Prevalence of cardiovascular disease risk factors in Tallinn, Estonia

Effectiveness and feasibility of cardiovascular disease personalized prevention on high polygenic risk score subjects: a randomized controlled pilot study

Aims

The aim of this study was to evaluate the effect of the intervention by proactively sharing a patient's high polygenic risk score (PRS) for coronary artery disease (CAD). Outcomes included: (i) reduction in cardiovascular disease (CVD) risk factors over 12 months; (ii) difference in purchased prescriptions of lipid-lowering and anti-hypertensive drugs between intervention group and control group subjects; and (iii) opinion of the participating physicians and subjects on PRS usefulness.

Methods and results

This randomized controlled trial was conducted among middle-aged subjects with a top 20% CAD PRS in a family medicine setting. Participants were selected from 26 953 Estonian Biobank cohort participants. Subjects were informed and counselled about their PRS score and CAD risk using the visual tool at baseline (Visit I), counselling session (Visit II), and on the final Visit III at 12 months. The primary endpoint was not significantly different. However, the intervention group participants had a significantly higher probability of initiating statin treatment compared with the controls. Their levels of LDL-cholesterol (LDL-C) were significantly decreased compared with baseline on Visit III and significantly lower than in the control group. The vast majority of participating family physicians believe that finding out about genetic risks will affect the subject's lifestyle and medication compliance.

Conclusion

Most of our outcome measures were in favour of this intervention. Participants achieved larger changes in cholesterol and blood pressure values. The vast majority (98.4%) of family physicians are interested in continuing to use genetic risk assessment in practice.

Reduction of cardiovascular risk factors among young men with hypertension using an interactive decision aid: cluster-randomized control trial

BACKGROUND

Coronary heart disease (CHD) mortality among young men is very high and the prevention methods usable in family practice (FP) settings are limited (1,2). The objectives of this study were to investigate the cardiovascular risk profile among young males (18-50) visiting their family doctor (FD) and to find out if using an interactive computer-based decision aid (DA) has advantages in reducing cardiovascular risk factors compared to usual counselling at the FD's office.

METHODS

The study was a cluster-randomized controlled trial including hypertensive male patients aged 18-50 recruited by their FD in 2015-2016. Patients with cardiovascular complications were not included. FDs were randomly divided into intervention groups (n = 9) and control groups (n = 11). Altogether, FDs recruited 130 patients, 77 into the intervention group (IG) and 53 into the control group (CG). IG patients were counselled about cardiovascular risk factors using a computer-based DA. CG patients received usual counselling by their FD. Data was collected with questionnaires, clinical examinations and laboratory analyses at the baseline and at the follow-up visit three months later. We compared the cardiovascular risk factors of the IG and CG patients.

RESULTS

Baseline characteristics of the IG and CG patients were comparable. Of the whole study group, 51.5% (n = 67) of the patients had hypertension grade 1, 45.4% (n = 59) had grade 2 and 3.1% (n = 4) had grade 3. Twenty-seven per cent (n = 21) of the IG and 42% (n = 22) of the CG patients were smokers. We found that shared decision making with the DA was more effective in smoking reduction compared to usual FD counselling: 21 smoking patients in the IG reduced the number of cigarettes per day which is significantly more than the 22 smoking patients in the CG (- 3.82 ± 1.32 (SE Mean) versus + 2.32 ± 1.29; p = 0.001). Systolic blood pressure (SBP), diastolic blood pressure (DBP) and the number of cigarettes per day, all showed a statistically significant reduction among patients who were using the DA. Male patients with hypertension grade 2 had a significantly greater reduction in their SBP (- 6.003 ± 2.59 (SE Mean) versus + 1.86 ± 2.58; p = 0.038) grade 1. Reduction of DBP, cigarettes per day and CVD risk in general were nearly significant in the IG whereas the CG showed an increase in all of these parameters.

CONCLUSION

Using interactive DAs at FD's offices for counselling of young hypertensive male patients is one possibility to help patients understand their risk factors and make changes in their treatment choices. DAs can be more effective in achieving behavioural changes like reducing smoking or blood pressure compared to normal counselling.

Interrelationships between obesity, blood pressure and metabolic profile in climacteric women

ABSTRACT Objective This study aimed to evaluate the interrelationships between obesity, blood pressure and metabolic profile in climacteric women. Methods This is a cross-sectional study with a random sample of 874 women, aged 40 to 65 years, assisted in Family Health Strategies units in Montes Claros, Minas Gerais, Brazil. A structural equation model was used to assess the interrelationships between obesity, blood pressure and metabolic profile, adjusted for age. The variables blood pressure, obesity and metabolic profile were treated as constructs, which measurement models were developed using confirmatory factor analysis. Results It was observed that age has a positive and significant effect on blood pressure (β=0.20; p<0.001) and obesity (β=0.10; p=0.004). There was a direct and positive effect of obesity on blood pressure (β=0.26; p<0.001) and on the metabolic profile (β=0.10; p=0.037), adjusted for physical activity. Conclusions The simultaneous analysis of the relationships between age, obesity, blood pressure and metabolic profile in menopausal women suggests that, ageing has an effect on the increase of obesity and blood pressure, just as obesity increases blood pressure and changes the metabolic profile.

