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Wong ND, Sattar N. Cardiovascular risk in diabetes mellitus: epidemiology, assessment and prevention. Nat Rev Cardiol 2023; 20:685-695. [PMID: 37193856 DOI: 10.1038/s41569-023-00877-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/18/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading causes of morbidity and mortality in individuals with type 2 diabetes mellitus (T2DM). Secular changes in CVD outcomes have occurred over the past few decades, mainly due to a decline in the incidence of ischaemic heart disease. The onset of T2DM at a young age (<40 years), leading to a greater number of life-years lost, has also become increasingly common. Researchers are now looking beyond established risk factors in patients with T2DM towards the role of ectopic fat and, potentially, haemodynamic abnormalities in mediating important outcomes (such as heart failure). T2DM confers a wide spectrum of risk and is not necessarily a CVD risk equivalent, indicating the importance of risk assessment strategies (such as global risk scoring, consideration of risk-enhancing factors and assessment of subclinical atherosclerosis) to inform treatment. Data from epidemiological studies and clinical trials demonstrate that successful control of multiple risk factors can reduce the risk of CVD events by ≥50%; however, only ≤20% of patients achieve targets for risk factor reduction (plasma lipid levels, blood pressure, glycaemic control, body weight and non-smoking status). Improvements in composite risk factor control with lifestyle management (including a greater emphasis on weight loss interventions) and evidence-based generic and novel pharmacological therapies are therefore needed when the risk of CVD is high.
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Affiliation(s)
- Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, USA.
| | - Naveed Sattar
- Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
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The clinical impact of anti-hypertensive treatment drug-gene pairs in the asian population: a systematic review of publications in the past decade. J Hum Hypertens 2023; 37:170-180. [PMID: 36302845 DOI: 10.1038/s41371-022-00765-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/17/2022] [Accepted: 09/30/2022] [Indexed: 11/08/2022]
Abstract
Pharmacogenetics play an important role in determining the anti-hypertensive effects of blood pressure-lowering medications and have the potential to improve future patient care. Current literature on the topic, however, has a heavy focus on Caucasians and may not be generalisable to the Asian populations. Therefore, we have conducted this systematic review to summarise and evaluate the literature of the past decade. PubMed, Embase, and the Cochrane Register of Controlled Trials were searched for relevant studies from 1 January 2011 to 23 July 2021. The outcome of interest was the response to anti-hypertensive treatment in Asians according to each genetic polymorphism. A total of 26 studies with a total of 8837 patients were included in our review, covering five classes of anti-hypertensive agents-namely, angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), beta-blockers (BB), calcium channel blockers (CCB), and thiazide-like diuretics. Response to ACEI therapy was most susceptible to genotypic variations, while the efficacy of ARB and CCB were affected by pharmacogenetic differences to varying extent. For BB, only variations in the ADRB1 genotype significantly affects therapeutic response, while the therapeutic efficacy of thiazide-like diuretics was correlated with genotypic variations in the REN and ACE. This systematic review evaluated the impact of pharmacogenetic variations on the therapeutic efficacy of anti-hypertensive treatment in Asians and has described numerous drug-gene pairs that are potentially clinically important. Future prospective studies with larger sample sizes and longer follow-up periods are needed to better elucidate the impact of these drug-gene pairs.
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Roth M, Lehmann T, Kloos C, Schmidt S, Kellner C, Wolf G, Müller N. Metabolic Control, Diabetic Complications and Drug Therapy in a Cohort of Patients with Type 1 and Type 2 Diabetes in Secondary and Tertiary Care between 2004 and 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2631. [PMID: 36768000 PMCID: PMC9916122 DOI: 10.3390/ijerph20032631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
This paper studies the features of metabolic parameters, diabetic complications and drug therapy of a single-centre cohort of patients with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) in secondary care and tertiary care over a 15-year period. METHODS Retrospective cross-sectional analysis of four single-centre cohorts between 2004 and 2019. All patients with T1DM or T2DM in secondary care (n = 5571) or tertiary care (n = 2001) were included. Statistical analyses were performed using linear mixed models. RESULTS Diabetes duration increased in both patients with T1DM and T2DM in secondary care and tertiary care (p < 0.001). Patients in secondary care consistently showed good glycaemic control, while patients in tertiary care showed inadequate glycaemic control. All four cross-sectional cohorts showed a significant increase in the prevalence of nephropathy over time and three out of four cohorts (T1DM and T2DM in secondary care and T2DM in tertiary care) showed an increase in the prevalence of neuropathy (all p < 0.001). The incidence of severe hypoglycaemia was consistently low. The use of insulin pumps and insulin analogues in the therapy of T1DM increased significantly. CONCLUSIONS The increased prevalence of complications is likely due to older age and longer diabetes duration. Low rates of hypoglycaemia, lower limb amputations and good glycaemic control in secondary care patients indicate a good structure of patient care.
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Affiliation(s)
- Matthias Roth
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Thomas Lehmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, 07743 Jena, Germany
| | - Christof Kloos
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Sebastian Schmidt
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Christiane Kellner
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
| | - Nicolle Müller
- Department of Internal Medicine III, Jena University Hospital, 07747 Jena, Germany
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Han E, Song SO, Kim HS, Son KJ, Jee SH, Cha BS, Lee BW. Improvement in Age at Mortality and Changes in Causes of Death in the Population with Diabetes: An Analysis of Data from the Korean National Health Insurance and Statistical Information Service, 2006 to 2018. Endocrinol Metab (Seoul) 2022; 37:466-474. [PMID: 35798550 PMCID: PMC9262683 DOI: 10.3803/enm.2022.1440] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/19/2022] [Accepted: 05/23/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGRUOUND Diabetes is a leading cause of death that is responsible for 1.6 million annual deaths worldwide. However, the life expectancy and age at death of people with diabetes have been a matter of debate. METHODS The National Health Insurance Service claims database, merged with death records from the National Statistical Information Service in Korea from 2006 to 2018, was analyzed. RESULTS In total, 1,432,567 deaths were collected. The overall age at death increased by 0.44 and 0.26 year/year in the diabetes and control populations, respectively. The disparity in the mean age at death between the diabetes and control populations narrowed from 5.2 years in 2006 to 3.0 years in 2018 (p<0.001). In a subgroup analysis according to the presence of comorbid diseases, the number and proportion of deaths remained steady in the group with diabetes only, but steadily increased in the groups with diabetes combined with dyslipidemia and/or hypertension. Compared to the control population, the increase in the mean death age was higher in the population with diabetes. This trend was more prominent in the groups with dyslipidemia and/or hypertension than in the diabetes only group. Deaths from vascular disease and diabetes decreased, whereas deaths from cancer and pneumonia increased. The decline in the proportion of deaths from vascular disease was greater in the diabetes groups with hypertension and/or dyslipidemia than in the control population. CONCLUSION The age at death in the population with diabetes increased more steeply and reached a comparable level to those without diabetes.
