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Lazar RM, Howard VJ, Kernan WN, Aparicio HJ, Levine DA, Viera AJ, Jordan LC, Nyenhuis DL, Possin KL, Sorond FA, White CL. A Primary Care Agenda for Brain Health: A Scientific Statement From the American Heart Association. Stroke 2021; 52:e295-e308. [PMID: 33719523 DOI: 10.1161/str.0000000000000367] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A healthy brain is critical for living a longer and fuller life. The projected aging of the population, however, raises new challenges in maintaining quality of life. As we age, there is increasing compromise of neuronal activity that affects functions such as cognition, also making the brain vulnerable to disease. Once pathology-induced decline begins, few therapeutic options are available. Prevention is therefore paramount, and primary care can play a critical role. The purpose of this American Heart Association scientific statement is to provide an up-to-date summary for primary care providers in the assessment and modification of risk factors at the individual level that maintain brain health and prevent cognitive impairment. Building on the 2017 American Heart Association/American Stroke Association presidential advisory on defining brain health that included "Life's Simple 7," we describe here modifiable risk factors for cognitive decline, including depression, hypertension, physical inactivity, diabetes, obesity, hyperlipidemia, poor diet, smoking, social isolation, excessive alcohol use, sleep disorders, and hearing loss. These risk factors include behaviors, conditions, and lifestyles that can emerge before adulthood and can be routinely identified and managed by primary care clinicians.
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Ukoh UC, Ujunwa FA, Muoneke UV, Manyike PC, Okike CO, Ibe BC. Oscillometric blood pressure profile of adolescent secondary school students in Abakaliki metropolis. Ann Afr Med 2020; 19:31-39. [PMID: 32174613 PMCID: PMC7189881 DOI: 10.4103/aam.aam_21_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Context: Adolescence is characterized by a tremendous pace in growth, biological, and psychosocial changes. This may translate to rapid increases in anthropometric parameters and indulgence in youth risk behaviors, and these are the risk factors for arterial hypertension (HTN). Aim: This study aimed to determine the oscillometric blood pressure (BP) profile of apparently healthy secondary school adolescents in Abakaliki metropolis and its relationship with sex and anthropometric variables. Subjects and Methods: This multistage process selected 2401 students among those aged 10–19 years spanning from August 2015 to January 2016. BP was measured using the oscillometric method. Information on modifiable risk factors for HTN was obtained. Anthropometric parameters were measured. Data were analyzed with Student’s t-test, analysis of variance, and correlation analysis. Results: The mean age (years) of the study population was 15.12 ± 2.29. The mean systolic BP (SBP) and diastolic BP (DBP) were 106.72 ± 11.37 mmHg and 63.60 ± 7.34 mmHg, respectively. Females had significantly higher mean DBP but with no significant gender difference in mean SBP. The means of anthropometric parameters were 49.19 ± 10.28 kg, 1.54 ± 0.10 m, and 20.46 ± 2.86 kg/m2 for weight, height, and body mass index, respectively, and all showed significant gender differences, with females having higher values except for height. A relatively low rate of indulgence in alcohol use compared to another study in the same region as well as a significant association of alcohol use among those found to have HTN was noted. The prevalence of HTN was 4.6%, which was significantly higher in females. Conclusions: Routine BP monitoring is recommended for adolescents, especially those with prevailing risk factors including a family history of HTN, obesity, and substance and alcohol misuse. Early detection will help in mitigating the effect of these cardiovascular risk factors.
