1
|
Li X, Jansåker F, Sundquist J, Sundquist K. Neighbourhood deprivation and type 2 diabetes in patients with bipolar disorder: A nationwide follow-up study. Stress Health 2024; 40:e3302. [PMID: 37565544 DOI: 10.1002/smi.3302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 05/18/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
Patients with bipolar disorder have higher rates of type 2 diabetes (T2D) compared to the general population. Neighbourhood deprivation is associated with T2D and bipolar disorder. The aim of this study was to explore the potential effect of neighbourhood deprivation on incident T2D in patients with bipolar disorder. This nationwide open cohort study (1997-2018) included adults in Sweden ≥20 years with bipolar disorder (90,780 patients) to examine the subsequent risk of T2D. The association between neighbourhood deprivation and T2D was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for individual-level sociodemographic factors and comorbidities. Neighbourhood deprivation was significantly associated with T2D in patients with bipolar disorder. The HRs were 1.61 (95% CI 1.40-1.86) for men and 1.83 (1.60-2.10) for women living in high deprivation neighbourhoods compared to those from low deprivation neighbourhoods. After adjustment, these results remained significant: 1.35 (1.17-1.56) in men and 1.39 (1.20-1.60) in women living in high deprivation neighbourhoods. The suggested graded association of higher incident T2D among patients with bipolar disorder, observed when levels of neighbourhood deprivation increased, raises important clinical and public health concerns. The results may help develop a contextual approach to prevention of T2D in patients with bipolar disorder that includes the neighbourhood environment.
Collapse
Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University, Lund, Sweden
| | - Filip Jansåker
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Center of Diagnostic Investigations, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Lund, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Matsue, Japan
| |
Collapse
|
2
|
Bamoshmoosh M. Cardiovascular diseases in European ethnic minorities: Beyond the traditional cardiovascular risk factors. World J Cardiol 2024; 16:98-103. [PMID: 38576522 PMCID: PMC10989226 DOI: 10.4330/wjc.v16.i3.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/14/2024] [Accepted: 02/07/2024] [Indexed: 03/21/2024] Open
Abstract
This editorial is intended to be a reflection on cardiovascular disease (CVD) burden in European ethnic minorities. In some European countries, ethnic minority realities, due to their recent appearance, are still to be studied in depth. The experience of several European countries, where the migration processes started earlier, even more than a century ago, can help by being an example. Many studies have shown that major differences in CVD burden exist not only between countries, but also within the same country when considering different social strata and ethnic groups. The CV risk factors underlying heart disease have been well established. Important epidemiological studies have helped us understand that the underlying causes of heart disease as well as the behaviors that can help prevent them are the same. We are now well aware that CVD should be treated by considering a holistic approach. This is why the social determinants (SDs) of health that may worsen the disease burden or that, vice versa, may improve the treatment, and even more significantly, the prognosis of a patient's illness should be taken into consideration. For ethnic minority patients, this holistic, hermeneutic approach is of importance. Several SDs of health that influence CVDs have been identified but their relevance for the health of ethnic minorities has not yet been clearly defined. In some European countries, most ethnic minorities are largely also religious minorities. Only a few studies have evaluated the role of religion, which is an important SD that affects the probability of having CV risk factors and diseases. Adolescents, particularly those belonging to the second generation, seem to be the weak link. If we believe that these young people are really citizens of their country of birth, then a way of recognizing their belonging to the community starts from a will to better understand their condition, in order to assist them while they grow physically and mentally. Thinking about safeguarding the health of this population should be more than a health task, rather a goal of social justice.
Collapse
Affiliation(s)
- Mohamed Bamoshmoosh
- Department of Cardiology, University of Science and Technology, Aden 0, Yemen
- Department of Cardiology, Fanfani Clinical Research Institute, Florence 50100, Italy.
| |
Collapse
|
3
|
Wong YL, Yu M, Chong C, Yang D, Xu D, Lee ML, Hsu W, Wong TY, Cheng C, Cheung CY. Association between deep learning measured retinal vessel calibre and incident myocardial infarction in a retrospective cohort from the UK Biobank. BMJ Open 2024; 14:e079311. [PMID: 38514140 PMCID: PMC10961540 DOI: 10.1136/bmjopen-2023-079311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Cardiovascular disease is a leading cause of global death. Prospective population-based studies have found that changes in retinal microvasculature are associated with the development of coronary artery disease. Recently, artificial intelligence deep learning (DL) algorithms have been developed for the fully automated assessment of retinal vessel calibres. METHODS In this study, we validate the association between retinal vessel calibres measured by a DL system (Singapore I Vessel Assessment) and incident myocardial infarction (MI) and assess its incremental performance in discriminating patients with and without MI when added to risk prediction models, using a large UK Biobank cohort. RESULTS Retinal arteriolar narrowing was significantly associated with incident MI in both the age, gender and fellow calibre-adjusted (HR=1.67 (95% CI: 1.19 to 2.36)) and multivariable models (HR=1.64 (95% CI: 1.16 to 2.32)) adjusted for age, gender and other cardiovascular risk factors such as blood pressure, diabetes mellitus (DM) and cholesterol status. The area under the receiver operating characteristic curve increased from 0.738 to 0.745 (p=0.018) in the age-gender-adjusted model and from 0.782 to 0.787 (p=0.010) in the multivariable model. The continuous net reclassification improvements (NRIs) were significant in the age and gender-adjusted (NRI=21.56 (95% CI: 3.33 to 33.42)) and the multivariable models (NRI=18.35 (95% CI: 6.27 to 32.61)). In the subgroup analysis, similar associations between retinal arteriolar narrowing and incident MI were observed, particularly for men (HR=1.62 (95% CI: 1.07 to 2.46)), non-smokers (HR=1.65 (95% CI: 1.13 to 2.42)), patients without DM (HR=1.73 (95% CI: 1.19 to 2.51)) and hypertensive patients (HR=1.95 (95% CI: 1.30 to 2.93)) in the multivariable models. CONCLUSION Our results support DL-based retinal vessel measurements as markers of incident MI in a predominantly Caucasian population.
