1
|
Mengome MFA, Kono HN, Bivigou EA, M’bondoukwe NP, Ngomo JMN, Ditombi BM, Ngondza BP, Bisseye C, Mawili-Mboumba DP, Bouyou Akotet MK. Prevalence of cardiometabolic risk factors according to urbanization level, gender and age, in apparently healthy adults living in Gabon, Central Africa. PLoS One 2024; 19:e0285907. [PMID: 38578783 PMCID: PMC10997135 DOI: 10.1371/journal.pone.0285907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND The prevalence of cardiometabolic risk factors (CMRFs) is increasing in sub-Saharan Africa and represents a serious public health issue. Accurate data are required to implement adapted prevention programs and healthcare strategies. Thus, the aim of this study was to estimate the prevalence rates of CMRFs according to the level of urbanization, age and gender in Gabon. METHODS A cross-sectional study was conducted in northern (Bitam), western coast (Libreville, Melen) and southeast (Koulamoutou) areas of Gabon using the World Health Organization's (WHO) stepwise approach for the surveillance of chronic disease risk factors. Participants over 18 years of age, without known underlying disease, living in rural and urban areas of Gabon were included. Sociodemographic, biological, and behavioral data were collected. Univariate and multivariate analysis were used to identify the CMRFs. RESULTS Of the 978 participants, 499 lived in urban and 479 in rural areas. Their median age was 38[28-50] years. Tobacco (26.1% vs 6.2%; p < 0.01) and excessive alcohol consumption (19.4% vs 9.6%; p < 0.01) predominated in rural than in urban areas, respectively. Urban dwellers had more often insufficient physical activity than rural people (29.5% vs 16.3%; p < 0.01). In total, 79.9% of participants aged under 54 years had a high blood pressure;10.6% of the younger participants had pre-hypertension. Metabolic syndrome was more frequent in women (21.7%) than in men (10.0%) (p < 0.01); 6.4% of men and 2.5% of women had a high Framingham score (p = 0.03). Finally, 54.0% of the participants had three or four CMRFs. The multivariate analysis showed that men were more likely to be smokers and to be at risk of pre-hypertension or high blood pressure (p < 0.01). Women were more likely to be obese or to have a metabolic syndrome (p < 0.01). Living in urban areas was also a risk factor for hypertension, diabetes, metabolic syndrome and high LDL cholesterol level. CONCLUSION The prevalence of CMRFs was high in the study population. Disparities were observed according to urban and rural areas, gender and age. National prevention and healthcare strategies for cardiometabolic diseases in Gabon should consider these observed differences.
Collapse
Affiliation(s)
- Mérédith Flore Ada Mengome
- Département de Parasitologie-Mycologie, Université des Sciences de la Santé (USS), Libreville, Gabon
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku (USTM), Franceville, Gabon
| | - Héléna Noéline Kono
- Département de Parasitologie-Mycologie, Université des Sciences de la Santé (USS), Libreville, Gabon
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku (USTM), Franceville, Gabon
| | - Elsa Ayo Bivigou
- Faculté de Médecine, Département de Médecine, Université des Sciences de la Santé, Libreville, Gabon
| | - Noé Patrick M’bondoukwe
- Département de Parasitologie-Mycologie, Université des Sciences de la Santé (USS), Libreville, Gabon
| | - Jacques-Mari Ndong Ngomo
- Département de Parasitologie-Mycologie, Université des Sciences de la Santé (USS), Libreville, Gabon
| | - Bridy Moutombi Ditombi
- Département de Parasitologie-Mycologie, Université des Sciences de la Santé (USS), Libreville, Gabon
| | - Bedrich Pongui Ngondza
- Département de Parasitologie-Mycologie, Université des Sciences de la Santé (USS), Libreville, Gabon
| | - Cyrille Bisseye
- Laboratoire de Biologie Moléculaire et Cellulaire (LABMC), Université des Sciences et Techniques de Masuku (USTM), Franceville, Gabon
| | | | | |
Collapse
|
2
|
Sharma JK, Turner ME, Paynter AS, White CA, Ward EC, Adams MA, Holden RM. Obesity attenuates acute phosphate excretion after an oral challenge in females: A sex-specific effect of obesity on phosphate handling. Diabetes Obes Metab 2024; 26:777-781. [PMID: 37994379 DOI: 10.1111/dom.15362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Jaya K Sharma
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Mandy E Turner
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Amanda S Paynter
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Christine A White
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Emilie C Ward
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Michael A Adams
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Rachel M Holden
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
3
|
Marzà-Florensa A, Gutierrez L, Gulayin P, Vaartjes I, Grobbee DE, Klipstein-Grobusch K, Irazola V. Risk factor clustering in men and women with CHD in the Southern Cone of Latin America. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 16:200172. [PMID: 36874043 PMCID: PMC9975232 DOI: 10.1016/j.ijcrp.2023.200172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 01/15/2023]
Abstract
Background Presence of multiple risk factors (RF) increases the risk for cardiovascular morbidity and mortality, and this is especially important in patients with coronary heart disease (CHD). The current study investigates sex differences in the presence of multiple cardiovascular RF in subjects with established CHD in the southern Cone of Latin America. Methods We analyzed cross-sectional data from the 634 participants aged 35-74 with CHD from the community-based CESCAS Study. We calculated the prevalence for counts of cardiometabolic (hypertension, dyslipidemia, obesity, diabetes) and lifestyle (current smoking, unhealthy diet, low physical activity, excessive alcohol consumption) RF. Differences in RF number between men and women were tested with age-adjusted Poisson regression. We identified the most common RF combinations among participants with ≥4 RF. We performed a subgroup analysis by educational level. Results The prevalence of cardiometabolic RF ranged from 76.3% (hypertension) to 26.8% (diabetes), and the prevalence of lifestyle RF from 81.9% (unhealthy diet) to 4.3% (excessive alcohol consumption). Obesity, central obesity, diabetes and low physical activity were more common in women, while excessive alcohol consumption and unhealthy diet were more common in men. Close to 85% of women and 81.5% of men presented with ≥4 RF. Women presented with a higher number of overall (relative risk (RR) 1.05, 95% CI 1.02-1.08) and cardiometabolic RF (1.17, 1.09-1.25). These sex differences were found in participants with primary education (RR women overall RF 1.08, 1.00-1.15, cardiometabolic RF 1.23, 1.09-1.39), but were diluted in those with higher educational attainment. The most common RF combination was hypertension/dyslipidemia/obesity/unhealthy diet. Conclusion Overall, women showed a higher burden of multiple cardiovascular RF. Sex differences persisted in participants with low educational attainment, and women with low educational level had the highest RF burden.
Collapse
Affiliation(s)
- Anna Marzà-Florensa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Laura Gutierrez
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Pablo Gulayin
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| | - Ilonca Vaartjes
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - 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 and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vilma Irazola
- Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
| |
Collapse
|
4
|
Ortiz C, López-Cuadrado T, Rodríguez-Blázquez C, Simón L, Perez-Vicente R, Merlo J, Galán I. Physical and social environmental factors related to co-occurrence of unhealthy lifestyle behaviors. Health Place 2022; 75:102804. [PMID: 35462183 DOI: 10.1016/j.healthplace.2022.102804] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 11/04/2022]
Abstract
Previous work identifying determinants of co-occurrence of behavioral risk factors have focused on their association with individuals' characteristics with scant attention paid to their relationship to contextual factors. Data came from 21,007 individuals ≥15 years of age who participated in the cross-sectional 2011-2012 Spanish National Health Survey. Two indicators were defined by tobacco consumption, alcohol intake, diet, physical activity, and body mass index. The first indicator, based on dichotomized measures, ranges from 0 to 5. The second one (unhealthy lifestyle index), ranges from 0 to 15, with 0 denoting the healthiest score. Among the determinants, we examined social support, five perceived characteristics of the neighborhood, and the socioeconomic deprivation index of the census tract of residence. Data were analyzed using multilevel linear and logistic regression models adjusted for the main sociodemographic characteristics. Using the dichotomized indicator, the probability of having 3-5 risk factors versus <3 factors was associated with low social support (Odds Ratio [OR] 1.50; 95% Confidence Interval [CI]: 1.25-1.80). Issues surrounding neighborhood cleanliness (OR = 1.18; 95%CI: 1.04-1.33), air pollution (OR = 1.38; 95%CI: 1.16-1.64), and street crime (OR = 1.21; 95%CI: 1.03-1.42) were associated with determinants of co-occurrence. Risk factors co-occurrence increased as deprivation level increased: the OR for the highest deprivation quintile versus the lowest was 1.30 (95%CI: 1.14-1.48). Similar results were observed when using the unhealthy lifestyle index. Poorer physical and social environments are related to greater co-occurrence of risk factors for chronic diseases. Health promotion interventions targeting the prevention of risk factors should consider the contextual characteristics of the neighborhood environment.
Collapse
Affiliation(s)
- Cristina Ortiz
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa López-Cuadrado
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health. Autonomous University of Madrid/IdiPAZ, Madrid, Spain
| | | | - Lorena Simón
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Perez-Vicente
- Research Unit of Social Epidemiology. Faculty of Medicine, Lund University, Malmö, Sweden
| | - Juan Merlo
- Research Unit of Social Epidemiology. Faculty of Medicine, Lund University, Malmö, Sweden; Centre for Primary Health Care Research, Region Skåne, Malmö, Sweden
| | - Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; Department of Preventive Medicine and Public Health. Autonomous University of Madrid/IdiPAZ, Madrid, Spain.
| |
Collapse
|
5
|
Risk Factor Clusters and Cardiovascular Disease in High-Risk Patients: The UCC-SMART Study. Glob Heart 2022; 16:85. [PMID: 35141126 PMCID: PMC8698229 DOI: 10.5334/gh.897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/11/2021] [Indexed: 02/02/2023] Open
Abstract
Background: Clustering of vascular risk factors, i.e., the co-existence of two or more risk factors, has been associated with a higher risk of cardiovascular disease (CVD) in the general population. This study aims to firstly, examine patterns of clustering of major cardiovascular risk factors in high-risk patients and their relation with the risk of recurrent cardiovascular disease and all-cause mortality. Secondly, to assess which combinations are associated with the highest risk of CVD and all-cause mortality and to study population attributable fractions. Methods: A total of 12,616 patients from the Utrecht Cardiovascular Cohort – Second Manifestations of ARTerial diseases (UCC-SMART) study consisting of patients with or a high risk to develop cardiovascular disease were studied. We constructed sixteen clusters based on four individual modifiable risk factors (hypertension, dyslipidemia, current smoking, overweight). Patients were followed from September 1997 to March 2017. Cox proportional hazard models were used to compute adjusted hazard ratios for CVD risk and all-cause mortality and 95% confidence intervals for clusters, with patients without any risk factor as reference group. The population attributable fractions (PAFs) were calculated. Subgroup analyses were conducted by age and sex. Results: During a mean follow-up period of 8.0 years, 1836 CVD events were registered. The prevalence of patients with zero, one, two, three, and four risk factors was 1.4, 11.4, 32.0, 44.8 and 10.4%. The corresponding hazard ratios (HR) for CVD risk and all-cause mortality were 1.65 (95% CI 0.77; 3.54) for one risk factor, 2.61 (1.24; 5.50) for two, 3.25 (1.55; 6.84) for three, and 3.74 (1.77; 7.93) for four risk factors, with patients without any risk factor as reference group. The PAFs were 6.9, 34.0, 50.1 and 22.2%, respectively. The smoking-hypertension-dyslipidemia combination was associated with the highest HR: 4.06 (1.91; 8.63) and the hypertension-dyslipidemia combination with the highest PAF: 37.1%. Conclusion: Clusters including smoking and hypertension contributed to the highest risk of CVD and all-cause mortality. This study confirms that risk factor clustering is common among patients at high-risk for CVD and is associated with an increased risk of CVD and all-cause mortality.