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Affiliation(s)
- Eugene Han
- Division of Endocrinology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Sun Ok Song
- Divison of Endocrinology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Hye Soon Kim
- Division of Endocrinology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Kang Ju Son
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Sun Ha Jee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
| | - Bong-Soo Cha
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Wan Lee
- Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Abu El Hawa AA, Klein D, Bekeny JC, Severin JH, Zolper EG, Tefera E, Evans KK, Fan KL, Attinger CE. The impact of statins on wound healing: an ally in treating the highly comorbid patient. J Wound Care 2022; 31:S36-S41. [PMID: 35148640 DOI: 10.12968/jowc.2022.31.sup2.s36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To identify the impact that HMG-CoA reductase inhibitors (statins) use has on wound healing outcomes in patients with comorbidities. METHOD A retrospective chart review evaluating all new patients presenting to our tertiary wound care centre in 2013 with lower extremity wounds. Patients were divided into two groups depending on whether they took statins or not. Data on wound healing outcomes and wound/patient characteristics were collected. Primary outcomes included healing rate and progression to complete wound healing. Patients were excluded if they had incomplete data or were lost to follow-up before healing status could be confirmed. RESULTS A total of 194 patients met the inclusion criteria and were allocated to either the statin group (n=89) or to the non-statin group (n=105). Median initial wound size was 0.6cm3 (Interquartile range (IQR): 0.15-2.4) (p=0.684). In the statin group, 54 (60.6%) patients progressed to complete wound healing compared with 47 (44.7%) in the non-statin group (p=0.027). Median rate of wound healing was 6.7×10-3cm3/day (IQR: 1.5×10-3-2.6×10-2) compared with 3.8×10-3cm3/day (IQR: 1.7×10-3-1.3×10-2) in the non-statin group (p=0.773). Increased age and a higher number of comorbidities were reported in the statin group (p<0.001), respectively). A total of seven patients required amputation: five patients in the statin group and two patients in the non-statin group (p=0.250). CONCLUSION This study revealed increased progression to wound healing in patients who were taking statins. The influence of statins on wound healing is promising, but future trials are needed to justify use of this medication class independent of cardiovascular benefit and exclusively for wound healing.
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Affiliation(s)
- Areeg A Abu El Hawa
- Georgetown University School of Medicine; Washington, District of Columbia, US
| | - Doron Klein
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia, US
| | - Jenna C Bekeny
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia, US
| | - James H Severin
- Georgetown University School of Medicine; Washington, District of Columbia, US
| | - Elizabeth G Zolper
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia, US
| | - Eshetu Tefera
- MedStar Health Research Institute; Washington, District of Columbia, US
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia, US
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia, US
| | - Christopher E Attinger
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia, US
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Al-Lami RA, Taha SA, Jalloul RJ, Taylor HS. High-sensitivity C-reactive protein is not independently associated with self-reported infertility in National Health and Nutrition Examination Survey 2015–2018 data. F S Rep 2021; 3:63-70. [PMID: 35386498 PMCID: PMC8978077 DOI: 10.1016/j.xfre.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To study the association between high-sensitivity C-reactive protein (hs-CRP) and infertility among reproductive-age women while controlling for obesity and other metabolic markers. Previous studies found a link between infertility and cardiovascular diseases (CVDs). C-reactive protein is a sensitive marker of CVDs, and its levels are affected by obesity. Design/Setting We conducted a cross-sectional study using national data from 2015 through 2018. Patients A total of 940 women aged 20–45 years who self-reported infertility, had hs-CRP values measured, and did not have CRP >10 mg/L, asthma, arthritis, bronchitis, thyroid disease, bilateral oophorectomy, hysterectomy, and who were not breastfeeding or pregnant, premenarchal at the time of study or had menarche after the age of 20. Interventions N/A. Main outcome measure(s) Infertility status (ever reporting inability to conceive with 12 months of trying to become pregnant). Results In comparison to noninfertile women, self-reported infertile women had higher mean of hs-CRP (3.11 mg/L vs. 2.40 mg/L) and higher percentage of moderate/high hs-CRP values (77.0% vs 58.8%). However, after adjusting for metabolic markers, there was a nonsignificant association between moderate/high hs-CRP and self-reported infertility in the multivariable logistic regression analysis. Odds ratio estimates of the association between hs-CRP and infertility increased over 40% after removing obesity measures and/or high-density lipoprotein from regression models. Conclusion There was no association between hs-CRP and self-reported infertility after controlling for obesity measures and other risk factors for CVDs in a sample of U.S. women aged 20–45 years.
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Lee JM, Lee SH, Kim J, Choi KH, Park TK, Yang JH, Song YB, Hahn JY, Choi JH, Choi SH, Kim HS, Chun WJ, Nam CW, Hur SH, Han SH, Rha SW, Chae IH, Jeong JO, Heo JH, Yoon J, Lim DS, Park JS, Hong MK, Doh JH, Cha KS, Kim DI, Lee SY, Chang K, Hwang BH, Choi SY, Jeong MH, Hong SJ, Koo BK, Gwon HC. Ten-Year Trends in Coronary Bifurcation Percutaneous Coronary Intervention: Prognostic Effects of Patient and Lesion Characteristics, Devices, and Techniques. J Am Heart Assoc 2021; 10:e021632. [PMID: 34514841 PMCID: PMC8649555 DOI: 10.1161/jaha.121.021632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Despite advances in devices and techniques, coronary bifurcation lesion remains a challenging lesion subset in the field of percutaneous coronary intervention (PCI). We evaluate 10‐year trends in bifurcation PCI and their effects on patient outcomes. Methods and Results We analyzed 10‐year trends in patient/lesion characteristics, devices, PCI strategy, stent optimization techniques, and clinical outcomes using data from 5498 patients who underwent bifurcation PCI from 2004 to 2015. Clinical outcomes 2 years after the index procedure were evaluated in terms of target vessel failure (a composite of cardiac death, myocardial infarction, and target vessel revascularization) and a patient‐oriented composite outcome (a composite of all‐cause death, myocardial infarction, and any revascularization). During the 10‐year study period, patient and lesion complexity, such as multivessel disease, diabetes mellitus, chronic kidney disease, and left main bifurcation, increased continuously (all P<0.001). The risk of target vessel failure or patient‐oriented composite outcome decreased continuously from 2004 to 2015 (target vessel failure: from 12.3% to 6.9%, log‐rank P<0.001; patient‐oriented composite outcome: from 13.6% to 9.3%, log‐rank P<0.001). The use of a second‐generation drug‐eluting stent and decreased target vessel failure risk in true bifurcation lesions were the major contributors to improved patient prognosis (interaction P values were <0.001 and 0.013, respectively). Conclusions During the past decade of bifurcation PCI, patient and lesion characteristics, devices, PCI techniques, and patient prognosis have all significantly changed. Despite increased patient and lesion complexity, clinical outcomes after bifurcation PCI have improved, mainly because of better devices and more widespread adoption of procedural optimization techniques and appropriate treatment strategies. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01642992 and NCT03068494.
