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Pardhan S, Raman R, Biswas A, Jaisankar D, Ahluwalia S, Sapkota R. Knowledge, attitude, and practice of diabetes in patients with and without sight-threatening diabetic retinopathy from two secondary eye care centres in India. BMC Public Health 2024; 24:55. [PMID: 38167028 PMCID: PMC10763332 DOI: 10.1186/s12889-023-17371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/28/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND/AIMS Good knowledge, Attitude, and Practice (KAP) of diabetes influence its control and complications. We examined the KAP of diabetes in patients with sight-threatening diabetic retinopathy (STDR) and non-sight-threatening diabetic retinopathy (NSTDR) attending two different referral hospitals in India. METHODS 400 consecutive patients (mean age = 58.5 years ± 10.3) with diabetic retinopathy attending retina referral clinics in Chennai (private) and Darjeeling (public) were recruited. A validated questionnaire on diabetic KAP was administered in English or the local language. Data were analysed using an established scalar-scoring method in which a score of 1 was assigned to the correct answer/healthy lifestyle and 0 to an incorrect answer/unhealthy lifestyle/practice. Clinical data included fasting blood sugar, blood pressure, retinopathy, and visual acuity. Retinopathy was graded as STDR/NSTDR from retinal images using Early Treatment of Diabetic Retinopathy Study criteria. RESULTS Usable data from 383 participants (95.8%) were analysed. Of these, 83 (21.7%) had STDR, and 300 (78.3%) had NSTDR. The NSTDR group reported a significantly lower total KAP score (mean rank = 183.4) compared to the STDR group (mean rank = 233.1), z = -3.0, p < 0.001. A significantly greater percentage in the NSTDR group reported to being unaware that diabetes could affect eyes, did not know about possible treatment for DR, and checked their blood sugar less frequently than once a month. CONCLUSION Patients who had not developed STDR had poorer KAP about diabetes and diabetes-related eye diseases. This is an important issue to address as the risk of their progressing to STDR is high unless appropriate steps to improve their knowledge/awareness and lifestyle practice are introduced early.
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Affiliation(s)
- Shahina Pardhan
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Young Street, Cambridge, CB1 2 LZ, UK.
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Anupama Biswas
- Department of Ophthalmology, Kurseong Sub-Divisional Hospital, Darjeeling, India
| | - Durgasri Jaisankar
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Sanjiv Ahluwalia
- School of Medicine, Anglia Ruskin University, Chelmsford, CM11SQ, UK
| | - Raju Sapkota
- Vision and Eye Research Institute, School of Medicine, Anglia Ruskin University, Young Street, Cambridge, CB1 2 LZ, UK.
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Gudowska-Sawczuk M, Mroczko B. Free Light Chains κ and λ as New Biomarkers of Selected Diseases. Int J Mol Sci 2023; 24:ijms24119531. [PMID: 37298479 DOI: 10.3390/ijms24119531] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnostic and prognostic markers are necessary to help in patient diagnosis and the prediction of future clinical events or disease progression. As promising biomarkers of selected diseases, the free light chains (FLCs) κ and λ were considered. Measurements of FLCs are currently used in routine diagnostics of, for example, multiple myeloma, and the usefulness of FLCs as biomarkers of monoclonal gammopathies is well understood. Therefore, this review focuses on the studies concerning FLCs as new potential biomarkers of other disorders in which an inflammatory background has been observed. We performed a bibliometric review of studies indexed in MEDLINE to assess the clinical significance of FLCs. Altered levels of FLCs were observed both in diseases strongly connected with inflammation such as viral infections, tick-borne diseases or rheumatic disorders, and disorders that are moderately associated with immune system reactions, e.g., multiple sclerosis, diabetes, cardiovascular disorders and cancers. Increased concentrations of FLCs appear to be a useful prognostic marker in patients with multiple sclerosis or tick-borne encephalitis. Intensive synthesis of FLCs may also reflect the production of specific antibodies against pathogens such as SARS-CoV-2. Moreover, abnormal FLC concentrations might predict the development of diabetic kidney disease in patients with type 2 diabetes. Markedly elevated levels are also associated with increased risk of hospitalization and death in patients with cardiovascular disorders. Additionally, FLCs have been found to be increased in rheumatic diseases and have been related to disease activity. Furthermore, it has been suggested that inhibition of FLCs would reduce the progression of tumorigenesis in breast cancer or colitis-associated colon carcinogenesis. In conclusion, abnormal levels of κ and λ FLCs, as well as the ratio of κ:λ, are usually the result of disturbances in the synthesis of immunoglobulins as an effect of overactive inflammatory reactions. Therefore, it seems that κ and λ FLCs may be significant diagnostic and prognostic biomarkers of selected diseases. Moreover, the inhibition of FLCs appears to be a promising therapeutical target for the treatment of various disorders where inflammation plays an important role in the development or progression of the disease.
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Affiliation(s)
- Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
| | - Barbara Mroczko
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
- Department of Neurodegeneration Diagnostics, Medical University of Bialystok, Waszyngtona 15A St., 15-269 Bialystok, Poland
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Sebastian SA, Avanthika C, Jhaveri S, Carrera KG, Camacho L GP, Balasubramanian R. The Risk of Cardiovascular Disease Among Immigrants in Canada. Cureus 2022; 14:e22300. [PMID: 35350529 PMCID: PMC8933291 DOI: 10.7759/cureus.22300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/05/2022] Open
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Coles B, Zaccardi F, Ling S, Davies MJ, Samani NJ, Khunti K. Cardiovascular events and mortality in people with and without type 2 diabetes: An observational study in a contemporary multi-ethnic population. J Diabetes Investig 2021; 12:1175-1182. [PMID: 33206469 PMCID: PMC8264396 DOI: 10.1111/jdi.13464] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/06/2020] [Accepted: 11/13/2020] [Indexed: 12/24/2022] Open
Abstract
AIMS/INTRODUCTION The aim of this study was to examine ethnicity-specific associations between type 2 diabetes mellitus and the risk of a cardiovascular disease (CVD) event as well as risk of specific CVD phenotypes in England. METHODS We obtained data from the Clinical Practice Research Datalink for adults with and without type 2 diabetes mellitus diagnosed 2000-2006. The outcome was the first CVD event during 2007-2017 and the following components: aortic aneurysm, cerebrovascular accidents, heart failure, myocardial infarction, peripheral vascular disease and other CVD-related conditions. Flexible parametric survival models were used to estimate ethnicity-specific adjusted hazard ratios. RESULTS A total of 734,543 people with and without type 2 diabetes mellitus (29,847; 4.1%) were included; most were of white ethnicity (93.0% with and 92.3% without type 2 diabetes mellitus) followed by South Asian (3.2 and 4.6%). During a median follow-up period of 11.0 years, 67,218 events occurred (6,156 in individuals with type 2 diabetes mellitus). Type 2 diabetes mellitus was associated with a small increase in CVD events (adjusted hazard ratio 1.06, 95% confidence interval 1.02-1.09) in individuals of white ethnicity; whereas the adjusted hazard ratios were considerably higher in individuals of South Asian ethnicity (1.28, 95% confidence interval 1.09-1.51), primarily due to an increased risk of myocardial infarction (1.53, 95% confidence interval 1.08-2.18). CONCLUSIONS Despite universal access to healthcare, there are large disparities in CVD outcomes in people with and without type 2 diabetes mellitus. Other non-traditional risk factors might play a role in the higher CVD risk associated with type 2 diabetes mellitus in individuals of South Asian ethnicity.