Collapse
|
6
|
The contribution of potentially modifiable risk factors to acute ischemic stroke burden - Comparing young and older adults. Prev Med 2022; 155:106933. [PMID: 34954243 DOI: 10.1016/j.ypmed.2021.106933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/15/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022]
Abstract
Stroke is a leading cause of death and disability. In order to estimate the contribution of five modifiable risk factors to acute ischemic stroke (AIS) incidence in Israel, we conducted a case-control study based on first AIS cases aged 21-90 reported to the Israeli National Stroke Registry during 2014-2015, and controls from a national health survey conducted between 2013 and 2015. We calculated the population attributable risk (PAR) of each risk factor and the combined PAR for all risk factors (hypertension, diabetes, current smoking, obesity and hyperlipidemia), in all study population and by subgroups of young adults (age < 55) and older adults (age ≥ 55). The final analysis included 571, 577 and 500 matched pairs for all study population, young adults and older adults, respectively. Among young adults, current smoking and hypertension were the two most contributing risk factors for AIS, accounting for 33.6% (95% CI 27.3-39.9) and 28.9% (95% CI 22.1-35.7) of AIS cases, respectively. Among older adults, hypertension was the single most contributing risk factor for AIS and diabetes was the second most contributing risk factor for AIS, accounting for 64.9% (95% CI 57.3-72.5) and 25.7% (95% CI 17.5-33.9) of AIS cases, respectively. The combined PAR was significantly lower among young adults (PAR = 67.9%), compared with older adults (PAR = 80.7%). The combined PAR for all study population was 80.1% (95% CI 74.0-86.2), indicating that five common and modifiable risk factors explain ~80% of AIS incidence in Israel. Primary prevention strategies targeting these risk factors have the potential to drastically reduce stroke related morbidity and mortality.
Collapse
|
7
|
Sarfo FS, Ovbiagele B, Akpa O, Akpalu A, Wahab K, Obiako R, Komolafe M, Owolabi L, Ogbole G, Calys-Tagoe B, Fakunle A, Sanni T, Mulugeta G, Abdul S, Akintunde AA, Olowookere S, Uvere EO, Ibinaiye P, Akinyemi J, Uwanuruochi K, Olayemi B, Odunlami OA, Abunimye E, Arulogun O, Isah SY, Abubakar SA, Oladimeji A, Adebayo P, Shidali V, Chukwuonye II, Akpalu J, Tito-Ilori MM, Asowata OJ, Sanya EO, Amusa G, Onyeonoro U, Ogunmodede JA, Sule AG, Akisanya C, Mensah Y, Oyinloye OI, Appiah L, Agunloye AM, Osaigbovo GO, Olabinri E, Kolo PM, Okeke O, Adeoye AM, Ajose O, Jenkins C, Lackland DT, Egberongbe AA, Adeniji O, Ohifemen Adeleye O, Tiwari HK, Arnett D, Laryea RY, Olunuga T, Akinwande KS, Imoh L, Ogah OS, Melikam ES, Adebolaji A, Oguike W, Ogunronbi M, Adeniyi W, Olugbo OY, Bello AH, Ohagwu KA, Ogunjimi L, Agyekum F, Iheonye H, Adesina J, Diala S, Dambatta HA, Ikubor J, Singh A, Adamu S, Obese V, Adusei N, Owusu D, Ampofo M, Tagge R, Efidi R, Fawale B, Yaria J, Akinyemi R, Owolabi M. Risk Factor Characterization of Ischemic Stroke Subtypes Among West Africans. Stroke 2022; 53:134-144. [PMID: 34587795 PMCID: PMC8712357 DOI: 10.1161/strokeaha.120.032072] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. METHODS The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. RESULTS There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 427 (17.6%) large-artery atherosclerosis, 258 (10.6%) cardio-embolic, 3 (0.1%) carotid dissections, and 719 (29.6%) undetermined/other causes. The adjusted odds ratio (95% CI) for the 8 dominant risk factors for ischemic stroke were hypertension, 10.34 (6.91-15.45); dyslipidemia, 5.16 (3.78-7.03); diabetes, 3.44 (2.60-4.56); low green vegetable consumption, 1.89 (1.45-2.46); red meat consumption, 1.89 (1.45-2.46); cardiac disease, 1.88 (1.22-2.90); monthly income $100 or more, 1.72 (1.24-2.39); and psychosocial stress, 1.62 (1.18-2.21). Hypertension, dyslipidemia, diabetes were confluent factors shared by small-vessel, large-vessel and cardio-embolic subtypes. Stroke cases and stroke-free controls had a mean of 5.3±1.5 versus 3.2±1.0 adverse cardio-metabolic risk factors respectively (P<0.0001). CONCLUSIONS Traditional vascular risk factors demonstrate important differential effect sizes with pathophysiologic, clinical and preventative implications on the occurrence of ischemic stroke among indigenous West Africans.
Collapse
Affiliation(s)
- Fred S. Sarfo
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bruce Ovbiagele
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| | - Onoja Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan,Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | - Kolawole Wahab
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Morenikeji Komolafe
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Lukman Owolabi
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Godwin Ogbole
- Department of Radiology, University of Ibadan, Nigeria
| | | | | | - Taofeek Sanni
- Federal Teaching Hospital, Ido-Ekiti Ado-Ekiti, Nigeria
| | | | | | | | - Samuel Olowookere
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Philip Ibinaiye
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Balogun Olayemi
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | - Esther Abunimye
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | - Suleiman Y. Isah
- Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | | | | | | | - Josephine Akpalu
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | - Osahon J. Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan,Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Nigeria
| | - Emmanuel O. Sanya
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | - James A. Ogunmodede
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | | | | | | | | | - Atinuke M. Agunloye
- College of Medicine, University of Ibadan, Nigeria,University College Hospital, Ibadan, Nigeria
| | | | | | - Philip M. Kolo
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Obiora Okeke
- Federal Medical Centre Umuahia, Abia state, Nigeria
| | - Abiodun M. Adeoye
- College of Medicine, University of Ibadan, Nigeria,University College Hospital, Ibadan, Nigeria
| | - Olabamiji Ajose
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | | | | | | | | | | | - Donna Arnett
- College of Public Health, University of Kentucky, USA
| | - Ruth Y. Laryea
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
| | | | | | - Lucius Imoh
- Jos University Teaching Hospital Jos, Nigeria
| | | | | | | | - Wisdom Oguike
- Department of Medicine, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Obiabo Y. Olugbo
- Delta State University/Delta State University Teaching Hospital, Oghara, Nigeria
| | - Abiodun H. Bello
- Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | | | - Luqman Ogunjimi
- Department of Pharmacology and Therapeutics, Olabisi Onabanjo University. Abeokuta, Nigeria
| | | | | | | | - Samuel Diala
- Department of Medicine, University of Ibadan, Nigeria
| | | | - Joyce Ikubor
- College of Public Health, University of Kentucky, USA
| | - Arti Singh
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Vida Obese
- Komfo Anokye Teaching Hospital Kumasi, Ghana
| | | | - Dorcas Owusu
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Raelle Tagge
- Weill Institute for Neurosciences, School of Medicine, University of California San-Francisco, USA
| | | | - Bimbo Fawale
- Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Rufus Akinyemi
- Federal Medical Centre, Abeokuta, Nigeria.,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Medicine, University of Ibadan, Nigeria,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | | |
Collapse
|
8
|
Oda Y, Ito T, Yamada Y, Koga T, Nagasato T, Ohnishi-Wada T, Hosokawa K, Fukase H, Hashiguchi T, Maruyama I. Cardiovascular risk factors are associated with augmented thrombogenicity in healthy individuals: analysis using the Total Thrombus-formation Analysis System. Thromb J 2021; 19:88. [PMID: 34789279 PMCID: PMC8597268 DOI: 10.1186/s12959-021-00341-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rupture of an atherosclerotic plaque and subsequent exposure of the subendothelial prothrombotic matrix to blood cause arterial thrombosis. Circulating platelets play an indispensable role in the growth of arterial thrombi partially owing to their unique ability to adhere to the subendothelial matrix and to aggregate to each other under flow conditions. Recently, the Total Thrombus-formation Analysis System (T-TAS) was developed for ex vivo analysis of the thrombogenic potential of whole blood samples under flow conditions. Despite the potential clinical utility of the T-TAS in assessing the risk for thrombosis and bleeding, reference intervals for T-TAS analysis in healthy individuals have not been determined. METHODS In total, 122 whole blood samples were collected from healthy volunteers ranging in age from 25 to 45 years. T-TAS analysis and hematological, physiological, and lifestyle assessments were conducted in these subjects. Whole blood samples anticoagulated with hirudin were perfused into a collagen-coated microchip (PL chip). The time to 10 kPa and the area under the flow pressure curve up to 10 min (AUC10) were analyzed as representative variables for thrombogenic potential. Reference intervals, which were defined as 2.5-97.5 percentiles, were determined. Additionally, univariate and multivariate analyses were performed to identify factors associated with the AUC10 in the T-TAS. RESULTS The time to 10 kPa and the AUC10 widely varied, even in healthy volunteers. The reference intervals were 1.50-4.02 min and 223.4-456.8, respectively, at a shear rate of 1500 s- 1. Univariate and multivariate analyses showed that platelet counts were most significantly associated with the AUC10 of the T-TAS. The presence of one or more cardiovascular risk factors of a high body mass index, a high pulse pressure, high fasting serum glucose levels, high low-density lipoprotein-cholesterol levels, a history of smoking, and no habitual exercise, had the second largest effect on the AUC10 of the T-TAS. CONCLUSIONS Healthy volunteers who had any cardiovascular risk factors showed augmented thrombogenicity, even in artificial uniform capillaries, compared with those without any risk factors in the T-TAS.
Collapse
Affiliation(s)
- Yuu Oda
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Takashi Ito
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan. .,Department of Biomedical Laboratory Sciences, Faculty of Life Sciences, Kumamoto University, 4-24-1 Kuhonji, Kumamoto, 862-0976, Japan.
| | | | | | - Tomoka Nagasato
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Research Institute, Fujimori Kogyo Co., Ltd., Yokohama, Japan
| | | | - Kazuya Hosokawa
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.,Research Institute, Fujimori Kogyo Co., Ltd., Yokohama, Japan
| | | | - Teruto Hashiguchi
- Department of Laboratory and Vascular Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Ikuro Maruyama
- Department of Systems Biology in Thromboregulation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| |
Collapse
|
9
|
Full KM, Whitaker KM, Pettee Gabriel K, Lewis CE, Sternfeld B, Sidney S, Reis JP, Jacobs DR, Gibbs BB, Schreiner PJ. Cardiovascular risk and functional burden at midlife: Prospective associations of isotemporal reallocations of accelerometer-measured physical activity and sedentary time in the CARDIA study. Prev Med 2021; 150:106626. [PMID: 34019927 PMCID: PMC8567420 DOI: 10.1016/j.ypmed.2021.106626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 05/11/2021] [Accepted: 05/16/2021] [Indexed: 12/13/2022]
Abstract
Cardiovascular risk and functional burden, or the accumulation of cardiovascular risk factors coupled with functional decline, may be an important risk state analogy to multimorbidity. We investigated prospective associations of sedentary time (ST), light intensity physical activity (LPA), and moderate to vigorous intensity physical activity (MVPA) with cardiovascular risk and functional burden at midlife. Participants were 1648 adults (mean ± SD age = 45 ± 4 years, 61% female, 39% Black) from Coronary Artery Risk Development in Young Adults (CARDIA) who wore accelerometers in 2005-2006 and 2015-2016. Cardiovascular risk and functional burden was defined as ≥2 cardiovascular risk factors (untreated/uncontrolled hypertension and hypercholesterolemia, type 2 diabetes, reduced kidney function) and/or functional decline conditions (reduced physical functioning and depressive symptoms). Prospective logistic regression models tested single activity, partition, and isotemporal substitution associations of accelerometer-measured ST, LPA, and MVPA with cardiovascular risk and functional burden 10 years later. In isotemporal models of baseline activity, reallocating 24 min of ST to MVPA was associated with 15% lower odds of cardiovascular risk and functional burden (OR: 0.85; CI: 0.75, 0.96). Reallocating 24 min of LPA to MVPA was associated with a 14% lower odds of cardiovascular risk and functional burden (OR: 0.86; CI: 0.75, 0.99). In longitudinal isotemporal models, similar beneficial associations were observed when 10-year increases in MVPA replaced time in ST or LPA. Findings suggest that maintaining an MVPA dose reflecting daily physical activity recommendations in early midlife is associated with lower odds of cardiovascular risk and functional burden later in midlife.