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Affiliation(s)
- Uchechukwu C Ukoh
- Department of Paediatrics, Federal Teaching Hospital, Abakaliki, Ebonyi, Nigeria
| | - Fortune A Ujunwa
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Uzoamaka Vivian Muoneke
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Pius C Manyike
- Department of Paediatrics, College of Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
| | - Clifford O Okike
- Department of Paediatrics, Federal Medical Centre, Asaba, Delta, Nigeria
| | - Bede C Ibe
- Department of Paediatrics, Federal Teaching Hospital; Department of Paediatrics, College of Medicine, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
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Dehmer SP, Maciosek MV, LaFrance AB, Flottemesch TJ. Health Benefits and Cost-Effectiveness of Asymptomatic Screening for Hypertension and High Cholesterol and Aspirin Counseling for Primary Prevention. Ann Fam Med 2017; 15:23-36. [PMID: 28376458 PMCID: PMC5217841 DOI: 10.1370/afm.2015] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/14/2016] [Accepted: 10/29/2016] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Our aim was to update estimates of the health and economic impact of clinical services recommended for the primary prevention of cardiovascular disease (CVD) for the comparative rankings of the National Commission on Prevention Priorities, and to explore differences in outcomes by sex and race/ethnicity. METHODS We used a single, integrated, microsimulation model to generate comparable results for 3 services recommended by the US Preventive Services Task Force: aspirin counseling for the primary prevention of CVD and colorectal cancer, screening and treatment for lipid disorders (usually high cholesterol), and screening and treatment for hypertension. Analyses compare lifetime outcomes from the societal perspective for a US-representative birth cohort of 100,000 persons with and without access to each clinical preventive service. Primary outcomes are health impact, measured by the net difference in lifetime quality-adjusted life years (QALYs), and cost-effectiveness, measured in incremental cost per QALY or cost savings per person in 2012 dollars. Results are also presented for population subgroups defined by sex and race/ethnicity. RESULTS Health impact is highest for hypertension screening and treatment (15,600 QALYs), but is closely followed by cholesterol screening and treatment (14,300 QALYs). Aspirin counseling has a lower health impact (2,200 QALYs) but is found to be cost saving ($31 saved per person). Cost-effectiveness for cholesterol and hypertension screening and treatment is $33,800 per QALY and $48,500 per QALY, respectively. Findings favor hypertension over cholesterol screening and treatment for women, and opportunities to reduce disease burden across all services are greatest for the non-Hispanic black population. CONCLUSIONS All 3 CVD preventive services continue to rank highly among other recommended preventive services for US adults, but individual priorities can be tailored in practice by taking a patient's demographic characteristics and clinical objectives into account.
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Jolobe OMP. Hypertension-related, but not necessarily age-related. Br J Hosp Med (Lond) 2012; 73:415. [DOI: 10.12968/hmed.2012.73.7.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Boxwala AA, Rocha BH, Maviglia S, Kashyap V, Meltzer S, Kim J, Tsurikova R, Wright A, Paterno MD, Fairbanks A, Middleton B. A multi-layered framework for disseminating knowledge for computer-based decision support. J Am Med Inform Assoc 2011; 18 Suppl 1:i132-9. [PMID: 22052898 PMCID: PMC3241169 DOI: 10.1136/amiajnl-2011-000334] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Accepted: 09/27/2011] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There are several challenges in encoding guideline knowledge in a form that is portable to different clinical sites, including the heterogeneity of clinical decision support (CDS) tools, of patient data representations, and of workflows. METHODS We have developed a multi-layered knowledge representation framework for structuring guideline recommendations for implementation in a variety of CDS contexts. In this framework, guideline recommendations are increasingly structured through four layers, successively transforming a narrative text recommendation into input for a CDS system. We have used this framework to implement rules for a CDS service based on three guidelines. We also conducted a preliminary evaluation, where we asked CDS experts at four institutions to rate the implementability of six recommendations from the three guidelines. CONCLUSION The experience in using the framework and the preliminary evaluation indicate that this approach has promise in creating structured knowledge, to implement in CDS systems, that is usable across organizations.
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Affiliation(s)
- Aziz A Boxwala
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California 92093-0728, USA.