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Osawa I, Goto T, Asami Y, Itoh N, Kaga Y, Yamamoto Y, Tsugawa Y. Physician visits and medication prescriptions for major chronic diseases during the COVID-19 pandemic in Japan: retrospective cohort study. BMJ Open 2021; 11:e050938. [PMID: 34301667 PMCID: PMC8313311 DOI: 10.1136/bmjopen-2021-050938] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES There have been concerns that patients with chronic conditions may be avoiding in-person physician visits due to fear of COVID-19, leading to lower quality of care. We aimed to investigate changes in physician visits and medication prescriptions for chronic diseases before and during the COVID-19 pandemic at the population level. DESIGN Retrospective cohort study. SETTING Nationwide claims data in Japan, 2018-2020. PARTICIPANTS Working-age population (aged 18-74 years) who visited physicians and received any prescriptions for major chronic diseases (hypertension, diabetes and dyslipidaemia) before the pandemic. OUTCOME MEASURES The outcomes were the monthly number of physician visits, the monthly proportion of physician visits and the monthly proportion of days covered by prescribed medication (PDC) during the pandemic (April-May 2020, as the first state of emergency over COVID-19 was declared on 7 April, and withdrawn nationally on 25 May). RESULTS Among 10 346 patients who visited physicians for chronic diseases before the pandemic, we found a temporary decline in physician visits (mean number of visits was 1.9 in March vs 1.7 in April; p<0.001) and an increase in the proportion of patients who did not visit any physicians during the pandemic (15% in March vs 24% in April; p<0.001). Physician visits returned to the baseline in May (the mean number of visits: 1.8, and the proportion of patients who did not visit any physicians: 9%). We observed no clinically meaningful difference in PDC between before and during the pandemic (eg, 87% in March vs 87% in April; p=0.45). A temporary decline in physician visits was more salient in seven prefectures with a larger number of COVID-19 cases than in other areas. CONCLUSIONS Although the number of physician visits declined right after the COVID-19 outbreak, it returned to the baseline one month later; patients were not skipping medications during the pandemic.
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Affiliation(s)
- Itsuki Osawa
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
- TXP Medical Co. Ltd, Bunkyo-ku, Tokyo, Japan
| | - Yuko Asami
- Viatris Pharmaceuticals Japan Inc, Shibuya-ku, Tokyo, Japan
| | - Noriharu Itoh
- Viatris Pharmaceuticals Japan Inc, Shibuya-ku, Tokyo, Japan
| | | | | | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Service Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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Olufade OA, Patel A, Cherian C, Waterbrook AL, Zaremski JL, Sussman WI, Bowers R, Hrubes M, Myers RA. Suggested Curricular Guidelines for Musculoskeletal and Sports Medicine in Physical Medicine and Rehabilitation Residency Training. Curr Sports Med Rep 2021; 20:366-373. [PMID: 34234092 DOI: 10.1249/jsr.0000000000000862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT A sports medicine physician manages musculoskeletal (MSK) injuries and sport-related medical and MSK conditions of patients of all ages and abilities. Physical medicine and rehabilitation physicians (physiatrists) must be adequately trained to provide this care for all patients including, but not limited to, athletes participating in organized sports, the weekend warrior as well as athletes with disabilities. Accreditation Council of Graduate Medical Education core requirements and basic guidelines help physiatry residency training programs develop and implement residency curriculums. The goal of this article is to provide suggested curricular guidelines to optimize physiatrist training in MSK and sports medicine.
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Affiliation(s)
| | | | - Chris Cherian
- Department of Sports Medicine, Rothman Orthopaedic Institute, Paramus, NJ
| | - Anna L Waterbrook
- Emergency and Sports Medicine, The University of Arizona Tucson, Arizona
| | - Jason L Zaremski
- Divisions of PM&R, Sports Medicine & Research, Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | | | | | - Melody Hrubes
- Department of Sports Medicine, Rothman Orthopaedic Institute, New York, NY
| | - Rebecca A Myers
- Department of Family Medicine, University of Colorado Longs Peak Family and Sports Medicine, Longmont, CO
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Touloumi G, Karakosta A, Kalpourtzi N, Gavana M, Vantarakis A, Kantzanou M, Hajichristodoulou C, Chlouverakis G, Trypsianis G, Voulgari PV, Alamanos Y, Makrilakis K, Liatis S, Chatzipanagiotou S, Stergiou G. High prevalence of cardiovascular risk factors in adults living in Greece: the EMENO National Health Examination Survey. BMC Public Health 2020; 20:1665. [PMID: 33160307 PMCID: PMC7648277 DOI: 10.1186/s12889-020-09757-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/23/2020] [Indexed: 11/14/2022] Open
Abstract
Background Nationwide data on cardiovascular risk factors prevalence is lacking in Greece. This work presents the findings of the national health examination survey EMENO (2013–2016) regarding the prevalence of hypertension, hypercholesterolemia, diabetes, obesity and smoking. Methods A random sample of adults (≥18 years) was drawn by multistage stratified random sampling based on 2011 Census. All EMENO participants with ≥1 measurement of interest [blood pressure (BP), fasting glucose, HbA1c, total cholesterol (TC), Body Mass Index (BMI)] were included. Hypertension was defined as BP ≥ 140/90 mmHg and/or antihypertensive treatment; diabetes as fasting glucose≥126 mg/dL and/or HbA1c ≥ 6.5% or self-reported diabetes; hypercholesterolemia as TC ≥ 190 mg/dL. Sampling weights were applied to adjust for study design and post-stratification weights to match sample age and sex distribution to population one. Non-response was adjusted by inverse probability weighting. Results Of 6006 EMENO participants, 4822 were included (51.5% females, median age:47.9 years). The prevalence of hypertension was 39.2%, higher in men (42.4%) than in women (36.1%); of hypercholesterolemia 60.2%, similar in men (59.5%) and women (60.9%); of diabetes 11.6%, similar men (12.4%) and women (10.9%); of obesity 32.1%, higher in women (33.5% vs 30.2%), although in subjects aged 18–40 year it was higher in men; of current smoking 38.2%, higher in men (44.0%) than in women (32.7%). The prevalence of all risk factors increased substantially with age, except smoking, which followed an inverse U shape. Conclusions The burden of cardiovascular risk factors among Greek adults is alarming. There is considerable preventive potential and actions at health care and societal level are urgently needed.
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Affiliation(s)
- Giota Touloumi
- Department of Hygiene, Epidemiology, & Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece.
| | - Argiro Karakosta
- Department of Hygiene, Epidemiology, & Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - Natasa Kalpourtzi
- Department of Hygiene, Epidemiology, & Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | - Magda Gavana
- Department of Primary Health Care, General Practice and Health Services Research, Medical School of Aristotle University, Thessaloniki, Greece
| | | | - Maria Kantzanou
- Department of Hygiene, Epidemiology, & Medical Statistics, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Street, 11527, Athens, Greece
| | | | | | - Grigoris Trypsianis
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Thrace, Greece
| | - Paraskevi V Voulgari
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Yannis Alamanos
- Institute of Epidemiology, Preventive Medicine and Public Health, Corfu, Greece
| | - Konstantinos Makrilakis
- 1st Dept of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Diabetes Association (HDA), Athens, Greece
| | - Stavros Liatis
- 1st Dept of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Hellenic Diabetes Association (HDA), Athens, Greece
| | - Stylianos Chatzipanagiotou
- Department of Medical Biopathology, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - George Stergiou
- Hypertension Center STRIDE-7, 3rd Department of Medicine, Medical School, National and Kapodistrian University of Athens, Sotiria Hospital, Athens, Greece
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Yamane SS, De Gagne JC, Riggs A, Kimberly GD, Holye M. Assessment of a patient-centered initiative to improve hypertension management for adults with comorbid type 2 diabetes at a free clinic in the rural south. Nurs Forum 2020; 55:348-355. [PMID: 32034778 DOI: 10.1111/nuf.12434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Hypertension is the most modifiable risk factor for cardiovascular disease. Low levels of adherence to medication regimens, positive health behaviors, and ideal metric goals are associated with low rates of morbidity and mortality, impaired physical function, and frailty. AIM This quality improvement study sought to assess whether a program of patient and provider education, combined with a decision aid (DA) designed to increase shared decision making, would improve (a) patient knowledge about hypertension management, (b) provider adherence to prescription guidelines for the management of hypertension, (c) medication adherence for the management of hypertension by the patient, and (d) communication between provider and patient. SETTING Free clinic in the United States rural south. PARTICIPANTS Twenty-four patients with comorbid hypertension and type 2 diabetes. METHODS A pretest/posttest design utilizing a provider education, pre-encounter quiz, focused patient education, and DA was used to evaluate the intervention. RESULTS A significant increase in pretest/posttest scores 60% (SD = 29%) to 93% (SD = 15%), P < .001 about hypertension and its management was observed. Adherence to guideline-based medication use increased angiotensin-converting enzyme inhibitors 38% to 64%, angiotensin II receptor blockers 17% to 29%, dihydropyridine calcium channel blockers 29% to 43%, beta-blockers 8% to 25%, statins 65% to 83%, and diuretics 38% to 46%. CONCLUSIONS The intervention was an efficient method to provide patient-centered education that increased patient knowledge about medication and lifestyle management of hypertension.