Collapse
Affiliation(s)
- Kelsie M Full
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America.
| | - Kara M Whitaker
- Department of Health and Human Physiology, Department of Epidemiology, University of Iowa, Iowa City, IA, United States of America
| | - Kelley Pettee Gabriel
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States of America
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States of America
| | - Barbara Sternfeld
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States of America
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, United States of America
| | - David R Jacobs
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America
| | - Bethany Barone Gibbs
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, United States of America
| |
Collapse
|
10
|
Haghani A, Arpawong TE, Kim JK, Lewinger JP, Finch CE, Crimmins E. Female vulnerability to the effects of smoking on health outcomes in older people. PLoS One 2020; 15:e0234015. [PMID: 32497122 PMCID: PMC7272024 DOI: 10.1371/journal.pone.0234015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity.
Collapse
Affiliation(s)
- Amin Haghani
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Thalida Em Arpawong
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Jung Ki Kim
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Juan Pablo Lewinger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, United States of America
| | - Caleb E. Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| | - Eileen Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, United States of America
| |
Collapse
|
11
|
Dong S, Fang J, Li Y, Ma M, Hong Y, He L. The population attributable risk and clustering of stroke risk factors in different economical regions of China. Medicine (Baltimore) 2020; 99:e19689. [PMID: 32311944 PMCID: PMC7220510 DOI: 10.1097/md.0000000000019689] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The greatest regional variation in stroke prevalence exists in China. However, whether there are differences in population attributable risk (PAR) and clustering of stroke risk factors among regions resulting in stroke geographic variation is unclear.We conducted face-to-face surveys of residents of 14 provinces from September 2016 to May 2017 who participated in the Chinese Stroke Screening and Prevention Project. We compared the specific PAR values of eight risk factors and the different cluster rates and patterns in China.A total of 84,751partipants were included. Eight factors accounted for 70% to 80% of the PAR of overall stroke in China. Not only did the PAR of the total risk factors differ among the 3 regions, but the PAR of the same risk factor also varied among different regions. The top 3 factors with the greatest PAR variations among the 3 regions were dyslipidemia, physical inactivity and family history of stroke. The clustering rates and patterns varied by regions. The overall proportion of participants with 0, 1, 2, 3, and ≥4 risk factors were 34.4%, 28.0%, 17.4%, 9.2%, and 10.3% in eastern China; 31.0%, 27.9%, 19.8%, 10.8%, and 9.9% in Central China and 28.2%, 29.5%, 19.9%, 10.8%, and 11.0% in western China, respectively. On basis of hypertension, the most common risk cluster patterns were overweight or smoking, dyslipidemia and physical inactivity, with other risk factors in the eastern, central and western regions, respectively.The rates and patterns of clustering and the potential importance of stroke risk factors in different regions may together contribute to the geographical variation in stroke prevalence in China.
Collapse
|
12
|
Bailey JM, Clinton-McHarg TL, Wye PM, Wiggers JH, Bartlem KM, Bowman JA. Preventive care for physical activity and fruit and vegetable consumption: a survey of family carer expectations of health service delivery for people with a mental health condition. BMC Health Serv Res 2020; 20:201. [PMID: 32164730 PMCID: PMC7068924 DOI: 10.1186/s12913-020-5059-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/28/2020] [Indexed: 11/07/2022] Open
Abstract
Background Chronic disease is a leading cause of death globally, where inadequate fruit and vegetable consumption and inadequate physical activity are consistently implicated as key contributing risk factors for such diseases. People with a mental health condition are reported to experience a higher prevalence of such risks and experience an increased morbidity and mortality from resultant chronic disease. Despite guidelines identifying a need for services accessed by people with a mental health condition to provide care to address such health risk behaviours, sub-optimal care is frequently reported suggesting a need for innovative strategies to increase the provision of physical health care. An exploratory study was conducted to examine: 1) family carers’ expectations of care provision regarding fruit and vegetable consumption and physical activity by health and community services for people with a mental health condition; 2) carer’s own health risk behaviour status and perceptions of the influence of the health risk behaviours on mental health; and 3) possible associations of socio-demographic, clinical and attitudinal factors with carer expectations of care provision for fruit and vegetable consumption and physical activity. Methods Family carers (n = 144) of a person with a mental health condition completed a cross-sectional survey. Participants were members of a mental health carer support organisation operating in New South Wales, Australia. Results A high proportion of participants considered care for fruit and vegetable consumption and physical activity respectively should be provided by: mental health hospitals (78.5, 82.7%); community mental health services (76.7, 85.9%); general practice (81.1, 79.2%); and non-government organisations (56.2, 65.4%). Most participants perceived adequate fruit and vegetable consumption (55.9%), and physical activity (71.3%) would have a very positive impact on mental health. Carers who perceived adequate fruit and vegetable consumption and physical activity would have a positive impact on mental health were more likely to expect care for such behaviours from some services. Conclusions The majority of participants expected care for fruit and vegetable consumption and physical activity be provided by all services catering for people with a mental health condition, reinforcing the appropriateness for such services to provide physical health care for clients in a systematic manner.
Collapse
Affiliation(s)
- Jacqueline M Bailey
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Tara L Clinton-McHarg
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Paula M Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John H Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Kate M Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Jennifer A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| |
Collapse
|
13
|
Clusters of Cardiovascular Risk Factors and Their Impact on the 20-Year Cardiovascular Risk in a General Population. J Cardiovasc Nurs 2020; 35:210-216. [DOI: 10.1097/jcn.0000000000000637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Mitchell UA, Ailshire JA, Kim JK, Crimmins EM. Black-White Differences in 20-year Trends in Cardiovascular Risk in the United States, 1990-2010. Ethn Dis 2019; 29:587-598. [PMID: 31641326 DOI: 10.18865/ed.29.4.587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective Improvements in the Black-White difference in life expectancy have been attributed to improved diagnosis and treatment of cardiovascular diseases and declines in cardiovascular disease mortality. However, it is unclear whether race differences in total cardiovascular risk and the prevalence of cardiovascular risk factors have improved in the United States since the 1990s. Design Serial cross-sectional design. Setting Data from the 1988-1994, 1999-2002, and 2009-2012 National Health and Nutrition Examination Survey (NHANES). Methods We estimated total cardiovascular risk levels, the prevalence of high-risk cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs among US Black and White men and women to determine whether differential changes occurred from 1990-2010. Results Total cardiovascular risk declined for all races from 1990-2010. The Black-White difference was only significant in 2000 and sex-specific analyses showed that trends seen in the total population were driven by changes among women. Black and White men did not differ in risk at any time during this period. Conversely, Black women had significantly higher risk than White women in 1990 and 2000; this difference was eliminated by 2010. Improved diagnosis and treatment of high blood pressure and high cholesterol reduced risk in the total population; improved blood pressure and lipid profiles among Black women and increasing obesity prevalence among White women specifically contributed to the narrowing of the Black-White difference in risk among women. Conclusion Cardiovascular risk and racial disparities in risk declined among US Whites and Blacks due to greater use and effectiveness of lipid-lowering and antihypertensive medications.
Collapse
Affiliation(s)
- Uchechi A Mitchell
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago
| | - Jennifer A Ailshire
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| | - Jung Ki Kim
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| | - Eileen M Crimmins
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA
| |
Collapse
|
15
|
Hong X, Ye Q, He J, Wang Z, Yang H, Qi S, Chen X, Wang C, Zhou H, Li C, Qin Z, Xu F. Prevalence and clustering of cardiovascular risk factors: a cross-sectional survey among Nanjing adults in China. BMJ Open 2018; 8:e020530. [PMID: 29903789 PMCID: PMC6009515 DOI: 10.1136/bmjopen-2017-020530] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To estimate prevalence and clustering of cardiovascular risk factors (CRFs), and investigate the association between relevant characteristics and CRF clustering among adults in eastern China. DESIGN Community-based cross-sectional study. SETTING Data were collected by interview survey, physical measurements and laboratory examinations from the 2011 Nanjing Chronic Disease and Risk Factor Surveillance. PARTICIPANTS A representative sample of 41 072 residents aged ≥18 years volunteered to participate in the survey, with a response rate of 91.3%. We excluded 1232 subjects due to missing data or having a history of cardiovascular diseases; a total of 39 840 participants were included in the analysis. OUTCOME MEASURES Prevalence and clustering of five major CRFs including hypertension, diabetes, dyslipidaemia, overweight or obesity and current smoking. RESULTS Of 39 840 participants (mean age 47.9±16.2 years), 17 964 (45.1%) were men and 21 876 (54.9%) were women. The weighted prevalence of CRFs ranged between 6.2% for diabetes and 35.6% for overweight or obesity. The proportion of CRFs tended to be higher in men, the elderly, participants who lost a life partner, or lived in rural areas, or had lower level of education and total annual income. Overall, 30.1% and 35.2% of participants had one and at least two CRFs, respectively. Multivariate logistic regression revealed that men, older age, loss of a life partner, lower level of socioeconomic status, rural areas, insufficient physical activity or unhealthy diets were positively associated with CVD risk factor clustering, compared with their counterparts. CONCLUSIONS High regional prevalence of hypertension, dyslipidaemia, overweight or obesity and their clustering are present in Nanjing. The Nanjing government should develop effective public health policies at the regional level especially for high-risk groups, such as enhancing the public's health awareness, organising health promotion programmes, implementing smoke-free law, producing healthy nutrient foods, providing free or low-cost public sports and fitness facilities.
Collapse
Affiliation(s)
- Xin Hong
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Qing Ye
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Jing He
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhiyong Wang
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Huafeng Yang
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Shengxiang Qi
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Xupeng Chen
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Chenchen Wang
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Hairong Zhou
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Chao Li
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhenzhen Qin
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
| | - Fei Xu
- Department of Non-communicable Disease Prevention, Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| |
Collapse
|
16
|
Peters SAE, Wang X, Lam TH, Kim HC, Ho S, Ninomiya T, Knuiman M, Vaartjes I, Bots ML, Woodward M. Clustering of risk factors and the risk of incident cardiovascular disease in Asian and Caucasian populations: results from the Asia Pacific Cohort Studies Collaboration. BMJ Open 2018; 8:e019335. [PMID: 29511013 PMCID: PMC5855160 DOI: 10.1136/bmjopen-2017-019335] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the relationship between risk factor clusters and cardiovascular disease (CVD) incidence in Asian and Caucasian populations and to estimate the burden of CVD attributable to each cluster. SETTING Asia Pacific Cohort Studies Collaboration. PARTICIPANTS Individual participant data from 34 population-based cohorts, involving 314 024 participants without a history of CVD at baseline. OUTCOME MEASURES Clusters were 11 possible combinations of four individual risk factors (current smoking, overweight, blood pressure (BP) and total cholesterol). Cox regression models were used to obtain adjusted HRs and 95% CIs for CVD associated with individual risk factors and risk factor clusters. Population-attributable fractions (PAFs) were calculated. RESULTS During a mean follow-up of 7 years, 6203 CVD events were recorded. The ranking of HRs and PAFs was similar for Australia and New Zealand (ANZ) and Asia; clusters including BP consistently showed the highest HRs and PAFs. The BP-smoking cluster had the highest HR for people with two risk factors: 4.13 (3.56 to 4.80) for Asia and 3.07 (2.23 to 4.23) for ANZ. Corresponding PAFs were 24% and 11%, respectively. For individuals with three risk factors, the BP-smoking-cholesterol cluster had the highest HR (4.67 (3.92 to 5.57) for Asia and 3.49 (2.69 to 4.53) for ANZ). Corresponding PAFs were 13% and 10%. CONCLUSIONS Risk factor clusters act similarly on CVD risk in Asian and Caucasian populations. Clusters including elevated BP were associated with the highest excess risk of CVD.