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Affiliation(s)
- Briana Coles
- Leicester Real World Evidence UnitDiabetes Research CenterUniversity of LeicesterLeicesterUK
| | - Francesco Zaccardi
- Leicester Real World Evidence UnitDiabetes Research CenterUniversity of LeicesterLeicesterUK
| | - Suping Ling
- Leicester Real World Evidence UnitDiabetes Research CenterUniversity of LeicesterLeicesterUK
| | - Melanie J Davies
- National Institute for Health Research Leicester Biomedical Research CenterLeicester Diabetes CentreLeicesterUK
| | - Nilesh J Samani
- Department of Cardiovascular SciencesNIHR Leicester Biomedical Research CenterUniversity of LeicesterLeicesterUK
| | - Kamlesh Khunti
- National Institute for Health Research Applied Research Collaboration ‐ East MidlandsLeicester Diabetes CenterLeicesterUK
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Benedetti S, Moir HJ, Stensel DJ, Thackray AE, Naughton D, Allgrove JE. Effects of moderate to vigorous intensity cycling on appetite, ad libitum energy intake and appetite-related hormones in healthy South Asian and white European men. Appetite 2021; 165:105282. [PMID: 33971288 DOI: 10.1016/j.appet.2021.105282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022]
Abstract
Compensatory changes in appetite and energy intake do not appear to occur in the short-term after acute exercise; however, responses have not been compared in South Asians, a group at high risk of central obesity and type 2 diabetes, with white Europeans. This study examined appetite perceptions, energy intake and appetite-related hormones after moderate-to-vigorous intensity cycling in South Asian versus white European men. Fifteen South Asians (mean(SD) 29(8) years; 25.4(4.5) kg m-2) and fifteen white Europeans (33(10) years; 26.1(3.8) kg m-2) matched for age and body mass index completed two 7 h trials (control and exercise). Participants rested throughout both trials apart from completing 60 min cycling at 2-3 h in the exercise trial. A standardised breakfast was consumed at 0 h and an ad libitum buffet meal at 4 h. Appetite perceptions and appetite-related hormones were measured at predetermined intervals. Exercise suppressed acylated ghrelin (d = 0.19, P < 0.001) and increased total peptide YY (PYY) (d = 0.14, P = 0.004), insulin (d = 0.09, P = 0.046) and glucose concentrations (d = 0.31, P < 0.001) (main effect of trial), without stimulating compensatory increases in energy intakes in either group (group-by-trial interactions). South Asians exhibited lower absolute energy intake and higher insulin concentrations than white Europeans (main effect group d ≥ 0.63, P ≤ 0.003), whereas group-by-time interactions revealed lower acylated ghrelin concentrations at 3 and 4 h (d ≥ 0.75, P ≤ 0.038) and higher glucose concentrations at 0.75 and 2 h (d ≥ 0.67, P ≤ 0.008) in South Asian than white European men. These findings demonstrate that acute exercise induces a short-term energy deficit and similar appetite responses in South Asian and white European men.
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Affiliation(s)
- Simone Benedetti
- Applied & Human Sciences, School of Life Sciences, Pharmacy & Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK.
| | - Hannah J Moir
- Applied & Human Sciences, School of Life Sciences, Pharmacy & Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK.
| | - David J Stensel
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
| | - Alice E Thackray
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK; National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and University of Leicester, Leicester, UK.
| | - Declan Naughton
- Applied & Human Sciences, School of Life Sciences, Pharmacy & Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK.
| | - Judith E Allgrove
- Applied & Human Sciences, School of Life Sciences, Pharmacy & Chemistry, Kingston University London, Kingston upon Thames KT1 2EE, UK.
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Gupta R, Tyagi K, Anoop S, Ghosh A, Misra A. About 1/3rd of north Indian patients less than 50 years of age with type 2 diabetes have high pulse wave velocity indicating high risk of atherosclerosis. Diabetes Metab Syndr 2020; 14:2205-2210. [PMID: 33336647 DOI: 10.1016/j.dsx.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Asian Indian patients with type 2 diabetes mellitus (T2DM) have a high cardiovascular risk even at young age. There is a need to assess this increased risk and identify atherosclerosis early so that appropriate measures for risk reduction can be taken. We aimed to study carotid-femoral pulse wave velocity (Cf-PWV), a non-invasive indicator of atherosclerosis, in patients with diabetes below 50 years of age and its correlation with markers of obesity and other cardiovascular risk factors. METHODS Patients (n, 299) with T2DM below 50 years of age underwent measurement of Cf-PWV by applanation tonometry. Anthropometric parameters, blood pressure, liver span, glycosylated hemoglobin, serum lipid profile, urinary microalbumin, ankle brachial index and carotid intima media thickness were measured. RESULTS Data show that 32.4% of patients had high Cf-PWV, with mean values higher in males than females. On stepwise multiple linear regression analysis, the significant independent determinants of PWV were age, systolic blood pressure, waist circumference, microalbumin and liver span. CONCLUSION About one third patients with T2DM less than 50 years of age, in north India have increased arterial stiffness which correlates with blood pressure, abdominal obesity, liver size and microalbumin, indicating increased risk for coronary artery disease.