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Affiliation(s)
- Sandra S Yamane
- Department of Nursing, Catawba College, Salisbury, North Carolina
| | | | - Alysse Riggs
- Davie County Health Department, Mocksville, North Carolina
| | | | - Martha Holye
- Storehouse for Jesus, Mocksville, North Carolina
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Lee SJ, Oh J, Hong SJ, Cho IJ, Kim SR, Uhm JS, Shim CY, Chang HJ, Ahn CM, Kim JS, Kim BK, Park S, Lee SH, Hong GR, Ko YG, Choi D. Effectiveness of Fimasartan and Rosuvastatin Combination Treatment in Hypertensive Patients With Dyslipidemia. Clin Ther 2020; 42:1058-1066.e3. [PMID: 32376036 DOI: 10.1016/j.clinthera.2020.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/25/2020] [Accepted: 03/30/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The goal of this study was to evaluate the concurrent control rate of hypertension and dyslipidemia by fimasartan and rosuvastatin in patients who were concomitantly prescribed both drugs. METHODS This single-center, cross-sectional study was conducted in 536 patients with hypertension and dyslipidemia who were taking fimasartan and rosuvastatin together for at least 12 weeks. Patients were enrolled from October 2016 to March 2018 at a tertiary hospital in the Republic of Korea. The primary end point was the concurrent control rate of blood pressure (<140/90 mm Hg) and LDL-C. As a secondary end point, the target blood pressure <130/80 mm Hg was adopted in all patients or in high-risk patients with atherosclerotic cardiovascular diseases. Target LDL-C and non-HDL-C levels followed the domestic guidelines. Correlation between blood pressure control and lipid profile was also evaluated. All parameters were assessed in a clinic by board-certified physicians. FINDINGS Of the total 536 patients, 69% (n = 368) had very high (n = 308) or high (n = 60) cardiovascular risk, with an average age of 65 years; 57% were male. When the target blood pressure was set at 140/90 mm Hg, the proportion of patients meeting the targeting LDL-C level was 40.3% (95% CI, 36.2-44.5; P < 0.001). When applied to the revised blood pressure criteria targeting 130/80 mm Hg, the concurrent control rate dropped by one half to 20.3% (95% CI, 17.2-24.0; P < 0.001). To apply the new blood pressure criteria, more intensive management is mandatory in patients with high or very high cardiovascular risk. There was no positive correlation between the controlled rate of hypertension and dyslipidemia. IMPLICATIONS Fimasartan and rosuvastatin were shown to have effects on target diseases, but there was no synergistic effect when administered in combination. The higher the cardiovascular risk of the patients, the lower the rate of concurrent control when fimasartan and rosuvastatin were administered simultaneously. More active treatment is therefore required in high-risk patients.
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Affiliation(s)
- Seung-Jun Lee
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Jaewon Oh
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - In-Jeong Cho
- Cardiology Division, Department of Internal Medicine, Ewha Womans University Medical Center, Seoul, Republic of Korea
| | - Su Rae Kim
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Chi Young Shim
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Hyuk-Jae Chang
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Sungha Park
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Sang-Hak Lee
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Geu Ru Hong
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Young-Guk Ko
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea
| | - Donghoon Choi
- Cardiology Division, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, Republic of Korea.
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Timpel P, Oswald S, Schwarz PEH, Harst L. Mapping the Evidence on the Effectiveness of Telemedicine Interventions in Diabetes, Dyslipidemia, and Hypertension: An Umbrella Review of Systematic Reviews and Meta-Analyses. J Med Internet Res 2020; 22:e16791. [PMID: 32186516 PMCID: PMC7113804 DOI: 10.2196/16791] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/26/2019] [Accepted: 12/15/2019] [Indexed: 12/22/2022] Open
Abstract
Background Telemedicine is defined by three characteristics: (1) using information and communication technologies, (2) covering a geographical distance, and (3) involving professionals who deliver care directly to a patient or a group of patients. It is said to improve chronic care management and self-management in patients with chronic diseases. However, currently available guidelines for the care of patients with diabetes, hypertension, or dyslipidemia do not include evidence-based guidance on which components of telemedicine are most effective for which patient populations. Objective The primary aim of this study was to identify, synthesize, and critically appraise evidence on the effectiveness of telemedicine solutions and their components on clinical outcomes in patients with diabetes, hypertension, or dyslipidemia. Methods We conducted an umbrella review of high-level evidence, including systematic reviews and meta-analyses of randomized controlled trials. On the basis of predefined eligibility criteria, extensive automated and manual searches of the databases PubMed, EMBASE, and Cochrane Library were conducted. Two authors independently screened the studies, extracted data, and carried out the quality assessments. Extracted data were presented according to intervention components and patient characteristics using defined thresholds of clinical relevance. Overall certainty of outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tool. Results Overall, 3564 references were identified, of which 46 records were included after applying eligibility criteria. The majority of included studies were published after 2015. Significant and clinically relevant reduction rates for glycated hemoglobin (HbA1c; ≤−0.5%) were found in patients with diabetes. Higher reduction rates were found for recently diagnosed patients and those with higher baseline HbA1c (>8%). Telemedicine was not found to have a significant and clinically meaningful impact on blood pressure. Only reviews or meta-analyses reporting lipid outcomes in patients with diabetes were found. GRADE assessment revealed that the overall quality of the evidence was low to very low. Conclusions The results of this umbrella review indicate that telemedicine has the potential to improve clinical outcomes in patients with diabetes. Although subgroup-specific effectiveness rates favoring certain intervention and population characteristics were found, the low GRADE ratings indicate that evidence can be considered as limited. Future updates of clinical care and practice guidelines should carefully assess the methodological quality of studies and the overall certainty of subgroup-specific outcomes before recommending telemedicine interventions for certain patient populations.