Pulse wave velocity and its gender-related associations with cardiovascular risk factors in a high cardiovascular risk population

Introduction

Associations found between pulse wave velocity (PWV) and cardiovascular risk factors (CVrF) are diverse. We aimed to evaluate whether differences in PWV and its associations with CVrF in a high cardiovascular risk population exist between genders and between the whole population (WHgr) and groups of apparently healthy (AHgr) and those of hypertensive, obese or diabetics (Rgr).

Material and methods

Pulse wave velocity measured by Arteriograph was investigated in 805 adults aged 20-65, randomly selected from the Tallinn Population Register.

Results

Pulse wave velocity was the highest in Rgr and no differences were found between genders of the same group. In women of WHgr and AHgr age and SBP with addition of BMI and apolipoprotein B (ApoB) were associated with 54% and 48%, and without ApoB in Rgr with only 30% of PWV values. In men aged ≥ 50 of WHgr with elevated SBP odds ratios for increased PWV were 25.3 and 3.5, in Rgr 21.2 and 2.2, in those aged ≥ 50 AHgr 28.4. In women aged ≥ 50 of WHgr with elevated SBP and diabetes odds ratios were 5.5, 4.9 and 4.0, in Rgr with elevated SBP and diabetes 3.6 and 3.7, in those aged ≥ 50 AHgr 29.3.

Conclusions

The associations of ApoB and BMI with PWV and diabetes with elevated PWV indicative of increased aortic stiffness were unique for women. Aging and SBP were related to PWV even in AHgr, although age ≥ 50 years in Rgr women and normal SBP in AHgr were not associated with elevated PWV.

Increasing kidney cancer incidence and survival in Estonia: role of age and stage

BACKGROUND

Kidney cancer rates in Estonia are high. The study aimed to examine long-term trends in kidney cancer incidence, mortality and survival in Estonia, with special focus on age, birth cohorts, morphology and TNM stage.

MATERIAL AND METHODS

Estonian Cancer Registry provided data on all incident cases of kidney cancer (ICD-10 C64), diagnosed in adults (age ≥15 years) in Estonia during 1995 - 2014. Relative survival ratios (RSR) were calculated and excess hazard ratios of dying were estimated with gender, age, period of diagnosis and TNM stage as independent variables. Joinpoint regression modeling was used to calculate estimated annual percentage change for incidence (1970-2014) and mortality (1995-2016) trends. Age-specific incidence rates were presented by birth cohort and period of diagnosis.

RESULTS

Incidence increased significantly in both sexes, with the steepest rise seen for localized cancer. Cohort effects were pronounced particularly in men, while period effects were seen from the mid-1980s to mid-1990s in both sexes. Age-standardized five-year RSR for total kidney cancer increased by 13 percentage units (from 53% to 65%) over the study period; the increase was larger for renal cell carcinoma (from 63% to 78%). Survival increases of about five percentage units were seen for stages I/II and III. Age and gender were not associated with excess risk of dying from renal cell carcinoma after adjusting for stage.

CONCLUSION

Estonia is currently among countries with the highest incidence of kidney cancer. The results suggest a combined effect of changing risk profiles in successive birth cohorts and increasing diagnostic activity around 1990. Large survival increase can mostly be attributed to earlier detection, but improved diagnosis and treatment have probably influenced stage-specific survival. High proportion of tumors with unspecified morphology and those with unknown stage among the elderly warrants further investigation of diagnostic and treatment practices.

Novel biomarkers for cardiovascular risk

Cardiovascular disease refers to different diseases involving the heart and/or the arteries and/or the veins. Cardiovascular disease, overall considered, is a notable source of morbidity and mortality worldwide. Therefore, several research studies are dedicated to explore, by means of biomarkers, the possiblity to calculate the cardiovascular risk both for the onset and for the complications of the related clinical manifestations such as coronary artery disease, carotid artery stenosis, peripheral artery disease, arterial aneurysm, chronic venous disease and venous thromboembolism. This review discusses the most updated information in the area of the novel biomarkers related to omics, imaging techniques and clinical data, that may help physicians in order to improve the knowledge and the management of the cardiovascular risk.