Collapse
Affiliation(s)
- Sanne A E Peters
- George Institute for Global Health, University of Oxford, Oxford, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Xin Wang
- George Institute for Global Health, University of Oxford, Oxford, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The First Hospital of Jilin University, Changchun, China
| | - Tai-Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Hyeon Chang Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suzanne Ho
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Kyushu University, Fukuoka, Japan
| | - Matthew Knuiman
- School of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark Woodward
- George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
17
|
Otite FO, Liaw N, Khandelwal P, Malik AM, Romano JG, Rundek T, Sacco RL, Chaturvedi S. Increasing prevalence of vascular risk factors in patients with stroke: A call to action. Neurology 2017; 89:1985-1994. [PMID: 29021359 PMCID: PMC5679417 DOI: 10.1212/wnl.0000000000004617] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 08/09/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To evaluate trends in prevalence of cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, and drug abuse) and cardiovascular diseases (carotid stenosis, chronic renal failure [CRF], and coronary artery disease [CAD]) in acute ischemic stroke (AIS) in the United States. METHODS We used the 2004-2014 National Inpatient Sample to compute weighted prevalence of each risk factor in hospitalized patients with AIS and used joinpoint regression to evaluate change in prevalence over time. RESULTS Across the 2004-2014 period, 92.5% of patients with AIS had ≥1 risk factor. Overall age- and sex-adjusted prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse were 79%, 34%, 47%, 15%, and 2%, respectively, while those of carotid stenosis, CRF, and CAD were 13%, 12%, and 27%, respectively. Risk factor prevalence varied by age (hypertension: 44% in 18-39 years vs 82% in 60-79 years), race (diabetes: Hispanic 49% vs white 30%), and sex (drug abuse: men 3% vs women 1.4%). Using joinpoint regression, prevalence of hypertension increased annually by 1.4%, diabetes by 2%, dyslipidemia by 7%, smoking by 5%, and drug abuse by 7%. Prevalence of CRF, carotid stenosis, and CAD increased annually by 13%, 6%, and 1%, respectively. Proportion of patients with multiple risk factors also increased over time. CONCLUSIONS Despite numerous guidelines and prevention initiatives, prevalence of hypertension, diabetes, dyslipidemia, smoking, and drug abuse in AIS increased across the 2004-2014 period. Proportion of patients with carotid stenosis, CRF, and multiple risk factors also increased. Enhanced risk factor modification strategies and implementation of evidence-based recommendations are needed for optimal stroke prevention.
Collapse
Affiliation(s)
- Fadar Oliver Otite
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL.
| | - Nicholas Liaw
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Priyank Khandelwal
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Amer M Malik
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Jose G Romano
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Tatjana Rundek
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Ralph L Sacco
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| | - Seemant Chaturvedi
- From the Departments of Neurology (F.O.O., N.L., P.K., A.M.M., J.G.R., T.R., R.L.S., S.C.) and Public Health Sciences (T.R., R.L.S.), University of Miami Miller School of Medicine, FL
| |
Collapse
|
18
|
Sex differences in ischaemic stroke: potential cellular mechanisms. Clin Sci (Lond) 2017; 131:533-552. [PMID: 28302915 DOI: 10.1042/cs20160841] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/16/2016] [Accepted: 01/09/2017] [Indexed: 12/12/2022]
Abstract
Stroke remains a leading cause of mortality and disability worldwide. More women than men have strokes each year, in part because women live longer. Women have poorer functional outcomes, are more likely to need nursing home care and have higher rates of recurrent stroke compared with men. Despite continued advancements in primary prevention, innovative acute therapies and ongoing developments in neurorehabilitation, stroke incidence and mortality continue to increase due to the aging of the U.S. POPULATION Sex chromosomes (XX compared with XY), sex hormones (oestrogen and androgen), epigenetic regulation and environmental factors all contribute to sex differences. Ischaemic sensitivity varies over the lifespan, with females having an "ischaemia resistant" phenotype that wanes after menopause, which has recently been modelled in the laboratory. Pharmacological therapies for acute ischaemic stroke are limited. The only pharmacological treatment for stroke approved by the Food and Drug Administration (FDA) is tissue plasminogen activator (tPA), which must be used within hours of stroke onset and has a number of contraindications. Pre-clinical studies have identified a number of potentially efficacious neuroprotective agents; however, nothing has been effectively translated into therapy in clinical practice. This may be due, in part, to the overwhelming use of young male rodents in pre-clinical research, as well as lack of sex-specific design and analysis in clinical trials. The review will summarize the current clinical evidence for sex differences in ischaemic stroke, and will discuss sex differences in the cellular mechanisms of acute ischaemic injury, highlighting cell death and immune/inflammatory pathways that may contribute to these clinical differences.
Collapse
|
19
|
van Doorn D, Richardson N, Osborne A. Farmers Have Hearts: The Prevalence of Risk Factors for Cardiovascular Disease Among a Subgroup of Irish Livestock Farmers. J Agromedicine 2017; 22:264-274. [DOI: 10.1080/1059924x.2017.1318728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Diana van Doorn
- Department of Science and Health, National Centre for Men’s Health, Institute of Technology Carlow, Carlow, Ireland
| | - Noel Richardson
- Department of Science and Health, National Centre for Men’s Health, Institute of Technology Carlow, Carlow, Ireland
| | - Aoife Osborne
- School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| |
Collapse
|
20
|
Dawson IGJ, Johnson JEV, Luke MA. One Too Many? Understanding the Influence of Risk Factor Quantity on Perceptions of Risk. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2017; 37:1157-1169. [PMID: 27653800 DOI: 10.1111/risa.12690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 06/30/2016] [Accepted: 07/21/2016] [Indexed: 06/06/2023]
Abstract
Forming a subjective risk judgment in circumstances that feature multiple risk factors is a common, yet complex task. One would expect variations in the number of risk factors in a given situation to have an important influence on risk judgments, yet the exact nature of this influence remains empirically untested. We conducted three studies to address this issue. In Study 1, we found that, when individuals were confronted with a preset number of risk factors (zero, one, two, or three) in the same scenario, their risk judgments were virtually identical for zero, one, and two risk factors, yet markedly higher for three risk factors. By contrast, Study 2 showed that when confronted with variations in the number of risk factors (zero, one, two, and three) for that same scenario, individuals' risk judgments increased/decreased in relatively even increments concurrent with increases/decreases in the number of risk factors. Study 3 identified that pronounced increases in risk judgments, like those observed in Study 1, may occur when the numbers of factors is "high" relative to the potential victim's vulnerability to those factors. Our results show that the number of risk factors in given circumstances can have an important influence on risk judgments and that this influence can differ based on the characteristics of the situation. We discuss how these findings provide a better understanding of subjective risk judgments and highlight the importance of those who seek to communicate risk information being mindful of how data about multiple risk factors could be (mis)interpreted.
Collapse
Affiliation(s)
- Ian G J Dawson
- Centre for Risk Research, Southampton Business School, University of Southampton, Southampton, UK
| | - Johnnie E V Johnson
- Centre for Risk Research, Southampton Business School, University of Southampton, Southampton, UK
| | - Michelle A Luke
- School of Business, Management & Economics, University of Sussex, Brighton, UK
| |
Collapse
|
21
|
Bartys S, Baker D, Lewis P, Middleton E. Inequity in Recording of Risk in a Local Population-Based Screening Programme for Cardiovascular Disease. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/204748730501200110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Screening for cardiovascular disease is an important primary preventive measure, yet research has documented that not all population groups receive the same quality of preventive healthcare. Design Longitudinal analysis of cardiovascular disease risk factor recording. Methods Data were made available from a local population-based screening programme for cardiovascular disease (1989-1999), whereby residents aged 35-60 years were invited for screening every 5 years (n = 84 646). Data were recorded for major risk factors including blood pressure, cholesterol, body mass index, smoking status, and alcohol consumption. Completeness of risk factor recording was compared between groups in the screened population defined by gender, ethnicity (Caucasian/South Asian) and employment status (employed/unemployed). Results Recording of risk in the screened population was significantly less complete for women and South Asian participants over the duration of the screening programme, compared with men and Caucasian participants respectively. Conversely, recording of risk was significantly more complete for the unemployed compared with the employed participants. Conclusions These findings present evidence of a less systematic screening procedure for women and South Asians, whilst it seems that men, Caucasian participants and the unemployed were appropriately screened. Inequalities at the primary preventive level will likely influence outcome, because equitable identification of risk is important for the provision of successful treatment measures, and to reduce inequalities in morbidity and mortality due to cardiovascular disease.
Collapse
Affiliation(s)
- Serena Bartys
- Institute for Public Health Research & Policy, The University of Salford, UK
| | - Deborah Baker
- Institute for Public Health Research & Policy, The University of Salford, UK
| | - Philip Lewis
- Department of Cardiology, Stepping Hill Hospital, Stockport NHS Trust, UK
| | - Elizabeth Middleton
- National Primary Care Research and Development Centre, The University of Manchester, UK
| |
Collapse
|
22
|
Jensen IJ, Mæhre HK. Preclinical and Clinical Studies on Antioxidative, Antihypertensive and Cardioprotective Effect of Marine Proteins and Peptides-A Review. Mar Drugs 2016; 14:md14110211. [PMID: 27869700 PMCID: PMC5128754 DOI: 10.3390/md14110211] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 12/31/2022] Open
Abstract
High seafood consumption has traditionally been linked to a reduced risk of cardiovascular diseases, mainly due to the lipid lowering effects of the long chained omega 3 fatty acids. However, fish and seafood are also excellent sources of good quality proteins and emerging documentation show that, upon digestion, these proteins are sources for bioactive peptides with documented favorable physiological effects such as antioxidative, antihypertensive and other cardioprotective effects. This documentation is mainly from in vitro studies, but also animal studies are arising. Evidence from human studies evaluating the positive health effects of marine proteins and peptides are scarce. In one study, a reduction in oxidative stress after intake of cod has been documented and a few human clinical trials have been performed evaluating the effect on blood pressure. The results are, however, inconclusive. The majority of the human clinical trials performed to investigate positive health effects of marine protein and lean fish intake, has focused on blood lipids. While some studies have documented a reduction in triglycerides after intake of lean fish, others have documented no effects.
Collapse
Affiliation(s)
- Ida-Johanne Jensen
- Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UIT The Arctic University of Norway, N-9037 Tromsø, Norway.
| | - Hanne K Mæhre
- Norwegian College of Fishery Science, Faculty of Biosciences, Fisheries and Economics, UIT The Arctic University of Norway, N-9037 Tromsø, Norway.
| |
Collapse
|
23
|
O'Connell ML, Freeman M, Jennings G, Chan W, Greci LS, Manta ID, Katz DL. Smoking Cessation for High School Students. Behav Modif 2016; 28:133-46. [PMID: 14710710 DOI: 10.1177/0145445503259262] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This pilot study was designed to evaluate the feasibility and the impact of a smoking-cessation program that would meet the specific needs of high school students. Feedback from focus groups conducted with adolescent smokers at a Connecticut high school was used to develop a tailored intervention. Intervention components included commonly used behavioral strategies, with additional options to assist students to quit smoking, including use of bupropion, concomitant support for parent smoking cessation, stress management, and physician counseling. On completion, 20 of the 22 enrolled students remained committed to quitting. Twenty-seven percent of students quit smoking and 69% of those who continued to smoke reduced the number of cigarettes smoked per day by an average of 13. Providing additional options to students and additional support for concomitant parental cessation may enhance the appeal of adolescent smoking-cessation programs. Further investigation into efficacy of bupropion use for adolescent cessation is warranted.
Collapse
|
24
|
Abstract
Public health has either implicitly or explicitly drawn upon a range of psychological theories. This paper identifies four areas where the application of such theory could be developed, health communication, environmental initiatives, the negotiation of behaviour and participation and empowerment. Recommendations are made regarding content, sources and recipient characteristics that can be used to develop targeted health communication campaigns. Psychology also has a role to play in informing structural approaches to prevention. To facilitate this, a framework which focuses on cues, reinforcer and barriers and an understanding of how behaviour is achieved through negotiation and interaction is outlined. Finally we highlight a role for psychology in approaches that focus on participation and empowerment in relation to health.
