaw Medical University, Bujwida 44, 50-345, Wrocław, Poland.
| | - Alicja Basiak
- Department of Social Medicine, Wroclaw Medical University, Bujwida 44, 50-345, Wrocław, Poland
| | - Barbara Sozańska
- 1st Department and Clinic of Paediatrics, Allergology and Cardiology, Wroclaw Medical University, Chałubińskiego 2a, 50-368, Wrocław, Poland
| | - Dagmara Gaweł-Dąbrowska
- Department of Internal Medicine, 4th Military Hospital in Wroclaw, Rudolfa Weigla 5, 50-981, Wrocław, Poland
| | - Maria Wołyniec
- Department of Social Medicine, Wroclaw Medical University, Bujwida 44, 50-345, Wrocław, Poland
| | - Andrzej Szuba
- Department of Internal Medicine, 4th Military Hospital in Wroclaw, Rudolfa Weigla 5, 50-981, Wrocław, Poland.,Department of Angiology, Wroclaw Medical University, Bartla 5, 51-618, Wrocław, Poland
| | - Witold Zatoński
- Department of Angiology, Wroclaw Medical University, Bartla 5, 51-618, Wrocław, Poland.,Health Promotion Foundation, Mszczonowska 51, 05-830, Nadarzyn, Poland
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Kshatriya GK, Kumari A, Acharya SK. Comparing the ability of anthropometric indicators in determining the prevalence of hypertension among Indian tribes. Diabetes Metab Syndr 2019; 13:696-706. [PMID: 30641792 DOI: 10.1016/j.dsx.2018.11.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 11/11/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We compared the ability of the selected anthropometric indicators to best predict the prevalence of hypertension among the Indian tribes. METHODS A cross-sectional study was undertaken among 1431 adult participants (705 males and 726 females) between the ages of 20 and 60 years from six major tribes in India. Selected anthropometric indicators such as body mass index (BMI), waist-hip-ratio (WHR), waist-height-ratio (WHtR), percentage body fat (PBF), visceral fat (VF), minimum-waist-circumference (MWC) and sum-of-the-four skinfold thickness (SF4), along with the physiological parameters such as blood pressure were recorded. Discriminant analysis (DA) was performed to examine and compare the ability of the selected anthropometric indicators towards classifying hypertension among males, females and the total population. RESULTS Significant independent association was observed for hypertension and similar conditions within gender and selected age-group categories. The overall hypertension prevalence among the studied tribes was observed at 12.6%. Standardized function coefficients (SFCs) in discriminant analysis revealed PBF(0.89, 0.36, and 0.76 for overall, males, and females respectively) as the most powerful discriminator of hypertension. In addition, visceral fat (0.74, 1.46, and 0.58 for overall, males and females respectively) was observed to be the other significant indicator of hypertensive blood pressure. These exploratory findings for the first time indicate fat deposition, rather than body density alone, as an emerging physiological and metabolic risk among Indian tribes. CONCLUSION In the context of the highly prevalent chronic undernutrition, internal fat deposition is a major classifying factor of physiological and metabolic intolerance. It also indicates the increasing trend in lifestyle changes and the associated adversities among the Indian tribes.
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Affiliation(s)
| | - Anjali Kumari
- Department of Anthropology, University of Delhi, Delhi, 110007, India
| | - Subhendu K Acharya
- National Institute of Epidemiology, Social and Behavioural Sciences, Chennai, 600012, Tamil Nadu, India
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349
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Mulchandani R, Lyngdoh T, Chakraborty P, Kakkar AK. Satisfaction With Statin Treatment Among Adult Coronary Artery Disease Patients: An Experience From a Resource-Constrained Setting. Heart Lung Circ 2018; 28:1788-1794. [PMID: 30704841 DOI: 10.1016/j.hlc.2018.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 10/09/2018] [Accepted: 10/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Statins are the most widely prescribed hypolipidaemic drugs for coronary artery disease (CAD) patients, but have been found to cause muscle and nerve related adverse effects which can affect patient satisfaction with treatment. Literature on treatment satisfaction among statin users, especially from resource-limited settings is inadequate. The aim of this cross-sectional study was to assess the level of satisfaction with treatment among statin users and evaluate the relationship between adverse effects experienced by patients and their satisfaction with the medication. METHODS This study included 300 adult CAD patients visiting the cardiology department of a tertiary care hospital in the northern region of India, who were prescribed statins for their diagnoses. An interviewer administered, validated and standardised Treatment Satisfaction Questionnaire for Medication (version 1.4) was used for data collection. RESULTS Around three quarters of the population reported being overall satisfied with their medication. Mean scores were calculated for Effectiveness, Convenience, Side-Effects and Global Satisfaction. The patients reported high scores (above 60%) for all domains. Those experiencing any adverse effect were found to be more likely to report lower effectiveness. Additionally, medication effectiveness showed a positive correlation with overall treatment satisfaction. CONCLUSIONS The study shows that treatment satisfaction is critical to gauge patient experiences with the treatment which can impact medication adherence and compliance. It's a crucial measure especially among CAD and other chronic disease patients since greater satisfaction can improve clinical outcomes. More research is warranted to better understand the relationship between medication effectiveness and treatment satisfaction.
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Affiliation(s)
| | | | - Praloy Chakraborty
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
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350
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Iyngkaran P, Liew D, Neil C, Driscoll A, Marwick TH, Hare DL. Moving From Heart Failure Guidelines to Clinical Practice: Gaps Contributing to Readmissions in Patients With Multiple Comorbidities and Older Age. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818809358. [PMID: 30618487 PMCID: PMC6299336 DOI: 10.1177/1179546818809358] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/14/2018] [Indexed: 12/20/2022]
Abstract
This feature article for the thematic series on congestive heart failure (CHF) readmissions aims to outline important gaps in guidelines for patients with multiple comorbidities and the elderly. Congestive heart failure diagnosis manifests as a 3-phase journey between the hospital and community, during acute, chronic stable, and end-of-life (palliative) phases. This journey requires in variable intensities a combination of multidisciplinary care within tertiary hospital or ambulatory care from hospital outpatients or primary health services, within the general community. Management goals are uniform, ie, to achieve the lowest New York Heart Association class possible, with improvement in ejection fraction, by delivering gold standard therapies within a CHF program. Comorbidities are an important common denominator that influences outcomes. Comorbidities include diabetes mellitus, chronic obstructive airways disease, chronic renal impairment, hypertension, obesity, sleep apnea, and advancing age. Geriatric care includes the latter as well as syndromes such as frailty, falls, incontinence, and confusion. Many systems still fail to comprehensively achieve all aspects of such programs. This review explores these factors.
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Affiliation(s)
- Pupalan Iyngkaran
- Northern Territory Medical Program, Flinders University, Darwin, NT, Australia
- Pupalan Iyngkaran, Yellow Building 4 Cnr University Drive North & University Drive West Charles Darwin University, Casuarina, NT 0815, Australia.
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Christopher Neil
- Department of Medicine—Western Precinct, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Austin Health, Melbourne, VIC, Australia
| | | | - David L Hare
- Cardiovascular Research, The University of Melbourne, Melbourne, VIC, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC, Australia
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