Collapse
Affiliation(s)
- Yiu Lun Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Marco Yu
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Crystal Chong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Dawei Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Dejiang Xu
- School of Computing, National University of Singapore, Singapore
| | - Mong Li Lee
- School of Computing, National University of Singapore, Singapore
| | - Wynne Hsu
- School of Computing, National University of Singapore, Singapore
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Chingyu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
- Centre for Innovation and Precision Eye Health; and Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
4
|
Steffen HM, Mahanani MR, Neuhann F, Nhlema A, Kasper P, de Forest A, Chaweza T, Tweya H, Heller T, Chiwoko J, Winkler V, Phiri S. Blood pressure changes during tenofovir-based antiretroviral therapy among people living with HIV in Lilongwe, Malawi: results from the prospective LighTen Cohort Study. Clin Res Cardiol 2023; 112:1650-1663. [PMID: 37414923 PMCID: PMC10584708 DOI: 10.1007/s00392-023-02253-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Sub-Saharan Africa is one of the regions in the world with the highest numbers of uncontrolled hypertension as well as people living with HIV/AIDS (PLHIV). However, the association between hypertension and antiretroviral therapy is controversial. METHODS Participant demographics, medical history, laboratory values, WHO clinical stage, current medication, and anthropometric data were recorded at study entry and during study visits at 1, 3, 6 months, and every 6 months thereafter until month 36. Patients who stopped or changed their antiretroviral therapy (tenofovir, lamivudine, efavirenz) were censored on that day. Office blood pressure (BP) was categorized using ≥ 2 measurements on ≥ 2 occasions during the first three visits. Factors associated with systolic and mean BP were analyzed using bivariable and multivariable multilevel linear regression. RESULTS 1,288 PLHIV (751 females, 58.3%) could be included and 832 completed the 36 months of observation. Weight gain and a higher BP level at study entry were associated with an increase in BP (p < 0.001), while female sex (p < 0.001), lower body weight at study entry (p < 0.001), and high glomerular filtration rate (p = 0.009) protected against a rise in BP. The rate of uncontrolled BP remained high (73.9% vs. 72.1%) and despite indication treatment, adjustments were realized in a minority of cases (13%). CONCLUSION Adherence to antihypertensive treatment and weight control should be addressed in patient education programs at centers caring for PLHIV in low-resources settings like Malawi. Together with intensified training of medical staff to overcome provider inertia, improved control rates of hypertension might eventually be achieved. TRIAL REGISTRATION NCT02381275.
Collapse
Affiliation(s)
- Hans-Michael Steffen
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
- Hypertension Center, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
| | | | - Florian Neuhann
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | | | - Philipp Kasper
- Department of Gastroenterology and Hepatology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Andrew de Forest
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | | | - Hannock Tweya
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | - Tom Heller
- Lighthouse Clinic, Lilongwe, Malawi
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA
| | | | - Volker Winkler
- Institute for Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sam Phiri
- Lighthouse Clinic, Lilongwe, Malawi
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Public Health and Family Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi
| |
Collapse
|
5
|
Zhang T, Liu N, Xu J, Liu Z, Zhou Y, Yang Y, Li S, Huang Y, Jiang S. Flexible electronics for cardiovascular healthcare monitoring. Innovation (N Y) 2023; 4:100485. [PMID: 37609559 PMCID: PMC10440597 DOI: 10.1016/j.xinn.2023.100485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/23/2023] [Indexed: 08/24/2023] Open
Abstract
Cardiovascular diseases (CVDs) are one of the most urgent threats to humans worldwide, which are responsible for almost one-third of global mortality. Over the last decade, research on flexible electronics for monitoring and treatment of CVDs has attracted tremendous attention. In contrast to conventional medical instruments in hospitals that are usually bulky, hard to move, monofunctional, and time-consuming, flexible electronics are capable of continuous, noninvasive, real-time, and portable monitoring. Notable progress has been made in this emerging field, and thus a number of significant achievements and concomitant research prospects deserve attention for practical implementation. Here, we comprehensively review the latest progress of flexible electronics for CVDs, focusing on new functions provided by flexible electronics. First, the characteristics of CVDs and flexible electronics and the foundation of their combination are briefly reviewed. Then, four representative applications of flexible electronics for CVDs are elaborated: blood pressure (BP) monitoring, electrocardiogram (ECG) monitoring, echocardiogram monitoring, and direct epicardium monitoring. Their operational principles, progress, merits and demerits, and future efforts are discussed. Finally, the remaining challenges and opportunities for flexible electronics for cardiovascular healthcare are outlined.
Collapse
Affiliation(s)
- Tianqi Zhang
- Hangzhou Institute of Technology, Xidian University, Hangzhou 311200, China
| | - Ning Liu
- Department of Gastrointestinal Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou 570311, China
| | - Jing Xu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Zeye Liu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yunlei Zhou
- Hangzhou Institute of Technology, Xidian University, Hangzhou 311200, China
| | - Yicheng Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shoujun Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing 100037, China
| | - Yuan Huang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Pediatric Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing 100037, China
| | - Shan Jiang
- Hangzhou Institute of Technology, Xidian University, Hangzhou 311200, China
| |
Collapse
|
6
|
Osei-Yeboah J, Moll van Charante EP, Kengne AP, Owusu-Dabo E, van den Born BJH, Galenkamp-van der Ploeg H, Chilunga FP, Boateng D, Motazedi E, Agyemang C. Cardiovascular Risk Estimation Based on Country-of-Birth- and Country-of-Residence-Specific Scores among Migrants in the Netherlands: The HELIUS Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5148. [PMID: 36982057 PMCID: PMC10048928 DOI: 10.3390/ijerph20065148] [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: 02/01/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Regional and country-specific cardiovascular risk algorithms have been developed to improve CVD risk prediction. But it is unclear whether migrants' country-of-residence or country-of-birth algorithms agree in stratifying the CVD risk of these populations. We evaluated the risk stratification by the different algorithms, by comparing migrant country-of-residence-specific scores to migrant country-of-birth-specific scores for ethnic minority populations in the Netherlands. METHOD data from the HELIUS study was used in estimating the CVD risk scores for participants using five laboratory-based (Framingham, Globorisk, Pool Cohort Equation II, SCORE II, and WHO II) and three nonlaboratory-based (Framingham, Globorisk, and WHO II) risk scores with the risk chart for the Netherlands. For the Globorisk, WHO II, and SCORE II risk scores, we also computed the risk scores using risk charts specified for the migrant home country. Risk categorization was first done according to the specification of the risk algorithm and then simplified to low (green), moderate (yellow and orange), and high risk (red). RESULTS we observed differences in risk categorization for different risk algorithms ranging from 0% (Globorisk) to 13% (Framingham) for the high-risk category, as well as differences in the country-of-residence- and country-of-birth-specific scores. Agreement between different scores ranged from none to moderate. We observed a moderate agreement between the Netherlands-specific SCORE II and the country-of-birth SCORE II for the Turkish and a nonagreement for the Dutch Moroccan population. CONCLUSION disparities exist in the use of the country-of-residence-specific, as compared to the country-of-birth, risk algorithms among ethnic minorities living in the Netherlands. Hence, there is a need for further validation of country-of-residence- and country-of-birth-adjusted scores to ascertain appropriateness and reliability.