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Affiliation(s)
- Ritesh Gupta
- Fortis CDOC Hospital, Chirag Enclave, New Delhi, India.
| | - Kanika Tyagi
- Fortis CDOC Hospital, Chirag Enclave, New Delhi, India
| | - Shajith Anoop
- National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
| | - Amerta Ghosh
- Fortis CDOC Hospital, Chirag Enclave, New Delhi, India
| | - Anoop Misra
- Fortis CDOC Hospital, Chirag Enclave, New Delhi, India; National Diabetes, Obesity and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India
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Plasma Free Fatty Acids Metabolic Profile with LC-MS and Appetite-Related Hormones in South Asian and White European Men in Relation to Adiposity, Physical Activity and Cardiorespiratory Fitness: A Cross-Sectional Study. Metabolites 2019; 9:metabo9040071. [PMID: 31013892 PMCID: PMC6523813 DOI: 10.3390/metabo9040071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 11/22/2022] Open
Abstract
South Asians have a greater cardiovascular disease (CVD) and type 2 diabetes (T2D) risk than white Europeans, but the mechanisms are poorly understood. This study examined ethnic differences in free fatty acids (FFAs) metabolic profile (assessed using liquid chromatography-mass spectrometry), appetite-related hormones and traditional CVD and T2D risk markers in blood samples collected from 16 South Asian and 16 white European men and explored associations with body composition, objectively-measured physical activity and cardiorespiratory fitness. South Asians exhibited higher concentrations of five FFAs (laurate, myristate, palmitate, linolenic, linoleate; p ≤ 0.040), lower acylated ghrelin (ES = 1.00, p = 0.008) and higher leptin (ES = 1.11, p = 0.004) than white Europeans; total peptide YY was similar between groups (p = 0.381). South Asians exhibited elevated fasting insulin, C-reactive protein, interleukin-6, triacylglycerol and ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C) and lower fasting HDL-C (all ES ≥ 0.74, p ≤ 0.053). Controlling for body fat percentage (assessed using air displacement plethysmography) attenuated these differences. Despite similar habitual moderate-to-vigorous physical activity (ES = 0.18, p = 0.675), V˙O2max was lower in South Asians (ES = 1.36, p = 0.001). Circulating FFAs in South Asians were positively correlated with body fat percentage (r2 = 0.92), body mass (r2 = 0.86) and AUC glucose (r2 = 0.89) whereas in white Europeans FFAs were negatively correlated with total step counts (r2 = 0.96). In conclusion, South Asians exhibited a different FFA profile, lower ghrelin, higher leptin, impaired CVD and T2D risk markers and lower cardiorespiratory fitness than white Europeans.
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Knox A, Sculthorpe N, Grace F. Caucasian and south Asian men show equivalent improvements in surrogate biomarkers of cardiovascular and metabolic health following 6-weeks of supervised resistance training. F1000Res 2019; 7:1334. [PMID: 30918627 PMCID: PMC6419981 DOI: 10.12688/f1000research.15376.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2019] [Indexed: 11/20/2022] Open
Abstract
Background: The South Asian population have greater cardiovascular risk than their age-matched Caucasian counterparts, characterized by unfavorable biomarkers. South Asians may also be partially resistant to the pleiotropic benefits of physical activity on cardiovascular health. There is a current absence of studies that compare markers of cardio-metabolic health between Caucasians and South Asians employing resistance exercise. This study set out to compare the response in biomarkers of cardio-metabolic health in Caucasians and South Asians in response to resistance exercise. Methods: Caucasian (n=15, 25.5 ± 4.8 yrs) and South Asian (n=13, 25.4 ± 7.0 yrs) males completed a 6-week progressive resistance exercise protocol. Fasting blood glucose, insulin, and their product insulin resistance (HOMA-IR), triglycerides (TRIGS), low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (TC), vascular endothelial growth factor (VEGF), asymmetric dimythylarginine (ADMA), L-arginine (L-ARG) and C-reactive protein (CRP) were established at baseline and following resistance exercise. Results: There were significant improvements in fasting glucose, TC, LDL, HDL and VEGF in both groups following resistance exercise ( p<0.05, for all). No change was observed in insulin, HOMA-IR, TRIGS, ADMA, L-ARG following resistance exercise ( p>0.05, in both groups). CRP increased in the South Asian group ( p<0.05) but not the Caucasian group ( p>0.05) Conclusions: The cardio-metabolic response to resistance exercise is comparable in young Caucasian and South Asian males though inflammatory response to exercise may be prolonged in South Asians.
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Affiliation(s)
- Allan Knox
- Exercise Science Department, California Lutheran University, Thousand Oaks, CA, 91360, USA
| | - Nicholas Sculthorpe
- Institute of Clinical Exercise and Health Science, University of the West of Scotland, Hamilton, South Lanarkshire, ML3 0JB, UK
| | - Fergal Grace
- School of Health Science and Psychology, Federation University, Ballarat, Victoria, 3350, Australia
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Mahdavi S, Jenkins DJA, El-Sohemy A. Genetic variation in 9p21 is associated with fasting insulin in women but not men. PLoS One 2018; 13:e0202365. [PMID: 30138332 PMCID: PMC6107190 DOI: 10.1371/journal.pone.0202365] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 08/01/2018] [Indexed: 12/13/2022] Open
Abstract
Background Single nucleotide polymorphisms (SNPs) in the 9p21 region have been associated with cardiovascular disease (CVD), but previous studies have focussed on older populations. The objective of this study was to determine the association between 9p21 genotypes and biomarkers of CVD risk in young adults from different ethnocultural groups. Methods Subjects were 1,626 participants aged 20–29 years from the Toronto Nutrigenomics and Health Study. Fasting blood was collected to measure glucose, insulin, c-reactive protein and serum lipids, as well as to isolate DNA for genotyping subjects for five SNPs in 9p21. Analyses were conducted for the entire population and separately for women (n = 1,109), men (n = 517), Caucasians (n = 771), East Asians (n = 561) South Asians (n = 175) and Others (n = 119). ANOVA and ANCOVA were used to examine if 9p21 genotypes were associated with biomarkers of CVD risk. Results In the entire group, the risk alleles of rs10757278 and rs2383206 were associated with higher mean insulin (p = 0.01). Risk alleles for rs4977574, rs10757278, rs2383206, rs1333049 and rs10757274 were associated with higher serum insulin in women (p = 0.008, p = 0.008, p = 0.0003, p = 0.002, and p = 0.001, respectively), but not in men (p = 0.41, p = 0.13, p = 0.31, p = 0.34, and 0.35, respectively). The association between 9p21 and insulin remained significant among women not taking hormonal contraceptives (HC), but was not significant among women taking HCs. Conclusion Our findings suggest that 9p21 genotypes may play a role in the development of insulin resistance in early adulthood among women, but not men, and the effects appear to be attenuated by HC use.