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Affiliation(s)
- Patrick Timpel
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Sarah Oswald
- Master Program Health Sciences / Public Health at the Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine at the University Clinic Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter E H Schwarz
- Department for Prevention and Care of Diabetes, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Paul Langerhans Institute Dresden, Helmholtz Center Munich, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,German Center for Diabetes Research (DZD e V), Neuherberg, Germany
| | - Lorenz Harst
- Research Association Public Health Saxony / Center for Evidence-Based Healthcare, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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14
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Alkhouli M, Alqahtani F, Kalra A, Gafoor S, Alhajji M, Alreshidan M, Holmes DR, Lerman A. Trends in Characteristics and Outcomes of Patients Undergoing Coronary Revascularization in the United States, 2003-2016. JAMA Netw Open 2020; 3:e1921326. [PMID: 32058558 DOI: 10.1001/jamanetworkopen.2019.21326] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Data on the contemporary changes in risk profile and outcomes of patients undergoing percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) are limited. OBJECTIVE To assess the contemporary trends in the characteristics and outcomes of patients undergoing PCI or CABG in the United States. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a national inpatient claims-based database to identify patients undergoing PCI or CABG from January 1, 2003, to December 31, 2016. Data analysis was performed from July 15 to October 4, 2019. MAIN OUTCOMES AND MEASURES Demographic characteristics, prevalence of risk factors, and clinical presentation divided into 3 eras (2003-2007, 2008-2012, and 2013-2016) and in-hospital mortality of PCI and CABG stratified by clinical indication. RESULTS A total of 12 062 081 revascularization hospitalizations were identified: 8 687 338 PCIs (72.0%; mean [SD] patient age, 66.0 [10.8] years; 66.2% male) and 3 374 743 CABGs (28.0%; mean [SD] patient age, 64.5 [12.4] years; 72.1% male). The annual PCI volume decreased from 366 to 180 per 100 000 US adults and the annual CABG volume from 159 to 82 per 100 000 US adults. A temporal increase in the proportions of older, male, nonwhite, and lower-income patients and in the prevalence of atherosclerotic and nonatherosclerotic risk factors was found in both groups. The percentage of revascularization for myocardial infarction (MI) increased in the PCI group (22.8% to 53.1%) and in the CABG group (19.5% to 28.2%). Risk-adjusted mortality increased slightly after PCI for ST-segment elevation MI (4.9% to 5.3%; P < .001 for trend) and unstable angina or stable ischemic heart disease (0.8% to 1.0%; P < .001 for trend) but remained stable after PCI for non-ST-segment elevation MI (1.6% to 1.6%; P = .18 for trend). Risk-adjusted CABG morality markedly decreased in patients with MI (5.6% to 3.4% for all CABG and 4.8% to 3.0% for isolated CABG) and in those without MI (2.8% to 1.7% for all CABG and 2.1% to 1.2% for isolated CABG) (P < .001 for all). CONCLUSIONS AND RELEVANCE Significant changes were found in the characteristics of patients undergoing PCI and CABG in the United States between 2003 and 2016. Risk-adjusted mortality decreased significantly after CABG but not after PCI across all clinical indications.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Fahad Alqahtani
- Division of Cardiology, Department of Medicine, University of Kentucky, Lexington
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sameer Gafoor
- Swedish Heart and Vascular Institute, Seattle, Washington
| | | | | | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Amir Lerman
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
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Sofogianni A, Tziomalos K. Fixed-dose combinations of lipid-lowering and antihypertensive agents: The way forward? J Clin Hypertens (Greenwich) 2020; 22:270-272. [PMID: 32003930 DOI: 10.1111/jch.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Areti Sofogianni
- First Propedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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16
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Medina-Urrutia AX, Martínez-Sánchez FD, Posadas-Romero C, Jorge-Galarza E, Martínez-Alvarado MDR, González-Salazar MDC, Osorio-Alonso H, Juárez-Rojas JG. Metabolic control achievement in a population with premature coronary artery disease: results of the genetics of atherosclerotic disease study. Ther Adv Endocrinol Metab 2020; 11:2042018820943374. [PMID: 32782778 PMCID: PMC7385835 DOI: 10.1177/2042018820943374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/29/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND AIMS To the best of our knowledge, no studies have investigated the metabolic control of patients with premature coronary artery disease (CAD). The present study analyzes the metabolic control, defined as the simultaneous target in blood pressure, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and hemoglobin A1c, as well as the factors associated with its achievement in patients with premature CAD. METHODS The study included 1206 patients with CAD diagnosed before the age of 55 and 65 years in men and women, respectively. Sociodemographic, clinical and biochemical data were collected to know the prevalence of cardiovascular risk factors, including individual components of metabolic control plus smoking cessation and body mass index (BMI) <25 kg/m2. Non-strict and strict targets were used to evaluate metabolic control. RESULTS Participants were 54 ± 8 years old, 19.7% were women and had a median CAD evolution of 2.4 years. Non-strict and strict metabolic control was achieved by 18.4% and 6.2% of patients, respectively. Moreover, 79.8% and 67.6% met a composite of three or more cardiovascular risk factor goals using both criteria. BMI <25 kg/m2 was independently associated with 1.734 (95% confidence interval: 1.207-2.492) and 2.541 (95% confidence interval: 1.608-4.014) higher probabilities to meet non-strict or strict metabolic control. CONCLUSION Our results show that 18.4% and 6.2% of subjects with premature CAD achieved non-strict and strict metabolic control, respectively. BMI <25 kg/m2 was found to be associated with the achievement of metabolic control. Multidisciplinary strategies including healthy lifestyle changes and pharmacological therapies could decrease the socioeconomic and clinical impact of premature CAD.
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Affiliation(s)
- Aida X Medina-Urrutia
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | - Froylan D Martínez-Sánchez
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | - Carlos Posadas-Romero
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | - Esteban Jorge-Galarza
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | | | | | - Horacio Osorio-Alonso
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
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17
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Sarma PS, Sadanandan R, Thulaseedharan JV, Soman B, Srinivasan K, Varma RP, Nair MR, Pradeepkumar AS, Jeemon P, Thankappan KR, Kutty RV. Prevalence of risk factors of non-communicable diseases in Kerala, India: results of a cross-sectional study. BMJ Open 2019; 9:e027880. [PMID: 31712329 PMCID: PMC6858196 DOI: 10.1136/bmjopen-2018-027880] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 09/19/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of non-communicable disease (NCD) risk factors in Kerala. DESIGN A community-based, cross-sectional survey. PARTICIPANTS In 2016-2017 a multistage, cluster sample of 12 012 (aged 18-69 years) participants from all 14 districts of Kerala were studied. MAIN OUTCOME MEASURES NCD risk factors as stipulated in the WHO's approach to NCD risk factors surveillance were studied. Parameters that were studied included physical activity score, anthropometry, blood pressure (BP), and fasting blood glucose (FBG) and morning urine sample to estimate dietary intake of salt. RESULTS The mean age was 42.5 years (SD=14.8). Abdominal obesity was higher in women (72.6%; 95% CI 70.7 to 74.5) compared with men (39.1%; 95% CI 36.6 to 41.7), and also higher among urban (67.4%; 95% CI 65.0 to 69.7) compared with rural (58.6%; 95% CI 56.6 to 60.5) residents. Current use of tobacco and alcohol in men was 20.3% (95% CI 18.6 to 22.1) and 28.9% (95% CI 26.5 to 31.4), respectively. The estimated daily salt intake was 6.7 g/day. The overall prevalence of raised BP was 30.4% (95% CI 29.1 to 31.7) and raised FBG was 19.2% (95% CI 18.1 to 20.3). Raised BP was higher in men (34.6%; 95% CI 32.6 to 36.7) compared with women (28%; 95% CI 26.4 to 29.4), but was not different between urban (33.1%; 95% CI 31.3 to 34.9) and rural (29.8%; 95% CI 28.3 to 31.3) residents. Only 12.4% of individuals with hypertension and 15.3% of individuals with diabetes were found to have these conditions under control. Only 13.8% of urban and 18.4% of rural residents did not have any of the seven NCD risk factors studied. CONCLUSION Majority of the participants had more than one NCD risk factor. There was no rural-urban difference in terms of raised BP or raised FBG prevalence in Kerala. The higher rates of NCD risk factors and lower rates of hypertension and diabetes control call for concerted primary and secondary prevention strategies to address the future burden of NCDs.