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Bertoni AG, Burke GL, Owusu JA, Carnethon MR, Vaidya D, Barr RG, Jenny NS, Ouyang P, Rotter JI. Inflammation and the incidence of type 2 diabetes: the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care 2010; 33:804-10. [PMID: 20097779 PMCID: PMC2845031 DOI: 10.2337/dc09-1679] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Many studies have documented associations between inflammation and type 2 diabetes incidence. We assessed potential variability in this association in the major U.S. racial/ethnic groups. RESEARCH DESIGN AND METHODS Incident type 2 diabetes was assessed among men and women aged 45-84 years without prior clinical cardiovascular disease or diabetes in the prospective Multi-Ethnic Study of Atherosclerosis. Interleukin (IL)-6, fibrinogen, and C-reactive protein (CRP) were measured at baseline (2000-2002); fasting glucose and diabetes medication use was assessed at baseline and three subsequent in-person exams through 2007. Type 2 diabetes was defined as use of diabetes drugs or glucose > or =126 mg/dl. Covariates included baseline demographics, clinic, smoking, alcohol, exercise, hypertension medication, systolic blood pressure, insulin resistance, and BMI. Cox proportional hazards regression was used to calculate hazard ratios (HRs) by quartiles of CRP, IL-6, and fibrinogen. RESULTS Among 5,571 participants (mean age 61.6 years, 53% female, 42.1% white, 11.5% Chinese, 25.7% black, and 20.7% Hispanic), 410 developed incident diabetes during a median follow-up time of 4.7 years (incidence 16.8 per 1,000 person-years). CRP, IL-6, and fibrinogen levels were associated with incident diabetes in the entire sample. After adjustment, the associations were attenuated; however, quartile 4 (versus quartile 1) of IL-6 (HR 1.5 [95% CI 1.1-2.2]) and CRP (1.7 [1.3-2.4]) remained associated with incident diabetes. In stratified analyses, similar associations were observed among white, black, and Hispanic participants. CONCLUSIONS Higher levels of inflammation predict short-term incidence of type 2 diabetes in a multiethnic American sample.
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Affiliation(s)
- Alain G Bertoni
- Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA.
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Rockwood K, Middleton LE, Moorhouse PK, Skoog I, Black SE. The inclusion of cognition in vascular risk factor clinical practice guidelines. Clin Interv Aging 2009; 4:425-33. [PMID: 19966911 PMCID: PMC2785866 DOI: 10.2147/cia.s6738] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND People with vascular risk factors are at increased risk for cognitive impairment as well as vascular disease. The objective of this study was to evaluate whether vascular risk factor clinical practice guidelines consider cognition as an outcome or in connection with treatment compliance. METHODS Articles from PubMed, EMBASE, and the Cochrane Library were assessed by at least two reviewers and were included if: (1) Either hypertension, high cholesterol, diabetes, or atrial fibrillation was targeted; (2) The guideline was directed at physicians; (3) Adult patients (aged 19 years or older) were targeted; and (4) The guideline was published in English. Of 91 guidelines, most were excluded because they were duplicates, older versions, or focused on single outcomes. RESULTS Of the 20 clinical practice guidelines that met inclusion criteria, five mentioned cognition. Of these five, four described potential treatment benefits but only two mentioned that cognition may affect compliance. No guidelines adequately described how to screen for cognitive impairment. CONCLUSION Despite evidence that links cognitive impairment to vascular risk factors, only a minority of clinical practice guidelines for the treatment of vascular risk factors consider cognition as either an adverse outcome or as a factor to consider in treatment.
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Affiliation(s)
- Kenneth Rockwood
- Department of Medicine, Dalhousie University, Halifax, NS, Canada.
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Lee DS, Massaro JM, Wang TJ, Kannel WB, Benjamin EJ, Kenchaiah S, Levy D, D'Agostino RB, Vasan RS. Antecedent Blood Pressure, Body Mass Index, and the Risk of Incident Heart Failure in Later Life. Hypertension 2007; 50:869-76. [PMID: 17893376 DOI: 10.1161/hypertensionaha.107.095380] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Higher blood pressure and body mass index (BMI) are risk factors for heart failure. It is unknown whether the presence of these risk factors in midadulthood affect the future development of heart failure. In the community-based Framingham Heart Study, we examined the associations of antecedent blood pressure and BMI with heart failure incidence in later life. We studied 3362 participants (57% women; mean age: 62 years) who attended routine examinations between 1969 and 1994 and examined their systolic and diastolic blood pressure, pulse pressure, and BMI at current (baseline), recent (average of readings obtained 1 to 10 years before baseline), and remote (average of readings obtained 11 to 20 years before baseline) time periods. During 67 240 person-years of follow-up, 518 participants (280 women) developed heart failure. Current, recent, and remote systolic pressure; pulse pressure; and BMI were individually associated with incident heart failure (all P<0.001). Recent systolic pressure (hazards ratio [HR] per 1-SD increment: 1.31; 95% CI: 1.11 to 1.55), pulse pressure (HR per 1-SD increment: 1.33; 95% CI: 1.14 to 1.54), and BMI (HR per unit increase: 1.15; 95% CI: 1.08 to 1.23) were associated with heart failure risk even after adjusting for current measures. Similarly, remote systolic pressure (HR per 1 SD: 1.17; 95% CI: 1.04 to 1.31), pulse pressure (HR per 1 SD: 1.17; 95% CI: 1.06 to 1.31), and BMI (HR per unit: 1.09; 95% CI: 1.05 to 1.14) remained associated with incident heart failure after adjusting for current measurements. Higher blood pressure and BMI in midlife are harbingers of increased risk of heart failure in later life. Early risk factor modification may decrease heart failure burden.