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Affiliation(s)
- Sara Mahdavi
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David J. A. Jenkins
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Risk Factor Modification Centre and Division of Endocrinology and Metabolism, St. Michael's Hospital, St. Michael's Health Centre, Toronto, Ontario, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Ujka K, Bruno RM, Bastiani L, Bernardi E, Sdringola P, Dikic N, Basyal B, Bhandari SS, Basnyat B, Cogo A, Pratali L. Relationship Between Occupational Physical Activity and Subclinical Vascular Damage in Moderate-Altitude Dwellers. High Alt Med Biol 2017; 18:249-257. [PMID: 28876129 DOI: 10.1089/ham.2016.0104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Ujka, Kristian, Rosa Maria Bruno, Luca Bastiani, Eva Bernardi, Paolo Sdringola, Nenad Dikic, Bikash Basyal, Sanjeeb Sundarshan Bhandari, Buddha Basnyat, Annalisa Cogo, and Lorenza Pratali. Relationship between occupational physical activity and subclinical vascular damage in moderate-altitude dwellers. High Alt Med Biol. 18:249-257, 2017. BACKGROUND Occupational physical activity (OPA) has been associated with increased cardiovascular (CV) events. The aim of this study was to investigate the association between OPA and markers of subclinical vascular damage among a moderate-altitude population living in the rural village of Chaurikharka (Nepal; 2600 m sea level). METHODS Seventy-two individuals (age 42 ± 15 years, ranges 15-85 years, 23 men) were enrolled. Physical activity (PA) was evaluated using the International Physical Activity Questionnaire (IPAQ). Carotid-femoral pulse wave velocity (PWV), carotid ultrasound assessment, and flow-mediated dilation (FMD) were performed. RESULTS OPA was 9860 ± 5385 Metabolic Equivalent of Task (MET)-minutes/week, representing 77% of total energy expenditure, with 97% of the population performing high-intensity PA. In the univariate analysis, OPA was significantly associated with PWV (β = 0.474, p = 0.001) and carotid stiffness (CS) (β = 0.29, p = 0.019). In the multivariate analysis, including age, sex, oxygen saturation, mean blood pressure, low-density lipoprotein (LDL), and OPA, OPA remained an independent predictor of PWV (β = 0.403, p = 0.001) but not of CS (β = 0.028, p = 0.8). OPA remained an independent predictor of PWV independently from the Framingham risk score (FRS). CONCLUSION High-intensity OPA shows a positive, independent association with aortic stiffness in Himalayan moderate-altitude dwellers. This study suggests how vigorous OPA performed in moderate altitude may be a CV risk factor.
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Affiliation(s)
- Kristian Ujka
- 1 Institute of Clinical Physiology-CNR , Pisa, Italy
| | - Rosa Maria Bruno
- 1 Institute of Clinical Physiology-CNR , Pisa, Italy .,2 Department of Clinical and Experimental Medicine, University of Pisa , Pisa, Italy
| | - Luca Bastiani
- 1 Institute of Clinical Physiology-CNR , Pisa, Italy
| | - Eva Bernardi
- 3 Department of Clinical and Experimental Medicine, University of Ferrara , Ferrara, Italy
| | - Paolo Sdringola
- 4 Department of Engineering, University of Perugia , Perugia, Italy
| | | | | | | | | | - Annalisa Cogo
- 3 Department of Clinical and Experimental Medicine, University of Ferrara , Ferrara, Italy
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The role of free kappa and lambda light chains in the pathogenesis and treatment of inflammatory diseases. Biomed Pharmacother 2017; 91:632-644. [DOI: 10.1016/j.biopha.2017.04.121] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 04/08/2017] [Accepted: 04/27/2017] [Indexed: 12/12/2022] Open
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Mackay MH, Singh R, Boone RH, Park JE, Humphries KH. Outcomes following percutaneous coronary revascularization among South Asian and Chinese Canadians. BMC Cardiovasc Disord 2017; 17:101. [PMID: 28420368 PMCID: PMC5395833 DOI: 10.1186/s12872-017-0535-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 04/12/2017] [Indexed: 01/09/2023] Open
Abstract
Background Previous data suggest significant ethnic differences in outcomes following percutaneous coronary revascularization (PCI), though previous studies have focused on subgroups of PCI patients or used administrative data only. We sought to compare outcomes in a population-based cohort of men and women of South Asian (SA), Chinese and “Other” ethnicity. Methods Using a population-based registry, we identified 41,792 patients who underwent first revascularization via PCI in British Columbia, Canada, between 2001 and 2010. We defined three ethnic groups (SA, 3904 [9.3%]; Chinese, 1345 [3.2%]; and all “Others” 36,543 [87.4%]). Differences in mortality, repeat revascularization (RRV) and target vessel revascularization (TVR), at 30 days and from 31 days to 2 years were examined. Results Adjusted mortality from 31 days to 2 years was lower in Chinese patients than in “Others” (hazard ratio [HR] 0.72; 95% confidence interval [CI] 0.53-0.97), but not different between SAs and “Others”. SA patients had higher RRV at 30 days (adjusted odds ratio [OR] 1.30; 95% CI: 1.12-1.51) and from 31 days to 2 years (adjusted hazard ratio [HR] 1.17; 95% CI: 1.06-1.30) compared to “Others”. In contrast, Chinese patients had a lower rate of RRV from 31 days to 2 years (adjusted HR 0.79; 95% CI: 0.64-0.96) versus “Others”. SA patients also had higher rates of TVR at 30 days (adjusted OR 1.35; 95% CI: 1.10-1.66) and from 31 days to 2 years (adjusted HR 1.19; 95% CI: 1.06-1.34) compared to “Others”. Chinese patients had a lower rate of TVR from 31 days to 2 years (adjusted HR 0.76; 95% CI: 0.60-0.96). Conclusions SA had higher RRV and TVR rates while Chinese Canadians had lower rates of long-term RRV, compared to those of “Other” ethnicity. Further research to elucidate the reasons for these differences could inform targeted strategies to improve outcomes.
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Affiliation(s)
- Martha H Mackay
- School of Nursing, University of British Columbia, and St. Paul's Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Robinder Singh
- Faculty of Medicine, University of Manitoba and St. Boniface Hospital, Winnipeg, Canada
| | - Robert H Boone
- Division of Cardiology, University of British Columbia and St. Paul's Hospital, Vancouver, Canada
| | - Julie E Park
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, Canada
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Athyros VG, Mikhailidis DP. High incidence of metabolic syndrome further increases cardiovascular risk in patients with type 2 diabetes. Implications for everyday practice. J Diabetes Complications 2016; 30:9-11. [PMID: 26275865 DOI: 10.1016/j.jdiacomp.2015.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Vasilios G Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, Vascular Prevention Clinics, Royal Free Hospital Campus, University College Medical School, University College London, London, UK
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Arjunan SP, Deighton K, Bishop NC, King J, Reischak-Oliveira A, Rogan A, Sedgwick M, Thackray AE, Webb D, Stensel DJ. The effect of prior walking on coronary heart disease risk markers in South Asian and European men. Eur J Appl Physiol 2015; 115:2641-51. [DOI: 10.1007/s00421-015-3269-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
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Ahmed E, El-Menyar A. Management of Coronary Artery Disease in South Asian Populations: Why and How to Prevent and Treat Differently. Angiology 2015; 67:212-23. [PMID: 25969568 DOI: 10.1177/0003319715585663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The South Asian (SA) population constitutes one of the largest ethnic groups in the world. Several studies that compared host and migrant populations around the world indicate that SAs have a higher risk of developing cardiovascular disease (CVD) than their native-born counterparts. Herein, we review the literature to address the role of the screening tools, scoring systems, and guidelines for primary, secondary, and tertiary prevention in these populations. Management based on screening for the CVD risk factors in a high-risk population such as SAs can improve health care outcomes. There are many scoring tools for calculating 10-year CVD risk; however, each scoring system has its limitations in this particular ethnicity. Further work is needed to establish a unique scoring and guidelines in SAs.