Collapse
|
25
|
Mamudu HM, Paul TK, Wang L, Veeranki SP, Panchal HB, Alamian A, Sarnosky K, Budoff M. The effects of multiple coronary artery disease risk factors on subclinical atherosclerosis in a rural population in the United States. Prev Med 2016; 88:140-6. [PMID: 27090918 DOI: 10.1016/j.ypmed.2016.04.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 04/06/2016] [Accepted: 04/12/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION The risk factors for cardiovascular disease (CVD) are associated with coronary atherosclerosis and having multiple risk factors potentiates atherosclerosis. This study examined the prevalence of multiple biological and lifestyle/behavioral risk factors and their association with coronary artery calcium (CAC), a marker for subclinical coronary atherosclerosis. METHODS This is a cross-sectional study of 1607 community-dwelling asymptomatic individuals from central Appalachia who participated in CAC screening between January 2011 and December 2012. Data on demographics (sex and age) and 7 traditional risk factors for coronary artery disease (CAD) were collected and categorized into 5 groups (0-1, 2, 3, 4, and ≥5). Prevalence of these risk factors and CAC scores (0, 1-99, 100-399, ≥400) were assessed, and the impact of the number of risk factors on CAC scores were delineated using multiple logistic regression. RESULTS Over 98% of participants had ≥1 risk factor. While obesity, diabetes, hypertension, and family history of CAD significantly increased the odds of having CAC, CAC scores significantly increased with number of risk factors. After adjusting for demographic factors, having 3, 4, and ≥5 risk factors was significantly associated with increased odds of having higher CAC scores when compared to zero CAC score by more than one and half times [OR=1.65, CI (1.20-2.25)], two times [OR=2.32, CI (1.67-3.23)] and three times [OR=3.45, CI (2.42-4.92)], respectively. CONCLUSION The high prevalence of multiple risk factors in the study population suggests the need for aggressive multiple risk factors interventions for primary prevention of CAD, which could address CVD health disparities.
Collapse
Affiliation(s)
- Hadii M Mamudu
- Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN, United States.
| | - Timir K Paul
- Division of Cardiology, James. H. Quillen College of Medicine, East Tennessee State University, 329 N State of Franklin Rd, Johnson City, TN 37604, United States.
| | - Liang Wang
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Sreenivas P Veeranki
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, TX, United States.
| | - Hemang B Panchal
- Department of Internal Medicine, James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37604, United States.
| | - Arsham Alamian
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Kamrie Sarnosky
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, United States.
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, 1124 W Carson Street, Torrance, CA 90502, United States.
| |
Collapse
|
26
|
Oluyombo R, Akinwusi PO, Olamoyegun MO, Ayodele OE, Fawale MB, Okunola OO, Olanrewaju TO, Akinsola A. Clustering of cardiovascular risk factors in semi-urban communities in south-western Nigeria. Cardiovasc J Afr 2016; 27:322-327. [PMID: 27284905 PMCID: PMC5377874 DOI: 10.5830/cvja-2016-024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 03/08/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In addition to poor socio-economic indices and a high prevalence of infectious diseases, there have been various reports of a rising prevalence of cardiovascular diseases, with associated morbidity and mortality in developing countries. These factors co-exist, resulting in a synergy, with serious complications, difficult-to-treat conditions and fatal outcomes. Hence this study was conducted to determine the clustering of cardiovascular disease risk factors and its pattern in semi-urban communities in south-western Nigeria. METHODS This was a cross sectional study over seven months in 11 semi-urban communities in south-western Nigeria. RESULTS The total number of participants was 1 285 but only 1 083, with 785 (65%) females, completed the data. Participants were 18 years and older, and 51.2% were over 60 years. The mean age was 55.12 ± 19.85 years. There were 2.6% current cigarette smokers, 22% drank alcohol and 12.2% added salt at the table, while 2% had been told by their doctors they had diabetes, and 23.6% had hypertension. The atherogenic index of plasma was at a high-risk level of 11.1%. Elevated total cholesterol and low-density lipoprotein cholesterol, and low high-density lipoprotein cholesterol levels were seen in 5.7, 3.7 and 65.1%, respectively. Prevalence of hypertension was 44.9%, diabetes was 5.2%, obesity with body mass index (BMI) > 30 kg/m2 was 5.7%, and abdominal circumference was 25.7%. Prevalence of clusters of two, three, and four or more risk factors was 23.1, 15.5 and 8.4%, respectively. Increasing age 2.94 (95% CI: 1.30-6.67), BMI 1.18 (95% CI: 1.02-1.37), fasting plasma glucose level 1.03 (95% CI: 1.00-1.05), albuminuria 1.03 (95% CI: 1.00-1.05), systolic blood pressure 1.07 (95% CI: 1.04-1.10), diastolic blood pressure 1.06 (95% CI: 1.00-1.11) and female gender 2.94 (95% CI: 1.30-6.67) showed increased odds of clustering of two or more cardiovascular risk factors. CONCLUSION Clustering of cardiovascular risk factors is prevalent in these communities. Patterns of clustering vary. This calls for aggressive and targeted public health interventions to prevent or reduce the burden of cardiovascular disease, as the consequences could be detrimental to the country.
Collapse
Affiliation(s)
- R Oluyombo
- Renal Unit, Department of Internal Medicine, Federal Teaching Hospital, Ido-Ekiti, Ekiti State, Nigeria.
| | - P O Akinwusi
- Cardiology Unit, College of Health Sciences, Osun State University, Osogbo, Nigeria
| | - M O Olamoyegun
- Department of Internal Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - O E Ayodele
- Department of Internal Medicine, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - M B Fawale
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Osun State, Nigeria
| | - O O Okunola
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Osun State, Nigeria
| | - T O Olanrewaju
- Renal Division, Department of Medicine, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - A Akinsola
- Department of Internal Medicine, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Osun State, Nigeria
| |
Collapse
|
27
|
Wang X, Bots ML, Yang F, Sun J, He S, Hoes AW, Niu J, Vaartjes I. A comparison of the prevalence and clustering of major cardiovascular risk factors in the Netherlands and China. Eur J Prev Cardiol 2016; 23:1766-1773. [PMID: 27154590 DOI: 10.1177/2047487316648474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 04/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular risk factors tend to be clustered. Variations in clusters across populations have not been widely investigated. This study aims to compare the prevalence and clustering of major cardiovascular risk factors between adults in the Netherlands and China. METHODS A total of 6542 Dutch adults was recruited from 2001 to 2006 for the Utrecht Health Project, an ongoing cohort study among inhabitants of a newly developing area near Utrecht, the Netherlands. A total of 37,141 Chinese employees who received health screening in Changchun City, China was enrolled from 2003 to 2010, and 3850 residents from Dehui, another city from northeast China, were enrolled in 2007. RESULTS The Dutch and Chinese populations shared similar patterns with increasing prevalence with age for most cardiovascular risk factors. Age-specific levels of body mass index, blood pressure and total cholesterol were higher in the Dutch than in the Chinese population. An exception to this was young men (18-44 years old): Chinese young men had similar body mass index levels compared to their Dutch counterparts. The age-standardised prevalence of current smoking was much higher in Chinese men compared to Dutch men (P < 0.05). The clustering patterns of risk factors differed between the Dutch and Chinese with the smoking-heavy drinking cluster while smoking-hypercholesterolemia was more common in both Dutch young men and women. CONCLUSIONS Cardiovascular risk profiles and clustering patterns differ between the Dutch and the Chinese and seem to differ between men and women. This calls for race and sex-specific targeted prevention programmes.
Collapse
Affiliation(s)
- Xin Wang
- International Health Promotion Center, 1st Hospital of Jilin University, China Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Fang Yang
- International Health Promotion Center, 1st Hospital of Jilin University, China
| | - Jie Sun
- Department of Hepatology, 1st Hospital of Jilin University, China
| | - Shumei He
- Department of Hepatology, 1st Hospital of Jilin University, China
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| | - Junqi Niu
- Department of Hepatology, 1st Hospital of Jilin University, China
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands
| |
Collapse
|
28
|
Tang S, Bishwajit G, Ji L, Feng D, Fang H, Fu H, Shao T, Shao P, Liu C, Feng Z, Luba TR. Improving the Blood Pressure Control With the ProActive Attitude of Hypertensive Patients Seeking Follow-up Services: Evidence From China. Medicine (Baltimore) 2016; 95:e3233. [PMID: 27057859 PMCID: PMC4998775 DOI: 10.1097/md.0000000000003233] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Proactive attitude of hypertensive patients seeking follow-up services (FUS) lies at the core of self-efficacy. However, few evidence have shown the activeness of seeking FUS in the context of blood pressure control among hypertensive patients. Improvements in follow-up visits may not just by services itself cause better control of blood pressure among hypertensive patients, rather due to the patient's pro-active attitude of the patient in seeking FUS.A cross-sectional study was carried out in selected rural regions of China to explore the association between blood pressure control and sociodemographic and economic variables and activeness of hypertensive patients in seeking FUS. The primary clinical outcome for this study was blood pressure control (systolic blood pressure <140 mmHg or diastolic blood pressure <90 mmHg)Out of the total 2321 participants with hypertension aged 35 years or older participated in this survey. Number of proactive FUS seekers were 3.17 times greater than those of passive seekers (odds ratio [OR] = 3.17, 95% confidence interval [CI] = 2.56-3.93, P < 0.001). In all subgroups, hypertensive patients who were seeking FUS actively were more likely to control blood pressure better than those seeking FUS passively.Proactive attitude of seeking follow-up services can improve blood pressure control among hypertensive patients.
Collapse
Affiliation(s)
- Shangfeng Tang
- From the School of Medicine and Health Management (ST, GB, DF, HF, HF, TS, PS, CL, ZF, TRL), Tongji Medical College, Huazhong University of Science and Technology, Wuhan; and Cancer Center (LJ), Sun Yat-sen University, Guangzhou, Guangdong, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Wu J, Cheng X, Qiu L, Xu T, Zhu G, Han J, Xia L, Qin X, Cheng Q, Liu Q. Prevalence and Clustering of Major Cardiovascular Risk Factors in China: A Recent Cross-Sectional Survey. Medicine (Baltimore) 2016; 95:e2712. [PMID: 26962771 PMCID: PMC4998852 DOI: 10.1097/md.0000000000002712] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular disease is the leading cause of death in the Chinese population. Although general prevalence estimates of cardiovascular risk factors (CVRFs) are available for Chinese adults, prevalence estimates covering all adult age groups by race/ethnicity have not been reported. The aim of this study is to estimate the current prevalence and clustering of major CVRFs in Chinese adults, including a plurality of ethnic minorities.A cross-sectional survey was conducted in a nationally representative sample of 23,010 adults aged 18 years and older from 2007 to 2011. Questionnaires and physical examinations were performed, and fasting blood was collected for laboratory measurements. The prevalence of traditional CVRFs, including hypertension, diabetes, dyslipidemia, overweight, and current smoking, were determined.The prevalence of the major CVRFs, including hypertension, diabetes, dyslipidemia, overweight, and current smoking were 24.3%, 4.3%, 49.3%, 32.0%, and 21.7%, respectively. These risk factors were significantly associated with sex, age, region, ethnicity, and education levels. Overall, 70.3%, 40.3%, and 16.7% of Chinese adults had ≥1, ≥2, or ≥3 CVRFs, respectively. Men, northern and rural residents were more likely to have clustered CVRFs compared with women, southern and urban residents, respectively. Compared with Han residents, Hui and Mongolian residents were more likely, and Tujia and Miao residents were less likely, to have ≥1, ≥2, or ≥3 risk factors. The prevalence of Chinese women having ≥1, ≥2, or ≥3 CVRFs decreased with increasing levels of education.The prevalence and clustering of CVRFs is still high in Chinese adults ≥18 years old, especially in men and in individuals living in the northern and rural areas. Of note, there are differences in cardiovascular risk among different ethnic groups. Therefore, targeted and enhanced intervention measures are required to reduce the risk of cardiovascular disease and the corresponding economic burden of disease in China.