Collapse
Affiliation(s)
- James Osei-Yeboah
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, PMB KNUST, Kumasi GPS AK-448-4944, Ghana
| | - Eric P. Moll van Charante
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Department of General Practice, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
| | - Andre-Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Ellis Owusu-Dabo
- Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, PMB KNUST, Kumasi GPS AK-448-4944, Ghana
| | - Bert-Jan H. van den Born
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Henrike Galenkamp-van der Ploeg
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
| | - Felix P. Chilunga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
| | - Daniel Boateng
- Department of Epidemiology & Biostatistics, School of Public Health, Kwame Nkrumah University of Science and Technology, PMB KNUST, Kumasi GPS AK-448-4944, Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, 3584 CX Utrecht, The Netherlands
| | - Ehsan Motazedi
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Public and Occupational Health, De Boelelaan 1117, 1081 HZ Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1012 WX Amsterdam, The Netherlands
| |
Collapse
|
7
|
Lorenzi CH, Teixeira Leffa D, Bressan R, Belangero S, Gadelha A, Santoro ML, Salum GA, Rohde LA, Caye A. Replication of a predictive model for youth ADHD in an independent sample from a developing country. J Child Psychol Psychiatry 2023; 64:167-174. [PMID: 35959538 DOI: 10.1111/jcpp.13682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Very few predictive models in Psychiatry had their performance validated in independent external samples. A previously developed multivariable demographic model for attention-deficit/hyperactivity disorder (ADHD) accurately predicted young adulthood ADHD using clinical and demographical information collected in childhood in three samples from developed countries, but failed to replicate its performance in a sample from a developing country. Furthermore, consolidated risk factors for ADHD were not included among its predictors. METHODS Participants were 1905 children and adolescents from a community-based sample and followed from ages 6 to 14 years at baseline to ages 14 to 23 years (mean age 18) at follow-up. We applied the intercept and weights of the original model to the data, calculating the predicted probability of each participant according to the set of predictors collected in childhood, and compared the estimates with the actual outcome (ADHD) collected during adolescence and young adulthood. We explored the performance of the original model, and of models including novel predictors (prematurity, family history of ADHD, and polygenic risk score for ADHD). RESULTS The observed area under the curve of the original model was .76 (95% Confidence Interval .70 to .82). The multivariable demographical model outperformed single variable models using only prematurity, family history, or the ADHD PRS. Adding either of these variables, or all at once, did not improve the performance of the original demographical model. CONCLUSIONS Our findings suggest that the originally developed ADHD predictive model is suitable for use in different settings for clinical and research purposes.
Collapse
Affiliation(s)
- Cezar H Lorenzi
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas Teixeira Leffa
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil
| | - Rodrigo Bressan
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil.,Post-Graduation Program in Psychiatry and Medical Psychology, UNIFESP, São Paulo, Brazil
| | - Sintia Belangero
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil.,Post-Graduation Program in Psychiatry and Medical Psychology, UNIFESP, São Paulo, Brazil.,Genetics Division, Department of Morphology and Genetics, UNIFESP, São Paulo, Brazil
| | - Ary Gadelha
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil.,Post-Graduation Program in Psychiatry and Medical Psychology, UNIFESP, São Paulo, Brazil
| | - Marcos L Santoro
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil.,Post-Graduation Program in Psychiatry and Medical Psychology, UNIFESP, São Paulo, Brazil.,Genetics Division, Department of Morphology and Genetics, UNIFESP, São Paulo, Brazil
| | - Giovanni A Salum
- National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil
| | - Arthur Caye
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,National Institute of Developmental Psychiatry for Children and Adolescents (INPD), São Paulo, Brazil
| |
Collapse
|
8
|
Li AL, Peng Q, Shao YQ, Fang X, Zhang YY. The interaction on hypertension between family history and diabetes and other risk factors. Sci Rep 2021; 11:4716. [PMID: 33633182 PMCID: PMC7907071 DOI: 10.1038/s41598-021-83589-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/19/2021] [Indexed: 02/07/2023] Open
Abstract
To explore the individual effect and interaction of diabetes and family history and other risk factors on hypertension in Han in Shanghai China. The method of case-control study with l:l matched pairs was used, 342 cases of hypertension and 342 controls were selected and investigate their exposed factors with face-to-face. The method of epidemiology research was used to explore the individual effect and interaction of diabetes and family history and other risk factors on hypertension. The individual effect of family history (OR = 4.103, 95%CI 2.660-6.330), diabetes (OR = 4.219, 95%CI 2.926-6.083), personal taste (OR = 1.256, 95%CI 1.091-1.593), drinking behavior (OR = 1.391, 95%CI 1.010-1.914) and smoking behavior (OR = 1.057, 95%CI 1.00-1.117) were significant (p < 0.05). But individual effect of sex, education, occupation, work/life pressure, environmental noise, sleeping time and sports habit were not significant (p > 0.05). The OR of interaction between FH and DM to hypertension was 16.537 (95%CI 10.070-21.157), between FH and drinking behavior was 4.0 (95%CI 2.461-6.502), FH and sport habit was 7.668 (95%CI 3.598-16.344), FH and personal taste was 6.521 (95%CI 3.858-11.024), FH and smoking behavior was 5.526 (95%CI 3.404-8.972), FH and work/life pressure was 4.087 (95%CI 2.144-7.788). The SI of FH and DM was 2.27, RERI was 8.68, AP was 52.48% and PAP was 55.86%. FH and DM, personal taste, smoking behavior had positive interaction on hypertension, but FH and sport habits, drinking behavior, work/life pressure had reverse interaction on hypertension. FH and diabetes were very important risk factors with significant effect for hypertension. FH and diabetes, personal taste, smoking behavior had positive interaction on hypertension, but FH and sport habits, drinking behavior, work/life pressure had reverse interaction on hypertension.