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Affiliation(s)
- P S Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rajeev Sadanandan
- Department of Health and Family Welfare, Government of Kerala, Thiruvananthapuram, Kerala, India
| | - Jissa Vinoda Thulaseedharan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Kannan Srinivasan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - R P Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Manju R Nair
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - A S Pradeepkumar
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Raman V Kutty
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Majumdar UB, Hunt C, Doupe P, Baum AJ, Heller DJ, Levine EL, Kumar R, Futterman R, Hajat C, Kishore SP. Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns. BMJ Open 2019; 9:e029340. [PMID: 31619421 PMCID: PMC6797368 DOI: 10.1136/bmjopen-2019-029340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs. DESIGN Retrospective cross-sectional study. SETTING Mount Sinai Health System, set in all five boroughs of New York City, USA. PARTICIPANTS 192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014. METHODS We classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected. RESULTS 61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%. CONCLUSIONS In this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.
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Affiliation(s)
- Usnish B Majumdar
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Patrick Doupe
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Aaron J Baum
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Erica L Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | | | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Blom DJ, Santos RD, Daclin V, Mercier F, Ruiz AJ, Danchin N. The challenge of multiple cardiovascular risk factor control outside Western Europe: Findings from the International ChoLesterol management Practice Study. Eur J Prev Cardiol 2019; 27:1403-1411. [PMID: 31533447 PMCID: PMC7457454 DOI: 10.1177/2047487319871735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Comprehensive control of multiple cardiovascular risk factors reduces cardiovascular risk but is difficult to achieve. Design A multinational, cross-sectional, observational study. Methods The International ChoLesterol management Practice Study (ICLPS) investigated achievement of European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline low-density lipoprotein cholesterol (LDL-C) targets in patients receiving lipid-modifying therapy in countries outside Western Europe. We examined the rate of, and association between, control of multiple risk factors in ICLPS participants with dyslipidaemia, diabetes and hypertension (N = 2377). Results Mean (standard deviation) age of patients was 61.4 (10.4) years; 51.3% were male. Type 2 diabetes was the most common form of diabetes (prevalence, 96.9%). The prevalence of metabolic syndrome was 67.8%, obesity 40.4%, atherosclerotic disease 39.6% and coronary artery disease 33.5%. All patients were at high (38.2%) or very high (61.8%) cardiovascular risk according to ESC/EAS guidelines. Body mass index (BMI) was <25 kg/m2 in 20.3% of patients, 62.8% had never smoked and 25.2% were former smokers. Overall, 12.2% achieved simultaneous control of LDL-C, diabetes and blood pressure. Risk factor control was similar across all participating countries. The proportion of patients achieving individual guideline-specified treatment targets was 43.9% for LDL-C, 55.5% for blood pressure and 39.3% for diabetes. Multiple correspondence analysis indicated that control of LDL-C, control of blood pressure, control of diabetes, BMI and smoking were associated. Conclusion Comprehensive control of multiple cardiovascular risk factors in high-risk patients is suboptimal worldwide. Failure to control one risk factor is associated with poor control of other risk factors.
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Affiliation(s)
- Dirk J Blom
- University of Cape Town, Cape Town, South Africa
| | - Raul D Santos
- Heart Institute (InCor), University of Sao Paulo Medical School Hospital and Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | | | - Nicolas Danchin
- Cardiology, European Hospital Georges-Pompidou, Paris, France
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Plazak ME, Mouradjian MT, Watson K, Reed BN, Noel ZR, Devabhakthuni S, Gale SE. An aspirin a day? Clinical utility of aspirin therapy for the primary prevention of cardiovascular disease. Expert Rev Cardiovasc Ther 2019; 17:561-573. [PMID: 31305180 DOI: 10.1080/14779072.2019.1642108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Cardiovascular disease remains a leading cause of morbidity and mortality. Since the description of its therapeutic potential, aspirin has been a cornerstone of therapy following vascular events. However, aspirin in the primary prevention setting is controversial and major guideline groups provide inconsistent recommendations. Thus, there is variability in practice as providers are faced with a balance of therapeutic benefit and drug-induced harm. Areas covered: This article provides a critical appraisal of both past and present data for aspirin in the primary prevention setting. PubMed and Cochrane Central Register databases were searched from inception to May 1st, 2019. Expert opinion: The decision to initiate or withdraw aspirin for primary prevention requires an understanding of the equilibrium between efficacy and safety. In adults greater than 70 years of age, low to moderate cardiovascular risk, controlled diabetes, or at high risk of bleeding, initiation of aspirin for primary prevention should generally be avoided. Instead, risk factor modification should be prioritized. The net benefit of aspirin in those at high risk for cardiovascular disease and in those with uncontrolled diabetes is largely unknown. Ultimately, initiation or withdrawal of aspirin therapy must involve discussion of the patient's wishes and treatment expectations.
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Affiliation(s)
- Michael E Plazak
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Mallory T Mouradjian
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Kristin Watson
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Brent N Reed
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Zachary R Noel
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Sandeep Devabhakthuni
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Stormi E Gale
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy , Baltimore , MD , USA
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Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) has become a rising epidemic in the last century, more pressing in the last few decades with the exponential rise of obesity, and has become one of the leading causes of death worldwide. RECENT FINDINGS Genetic variants have also been a new field of epidemiology research to determine the underlying genetic component of those risk factors and the association of DM with CVD. In light of its significant prevalence, patients remain unaware of their disease progression that arises from genetic and metabolic risk factors. As compared to non-diabetics, those with type 2 DM carry a higher mortality risk from cardiovascular disease (CVD) across different ethnicity groups and sex. The most common cardiovascular manifestations in those with DM include heart failure, peripheral arterial disease, and coronary heart disease. Although DM does predispose patients to CVD, it in fact is not a risk equivalent, but carries significant heterogeneity in risk for CVD.