Collapse
Affiliation(s)
- Jie Wu
- From the Department of Clinical Laboratory (JW, XC, LQ, JH, LX, XQ, QC, QL), Peking Union Medical College Hospital; Department of Epidemiology and Statistics (TX), Institute of Basic Medical Sciences; and Department of Pathophysiology (GZ), Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Leifheit-Limson EC, D'Onofrio G, Daneshvar M, Geda M, Bueno H, Spertus JA, Krumholz HM, Lichtman JH. Sex Differences in Cardiac Risk Factors, Perceived Risk, and Health Care Provider Discussion of Risk and Risk Modification Among Young Patients With Acute Myocardial Infarction: The VIRGO Study. J Am Coll Cardiol 2016; 66:1949-1957. [PMID: 26515996 DOI: 10.1016/j.jacc.2015.08.859] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 07/28/2015] [Accepted: 08/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Differences between sexes in cardiac risk factors, perceptions of cardiac risk, and health care provider discussions about risk among young patients with acute myocardial infarction (AMI) are not well studied. OBJECTIVES This study compared cardiac risk factor prevalence, risk perceptions, and health care provider feedback on heart disease and risk modification between young women and men hospitalized with AMI. METHODS We studied 3,501 AMI patients age 18 to 55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study in U.S. and Spanish hospitals between August 2008 and January 2012, comparing the prevalence of 5 cardiac risk factors by sex. Modified Poisson regression was used to assess sex differences in self-perceived heart disease risk and self-reported provider discussions of risk and modification. RESULTS Nearly all patients (98%) had ≥1 risk factor, and 64% had ≥3. Only 53% of patients considered themselves at risk for heart disease, and even fewer reported being told they were at risk (46%) or that their health care provider had discussed heart disease and risk modification (49%). Women were less likely than men to be told they were at risk (relative risk: 0.89; 95% confidence interval: 0.84 to 0.96) or to have a provider discuss risk modification (relative risk: 0.84; 95% confidence interval: 0.79 to 0.89). There was no difference between women and men for self-perceived risk. CONCLUSIONS Despite having significant cardiac risk factors, only one-half of young AMI patients believed they were at risk for heart disease before their event. Even fewer discussed their risks or risk modification with their health care providers; this issue was more pronounced among women.
Collapse
Affiliation(s)
- Erica C Leifheit-Limson
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mitra Daneshvar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Mary Geda
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Héctor Bueno
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - John A Spertus
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| |
Collapse
|
31
|
Space-Time Analysis to Identify Areas at Risk of Mortality from Cardiovascular Disease. BIOMED RESEARCH INTERNATIONAL 2015; 2015:841645. [PMID: 26504836 PMCID: PMC4609383 DOI: 10.1155/2015/841645] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/31/2015] [Indexed: 01/04/2023]
Abstract
This study aimed at identifying areas that were at risk of mortality due to cardiovascular disease in residents aged 45 years or older of the cities of Cuiabá and Várzea Grande between 2009 and 2011. We conducted an ecological study of mortality rates related to cardiovascular disease. Mortality rates were calculated for each census tract by the Local Empirical Bayes estimator. High- and low-risk clusters were identified by retrospective space-time scans for each year using the Poisson probability model. We defined the year and month as the temporal analysis unit and the census tracts as the spatial analysis units adjusted by age and sex. The Mann-Whitney U test was used to compare the socioeconomic and environmental variables by risk classification. High-risk clusters showed higher income ratios than low-risk clusters, as did temperature range and atmospheric particulate matter. Low-risk clusters showed higher humidity than high-risk clusters. The Eastern region of Várzea Grande and the central region of Cuiabá were identified as areas at risk of mortality due to cardiovascular disease in individuals aged 45 years or older. High mortality risk was associated with socioeconomic and environmental factors. More high-risk clusters were observed at the end of the dry season.
Collapse
|
32
|
Mann SL, Selby EA, Bates ME, Contrada RJ. Integrating affective and cognitive correlates of heart rate variability: A structural equation modeling approach. Int J Psychophysiol 2015; 98:76-86. [PMID: 26168884 PMCID: PMC4980075 DOI: 10.1016/j.ijpsycho.2015.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/09/2015] [Accepted: 07/03/2015] [Indexed: 12/19/2022]
Abstract
High frequency heart rate variability (HRV) is a measure of neurocardiac communication thought to reflect predominantly parasympathetic cardiac regulation. Low HRV has been associated empirically with clinical and subclinical levels of anxiety and depression and, more recently, high levels of HRV have been associated with better performance on some measures of executive functioning (EF). These findings have offered support for theories proposing HRV as an index measure of a broad, self-regulatory capacity underlying aspects of emotion regulation and executive control. This study sought to test that proposition by using a structural equation modeling approach to examine the relationships of HRV to negative affect (NA) and EF in a large sample of U.S. adults ages 30s-80s. HRV was modeled as a predictor of an NA factor (self-reported trait anxiety and depression symptoms) and an EF factor (performance on three neuropsychological tests tapping facets of executive abilities). Alternative models also were tested to determine the utility of HRV for predicting NA and EF, with and without statistical control of demographic and health-related covariates. In the initial structural model, HRV showed a significant positive relationship to EF and a nonsignificant relationship to NA. In a covariate-adjusted model, HRV's associations with both constructs were nonsignificant. Age emerged as the only significant predictor of NA and EF in the final model, showing inverse relationships to both. Findings may reflect population and methodological differences from prior research; they also suggest refinements to the interpretations of earlier findings and theoretical claims regarding HRV.
Collapse
Affiliation(s)
- Sarah L Mann
- Department of Psychology, Rutgers, The State University of New Jersey, Tillett Hall, Livingston Campus, 53 Avenue E, Piscataway, NJ 08854-8040, USA.
| | - Edward A Selby
- Department of Psychology, Rutgers, The State University of New Jersey, Tillett Hall, Livingston Campus, 53 Avenue E, Piscataway, NJ 08854-8040, USA.
| | - Marsha E Bates
- Center of Alcohol Studies, Smithers Hall, Busch Campus, 607 Allison Road, Piscataway, NJ 08854-8001, USA; Department of Psychology, Rutgers, The State University of New Jersey, Tillett Hall, Livingston Campus, 53 Avenue E, Piscataway, NJ 08854-8040, USA.
| | - Richard J Contrada
- Department of Psychology, Rutgers, The State University of New Jersey, Tillett Hall, Livingston Campus, 53 Avenue E, Piscataway, NJ 08854-8040, USA.
| |
Collapse
|
33
|
ω-3 Fatty Acids and Cardiovascular Diseases: Effects, Mechanisms and Dietary Relevance. Int J Mol Sci 2015; 16:22636-61. [PMID: 26393581 PMCID: PMC4613328 DOI: 10.3390/ijms160922636] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/01/2015] [Accepted: 09/09/2015] [Indexed: 02/06/2023] Open
Abstract
ω-3 fatty acids (n-3 FA) have, since the 1970s, been associated with beneficial health effects. They are, however, prone to lipid peroxidation due to their many double bonds. Lipid peroxidation is a process that may lead to increased oxidative stress, a condition associated with adverse health effects. Recently, conflicting evidence regarding the health benefits of intake of n-3 from seafood or n-3 supplements has emerged. The aim of this review was thus to examine recent literature regarding health aspects of n-3 FA intake from fish or n-3 supplements, and to discuss possible reasons for the conflicting findings. There is a broad consensus that fish and seafood are the optimal sources of n-3 FA and consumption of approximately 2-3 servings per week is recommended. The scientific evidence of benefits from n-3 supplementation has diminished over time, probably due to a general increase in seafood consumption and better pharmacological intervention and acute treatment of patients with cardiovascular diseases (CVD).
Collapse
|
34
|
Prevalence and Clustering of Cardiovascular Disease Risk Factors among Tibetan Adults in China: A Population-Based Study. PLoS One 2015; 10:e0129966. [PMID: 26047133 PMCID: PMC4457922 DOI: 10.1371/journal.pone.0129966] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 05/14/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives The prevalence of cardiovascular disease risk factors has increased worldwide. However, the prevalence and clustering of cardiovascular disease risk factors among Tibetans is currently unknown. We aimed to explore the prevalence and clustering of cardiovascular disease risk factors among Tibetan adults in China. Methods In 2011, 1659 Tibetan adults (aged ≥18 years) from Changdu, China were recruited to this cross-section study. The questionnaire, physical examinations and laboratory testing were completed and the prevalence of cardiovascular disease risk factors, including hypertension, diabetes, overweight/obesity, dyslipidemia, and current smoking, were counted. The association between the clustering of cardiovascular disease risk factors and demographic characteristics, and geographic altitude were assessed. Results The age-standardized prevalence of hypertension, diabetes, overweight or obesity, dyslipidemia, and current smoking were 62.4%, 6.4%, 34.3%, 42.7%, and 6.1%, respectively, and these risk factors were associated with age, gender, education level, yearly family income, altitude, occupation, and butter tea consumption (P < 0.05). Overall, the age-adjusted prevalence of clustering of ≥1, ≥2, and ≥3 cardiovascular disease risk factors were 79.4%, 47.1%, and 20.9%, respectively. There appeared higher clustering of ≥2 and ≥3 cardiovascular disease risk factors among Tibetans with higher education level and family income yearly, and those living at an altitude < 3500 m and in a township. Conclusions The prevalence of cardiovascular disease risk factors, especially hypertension, was high in Tibetans. Moreover, there was an increased clustering of cardiovascular disease risk factors among those with higher socioeconomic status, lamas and those living at an altitude < 3500 m. These findings suggest that without the immediate implementation of an efficient policy to control these risk factors, cardiovascular disease will eventually become a major disease burden among Tibetans.
Collapse
|
35
|
Nag T, Ghosh A. Cardiovascular disease risk factor clustering among rural adult population in West Bengal, India. Obes Res Clin Pract 2015; 10:124-32. [PMID: 26008793 DOI: 10.1016/j.orcp.2015.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/29/2015] [Accepted: 05/01/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to find out the prevalence of cardiovascular disease (CVD) risk factor clustering in a rural adult population of West Bengal, India. METHODS This cross-sectional study was carried out among 1007 participants (645 males and 362 females) aged ≥20 years in a rural community. All participants were grouped: Group I (20-39 years); Group II (40-59 years); Group III (≥60 years). Anthropometric measures were collected using standard techniques. Metabolic profiles and blood pressure were also measured. RESULTS Mean of minimum waist circumference (MWC), waist-hip ratio (WHR), trunk-extremity ratio (TER), fat free mass (FFM), basal metabolic rate (BMR), intra-abdominal visceral fat (IVF) and arm muscle area (AMA) was found to be higher among males in comparison to females, whereas, the mean of body mass index (BMI), maximum hip circumference (MHC), waist-height ratio (WHtR), sum of four skinfolds (∑SF4), percentage of body fat (%BF), fat mass (FM), insulin, HOMA-IR and arm fat area (AFA) was higher in females. 37% of individuals (males 25% and females 49%) with high triglyceride (TG) also had low high density lipoprotein (HDL), whereas, 25% individuals (males 25% and females 24%) with overweight also had high fasting blood glucose (FBG). The prevalence of high systolic blood pressure (SBP) among individuals having high %BF was higher in the age groups of 40-59 years for both sexes. CONCLUSION The study showed that prevalence of CVD risk factor clustering is high in the study population and warranted early intervention to safeguard the cardiovascular health of the nation.
Collapse
Affiliation(s)
- Tanmay Nag
- Biomedical Research Laboratory, Department of Anthropology, Visva Bharati University, Santiniketan, West Bengal, India
| | - Arnab Ghosh
- Biomedical Research Laboratory, Department of Anthropology, Visva Bharati University, Santiniketan, West Bengal, India.
| |
Collapse
|
36
|
Kuritzky L, Epstein BJ, Lavernia F. How to Obtain Appropriate Type 2 Diabetes Control in the First 180 Days of Treatment Initiation. Postgrad Med 2015; 122:33-42. [DOI: 10.3810/pgm.2010.05.2140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
37
|
Xu M, Guo Y, Zhang Y, Westerdahl D, Mo Y, Liang F, Pan X. Spatiotemporal analysis of particulate air pollution and ischemic heart disease mortality in Beijing, China. Environ Health 2014; 13:109. [PMID: 25495440 PMCID: PMC4293109 DOI: 10.1186/1476-069x-13-109] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 12/03/2014] [Indexed: 05/03/2023]
Abstract
BACKGROUND Few studies have used spatially resolved ambient particulate matter with an aerodynamic diameter of <10 μm (PM10) to examine the impact of PM10 on ischemic heart disease (IHD) mortality in China. The aim of our study is to evaluate the short-term effects of PM10 concentrations on IHD mortality by means of spatiotemporal analysis approach. METHODS We collected daily data on air pollution, weather conditions and IHD mortality in Beijing, China during 2008 and 2009. Ordinary kriging (OK) was used to interpolate daily PM10 concentrations at the centroid of 287 township-level areas based on 27 monitoring sites covering the whole city. A generalized additive mixed model was used to estimate quantitatively the impact of spatially resolved PM10 on the IHD mortality. The co-effects of the seasons, gender and age were studied in a stratified analysis. Generalized additive model was used to evaluate the effects of averaged PM10 concentration as well. RESULTS The averaged spatially resolved PM10 concentration at 287 township-level areas was 120.3 ± 78.1 μg/m3. Ambient PM10 concentration was associated with IHD mortality in spatiotemporal analysis and the strongest effects were identified for the 2-day average. A 10 μg/m3 increase in PM10 was associated with an increase of 0.33% (95% confidence intervals: 0.13%, 0.52%) in daily IHD mortality. The effect estimates using spatially resolved PM10 were larger than that using averaged PM10. The seasonal stratification analysis showed that PM10 had the statistically stronger effects on IHD mortality in summer than that in the other seasons. Males and older people demonstrated the larger response to PM10 exposure. CONCLUSIONS Our results suggest that short-term exposure to particulate air pollution is associated with increased IHD mortality. Spatial variation should be considered for assessing the impacts of particulate air pollution on mortality.