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Affiliation(s)
- Douglas S Lee
- Institute for Clinical Evaluative Sciences and University Health Network, University of Toronto, Toronto, Canada
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U.S. and Canadian Guidelines for Hypertension. Hypertension 2007. [DOI: 10.1016/b978-1-4160-3053-9.50054-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hozawa A, Shimazu T, Kuriyama S, Tsuji I. Benefit of home blood pressure measurement after a finding of high blood pressure at a community screening. J Hypertens 2006; 24:1265-71. [PMID: 16794474 DOI: 10.1097/01.hjh.0000234105.23615.95] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Many hypertensive individuals are not under medical management. We studied whether incorporating home blood pressure measurement and subsequent tailored advice into the primary care system improved hypertension management among untreated hypertensive individuals (screening systolic blood pressure >or= 140 mmHg or diastolic blood pressure >or= 90 mmHg and not taking antihypertensive medication) diagnosed during a community screening. METHODS All residents aged 30 years or older in one district were asked to measure their blood pressure at home for 30 days, then received tailored advice (intervention area). Four of five Japanese districts served as a control. A self-administered questionnaire monitored the awareness and treatment of hypertension. RESULTS Eighty-eight per cent (106/120) of untreated hypertensive individuals in the intervention area measured home blood pressure. Of men and women meeting the criteria for untreated hypertension at a community screening in 2003, 97 intervention and 390 control individuals were rescreened in 2004. Among the untreated 2003 screening hypertensive individuals with home hypertension (home systolic blood pressure >or= 135 mmHg or diastolic blood pressure >or= 85 mmHg), the proportion not starting antihypertensive medication was 56%, and the proportion taking 'no action against hypertension' was 41%. These proportions were lower than in the control group (76%, 60%), yielding odds ratios (95% confidence interval) of 0.38 (0.21-0.68) and 0.42 (0.24-0.75), respectively. CONCLUSION Incorporating home blood pressure measurement coupled with tailored advice into the primary care system has the potential to reduce the risk of untreated hypertension.
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Affiliation(s)
- Atsushi Hozawa
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota 55454-1015, USA.
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Murasko JE. Gender differences in the management of risk factors for cardiovascular disease: the importance of insurance status. Soc Sci Med 2006; 63:1745-56. [PMID: 16762471 DOI: 10.1016/j.socscimed.2006.04.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Indexed: 10/24/2022]
Abstract
Despite cardiovascular disease (CVD) being the leading killer of both sexes in the US, there are indications that men and women have different experiences in the health system with prevention and treatment practices. Beyond largely descriptive findings, little research exists that addresses how men and women may differ in their response to certain key influences on CVD health services utilization. This paper examines gender differentials in the effect of insurance coverage on CVD preventive health services in the US. An economics framework is used to model individual demand for preventive services as a function of insurance status, while controlling for a comprehensive set of explanatory variables. The services analyzed include cholesterol and blood pressure screening, pharmaceutical use for hypertension and lipid disorders, and CVD-related physician visits. Both general and high-risk samples are evaluated. The results show that while a lack of insurance is associated with lower rates of utilization in both men and women, there are no observed gender differences in insurance-effects for recommended intervals of risk factor screening in the general population. However, for individuals with previously diagnosed heart disease or stroke, a lack of coverage is more strongly associated with lower rates of screening, pharmaceutical management, and physician contact in women than men. Potential reasons for these findings are discussed and policy implications are noted.