Collapse
Affiliation(s)
- An-le Li
- Jiading District Center for Disease Control and Prevention, Shanghai, China.
| | - Qian Peng
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yue-Qin Shao
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Xiang Fang
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yi-Ying Zhang
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| |
Collapse
|
9
|
Cardiovascular health care and health literacy among immigrants in Europe: a review of challenges and opportunities during the COVID-19 pandemic. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2020; 30:1285-1291. [PMID: 33134037 PMCID: PMC7592128 DOI: 10.1007/s10389-020-01405-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022]
Abstract
Objectives Europe is a destination for many migrants, a group whose proportion of the overall population will increase over the next decades. The cardiovascular (CV) risk distribution and outcomes, as well as health literacy, are likely to differ from the host population. Challenges related to migrant health status, cardiovascular risk distribution and health literacy are compounded by the ongoing coronavirus disease 2019 (COVID-2019) crisis. Methods We performed a narrative review of available evidence on migrant CV and health literacy in Europe. Results Health literacy is lower in migrants but can be improved through targeted interventions. In some subgroups of migrants, rates of cardiovascular disease (CVD) risk factors, most importantly hypertension and diabetes, are higher. On the other hand, there is strong evidence for a so-called healthy migrant effect, describing lower rates of CV risk distribution and mortality in a different subset of migrants. During the COVID-19 pandemic, CV risk factors, as well as health literacy, are key elements in optimally managing public health responses in the ongoing pandemic. Conclusions Migrants are both an opportunity and a challenge for public health in Europe. Research aimed at better understanding the healthy migrant effect is necessary. Implementing the beneficial behaviors of migrants could improve outcomes in the whole population. Specific interventions to screen for risk factors, manage chronic disease and increase health literacy could improve health care for migrants. This pandemic is a challenge for the whole population, but active inclusion of immigrants in established health care systems could help improve the long-term health outcomes of migrants in Europe.
Collapse
|
10
|
Sehgal A, Sibia RPS, Kaur J, Bhajni E, Sehgal VK. A Cross-Sectional Study to Evaluate Cardiovascular Risk Score in Type 2 Diabetes Mellitus. Int J Appl Basic Med Res 2020; 10:276-279. [PMID: 33376703 PMCID: PMC7758795 DOI: 10.4103/ijabmr.ijabmr_45_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/25/2020] [Accepted: 05/29/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of mortality worldwide, including in low- and middle-income countries. Cardiovascular risk assessment is essential to prevent the mortality caused by diabetes. AIM The current study was conducted to assess the prevalence of cardiovascular risk factors in type 2 diabetes and to compare the United Kingdom Prospective Diabetes Study (UKPDS) and World Health Organization (WHO)/International Society of Hypertension (ISH) chart in assessing cardiovascular risk score. MATERIALS AND METHODS Cardiac risk assessments were done in fifty patients attending the medicine outpatient department in an institutional hospital after ethical clearance and taking informed consent from patients. Two assessment tools were applied on the same patient. RESULTS Overall, 10% of people were obese (body mass index >30). Smoking was prevalent in 20% (10/50) of patients. Hypertension was observed in 60% (30/50) of patients. Raised total cholesterol (TC) was the most common lipid abnormality affecting 94% of patients. The WHO/ISH prediction charts identified 14% and 10% of patients with cardiovascular risk category <10 and 10-20, whereas the UKPDS engine predicted 24% and 38% in the same category. In high-risk categories 30-40 and >40, the WHO/ISH score predicted a higher proportion of patients (18% and 32%) than the UKPDS engine (8% and 4%, respectively). Kappa value was calculated to calculate the degree of agreement between two tools, and it was found to be 0.781 (P < 0.01). CONCLUSION Raised TC and hypertension were the most prevalent risk factors. There was no significant discrepancy between two assessment tools in predicting cardiovascular risk score among type 2 diabetes mellitus patients in our study.
Collapse
Affiliation(s)
- Arshiya Sehgal
- Department of Pharmacology, Government Medical College, Rajindra Hospital, Patiala, Punjab, India
| | - RPS Sibia
- Department of Medicine, Rajindra Hospital, Patiala, Punjab, India
| | - Jasleen Kaur
- Department of Pharmacology, Government Medical College, Rajindra Hospital, Patiala, Punjab, India
| | - Ena Bhajni
- Department of Pharmacology, Government Medical College, Rajindra Hospital, Patiala, Punjab, India
| | - Vijay Kumar Sehgal
- Department of Pharmacology, Government Medical College, Rajindra Hospital, Patiala, Punjab, India
| |
Collapse
|
11
|
Prevalence and determinants of blood pressure variability in pygmies of Southern region Cameroon. J Hypertens 2020; 38:2198-2204. [PMID: 32694331 DOI: 10.1097/hjh.0000000000002529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The impact of urbanization and living conditions on the prevalence of hypertension in the Cameroonian population is poorly known. AIM To evaluate the prevalence and determinants of blood pressure (BP) in adult Pygmies and Bantus living in urban and rural areas of Southern Cameroon. PARTICIPANTS AND METHODS This was a cross-sectional comparative study of 406 adults (96 urban Bantus, 100 urban Pygmies, 111 rural Bantus and 99 tropical rainforest Pygmies with a traditional Pygmies way of life), recruited in Southern Cameroon (mean age 42 ± 17 years; 56.7% women). Sociodemographic, anthropometric and BP parameters were collected. Hypertension was defined as BP at least 140/90 mmHg and/or use of BP-lowering drug(s). RESULTS The age-standardized prevalence of hypertension in urban Bantus, rural Bantus, urban Pygmies and traditional Pygmies was 18.0, 13.5, 9.3 and 4.1%, respectively. Mean SBP and DBP differed significantly according to Bantu vs. Pygmy ethnicity, and urban vs. rural residency. After multiple adjustments, mean arterial pressure was significantly associated with age, BMI, Bantu ancestry and urban residency. CONCLUSION Bantu ethnicity and urban residency are significantly associated with high-BP among people from Southern Cameroon.