Collapse
Affiliation(s)
- Meimei Xu
- />Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Yuming Guo
- />Department of Epidemiology and Biostatistics, School of Population Health, the University of Queensland, Brisbane, Australia
| | - Yajuan Zhang
- />Department of Occupational and Environmental Health, School of Public Health, Ningxia Medical University, Yinchuan, China
| | - Dane Westerdahl
- />Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY USA
| | - Yunzheng Mo
- />Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Fengchao Liang
- />Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| | - Xiaochuan Pan
- />Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
38
|
Wang X, Yang F, Bots ML, Guo W, Zhao D, Hoes AW, Vaartjes I. Prevalence and clustering of cardiovascular risk factors in adults in Northeast China. HEART ASIA 2014; 6:122-7. [PMID: 27326186 DOI: 10.1136/heartasia-2014-010516] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/06/2014] [Accepted: 08/15/2014] [Indexed: 01/03/2023]
Abstract
AIMS To estimate the prevalence and clustering of major cardiovascular risk factors in adults in Northeast China. METHODS In total, 37 141 individuals undergoing a health screening programme at the International Health Promotion Center at the 1st Hospital of Jilin University were enrolled. Height, weight, blood pressure, fasting serum glucose, total cholesterol (TC), triglyceride (TG), high-density lipoprotein and low-density lipoprotein were recorded. RESULTS Compared with women, the age-standardised prevalence of overweight (44.0% vs 25.0%) and obesity (20.2% vs 7.1%), hypertension (33.7% vs 19.3%), dyslipidaemia (63.8% vs 42.3%), impaired fasting glucose (5.1% vs 4.2%) and diabetes mellitus (8.1% vs 3.5%) was higher in men. Overall, 69.1%, 32.7% and 10.0% of participants had ≥1, ≥2 and ≥3 major cardiovascular risk factors, respectively (obesity, hypertension, dyslipidaemia, diabetes mellitus). For men, the figures were 79.2%, 41.1% and 13.3%, respectively, and for women 53.4%, 19.8% and 5.0%, respectively. With increasing age and increasing body mass index, the prevalence of clustering of cardiovascular risk factors increased in both men and women. CONCLUSIONS There is a high prevalence of cardiovascular risk factors in adults in Northeast China: one out of three has at least two risk factors. Prevalence was higher in men than in women. Clustering of risk factors is more common with increasing age and body mass index in both men and women. Prevention of the development of risk factors should be an extremely high priority in this region.
Collapse
Affiliation(s)
- Xin Wang
- International Health Promotion Center, 1st Hospital of Jilin University, Changchun, China; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fang Yang
- International Health Promotion Center, 1st Hospital of Jilin University , Changchun , China
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Weiying Guo
- Department of Endocrinology , 1st Hospital of Jilin University , Changchun , China
| | - Di Zhao
- International Health Promotion Center, 1st Hospital of Jilin University , Changchun , China
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht , The Netherlands
| |
Collapse
|
39
|
Li WX, Gou JF, Tian JH, Yan X, Yang L. Glucagon-like peptide-1 receptor agonists versus insulin glargine for type 2 diabetes mellitus: A systematic review and meta-analysis of randomized controlled trials. Curr Ther Res Clin Exp 2014; 71:211-38. [PMID: 24688145 DOI: 10.1016/j.curtheres.2010.08.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2010] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Glucagon-like peptide-1 (GLP-1) receptor agonists are a new class of hypoglycemic drugs, including exenatide, liraglutide, albiglutide, lixisenatide, and taspoglutide. Insulin glargine is a standard agent used to supplement basal insulin in type 2 diabetes mellitus (T2DM). OBJECTIVE The aim of this study was to review the efficacy and safety profiles of GLP-1 receptor agonists versus insulin glargine in type 2 diabetic patients who have not achieved treatment goals with oral hypoglycemic agents. METHODS The Cochrane Library, MEDLINE, EMBASE, Science Citation Index Expanded, and the database of ongoing trials were searched from inception through April 2010. Additional data were sought from relevant Web sites, the American Diabetes Association, reference lists of included trials and related (systematic) reviews, and industry. Randomized controlled trials (RCTs) were selected if they were ≥3 months in duration, compared GLP-1 receptor agonists with insulin glargine in patients with T2DM, and included ≥1 of the following outcomes: mortality, complications of T2DM, glycemie control, weight, lipids, blood pressure, adverse effects, and health-related quality of life. Quasirandomized controlled trials were excluded. The quality of the eligible studies was assessed on the basis of the following aspects: randomization procedure, allocation concealment, blinding, incomplete outcome data (intent-to-treat [ITT] analysis), selective outcome reporting, and publication bias. RESULTS A total of 410 citations were retrieved; 5 multicenter RCTs that met the inclusion criteria were identified. They were all open-label designs with an insulin glargine arm, predefined outcomes reported, and ITT analysis. One trial had an unclear randomization procedure and allocation concealment. Publication bias was not able to be determined. No data wete found with regard to mortality or diabetes-associated complications, and few data were found on quality of life. The results of the metaanalysis suggest that insulin glargine was significantly better in reducing the fasting blood glucose (mean difference [MD] [95% CI], 1.31 [1.04 to 1.58]; P < 0.001), but exhibits greater incidence of nocturnal hypoglycemia (risk ratio [RR] [95% CI], 0.40 [0.23 to 0.71]; P = 0.002) and influenza (RR [95% CI], 0.56 [0.32 to 0.98]; P = 0.04). GLP-1 receptor agonists are more conducive to reducing weight (MD [95% CI], -3.96 [-5.14 to -2.77]; P < 0.001), postprandial blood glucose (after breakfast, P < 0.001; after dinner, P < 0.001), and LDL-C (MD [95% CI], -0.18 [-0.28 to -0.08]; P < 0.001), but have significantly more gastrointestinal adverse effects (eg, nausea/ vomiting, P < 0.001). There were no significant differences between GLP-1 receptor agonists and insulin glargine in reducing glycosylated hemoglobin (HbA1c) levels (MD [95% CI], -0.03 [-0.13 to 0.08]) and the overall incidence of hypoglycemia (RR [95% CI], 0.69 [0.42 to 1.14]). CONCLUSIONS Compared with insulin glargine, GLP-1 receptor agonists did not have a significant difference in regard to reducing HbA1c levels and they were significantly associated with decreased weight but increased gastrointestinal adverse events. It remains unclear whether GLP-1 receptor agonists influence mortality or diabetes-associated complications in patients with T2DM. More trials with longer follow-up are needed to determine the exact long-term efficacy and safety profiles of this new class of hypoglycemic drugs.
Collapse
Affiliation(s)
- Wei-Xin Li
- Department of Geriatrics, First Hospital of Lanzhou University, Lanzhou, China ; Evidence-Based Medicine Center of Lanzhou University, Lanzhou, China
| | - Jian-Feng Gou
- College of Earth and Environmental Sciences of Lanzhou University, Lanzhou, China
| | - Jin-Hui Tian
- Evidence-Based Medicine Center of Lanzhou University, Lanzhou, China
| | - Xiang Yan
- Department of Geriatrics, First Hospital of Lanzhou University, Lanzhou, China ; Evidence-Based Medicine Center of Lanzhou University, Lanzhou, China
| | - Lin Yang
- Department of Geriatrics, First Hospital of Lanzhou University, Lanzhou, China
| |
Collapse
|
40
|
Bassareo PP, Mercuro G. Pediatric hypertension: An update on a burning problem. World J Cardiol 2014; 6:253-259. [PMID: 24944755 PMCID: PMC4062118 DOI: 10.4330/wjc.v6.i5.253] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 02/25/2014] [Accepted: 04/17/2014] [Indexed: 02/06/2023] Open
Abstract
A large number of adults worldwide suffer from essential hypertension, and because blood pressures (BPs) tend to remain within the same percentiles throughout life, it has been postulated that hypertensive pressures can be tracked from childhood to adulthood. Thus, children with higher BPs are more likely to become hypertensive adults. These “pre-hypertensive” subjects can be identified by measuring arterial BP at a young age, and compared with age, gender and height-specific references. The majority of studies report that 1 to 5% of children and adolescents are hypertensive, defined as a BP > 95th percentile, with higher prevalence rates reported for some isolated geographic areas. However, the actual prevalence of hypertension in children and adolescents remains to be fully elucidated. In addition to these young “pre-hypertensive” subjects, there are also children and adolescents with a normal-high BP (90th-95th percentile). Early intervention may help prevent the development of essential hypertension as they age. An initial attempt should be made to lower their BP by non-pharmacologic measures, such as weight reduction, aerobic physical exercise, and lowered sodium intake. A pharmacological treatment is usually needed should these measures fail to lower BP. The majority of antihypertensive drugs are not formulated for pediatric patients, and have thus not been investigated in great detail. The purpose of this review is to provide an update concerning juvenile hypertension, and highlight recent developments in epidemiology, diagnostic methods, and relevant therapies.
Collapse
|
41
|
Dawson IGJ, Johnson JEV, Luke MA. Using risk model judgements to better understand perceptions of synergistic risks. Br J Psychol 2014; 105:581-603. [PMID: 24588694 DOI: 10.1111/bjop.12059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 10/25/2013] [Indexed: 12/27/2022]
Abstract
Numerous scientific studies show that risk factors can interact to synergistically increase the likelihood of certain adverse and life-threatening outcomes. Yet, the extent to which individuals know that specific risk factor combinations present 'synergistic risks' is unclear and little is known about the determinants of such knowledge. This is largely because epistemological progress concerning this topic has been frustrated by a reliance on metrics that have latterly been judged to be of questionable validity. To address this issue, this paper presents two studies that assess an alternative approach (i.e., risk model judgements) which requires respondents to judge the risk for a factor combination relative to, rather than in isolation from, the risk attributable to each constituent factor. Results from both studies indicate that risk model judgements overcome the drawbacks of traditional metrics. More importantly, the results provide epistemological insights into what can determine whether an individual understands that a factor combination presents a synergistic risk; these determinants include experiential and intuitive insights into the effects of combining specific risk factors, domain-specific judgemental experience and exposure to effective learning opportunities. These findings can be utilized in interventions aimed at helping individuals to make better decisions concerning multiple risk factors.
Collapse
|
42
|
Nobel L, Mayo NE, Hanley J, Nadeau L, Daskalopoulou SS. MyRisk_Stroke Calculator: A Personalized Stroke Risk Assessment Tool for the General Population. J Clin Neurol 2014; 10:1-9. [PMID: 24465256 PMCID: PMC3896642 DOI: 10.3988/jcn.2014.10.1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE There is a variety of stroke risk factors, and engaging individuals in reducing their own personal risk is hugely relevant and could be an optimal dissemination strategy. The aim of the present study was to estimate the stroke risk for specific combinations of health- and lifestyle-related factors, and to develop a personalized stroke-risk assessment tool for health professionals and the general population (called the MyRisk_Stroke Calculator). METHODS This population-based, longitudinal study followed a historical cohort formed from the 1992 or 1998 Santé Québec Health Surveys with information for linkage to health administrative databases. Stroke risk factors were ascertained at the time of survey, and stroke was determined from hospitalizations and death records. Cox proportional hazards models were used, modeling time to stroke in relationship to all variables. RESULTS A total of 358 strokes occurred among a cohort of 17805 persons (men=8181) who were followed for approximately 11 years (i.e., -200000 person-years). The following regression parameters were used to produce 10-year stroke-risk estimates and assign risk points: for age (1 point/year after age 20 years), male sex (3 points), low education (4 points), renal disease (8 points), diabetes (7 points), congestive heart failure (5 points), peripheral arterial disease (2 points), high blood pressure (2 points), ischemic heart disease (1 point), smoking (8 points), >7 alcoholic drinks per week (3 points), low physical activity (2 points), and indicators of anger (4 points), depression (4 points), and anxiety (3 points). According to MyRisk_Stroke Calculator, a person with <50, 75, and 90 risk points has a 10-year stroke risk of <3%, 28%, and >75%, respectively. CONCLUSIONS The MyRisk_Stroke Calculator is a simple method of disseminating information to the general population about their stroke risk.