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Affiliation(s)
- Emad Ahmed
- Department of Adult Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical School, Qatar Clinical Research, Trauma Section, Hamad Medical Corporation (HMC), Qatar Internal Medicine, Cardiology Section, Ahmed Maher Teaching Hospital, Egypt
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Boon MR, Bakker LEH, van der Linden RAD, van Ouwerkerk AF, de Goeje PL, Counotte J, Jazet IM, Rensen PCN. High prevalence of cardiovascular disease in South Asians: Central role for brown adipose tissue? Crit Rev Clin Lab Sci 2015; 52:150-7. [PMID: 25955567 DOI: 10.3109/10408363.2014.1003634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death in modern society. Interestingly, the risk of developing CVD varies between different ethnic groups. A particularly high risk is faced by South Asians, representing over one-fifth of the world's population. Here, we review potential factors contributing to the increased cardiovascular risk in the South Asian population and discuss novel therapeutic strategies based on recent insights. In South Asians, classical ('metabolic') risk factors associated with CVD are highly prevalent and include central obesity, insulin resistance, type 2 diabetes, and dyslipidemia. A contributing factor that may underlie the development of this disadvantageous metabolic phenotype is the presence of a lower amount of brown adipose tissue (BAT) in South Asian subjects, resulting in lower energy expenditure and lower lipid oxidation and glucose uptake. As it has been established that the increased prevalence of classical risk factors in South Asians cannot fully explain their increased risk for CVD, other non-classical risk factors must underlie this residual risk. In South Asians, the prevalence of "inflammatory" risk factors including visceral adipose tissue inflammation, endothelial dysfunction, and HDL dysfunction are higher compared with Caucasians. We conclude that a potential novel therapy to lower CVD risk in the South Asian population is to enhance BAT volume or its activity in order to diminish classical risk factors. Furthermore, anti-inflammatory therapy may lower non-classical risk factors in this population and the combination of both strategies may be especially effective.
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Huo Y, Thompson P, Buddhari W, Ge J, Harding S, Ramanathan L, Reyes E, Santoso A, Tam LW, Vijayaraghavan G, Yeh HI. Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group. Int J Cardiol 2014; 183:63-75. [PMID: 25662044 DOI: 10.1016/j.ijcard.2014.11.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/26/2022]
Abstract
Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
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Affiliation(s)
| | - Yong Huo
- Peking University First Hospital, Beijing, China.
| | - Peter Thompson
- University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Wacin Buddhari
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Scott Harding
- Wellington Cardiovascular Research Group and School of Biological Sciences, Victoria University, Wellington, New Zealand
| | | | - Eugenio Reyes
- University of the Philippines, Philippine General Hospital-Section of Cardiology, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology - Vascular Medicine, Faculty of Medicine, University of Indonesia and National Cardiovascular Center, Harapan Kita, Indonesia
| | | | | | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
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Tziomalos K, Athyros VG, Karagiannis A. Cardiovascular Risk in Middle East Populations. Angiology 2014; 66:801-2. [DOI: 10.1177/0003319714557540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Asterios Karagiannis
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Abstract
South Asians (SAs), in their countries or after migration, are at high risk of coronary artery disease (CAD) and mortality compared to other ethnic groups. It has been shown that >90% of CAD global risk could be attributed to 9 modifiable risk factors (RFs) worldwide. However, these conventional RFs may not fully explain this high risk of CAD among SAs. Therefore, attention has been directed toward nonconventional RFs. In this narrative review, we evaluate the conventional and emerging cardiovascular RFs characterizing SAs. These factors may explain the high morbidity and mortality among SAs. Further prospective studies are urgently needed to set algorithms for the optimal management of these RFs in high-risk populations like SAs.
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Affiliation(s)
- Emad Ahmed
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Cardiology Department, National Heart Institute, Cairo, Egypt
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
- Clinical Research, Hamad General Hospital, Doha, Qatar
- Cardiology Unit, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
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Bellary S, Faint JM, Assi LK, Hutchison CA, Harding SJ, Raymond NT, Barnett AH. Elevated serum free light chains predict cardiovascular events in type 2 diabetes. Diabetes Care 2014; 37:2028-30. [PMID: 24742658 DOI: 10.2337/dc13-2227] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Elevated polyclonal serum immunoglobulin free light chains (FLCs; combined FLCκ+FLCλ [cFLC]) are associated with adverse clinical outcomes and increased mortality; we investigated cFLC and cardiovascular disease (CVD) events in type 2 diabetes. RESEARCH DESIGN AND METHODS In a cohort study of 352 south Asian patients with type 2 diabetes, serum cFLC, high-sensitivity C-reactive protein (hsCRP), and standard biochemistry were measured. CVD events over 2 years were recorded and assessed using multiple logistic regression. RESULTS cFLC levels were elevated significantly in 29 of 352 (8%) patients with CVD events during 2 years of follow-up (50.7 vs. 42.8 mg/L; P = 0.004). In multivariate analysis, elevated cFLC (>57.2 mg/L) was associated with CVD outcomes (odds ratio 3.3 [95% CI 1.3-8.2]; P = 0.012) and remained significant after adjusting for age, albumin-to-creatinine ratio, diabetes duration, or treatment. CONCLUSIONS cFLC elevation is a novel marker for CVD outcomes in type 2 diabetes that warrants further investigation.
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Affiliation(s)
- Srikanth Bellary
- Aston Research Centre for Healthy Ageing, Aston University, Birmingham, U.K.Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham, U.K.
| | | | | | | | | | - Neil T Raymond
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, U.K
| | - Anthony H Barnett
- Diabetes Centre, Heart of England NHS Foundation Trust, Birmingham, U.K.University of Birmingham, Birmingham, U.K
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Panidis D, Tziomalos K, Papadakis E. Metabolic syndrome in patients with the polycystic ovary syndrome. Expert Rev Endocrinol Metab 2013; 8:559-568. [PMID: 30736140 DOI: 10.1586/17446651.2013.853451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Polycystic ovary syndrome (PCOS) is frequently characterized by abdominal obesity and insulin resistance, which also represent the hallmarks of the metabolic syndrome (MetS). It is well established that MetS is associated with increased risk for both Type 2 diabetes mellitus and cardiovascular disease (CVD) and accumulating data suggest that PCOS is also a risk factor for Type 2 diabetes mellitus and CVD. Accordingly, the association of PCOS with MetS has major health care implications given also the high prevalence of both disorders. We aimed to critically analyze the major studies that compared the prevalence of MetS between women with PCOS and controls, to discuss the anthropometric, endocrine and metabolic characteristics of PCOS, which are implicated in the pathogenesis of Mets in women with PCOS and to comment on the implications and management of MetS in this population. We thus summarize the evidence regarding the prevalence of MetS in PCOS and discuss the primary determinants driving this association. Current evidence shows that MetS is frequently observed in women with PCOS, but this appears to be mainly due to the more pronounced abdominal obesity in these women and not due to PCOS per se. Lifestyle changes are the treatment of choice for MetS in women with PCOS, whereas pharmacotherapy should be individualized.