Collapse
|
12
|
Determinants of Selected Cardiovascular Diseases among Adult Patients at Cardiac Clinic of Debre Berhan Referral Hospital, Ethiopia: Unmatched Case-Control Study. Cardiovasc Ther 2020; 2020:7036151. [PMID: 32547636 PMCID: PMC7273416 DOI: 10.1155/2020/7036151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Africans are experiencing a rapid epidemiological transition characterized by urbanization and lifestyle changes, which are thought to contribute to increased incidence and prevalence of cardiovascular diseases (CVDs) in many African countries, including Ethiopia. Despite this, however, there is scarcity of evidence on cardiovascular disease risk factors among adults in the current research setting. This study thus aimed at assessing determinants of selected cardiovascular diseases among adult patients at Debre Berhan Referral Hospital (DBRH). Methodology. An unmatched case-control study was conducted on 143 newly diagnosed patients with CVDs and 286 controls at the cardiac clinic of DBRH from June to September 2017. Primary data were collected using the WHO-STEPS wise structured questionnaires. Multiple logistic regression analysis was used to identify potential risk factors for cardiovascular diseases at p values < 0.05. Result The mean age of study participants is estimated as 45.5 ± 13.8 and ranges from 25 to 64 years. Sixty-one (42.7%) of cases and 147 (51.4%) of controls are males. Half of the cases (49.9%) had ischemic heart diseases (IHD), and 44.1% of cases had hypertensive heart disease (HHD), whereas the rest had chronic valvular heart disease (CRVHD) (4.2%) and peripheral and vascular disease (2.1%). This study identified older age as a risk factor for CVD: age group 35–44 years (adjusted odds ratio (AOR) = 2.20; 95% CI: 1.05–4.62), 45-54 years (AOR = 4.23; 95% CI: 2.19–8.16), and 55-64 years (AOR = 5.98; 95% CI: 3.26–10.98). Other risk factors were smoking history (AOR = 9.52; 95% CI: 2.12–42.8), low level of physical activity (AOR = 2.19; 95% CI: 1.10–5.02), and higher waist circumference (AOR = 2.75; 95% CI: 1.16–6.56). Conclusion This study has demonstrated that the most frequent risk factors for CVD were older age, cigarette smoking, physical inactivity, and abdominal obesity. Therefore, behavior change communication focusing on lifestyle modification including regular physical activities, smoking cessation, and a balanced diet should be strengthened.
Collapse
|
13
|
Denli Yalvac ES. Cardiovascular diseases and their risk factors among Syrian refugees in Turkey. Rev Epidemiol Sante Publique 2020; 68:137-144. [PMID: 32139199 DOI: 10.1016/j.respe.2019.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Information on the world distribution of cardiovascular disease and its risk factors in refugees/migrants is not available at the same rate for all countries or for different ethnic and socioeconomic groups. Today, Syria's humanitarian catastrophe has become a public health concern, which cannot be ignored. METHODS A search was conducted across PubMed and Google Scholar for papers on cardiovascular diseases among refugees/migrants worldwide with a focus on Syrian in Turkey. RESULTS The total number of papers identified through the database searches and from reference lists was 486. Of these, 62 were found to be relevant after further screening. A further 42 papers were considered not eligible after full-text, language and data assessments, resulting in a final 20 papers included in the qualitative analysis. These studies discussed several major themes: cardiovascular diseases and their risk factors among refugees/migrants, the effects of changing living conditions on refugees/migrants, the effects of psychological and socioeconomic factors, and the prevention and treatment of cardiovascular diseases in refugees/migrants. The risk of cardiovascular disease varied by country of origin, country of destination, and duration of residence. The findings suggest that cardiovascular diseases and their risk factors are increased for Syrian refugees in Turkey. CONCLUSION Raising awareness, prevention, early detection, and good management as well as monitoring and reporting of risk factors are the key components to controlling cardiovascular diseases in refugees. Further studies and greater acquisition of survey data are urgently needed.
Collapse
Affiliation(s)
- E S Denli Yalvac
- Department of Cardiovascular Surgery, Göztepe Education and Research Hospital, Istanbul Medeniyet University, Kadiköy, Istanbul, Turkey.
| |
Collapse
|
14
|
Development and Use of Prediction Models for Classification of Cardiovascular Risk of Remote Indigenous Australians. Heart Lung Circ 2020; 29:374-383. [DOI: 10.1016/j.hlc.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/05/2018] [Accepted: 02/05/2019] [Indexed: 01/03/2023]
|
15
|
Joseph J, Kiran R, Nabeel PM, Shah MI, Bhaskar A, Ganesh C, Seshadri S, Sivaprakasam M. ARTSENS ® Pen-portable easy-to-use device for carotid stiffness measurement: technology validation and clinical-utility assessment. Biomed Phys Eng Express 2020; 6:025013. [PMID: 33438639 DOI: 10.1088/2057-1976/ab74ff] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The conventional medical imaging modalities used for arterial stiffness measurement are non-scalable and unviable for field-level vascular screening. The need for an affordable, easy-to-operate automated non-invasive technologies remains unmet. To address this need, we present a portable image-free ultrasound device-ARTSENS® Pen, that uses a single-element ultrasound transducer for carotid stiffness evaluation. APPROACH The performance of the device was clinically validated on a cohort of 523 subjects. A clinical-grade B-mode ultrasound imaging system (ALOKA eTracking) was used as the reference. Carotid stiffness measurements were taken using the ARTSENS® Pen in sitting posture emulating field scenarios. MAIN RESULTS A statistically significant correlation (r > 0.80, p < 0.0001) with a non-significant bias was observed between the measurements obtained from the two devices. The ARTSENS® Pen device could perform highly repeatable measurements (with variation smaller than 10%) on a relatively larger percentage of the population when compared to the ALOKA system. The study results also revealed the sensitivity of ARTSENS® Pen to detect changes in arterial stiffness with age. SIGNIFICANCE The easy-to-use technology and the automated algorithms of the ARTSENS® Pen make it suitable for cardiovascular risk assessment in resource-constrained settings.