Collapse
Affiliation(s)
- Lisa Nobel
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Nancy E Mayo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - James Hanley
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Lyne Nadeau
- Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
43
|
Tao J, Ma YT, Xiang Y, Xie X, Yang YN, Li XM, Fu ZY, Ma X, Liu F, Chen BD, Yu ZX, Chen Y. Prevalence of major cardiovascular risk factors and adverse risk profiles among three ethnic groups in the Xinjiang Uygur Autonomous Region, China. Lipids Health Dis 2013; 12:185. [PMID: 24341701 PMCID: PMC3866600 DOI: 10.1186/1476-511x-12-185] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/11/2013] [Indexed: 01/11/2023] Open
Abstract
Background Prevalence of cardiovascular disease (CVD) risk factors have been scarcely studied in Xinjiang, a multi-ethnic region. Methods Multi-ethnic, cross-sectional cardiovascular risk survey study in Xinjiang, including individuals of Uygur (n = 4695), Han (n = 3717) and Kazakh (n = 3196) ethnicities, aged 35-74 years. Analyses involved 11,608 participants with complete data enrolled between October 2007 and March 2010. Results There were differences in age-standardized prevalence of CVD risk factors between the three groups (all P < 0.001). Hypertension, obesity and smoking rates were higher among Kazakh (54.6%, 24.5%, and 35.8%, respectively). Dyslipidemia prevalence was higher among Uygur (54.3%), and diabetes prevalence was higher among Hans (7.1%). Age-standardized prevalence of adverse CVD risk profiles was different across different ethnicities. Compared with the Han participants, the Uygur and Kazakh had more CVD risk factors (P < 0.001). Compared with the Han participants, the adjusted odds ratios of 1, 2, and ≥3 risk factors profiles for Kazakh and Uygur participants were higher (all P < 0.001). Conclusions The present study showed the pervasive burden of CVD risk factors in all participant groups in the Xinjiang region. Three major ethnic groups living in Xinjiang had striking differences in the prevalence of major CVD risk factors and adverse risk profiles. Ethnic-specific strategies should be developed to prevent CVD in different ethnic groups, as well as to develop strategies to prevent future development of adverse CVD risk factors at a younger age.
Collapse
Affiliation(s)
| | - Yi-tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, P,R, China.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Abstract
PURPOSE Physical inactivity has been identified as a distinct health risk. However, little is known about how this can vary at leisure and work in cardiac patients. The aim of this study was to examine the prevalence and predictors of inactivity during leisure and work in the 12 months following a cardiac event in Australian cardiac patients. METHODS A total of 346 patients consecutively admitted to hospital with acute coronary syndrome or to undergo coronary artery bypass graft surgery were interviewed in hospital, and 4 and 12 months later. Leisure and occupational physical activity was measured using the Stanford Brief Activity Survey. Sociodemographic, psychosocial, and clinical data were also collected. RESULTS The prevalence of leisure-time physical inactivity declined over time, with 52% inactive preevent and 29% inactive at 12 months. Approximately 50% of participants were physically inactive in their work, regardless of whether this was measured before or after the cardiac event. Logistic regression revealed that the significant predictors of leisure-time physical inactivity at 12 months were non-home ownership (OR = 2.19; P = .007) and physical inactivity in leisure-time prior to the event (OR = 2.44; P = .001). The significant predictors of occupational physical inactivity at 12 months were white-collar occupation (OR = 3.10; P < .001) and physical inactivity at work prior to the event (OR = 12.99; P < .001). CONCLUSIONS Preevent physical inactivity, socioeconomic, and clinical factors predicted both leisure and work inactivity after an acute cardiac event. Effective interventions could be designed and implemented to target those most at risk of being physically inactive at work or leisure.
Collapse
|
45
|
Peters SAE, Huxley RR, Woodward M. Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes. Stroke 2013; 44:2821-8. [PMID: 23970792 DOI: 10.1161/strokeaha.113.002342] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE It is currently unknown whether the excess risk of stroke by smoking is the same for women and men. We performed a systematic review and meta-analysis to estimate the effect of smoking on stroke in women compared with men. METHODS PubMed MEDLINE was systematically searched for prospective population-based cohort studies published between January 1, 1966, and January 26, 2013. Studies that presented sex-specific estimates of the relative risk of stroke comparing current smoking with nonsmoking and its associated variability were selected. The sex-specific relative risks and their ratio (RRR), comparing women with men, were pooled using random-effects meta-analysis with inverse variance weighting. Similarly, the RRR for former versus never smoking was pooled. RESULTS Data from 81 prospective cohort studies that included 3,980,359 individuals and 42,401 strokes were available. Smoking was an independent risk factor for stroke in both sexes. Overall, the pooled multiple-adjusted RRR indicated a similar risk of stroke associated with smoking in women compared with men (RRR, 1.06 [95% confidence interval, 0.99-1.13]). In a regional analysis, there was evidence of a more harmful effect of smoking in women than in men in Western (RRR, 1.10 [1.02-1.18)] but not in Asian (RRR, 0.97 [0.87-1.09]) populations. Compared with never-smokers, the beneficial effects of quitting smoking among former smokers on stroke risk were similar between the sexes (RRR, 1.10 [0.99-1.22]). CONCLUSIONS Compared with nonsmokers, the excess risk of stroke is at least as great among women who smoke compared with men who smoke.
Collapse
Affiliation(s)
- Sanne A E Peters
- From The George Institute for Global Health, University of Sydney, New South Wales, Australia (S.A.E.P., R.R.H., M.W.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (S.A.E.P.); Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (R.R.H.); and Department of Epidemiology, Johns Hopkins University, Baltimore, MD (M.W.)
| | | | | |
Collapse
|
46
|
Leifheit-Limson EC, Spertus JA, Reid KJ, Jones SB, Vaccarino V, Krumholz HM, Lichtman JH. Prevalence of traditional cardiac risk factors and secondary prevention among patients hospitalized for acute myocardial infarction (AMI): variation by age, sex, and race. J Womens Health (Larchmt) 2013; 22:659-66. [PMID: 23841468 DOI: 10.1089/jwh.2012.3962] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Modification of traditional cardiac risk factors is an important goal for patients after an acute myocardial infarction (AMI). Risk factor prevalence and secondary prevention efforts at discharge are well characterized among older patients; however, research is limited for younger and minority AMI populations, particularly among women. METHODS Among 2369 AMI patients enrolled in a 19-center prospective study, we compared the prevalence and cumulative number of five cardiac risk factors (hypertension, hypercholesterolemia, current smoking, diabetes, obesity) by age, sex, and race. We also compared secondary prevention strategies at discharge for these risk factors, including prescription of antihypertensive or lipid-lowering medications and counseling on preventive behaviors (smoking cessation, diabetes management, diet/weight management). RESULTS Approximately 93% of patients had ≥1 risk factor, 72% had ≥2 factors, and 40% had ≥3 factors. The prevalence of multiple risk factors was markedly higher for blacks than for whites within each age-sex group; black women had the greatest risk factor burden of any subgroup (60% of older black women and 54% of younger black women had ≥3 risk factors). Secondary prevention efforts for smoking cessation were less common for black compared with white patients, and younger black patients were less often prescribed antihypertensive and lipid-lowering medications compared with younger white patients. CONCLUSIONS Multiple cardiac risk factors are highly prevalent in AMI patients, particularly among black women. Secondary prevention efforts, however, are less common for blacks compared to whites, especially among younger patients. Our findings highlight the need for improved risk factor modification efforts in these high-risk subgroups.
Collapse
Affiliation(s)
- Erica C Leifheit-Limson
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut 06519, USA.
| | | | | | | | | | | | | |
Collapse
|
47
|
Abstract
The scientific, medical, and lay communities are currently confronted with a serious medical and public health problem related to the marked non-remitting worldwide epidemic of obesity. This ever-increasing prevalence of obesity is accompanied by a host of inherently associated co-morbidities. As a result, obesity is fast becoming the major cause of premature death in the developed world. As pediatric and adult cardiologists, we have seen a dramatic increase in office referrals of overweight and obese children and adolescents, who already have obesity-related degenerative disease processes such as hypertension, dyslipidemia, the metabolic syndrome, and type 2 diabetes mellitus, as well as manifestations of early preclinical atherosclerotic cardiovascular disease, not previously observed in this age group. This article presents a review of the literature and recent scientific statements and recommendations issued by the American Heart Association (AHA) and the American Academy of Pediatrics (AAP) regarding the metabolic abnormalities associated with obesity, including newer identification and treatment strategies for obesity, dyslipidemia, and early subclinical coronary artery disease seen in high-risk children and adolescents.
Collapse
|
48
|
Morris LJ, Sargent-Cox K, Cherbuin N, Anstey KJ. Risk factors for chronic disease in young, midlife and older adults: the PATH Through Life study. Aust N Z J Public Health 2013; 37:295-6. [DOI: 10.1111/1753-6405.12055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
49
|
Pimenta AM, Felisbino-Mendes MS, Velasquez-Melendez G. Clustering and combining pattern of metabolic syndrome components in a rural Brazilian adult population. SAO PAULO MED J 2013; 131:213-9. [PMID: 24141291 PMCID: PMC10871831 DOI: 10.1590/1516-3180.2013.1314326] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 06/26/2011] [Accepted: 11/26/2012] [Indexed: 12/19/2022] Open
Abstract
CONTEXT AND OBJECTIVE Metabolic syndrome is characterized by clustering of cardiovascular risk factors such as obesity, dyslipidemia, insulin resistance, hyperinsulinemia, glucose intolerance and arterial hypertension. The aim of this study was to estimate the probability of clustering and the combination pattern of three or more metabolic syndrome components in a rural Brazilian adult population. DESIGN AND SETTING This was a cross-sectional study conducted in two rural communities located in the Jequitinhonha Valley, Minas Gerais, Brazil. METHODS The sample was composed of 534 adults (both sexes). Waist circumference, blood pressure and demographic, lifestyle and biochemical characteristics were assessed. The prevalences of metabolic syndrome and its components were estimated using the definitions of the National Cholesterol Education Program - Adult Treatment Panel III. A binomial distribution equation was used to evaluate the probability of clustering of metabolic syndrome components. The statistical significance level was set at 5% (P < 0.05). RESULTS Metabolic syndrome was more frequent among women (23.3%) than among men (6.5%). Clustering of three or more metabolic syndrome components was greater than expected by chance. The commonest combinations of three metabolic syndrome components were: hypertriglyceridemia + low levels of HDL-c + arterial hypertension and abdominal obesity + low levels of HDL-c + arterial hypertension; and of four metabolic syndrome components: abdominal obesity + hypertriglyceridemia + low levels of HDL-c + arterial hypertension. CONCLUSION The population studied presented high prevalence of metabolic syndrome among women and clustering of its components greater than expected by chance, suggesting that the combination pattern was non-random.
Collapse
Affiliation(s)
- Adriano Marçal Pimenta
- Department of Maternal and Child Nursing and Public Health, School of Nursing, Universidade Federal de Minas Gerais, Belo HorizonteMinas Gerais, Brazil
| | | | | |
Collapse
|
50
|
Barry W, St Andre JR, Evans CT, Sabharwal S, Miskevics S, Weaver FM, Smith BM. Hypertension and antihypertensive treatment in veterans with spinal cord injury and disorders. Spinal Cord 2012; 51:109-15. [DOI: 10.1038/sc.2012.122] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|