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Affiliation(s)
- Diana Glovaci
- Department of Medicine, Heart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA, 92697, USA.
| | - Wenjun Fan
- Department of Medicine, Heart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA, 92697, USA
| | - Nathan D Wong
- Department of Medicine, Heart Disease Prevention Program, Division of Cardiology, University of California, C240 Medical Sciences, Irvine, CA, 92697, USA
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de Havenon A, Majersik JJ, Tirschwell DL, McNally JS, Stoddard G, Rost NS. Blood pressure, glycemic control, and white matter hyperintensity progression in type 2 diabetics. Neurology 2019; 92:e1168-e1175. [PMID: 30737332 DOI: 10.1212/wnl.0000000000007093] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/01/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine whether higher blood pressure mean (BPM) or hemoglobin A1c is associated with progression of white matter hyperintensity (WMH) on MRI in patients with type 2 diabetes, and whether intensive blood pressure or glycemic control can reduce that progression. METHODS We performed a secondary analysis of the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD MIND) research materials. The primary outcome is change in WMH volume (ΔWMH) between a baseline and month-40 MRI, and the primary predictor is BPM and A1c between the MRIs. Additional analyses compared ΔWMH in the intensive vs standard glycemic control randomization arms (n = 502) and intensive vs standard blood pressure control randomization arms (n = 314). RESULTS Higher systolic BPM, but not diastolic BPM or A1c, was associated with WMH progression. The ΔWMH in tertiles of increasing systolic BPM (115 ± 4, 127 ± 3, and 139 ± 6 mm Hg) was 0.7, 0.9, and 1.2 cm3 (p < 0.001). ΔWMH was lower in the intensive vs standard blood pressure control randomization arm (ΔWMH = 0.67 ± 0.95 vs 1.16 ± 1.13 cm3, p < 0.001), but there was no difference in the glycemic control arms (p = 0.917). CONCLUSION In ACCORD MIND, higher systolic blood pressure was associated with WMH progression. The intensive blood pressure control intervention reduced this progression. Comorbid diabetes and hypertension has synergistic deleterious properties that increase the risk of micro- and macrovascular complications. These results provide further support for an aggressive approach to blood pressure control in type 2 diabetics.
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Affiliation(s)
- Adam de Havenon
- From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA.
| | - Jennifer J Majersik
- From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA
| | - David L Tirschwell
- From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA
| | - J Scott McNally
- From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA
| | - Gregory Stoddard
- From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA
| | - Natalia S Rost
- From the Department of Neurology (A.d.H., J.J.M., J.S.M., G.S.), University of Utah, Salt Lake City; Department of Neurology (D.L.T.), University of Washington, Seattle; Department of Neurology (N.S.R.), Harvard Medical School, Boston, MA
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23
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Channanath AM, AlWotayan R, Alkandari H, Davidsson L, Tuomilehto J, Thanaraj TA. Glycaemic control in native Kuwaiti Arab patients with type 2 diabetes. Prim Care Diabetes 2018; 12:526-532. [PMID: 30115526 DOI: 10.1016/j.pcd.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 01/26/2023]
Abstract
AIMS To evaluate the influence of age at diabetes diagnosis, diabetes duration, BMI, comorbidity with hypertension and medication regimen on glycaemic control in native Kuwaiti Arab patients with T2D. METHODS This cross-sectional study considered 7657 patients from Kuwait Diabetes Registry and analysed data from their laboratory and hospital records. RESULTS HbA1c and prevalence of hypertension increased significantly with diabetes duration. Duration of diabetes (β=0.034; P<0.001) and age at diagnosis (β=-0.03; P<0.001) were independently associated with HbA1c. Inadequate glycaemic control was more likely in patients diagnosed at <60 than in those ≥60 years of age (OR:1.80, 95%-CI:1.39-2.31). Increasing duration of diabetes witnessed decrease in metformin prescription and increase in sulfonylureas prescription; proportion of patients treated with insulin increased from 5.6% to 44.4% in 9 years of diagnosis. Patients with 9-years duration of diabetes or with combination therapy of insulin-metformin-sulfonylureas differed in mean BMI for adequate or inadequate glycaemic control (29.5 versus 31.2kg/m2; P<0.001 and 29.8 versus 33.2; P<0.01, respectively). CONCLUSIONS Only 25.6% of the T2D patients in this ethnic cohort exhibited adequate glycaemic control. The delineated relationship of inadequate glycaemic control with diabetes duration, onset age, obesity and hypertension prevalence has a bearing on diabetes management programs for Arabs.
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Affiliation(s)
- Arshad M Channanath
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
| | - Rihab AlWotayan
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Department of Primary Health Care, Ministry of Health, Kuwait
| | - Hessa Alkandari
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait; Department of Pediatrics, Farwaniya Hospital, Farwaniya, Kuwait
| | - Lena Davidsson
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
| | - Jaakko Tuomilehto
- Research Division, Dasman Diabetes Institute, P.O. Box 1180, Dasman 15462, Kuwait
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24
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Churchill TW, Krishnan S, Weisskopf M, A Yates B, Speizer FE, Kim JH, Nadler LE, Pascual-Leone A, Zafonte R, Baggish AL. Weight Gain and Health Affliction Among Former National Football League Players. Am J Med 2018; 131:1491-1498. [PMID: 30102909 PMCID: PMC6279549 DOI: 10.1016/j.amjmed.2018.07.042] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 07/24/2018] [Accepted: 07/25/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Professional American-style football players are among the largest athletes across contemporary sporting disciplines. Weight gain during football participation is common, but the health implications of this early-life weight gain remain incompletely understood. We sought to define weight trajectories of former professional American-style football athletes and to establish their relationship with 5 common health afflictions (cardiovascular disease, cardiometabolic disease, neurocognitive impairment, sleep apnea, and chronic pain). METHODS A health survey was distributed to former National Football League (NFL) players. Former players reported body weight at 4 time points (high school, college, professional, and time of survey response) as well as maximal retirement weight. Logistic regression was used to assess associations between weight gain during football participation and health affliction. RESULTS In this cohort of former NFL players (n = 3,506, age 53 ± 14 years), mean weight increase from high school to time of survey response was 40 ± 36 pounds, with the majority of weight gain occurring during periods of football participation (high-school-to-college and college-to-professional). The prevalence of health afflictions ranged from 9% (cardiovascular disease) to 28% (chronic pain). Weight gain during football participation was independently associated with risk of multiple later-life health afflictions in models adjusted for football exposure, lifestyle variables, and post-career weight gain. CONCLUSIONS Early-life weight gain among American-style football athletes is common and is associated with risk of adverse health profiles during later-life. These findings establish football-associated weight gain as a key predictor of post-career health and raise important questions about the central role of targeted weight gain in this population.
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Affiliation(s)
- Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Mass
| | | | | | - Brandon A Yates
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Mass
| | - Frank E Speizer
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Mass
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Ga
| | - Lee E Nadler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Mass
| | | | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, Mass
| | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Mass.
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25
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Donevant SB, Estrada RD, Culley JM, Habing B, Adams SA. Exploring app features with outcomes in mHealth studies involving chronic respiratory diseases, diabetes, and hypertension: a targeted exploration of the literature. J Am Med Inform Assoc 2018; 25:1407-1418. [PMID: 30137383 PMCID: PMC6188510 DOI: 10.1093/jamia/ocy104] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 06/29/2018] [Accepted: 07/10/2018] [Indexed: 01/06/2023] Open
Abstract
Objectives Limited data are available on the correlation of mHealth features and statistically significant outcomes. We sought to identify and analyze: types and categories of features; frequency and number of features; and relationship of statistically significant outcomes by type, frequency, and number of features. Materials and Methods This search included primary articles focused on app-based interventions in managing chronic respiratory diseases, diabetes, and hypertension. The initial search yielded 3622 studies with 70 studies meeting the inclusion criteria. We used thematic analysis to identify 9 features within the studies. Results Employing existing terminology, we classified the 9 features as passive or interactive. Passive features included: 1) one-way communication; 2) mobile diary; 3) Bluetooth technology; and 4) reminders. Interactive features included: 1) interactive prompts; 2) upload of biometric measurements; 3) action treatment plan/personalized health goals; 4) 2-way communication; and 5) clinical decision support system. Discussion Each feature was included in only one-third of the studies with a mean of 2.6 mHealth features per study. Studies with statistically significant outcomes used a higher combination of passive and interactive features (69%). In contrast, studies without statistically significant outcomes exclusively used a higher frequency of passive features (46%). Inclusion of behavior change features (ie, plan/goals and mobile diary) were correlated with a higher incident of statistically significant outcomes (100%, 77%). Conclusion This exploration is the first step in identifying how types and categories of features impact outcomes. While the findings are inconclusive due to lack of homogeneity, this provides a foundation for future feature analysis.