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Affiliation(s)
- Dimitrios Panidis
- a Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration Hospital, Division of Endocrinology and Human Reproduction, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- b First Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Efstathios Papadakis
- a Second Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Hippokration Hospital, Division of Endocrinology and Human Reproduction, Thessaloniki, Greece
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22
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Baker J, Mitchell R, Lawson K, Pell J. Ethnic differences in the cost-effectiveness of targeted and mass screening for high cardiovascular risk in the UK: cross-sectional study. Heart 2013; 99:1766-71. [DOI: 10.1136/heartjnl-2013-304625] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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ARJUNAN SARAVANAPILLAI, BISHOP NICOLETTECLAIRE, REISCHAK-OLIVEIRA ALVARO, STENSEL DAVIDJOHN. Exercise and Coronary Heart Disease Risk Markers in South Asian and European Men. Med Sci Sports Exerc 2013; 45:1261-8. [DOI: 10.1249/mss.0b013e3182853ecf] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Vibha D, Prasad K. Cerebrovascular disease in South Asia - Part II: Risk factors and prevention. JRSM Cardiovasc Dis 2012; 1:cvd.2012.012026. [PMID: 24175078 PMCID: PMC3738370 DOI: 10.1258/cvd.2012.012026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In South Asian countries, conventional vascular risk factors like hypertension, diabetes mellitus, cardiac disease, smoking, obesity, atrial fibrillation are the dominant ones, while other aetiologies like rheumatic heart disease, infective meningitis-related infarcts and postpartum cerebral venous thrombosis also constitute a big fraction. This review discusses the evidence of prevalence of various risk factors in South Asian countries and possible measures to combat the rising burden of cerebrovascular disease. The last part of the review discusses prevention and identification of risk factors that are unique to or especially found in patient population of South Asia.
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Affiliation(s)
| | - Kameshwar Prasad
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Prasad K, Vibha D, Meenakshi. Cerebrovascular disease in South Asia - Part I: A burning problem. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012025. [PMID: 24175076 PMCID: PMC3738368 DOI: 10.1258/cvd.2012.012025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Stroke is a non-communicable disease of increasing socioeconomic importance in ageing populations. According to the World Health Organization, stroke was the second most common cause of worldwide mortality. In South Asian countries demographic changes, urbanization and increased exposure to major stroke risk factors will fuel the stroke burden in the future. The prevalence of stroke in India is 44–843/100,000 (from community-based studies), 500–2000/100,000 in Bangladesh, 218/100,000 in Pakistan and 1000/100,000 in Sri Lanka and community-based prevalence studies in these countries are still lacking. There are no data on stroke prevalence from Nepal. Incidence studies are still less and an Indian study reported an incidence of 145/100,000. Incidence studies from other South Asian countries are lacking. This review attempts to give an overview of the evidence so far on the burden of stroke in this part of the globe.
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Affiliation(s)
- Kameshwar Prasad
- Department of Neurology, Neurosciences Centre, All India Institute of Medical Sciences , New Delhi , India
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Garduño-Diaz SD, Khokhar S. Prevalence, risk factors and complications associated with type 2 diabetes in migrant South Asians. Diabetes Metab Res Rev 2012; 28:6-24. [PMID: 21591242 DOI: 10.1002/dmrr.1219] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
It is estimated that type 2 diabetes (T2D) currently affects about 246 million people worldwide, with South Asians, especially Indians, having both the largest number of cases and the fastest growing prevalence. South Asian ethnicity has been identified as a major risk factor for the development of T2D with central adiposity, insulin resistance and an unfavourable lipid profile being identified as predominant signals of alarm. Leading databases, including Web of Science, Medline, PubMed and Science Direct, were consulted and manual searches were conducted for cited references in leading diabetes-related journals. In all, 152 articles were included for the final assessment reported in this review. Genetic predisposition, central adiposity and unfavourable lifestyle, including physical inactivity and an unhealthy diet, were associated with the prevalence of T2D in migrant South Asians. 'Westernization', acculturation, socio-economic factors and lack of knowledge about the disease have also been identified as contributors to the development of T2D in this population. Higher prevalence of T2D in migrant South Asians may not be entirely attributed to genetic predisposition; hence, ethnicity and associated modifiable risk factors need further investigation. Preventive measures and appropriate interventions are currently limited by the lack of ethnic-specific cut-off points for anthropometric and biological markers, as well as by the absence of reliable methods for dietary and physical activity assessment. This article describes the prevalence rate, risk factors and complications associated with T2D in migrant South Asians living in different countries.
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Gupta LS, Wu CC, Young S, Perlman SE. Prevalence of diabetes in New York City, 2002-2008: comparing foreign-born South Asians and other Asians with U.S.-born whites, blacks, and Hispanics. Diabetes Care 2011; 34:1791-3. [PMID: 21715521 PMCID: PMC3142031 DOI: 10.2337/dc11-0088] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe diabetes prevalence in New York City by race/ethnicity and nativity. RESEARCH DESIGN AND METHODS Data were from the New York City 2002-2008 Community Health Surveys. Respondents were categorized on the basis of self-reported race/ethnicity and birth country: foreign-born South Asian (Indian subcontinent), foreign-born other Asian, U.S.-born non-Hispanic black, U.S.-born non-Hispanic white, and U.S.-born Hispanic. Diabetes status was defined by self-reported provider diagnosis. Multivariable models examined diabetes prevalence by race/ethnicity and birth country. RESULTS Prevalence among foreign-born South Asians was nearly twice that of foreign-born other Asians (13.6 vs. 7.4%, P = 0.001). In multivariable analyses, normal-BMI foreign-born South Asians had nearly five times the diabetes prevalence of comparable U.S.-born non-Hispanic whites (14.1 vs. 2.9%, P < 0.001) and 2.5 times higher prevalence than foreign-born other Asians (P < 0.001). CONCLUSIONS Evaluating Asians as one group masks the higher diabetes burden among South Asians. Researchers and clinicians should be aware of differences in this population.
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Affiliation(s)
- Leena S Gupta
- New York City Department of Health and Mental Hygiene, New York, NY, USA.