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Botella Carretero JI, Fresneda Moreno J, Manzano Espinosa L. Papel de los antagonistas de los receptores de la angiotensina II en el tratamiento del síndrome metabólico. Rev Clin Esp 2006; 206:284-8. [PMID: 16762293 DOI: 10.1157/13088590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The metabolic syndrome, defined as the association of abdominal obesity, insulin resistance, dyslipidemia and hypertension, is a very prevalent disorder. Moreover, it identifies patients with a high cardiovascular risk, and when diagnosed, life style modifications and/or drug therapy can be initiated in these patients with the aim to reduce their cardiovascular risk. In the last few years, there has been much interest on drugs that lower insulin resistance, a central component of the metabolic syndrome as well as drugs that interrupt the renin-angiotensin system (achieved by angiotensive converting enzyme inhibitors and angiotensin II receptor blockers), due to their beneficial metabolic effects. Of special interest are the so-called selective PPARg modulators, such as telmisartan or the nTZDpa compound. In the future, they may show important benefits in the treatment of patients with the metabolic syndrome.
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Affiliation(s)
- J I Botella Carretero
- Unidad de Nutrición Clínica y Dietética, Servicio de Endocrinología y Nutrición, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
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Gibson L, Strong J. Safety issues in functional capacity evaluation: findings from a trial of a new approach for evaluating clients with chronic back pain. JOURNAL OF OCCUPATIONAL REHABILITATION 2005; 15:237-51. [PMID: 15844680 DOI: 10.1007/s10926-005-1222-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Although safety is recognized as a critical issue in functional capacity evaluations (FCEs), it has rarely been investigated. This paper reports on the findings of a study which examined safety aspects of a new approach to FCE. Fourteen rehabilitation clients with chronic back pain participated in the study. Aspects examined included the pre-FCE screening procedures, the monitoring of performance and safety during the FCE, and the end of FCE measures and follow-up procedures. Support was found for the screening procedures of the approach, particularly blood pressure measurement, and for the combined approach to monitoring of the person's performance from biomechanical, physiological and psychophysical perspectives. Issues for FCE safety in general are identified and discussed, including the importance of screening procedures to determine readiness for FCEs and the issue of load handling in FCEs, especially in relation to clients with chronic back pain.
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Affiliation(s)
- Libby Gibson
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Abstract
BACKGROUND Cardiovascular disease (CVD) risk-reduction practices are suboptimal in populations at high risk for CVD, and this problem may be worse in women than in men. METHODS In 2003, CVD risk-reduction practices were compared between men and women after stratification by CVD risk status (high, intermediate, low) in a cross-sectional analysis of the 1999 Behavioral Risk Factor Surveillance System (BRFSS), a random-digit telephone survey of state population-based samples of the civilian non-institutionalized population of adults. This analysis included persons aged >40 years who answered questions regarding lipid and blood pressure screening, recommendations for lifestyle modification, that is, exercise and reduced fat intake, and aspirin use. Risk status was defined according to Adult Treatment Panel III definitions. RESULTS In the 97,387 adults included in this analysis, high CVD risk was associated with lipid and blood pressure screening, lifestyle modification, and aspirin use in both men and women compared to intermediate-risk and low-risk (p <0.001). Among high-risk adults, men and women reported similar frequency of blood pressure and cholesterol measurement and physician advice on lifestyle modification; among intermediate- and low-risk adults, women reported slightly more frequent screening and lifestyle modification than men (p <0.001). In all CVD risk categories, women reported significantly less aspirin use than in men (p <0.001). CONCLUSIONS Among people at high risk for CVD, women report lifestyle modification more often than men, while men report use of aspirin more often than women. These findings may assist with targeting interventions to reduce CVD risk to the unique needs of men and women.
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Affiliation(s)
- Catherine Kim
- Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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