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Affiliation(s)
- Sara Belle Donevant
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | | | - Joan Marie Culley
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Brian Habing
- Department of Statistics, University of South Carolina, Columbia, South Carolina, USA
| | - Swann Arp Adams
- College of Nursing/Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
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26
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Karanam VC, Tamariz L, Batawi H, Wang J, Galor A. Functional slit lamp biomicroscopy metrics correlate with cardiovascular risk. Ocul Surf 2018; 17:64-69. [PMID: 30253248 DOI: 10.1016/j.jtos.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Our aim was to correlate cardiovascular risk factor estimation with bulbar conjunctival blood flow metrics as measured through Functional Slit Lamp Biomicroscopy (FSLB). METHODS Cross-sectional study of individuals with otherwise healthy eyelid and corneal anatomy recruited from the Miami Veterans Affairs (VA) Healthcare System eye clinic. We measured conjunctival microvascular hemodynamics by mounting a camera on a slit lamp and cardiovascular risk using the Framingham risk score. Our main outcome measures were correlations between conjunctival vessel parameters (axial and cross-sectional blood flow velocity, blood flow rate) and Framingham score. RESULTS We included 84 patients who underwent FSLB. The mean age was 60 years, the majority were male (88%) and approximately half the patients were black (54%). Mean vessel diameter was similar between all Framingham score categories. Axial and cross-sectional blood flow velocities and blood flow rate were lower in individuals with higher Framingham risk score. Specifically, mean cross-sectional blood flow velocity in individuals with a low Framingham risk score was 0.37 ± 0.0.9 mm/s, with an intermediate score was 0.30 ± 0.09 mm/s, and with a high score was 0.29 ± 0.10 mm/s, p = 0.04. Mean blood flow rate in individuals with a low Framingham risk score was 133.4 ± 59.6 pl/s, with an intermediate score was 123.6 ± 39.3 pl/s, and with a high score was 121.9 ± 52.6 pl/s, p = 0.04. The beta coefficient of the blood flow rate for change in Framingham score was -0.73; 95% CI-1.34-0.13, p = 0.02, adjusted for race. CONCLUSION FSLB correlates with cardiovascular risk estimation. Future studies should evaluate if FSLB can predict cardiovascular outcomes.
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Affiliation(s)
| | - Leonardo Tamariz
- Miami VA, Veterans Affairs Medical Center, Miami, FL, USA; Division of Population Health and Computational Medicine, USA
| | - Hatim Batawi
- Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Anat Galor
- Miami VA, Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA.
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27
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Orces CH, Lorenzo C. Prevalence of prediabetes and diabetes among older adults in Ecuador: Analysis of the SABE survey. Diabetes Metab Syndr 2018; 12:147-153. [PMID: 29273428 DOI: 10.1016/j.dsx.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/12/2017] [Indexed: 01/02/2023]
Abstract
AIMS To examine the prevalence of prediabetes and diabetes among subjects aged 60 years and older in Ecuador. MATERIALS AND METHODS The present study used data from the National Survey of Health, Wellbeing, and Aging to describe the prevalence of prediabetes and diabetes among older adults. Logistic regression models were assembled to examine the association between certain demographic and health characteristics of participants and prediabetes and diabetes prevalence rates. RESULTS Of 2298 participants, the prevalence of prediabetes and diabetes was 36.9% (95% CI: 34.2%-39.6%) and 16.7% (95% CI: 14.9%-18.7%) among older adults in Ecuador, respectively. Notably, higher diabetes prevalence rates were seen among women, black subjects, residents in the urban coastal region, and obese participants than those without. In general, the prevalence of diabetes widely varied across provinces of the country, with higher rates seen in provinces along the coastal region of the country. After adjustment for age, gender, and BMI, residents in the urban coast, subjects with greater number of comorbidities, and those classified as having hypertension, and hypertriglyceridemia had significantly higher odds of having diabetes than those without. CONCLUSIONS Prediabetes and diabetes are prevalent among older adults in Ecuador. The increased prevalence of these metabolic disorders was particularly associated with obesity. Thus, the present findings may assist health care authorities to implement healthy lifestyle interventions among older Ecuadorians at risk for diabetes.
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Affiliation(s)
- Carlos H Orces
- Laredo Medical Center, Department of Medicine, 1700 East Saunders, Laredo, TX 78041, United States.
| | - Carlos Lorenzo
- University of Texas Health Science Center, Division of Clinical Epidemiology, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States.
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28
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4559] [Impact Index Per Article: 759.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Jahangiry L, Ghanbari J, Abbasalizad Farhangi M, Sarbakhsh P, Ponnet K. Predictors of poor blood pressure control among Iranian hypertensive patients. BMC Res Notes 2017; 10:668. [PMID: 29202794 PMCID: PMC5715656 DOI: 10.1186/s13104-017-2971-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/21/2017] [Indexed: 11/17/2022] Open
Abstract
Objective The aim of this study is to investigate factors associated with poor blood pressure (BP) control in older hypertensive patients living in Iran. Poorly controlled hypertension was defined as blood pressure greater than or equal to 140/90 mmHg. Multiple logistic regressions were performed to identify factors associated with poor BP control. Results More than half of the patients (55.1%) had poor control of hypertension. Multivariate logistic regression analysis showed that being over 60 years of age (OR 1.67; 95% CI 1.18–2.37; p = .003), being widowed or divorced (OR 1.56; 95% CI 1.03–2.35; p = .035], smoking (OR 1.78; 95% CI 1.07–2.65; p = .01], BMI > 25 kg/m2 (OR 1.51 95% CI 1.05–2.78), having a waist circumference ≥ 90 cm (OR 1.7; 95% CI 1.2–2.42; p = .003], the use of calcium channel blockers (OR 2.69; 95% CI 1.26–5.72; p = .01], and the use of angiotensin converting enzyme inhibitors (OR 1.66; 95% CI 1.01–2.72; p = .044] contributed significantly to poor control of hypertension. Making a key BP control screening target (such as age over 60 and waist circumference of 90 cm or more) for cardiovascular specialists and other health care practitioners is needed for elderly patients at risk for poor BP control. Electronic supplementary material The online version of this article (10.1186/s13104-017-2971-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leila Jahangiry
- Health Education and Health Promotion Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalileh Ghanbari
- Health Education and Health Promotion Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Abbasalizad Farhangi
- Department of Community Nutrition, Faculty of Health and Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Epidemiology and Biostatistics Department, School of Public Health, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Koen Ponnet
- Department of Communication Sciences, MICT-IMEC, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium.,Faculty of Social Sciences, University of Antwerp, Antwerp, Belgium
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