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Koh AS, Khin LW, Choi LM, Sim LL, Chua TS, Koh TH, Tan JW, Chia S. Percutaneous coronary intervention in Asians--are there differences in clinical outcome? BMC Cardiovasc Disord 2011; 11:22. [PMID: 21605387 PMCID: PMC3114787 DOI: 10.1186/1471-2261-11-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Accepted: 05/23/2011] [Indexed: 11/17/2022] Open
Abstract
Background Ethnic differences in clinical outcome after percutaneous coronary intervention (PCI) have been reported. Data within different Asian subpopulations is scarce. We aim to explore the differences in clinical profile and outcome between Chinese, Malay and Indian Asian patients who undergo PCI for coronary artery disease (CAD). Methods A prospective registry of consecutive patients undergoing PCI from January 2002 to December 2007 at a tertiary care center was analyzed. Primary endpoint was major adverse cardiovascular events (MACE) of myocardial infarction (MI), repeat revascularization and all-cause death at six months. Results 7889 patients underwent PCI; 7544 (96%) patients completed follow-up and were included in the analysis (79% males with mean age of 59 years ± 11). There were 5130 (68%) Chinese, 1056 (14%) Malays and 1001 (13.3%) Indian patients. The remaining 357 (4.7%) patients from other minority ethnic groups were excluded from the analysis. The primary end-point occurred in 684 (9.1%) patients at six months. Indians had the highest rates of six month MACE compared to Chinese and Malays (Indians 12% vs. Chinese 8.2% vs. Malays 10.7%; OR 1.55 95%CI 1.24-1.93, p < 0.001). This was contributed by increased rates of MI (Indians 1.9% vs. Chinese 0.9% vs. Malays 1.3%; OR 4.49 95%CI 1.91-10.56 p = 0.001), repeat revascularization (Indians 6.5% vs. Chinese 4.1% vs. Malays 5.1%; OR 1.64 95%CI 1.22-2.21 p = 0.0012) and death (Indians 11.4% vs. Chinese 7.6% vs. Malays 9.9%; OR 1.65 95%CI 1.23-2.20 p = 0.001) amongst Indian patients. Conclusion These data indicate that ethnic variations in clinical outcome exist following PCI. In particular, Indian patients have higher six month event rates compared to Chinese and Malays. Future studies are warranted to elucidate the underlying mechanisms behind these variations.
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Jaumdally RJ, Lip GYH, Varma C, Blann AD. Impact of High-Dose Atorvastatin on Endothelial, Platelet, and Angiogenic Indices. Angiology 2011; 62:571-8. [DOI: 10.1177/0003319711401904] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lipid lowering with statins improves morbidity and mortality, particularly in diabetics, and may have additional nonlipid effects. South Asians (SAs) are at higher risk of cardiovascular disease and diabetes compared with white Europeans (WEs). We hypothesized that abnormal endothelial (marked by von Willebrand factor), angiogenesis (VEGF, angiopoietins 1 and 2) and platelet function (soluble P selectin, soluble CD40L) improve with statin treatment in diabetics in different ethnic groups. Plasma was obtained before and 8 weeks after treatment with atorvastatin (80 mg/day) by SAs and WEs with or without diabetes. Research indices were measured by enzyme-linked-immunosorbent assay (ELISA). Treatment increased angiopoietin-2 ( P < .04) in all groups regardless of diabetes or ethnicity. In those free of diabetes, angiopoietin-2 increased 3-fold, whereas in diabetes, it increased 2-fold. We suggest that an additional effect of statins is to increase levels of growth factor angiopoietin-2 in the direction of normality. This effect is weaker in participants with diabetes.
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Affiliation(s)
- Rumi J. Jaumdally
- Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Gregory Y. H. Lip
- Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Chetan Varma
- Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - Andrew D. Blann
- Haemostasis, Thrombosis and Vascular Biology Unit, University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK
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Jain A, Persaud JW, Rao N, Harvey D, Robertson L, Nirmal L, Nirmal D, Thomas M, Mikhailidis DP, Nair DR. Point of care testing is appropriate for National Health Service health check. Ann Clin Biochem 2011; 48:159-65. [PMID: 21355015 DOI: 10.1258/acb.2010.010195] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Department of Health launched a cardiovascular disease risk assessment initiative with particular reference to reducing health inequalities in ethnic minorities. Collaboration between HEART UK, Royal Free Hampstead NHS Trust and Hindu Temples resulted in vascular screening in North London. METHODS Subjects of South Asian origin were screened. A full lipid profile and glucose were measured using a point of care testing (POCT) Cholestech LDX analyser (LDX). Venous samples were analysed in our hospital laboratory. RESULTS The results (215 men; 191 women) were divided into tertiles and Bland-Altman plots were used to assess agreement. At high-density lipoprotein cholesterol (HDL-C) concentrations < 1.0 mmol/L the LDX underestimated values by -0.2 mmol/L (P<0.0001). At HDL-C concentrations >1.3 mmol/L this bias disappeared. For total cholesterol the concentration-dependent negative bias was evident at concentrations of < 4.1 mmol/L (P < 0.0001). This bias was less evident at higher concentrations. A similar pattern was seen for low-density lipoprotein cholesterol. There were also small variations in glucose and triglyceride values. However, there was excellent agreement in calculated cardiovascular disease risk using kappa analysis for JBS2, QRISK2, ETHRISK and Framingham (κ = 0.86, 0.92, 0.94 and 0.88, respectively). This was a high-risk population since 9.7-19.4% had a ≥ 20% 10-y probability of a vascular event depending on the risk engine and assay method used. The corresponding values for intermediate risk (11-19%) were 18.6-25.7%. CONCLUSIONS There was a minimum mismatch irrespective of the type of risk calculator used. POCT measurements are adequate for the National Health Service Health Check.