Collapse
Affiliation(s)
- Jayaraj Joseph
- Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Taramani, Chennai, Tamil Nadu-600 113, India
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Rastegar S, GholamHosseini H, Lowe A. Non-invasive continuous blood pressure monitoring systems: current and proposed technology issues and challenges. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2019; 43:10.1007/s13246-019-00813-x. [PMID: 31677058 DOI: 10.1007/s13246-019-00813-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/25/2019] [Indexed: 01/03/2023]
Abstract
High blood pressure (BP) or hypertension is the single most crucial adjustable risk factor for cardiovascular diseases (CVDs) and monitoring the arterial blood pressure (ABP) is an efficient way to detect and control the prevalence of the cardiovascular health of patients. Therefore, monitoring the regulation of BP during patients' daily life plays a critical role in the ambulatory setting and the latest mobile health technology. In recent years, many studies have been conducted to explore the feasibility and performance of such techniques in the health care system. The ultimate aim of these studies is to find and develop an alternative to conventional BP monitoring by using cuff-less, easy-to-use, fast, and cost-effective devices for controlling and lowering the physical harm of CVDs to the human body. However, most of the current studies are at the prototype phase and face a range of issues and challenges to meet clinical standards. This review focuses on the description and analysis of the latest continuous and cuff-less methods along with their key challenges and barriers. Particularly, most advanced and standard technologies including pulse transit time (PTT), ultrasound, pulse arrival time (PAT), and machine learning are investigated. The accuracy, portability, and comfort of use of these technologies, and the ability to integrate to the wearable healthcare system are discussed. Finally, the future directions for further study are suggested.
Collapse
Affiliation(s)
- Solmaz Rastegar
- School of Engineering, Computer, and Mathematical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand.
| | - Hamid GholamHosseini
- School of Engineering, Computer, and Mathematical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Andrew Lowe
- School of Engineering, Computer, and Mathematical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| |
Collapse
|
17
|
Lee H, Park JH, Floyd JS, Park S, Kim HC. Combined Effect of Income and Medication Adherence on Mortality in Newly Treated Hypertension: Nationwide Study of 16 Million Person-Years. J Am Heart Assoc 2019; 8:e013148. [PMID: 31422733 PMCID: PMC6759906 DOI: 10.1161/jaha.119.013148] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Low socioeconomic status and poor medication adherence are known to be associated with increased morbidity and mortality among patients with hypertension, but their combined effects have not been studied. We therefore evaluated the joint association of household income and medication adherence with death and cardiovascular disease in patients newly treated for hypertension. Methods and Results This was a nationwide cohort study using the Korean National Health Insurance database. We included 1 651 564 individuals, aged 30 to 80 years, with newly treated hypertension and no prior cardiovascular disease and followed them for 10 years. Main exposures were household income in quintiles and adherence to antihypertensive medication, estimated by medication possession ratio: good (≥0.8), moderate (0.5 to <0.8), or poor (<0.5). The primary outcomes were all-cause and cardiovascular deaths. Higher mortality risk was observed in patients with low income (adjusted hazard ratio=1.50, 99% CI=1.46-1.53; lowest versus highest quintile) and poor medication adherence (adjusted hazard ratio=1.66, 99% CI=1.63-1.68; poor versus good adherence). When compared with the highest-income and good-adherence group, adjusted hazard ratio (99% CI) of death was 1.56 (1.52-1.61) for highest-income poor-adherers, 1.46 (1.41-1.51) for lowest-income good-adherers, and 2.46 (2.38-2.54) for lowest-income poor-adherers (P for interaction <0.001). Conclusions Low socioeconomic status and poor adherence to antihypertensive medication are associated with increased mortality and cardiovascular disease risks, but patients with low income are subject to larger excess risks by nonadherence. This highlights the potential importance of promoting medication adherence for risk reduction, especially in low-income patients with hypertension.
Collapse
Affiliation(s)
- Hokyou Lee
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea.,Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Graduate School Yonsei University College of Medicine Seoul Korea
| | - Jong Heon Park
- Big Data Steering Department National Health Insurance Service Wonju Korea
| | - James S Floyd
- Department of Medicine University of Washington Seattle WA.,Department of Epidemiology University of Washington Seattle WA
| | - Sungha Park
- Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Division of Cardiology Severance Cardiovascular Hospital and Cardiovascular Research Institute Yonsei University College of Medicine Seoul Korea
| | - Hyeon Chang Kim
- Department of Preventive Medicine Yonsei University College of Medicine Seoul Korea.,Department of Internal Medicine Yonsei University College of Medicine Seoul Korea.,Big Data Steering Department National Health Insurance Service Wonju Korea
| |
Collapse
|
18
|
Li AL, Fang X, Zhang YY, Peng Q, Yin XH. Familial aggregation and heritability of hypertension in Han population in Shanghai China: a case-control study. Clin Hypertens 2019; 25:17. [PMID: 31428454 PMCID: PMC6694643 DOI: 10.1186/s40885-019-0122-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/07/2019] [Indexed: 02/07/2023] Open
Abstract
Background To explore the familial aggregation and heritability of hypertension in Han in Shanghai China. Methods According to l:l matched pairs design, 342 patients of hypertension and 342 controls were selected and investigate their nuclear family members in the case-control study. The method of genetic epidemiology research was used to explore the familial aggregation and heritability of hypertension. Results The prevalence rate of hypertension of first-degree relatives was significantly higher (34.44%) than that of second- degree relatives (17.60%) and third-degree relatives (13.51%) in Han Population in Shanghai China. Separation ratio p was 0.217, and prevalence rate of case group relatives was higher than that of control group relatives. The results showed a phenomenon of familial aggregation in the distribution of hypertension. The heritability of first- degree relatives was 49.51%; that of second-degree relatives and third-degree relatives were respectively 23.42 and 21.41%. Conclusion The distribution of essential hypertension has phenomenon of familial aggregation in Han Population in Shanghai China. The separation ratio of essential hypertension in this study shows that essential hypertension conform to the characteristics of multigene genetic disease. The heritability of first-degree relatives is bigger than that of second-degree relatives and third-degree relatives.