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Affiliation(s)
- Anjly Jain
- Department of Clinical Biochemistry, The Royal Free Hampstead NHS Trust, London NW32QG, UK
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Jones GL, Palep-Singh M, Ledger WL, Balen AH, Jenkinson C, Campbell MJ, Lashen H. Do South Asian women with PCOS have poorer health-related quality of life than Caucasian women with PCOS? A comparative cross-sectional study. Health Qual Life Outcomes 2010; 8:149. [PMID: 21171983 PMCID: PMC3024276 DOI: 10.1186/1477-7525-8-149] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 12/20/2010] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is the most common chronic endocrine disorder affecting women of reproductive age. This study aimed to compare the HRQoL of South Asian and white Caucasian women with PCOS, given that it is particularly common among women of South Asian origin and they have been shown to have more severe symptoms. METHODS The Polycystic Ovary Syndrome Questionnaire (PCOSQ) and the Short Form-36 (SF-36) were administered in a cross-sectional survey to 42 South Asian and 129 Caucasian women diagnosed with PCOS recruited from the gynaecology outpatient clinics of two university teaching hospitals in Sheffield and Leeds. Additional clinical data was abstracted from medical notes. Normative data, collected as part of the Oxford Health and Lifestyles II survey, was obtained to compare SF-36 results with ethnically matched women from the general UK population. Using the SF-36, normative HRQoL scores for women of South Asian origin were lower than for Caucasian women. Given this lower baseline we tested whether the same relationship holds true among those with PCOS. RESULTS Although HRQoL scores for women with PCOS were lower than normative data for both groups, South Asian women with PCOS did not have poorer HRQoL than their Caucasian counterparts. For both the SF-36 and PCOSQ, mean scores were broadly the same for both Asian and Caucasian women. For both groups, the worst two HRQoL domains as measured on the PCOSQ were 'infertility' and 'weight', with respective scores of 35.3 and 42.3 for Asian women with PCOS compared to 38.6 and 35.4 for Caucasian women with PCOS. The highest scoring domain for South Asian women with PCOS was 'menstrual problems' (55.3), indicating best health, and was the only statistically significant difference from Caucasian women (p = 0.01). On the SF-36, the lowest scoring domain was 'Energy & Vitality' for Caucasian women with PCOS, but this was significantly higher for Asian women with PCOS (p = 0.01). The best health status for both groups was 'physical functioning', although this was significantly lower for South Asian women with PCOS (p = 0.005). Interestingly, only two domains differed significantly from the normative data for the Asian women with PCOS, while seven domains were significantly different for the Caucasian women with PCOS compared to their normative counterparts. CONCLUSIONS The HRQoL differences that exist between South Asian and Caucasian women in the general population do not appear to be replicated amongst women with PCOS. PCOS reduces HRQoL to broadly similar levels, regardless of ethnicity and differences in the normative baseline HRQoL of these groups.
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Affiliation(s)
- Georgina L Jones
- Senior Lecturer, Health Services Research Section, ScHARR, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Manisha Palep-Singh
- Consultant Gynaecologist & Subspecialist in Reproductive Medicine & Surgery, Saint Mary's University Teaching Hospital & CMMC NHS Trust, Manchester, M13 0JH, UK
| | - William L Ledger
- Professor, Academic Unit of Reproductive & Developmental Medicine, Jessop Wing Hospital, Tree Root Walk, Sheffield, S10 2TJ, UK
| | - Adam H Balen
- Professor, United Leeds Teaching Hospitals, Clarendon Wing, Leeds General Infirmary, LS2 9NS, UK
| | - Crispin Jenkinson
- Professor, Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Michael J Campbell
- Professor, Medical Statistics Unit, ScHARR, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Hany Lashen
- Senior Lecturer, Academic Unit of Reproductive & Developmental Medicine, Jessop Wing Hospital, Tree Root Walk, Sheffield, S10 2TJ, UK
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Athyros VG, Tziomalos K, Karagiannis A, Mikhailidis DP. Lipid-lowering agents and new onset diabetes mellitus. Expert Opin Pharmacother 2010; 11:1965-70. [PMID: 20486831 DOI: 10.1517/14656566.2010.489553] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Statin treatment (and possibly niacin when given alone or in combination with statins) appears to be associated with a slightly increased risk of new onset diabetes mellitus (NODM). However, statin induced cardiovascular disease (CVD) risk reduction is greater in patients with DM than in non-diabetic patients in several survival studies. Thus, statin treatment outweighs any potential increase in CVD risk related to NODM and in high-risk Caucasian patients present clinical practice should not change. However, the risk/benefit ratio of treatment might not be as favourable in subjects with propensity to develop DM such as the elderly and in subjects of Asian ethnicity. Colesevelam was shown to improve both glycaemic control and lipid profile in inadequately controlled T2DM and might reduce the risk for NODM. There are no data on the incidence of NODM in fibrate-treated non-diabetic patients. Prospective studies are needed to clarify these issues.
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Katsiki N, Mikhailidis DP, Athyros VG, Hatzitolios AI, Karagiannis A, Banach M. Are we getting to lipid targets in real life? Arch Med Sci 2010; 6:639-41. [PMID: 22419917 PMCID: PMC3298327 DOI: 10.5114/aoms.2010.17073] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 09/04/2010] [Indexed: 11/17/2022] Open
Affiliation(s)
- Niki Katsiki
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London, London, United Kingdom
- 1 Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London, London, United Kingdom
| | - Vasilis G Athyros
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I. Hatzitolios
- 1 Propedeutic Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Asterios Karagiannis
- 2 Propedeutic Department of Internal Medicine, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Lodz, Poland
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Abstract
PURPOSE OF REVIEW To provide an update of the literature describing the link between lipoprotein a and vascular disease. RECENT FINDINGS There is evidence that elevated plasma lipoprotein a levels are associated with coronary heart disease, stroke and other manifestations of atherosclerosis. Several mechanisms may be implicated, including proinflammatory actions and impaired fibrinolysis. SUMMARY Lipoprotein a potentially represents a useful tool for risk stratification in the primary and secondary prevention setting. However, there are still unresolved methodological issues regarding the measurement of lipoprotein a levels. Targeting lipoprotein a in order to reduce vascular risk is hampered by the lack of well tolerated and effective pharmacological interventions. Moreover, it has not yet been established whether such a reduction will result in fewer vascular events. The risk attributed to lipoprotein a may be reduced by aggressively tackling other vascular risk factors, such as low-density lipoprotein cholesterol.
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Congdon P. Estimating prevalence of coronary heart disease for small areas using collateral indicators of morbidity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:164-77. [PMID: 20195439 PMCID: PMC2819782 DOI: 10.3390/ijerph7010164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 01/14/2010] [Indexed: 11/16/2022]
Abstract
Different indicators of morbidity for chronic disease may not necessarily be available at a disaggregated spatial scale (e.g., for small areas with populations under 10 thousand). Instead certain indicators may only be available at a more highly aggregated spatial scale; for example, deaths may be recorded for small areas, but disease prevalence only at a considerably higher spatial scale. Nevertheless prevalence estimates at small area level are important for assessing health need. An instance is provided by England where deaths and hospital admissions for coronary heart disease are available for small areas known as wards, but prevalence is only available for relatively large health authority areas. To estimate CHD prevalence at small area level in such a situation, a shared random effect method is proposed that pools information regarding spatial morbidity contrasts over different indicators (deaths, hospitalizations, prevalence). The shared random effect approach also incorporates differences between small areas in known risk factors (e.g., income, ethnic structure). A Poisson-multinomial equivalence may be used to ensure small area prevalence estimates sum to the known higher area total. An illustration is provided by data for London using hospital admissions and CHD deaths at ward level, together with CHD prevalence totals for considerably larger local health authority areas. The shared random effect involved a spatially correlated common factor, that accounts for clustering in latent risk factors, and also provides a summary measure of small area CHD morbidity.
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Affiliation(s)
- Peter Congdon
- Department of Geography and Centre for Statistics, Queen Mary University of London, Mile End Rd, London E1 4NS, UK.
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