Collapse
Affiliation(s)
- An-le Li
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Xiang Fang
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Yi-Ying Zhang
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Qian Peng
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| | - Xian-Hong Yin
- Jiading District Center for Disease Control and Prevention, Shanghai, China
| |
Collapse
|
19
|
Li X, Sundquist J, Forsberg PO, Sundquist K. Association Between Neighborhood Deprivation and Heart Failure Among Patients With Diabetes Mellitus: A 10-Year Follow-Up Study in Sweden. J Card Fail 2019; 26:193-199. [PMID: 31051260 DOI: 10.1016/j.cardfail.2019.04.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/07/2019] [Accepted: 04/29/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Our aim was to study the potential effect of neighborhood deprivation on incident heart failure (HF) in patients with diabetes mellitus (DM). METHODS The study population included adults (n = 434,542) aged 30 years or older with DM followed from 2005 to 2015 in Sweden for incident HF. The association between neighborhood deprivation and the outcome was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for age, educational level, family income, employment status, region of residence, immigrant status, marital status, mobility, and comorbidities. DM patients living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores (reference group). RESULTS There was an association between level of neighborhood deprivation and HF in DM patients. The HRs were 1.27, 95% CI 1.21-1.33, for men and 1.30, 95% CI 1.23-1.37, for women) among DM patients living in high deprivation neighborhoods compared with those from low deprivation neighborhoods. After adjustments for potential confounders, the higher HRs of HF remained significant: 1.11, 95% CI 1.06-1.16, in men and 1.15, 95% CI 1.09-1.21, in women living in high deprivation neighborhoods. CONCLUSIONS Increased incidence rates of HF among DM patients living in deprived neighborhoods raise important clinical and public health concerns. These findings could serve as an aid to policy-makers when allocating resources in primary health-care settings as well as to clinicians who encounter patients in deprived neighborhoods.
Collapse
Affiliation(s)
- Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden.
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| | - Per-Ola Forsberg
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, USA; Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine, Shimane University, Shimane, Japan
| |
Collapse
|
20
|
Khunti K, Jung H, Dans AL, Held C, Dagenais GR, Yusuf S, Lonn E. Statin Use in Primary Prevention: A Simple Trial-Based Approach Compared With Guideline-Recommended Risk Algorithms for Selection of Eligible Patients. Can J Cardiol 2019; 35:644-652. [PMID: 31030865 DOI: 10.1016/j.cjca.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiovascular disease risk assessment tools help identify individuals likely to benefit from preventative therapies. In this study we compared outcomes using the American College of Cardiology/American Heart Association (ACC/AHA) risk algorithm and the Framingham Risk Score (FRS) tool in the Heart Outcomes Prevention Evaluation (HOPE)-3 study. METHODS We compared outcomes using the ACC/AHA algorithm and the FRS with those seen in HOPE-3, which randomized participants to 10 mg rosuvastatin or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; second coprimary outcome additionally included heart failure, cardiac arrest, and revascularization. RESULTS Relative risks using risk scores were similar to those observed in the HOPE-3. Hazards ratios for the first coprimary outcome according to risk categories of ≤ 10%, 10%-20%, and ≥ 20% using the ACC/AHA algorithm were 0.82 (95% confidence interval [CI], 0.53-1.28), 0.72 (95% CI, 0.53-0.96), and 0.72 (95% CI, 0.55-0.93), and absolute risk reduction (ARR) of 0.18%, 1.33%, and 1.85%, respectively, over a median of 5.6 years. Corresponding results using the FRS were 0.69 (95% CI, 0.36-1.35), 0.73 (95% CI, 0.52-1.01), and 0.75 (95% CI, 0.60- 0.94); and ARR of 1.32%, 0.61%, and 1.43%. Hazard ratios for the second coprimary outcome were 0.77 (95% CI, 0.51-1.14), 0.73 (95% CI, 0.56-0.95), and 0.74 (95% CI, 0.58-0.94); and ARR of 0.36%, 1.49%, and 1.85%, using the ACC/AHA algorithm and 0.76 (95% CI, 0.41-1.41), 0.70 (95% CI, 0.52-0.95), and 0.76 (95% CI, 0.62-0.94); and ARR of 1.08%, 0.83%, and 1.56% using the FRS. CONCLUSIONS The pragmatic HOPE-3 trial approach identifies in an ethnically diverse primary prevention population individuals at intermediate risk who benefit from statin therapy using simple clinical characteristics without the need for complex, currently used risk assessment tools.
Collapse
Affiliation(s)
- Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom.
| | - Hyejung Jung
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Antonio L Dans
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala, Sweden
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, Quebec City, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Medicine and Population Health Research Institute, Hamilton Health Sciences General Site, McMaster University, Hamilton, Ontario, Canada
| | - Eva Lonn
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Medicine and Population Health Research Institute, Hamilton Health Sciences General Site, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
21
|
Tymejczyk O, McNairy ML, Petion JS, Rivera VR, Dorélien A, Peck M, Seo G, Walsh KF, Fitzgerald DW, Peck RN, Joshi A, Pape JW, Nash D. Hypertension prevalence and risk factors among residents of four slum communities: population-representative findings from Port-au-Prince, Haiti. J Hypertens 2019; 37:685-695. [PMID: 30817448 PMCID: PMC7680636 DOI: 10.1097/hjh.0000000000001966] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to estimate the prevalence of hypertension and its risk factors among adults in four slum communities in Port-au-Prince. METHODS Cluster area random sampling was used to select adults for a health and demographic survey, including anthropometric measurements. Hypertension was defined as SBP at least 140 mmHg and/or DBP at least 90 mmHg, or current hypertension treatment, and was age-standardized to WHO world population. Correlates of hypertension were tested using sex-stratified logistic regression. RESULTS Overall, 20.3% of adults had hypertension (28.5% age-standardized), including 22.3% of men and 18.9% of women. Three percent of participants reported current hypertension treatment, and 49.5% of them had their hypertension controlled. Overweight/obesity (BMI ≥25) was the most common risk factor (20.6% among men, 48.5% among women), while smoking was less common (11.8 and 3.9%, respectively). Increasing age and hypertension prevalence in immediate surroundings were associated with greater odds of hypertension. Among men, having in-migrated in the 3 years prior (versus ≥3 years) was also associated with hypertension [adjusted odds ratio (aOR)=3.32, 95% confidence interval (95% CI): 1.79-6.17], as was overweight and obesity (aOR = 1.90, 95% CI: 1.09-3.33, and aOR = 5.73, 95% CI: 2.49-13.19, respectively) and nonreceipt of needed medical care in the preceding 6 months (aOR = 2.82, 95% CI: 1.35-5.88) among women. CONCLUSION Hypertension prevalence was high across the age spectrum, in addition to substantial levels of overweight/obesity and unmet healthcare needs. It is important to better understand the possible effects of intraurban migration and environmental risk factors on hypertension and ensure that the benefits of increasingly cost-effective prevention and treatment programmes extend to slum residents.
Collapse
Affiliation(s)
- Olga Tymejczyk
- Institute of Implementation Science in Population Health
- Graduate School of Public Health and Health Policy, City University of New York
| | - Margaret L McNairy
- Center for Global Health
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jacky S Petion
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa R Rivera
- Center for Global Health
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Audrey Dorélien
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota
| | - Mireille Peck
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Kathleen F Walsh
- Center for Global Health
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Daniel W Fitzgerald
- Center for Global Health
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Robert N Peck
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
- Departments of Medicine and Pediatrics, Weill Bugando School of Medicine
- Mwanza Interventions Trial Unit, Mwanza, Tanzania
| | - Ashish Joshi
- Institute of Implementation Science in Population Health
- Graduate School of Public Health and Health Policy, City University of New York
| | - Jean W Pape
- Center for Global Health
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Denis Nash
- Institute of Implementation Science in Population Health
- Graduate School of Public Health and Health Policy, City University of New York
| |
Collapse
|
22
|
Li AL, Peng Q, Shao YQ, Fang X, Zhang YY. The effect of body mass index and its interaction with family history on hypertension: a case-control study. Clin Hypertens 2019; 25:6. [PMID: 30828463 PMCID: PMC6383274 DOI: 10.1186/s40885-019-0111-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/06/2019] [Indexed: 01/11/2023] Open
Abstract
Background BMI is an indicator commonly used in the world to measure the weight and height of the body, it reflects the comprehensive outcome of acquired lifestyle; FH is a sign reflecting the main role of genetic factors. This study aimed to evaluate the effect of BMI and interaction with FH on hypertension risk in Shanghai adult population. Methods According to l:l matched pairs design, 342 cases and 342 controls were selected and investigated in this study, this study was performed in Shanghai, China. Participants received face-to-face questionnaire survey, anthropometric tests and laboratory examinations. Relevant indicators that reflect obesity including BMI and waist to hip ratio (WHR) were calculated. Multivariate logistic regression analysis was applied to explore the association between factors and hypertension risk. Interactive effect was evaluated by synergy index (SI), relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and the percentage of the interaction between the pure factors (PAP). Results Among 684 study participants aged 28–87 years old, the differences of mean age and height between case group and control group are no significant (p > 0.05), but the differences of mean of weight, WC, HC, BMI and WHR are significant (p < 0.001). The OR of FH on hypertension is 4.986 (95%CI: 2.832~ 8.877); the OR of BMI on hypertension is respectively: low weight is 1.528 (95%CI: 0.551~ 4.239), overweight is 3.333 (95%CI: 1.678~ 6.617) and obesity is 7.312 (95%CI: 3.556~ 15.035). The OR of interaction between FH and BMI to hypertension is 12.993 (95%CI: 7.426~22.734). SI is 1.90 (95% CI: 1.48~3.78), RERI is 5.67 (95% CI: 1.66~11.88), AP is 43.87% (95% CI: 12.84~91.88%), and PAP is 47.55% (95%CI: 13.91~99.58%). FH and BMI have positive interaction on hypertension. 43.87% of hypertension exposed to both FH and BMI was attributable to the interaction of them. Conclusions FH and BMI are significant higher risks of hypertension; with the increase of BMI, the risk of hypertension will increase more. FH and BMI have positive interaction with hypertension, the interaction is greater than the sum of two independent actions.
Collapse
Affiliation(s)
- An-le Li
- Jiading district center for disease control and prevention, Shanghai, China
| | - Qian Peng
- Jiading district center for disease control and prevention, Shanghai, China
| | - Yue-Qin Shao
- Jiading district center for disease control and prevention, Shanghai, China
| | - Xiang Fang
- Jiading district center for disease control and prevention, Shanghai, China
| | - Yi-Ying Zhang
- Jiading district center for disease control and prevention, Shanghai, China
| |
Collapse
|
23
|
Kennedy SH, Victora CG, Craik R, Ash S, Barros FC, Barsosio HC, Berkley JA, Carvalho M, Fernandes M, Cheikh Ismail L, Lambert A, Lindgren CM, McGready R, Munim S, Nellåker C, Noble JA, Norris SA, Nosten F, Ohuma EO, Papageorghiou AT, Stein A, Stones W, Tshivuila-Matala COO, Staines Urias E, Vatish M, Wulff K, Zainab G, Zondervan KT, Uauy R, Bhutta ZA, Villar J. Deep clinical and biological phenotyping of the preterm birth and small for gestational age syndromes: The INTERBIO-21 st Newborn Case-Control Study protocol. Gates Open Res 2019; 2:49. [PMID: 31172050 PMCID: PMC6545521 DOI: 10.12688/gatesopenres.12869.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2019] [Indexed: 12/17/2022] Open
Abstract
Background: INTERBIO-21
st is Phase II of the INTERGROWTH-21
st Project, the population-based, research initiative involving nearly 70,000 mothers and babies worldwide coordinated by Oxford University and performed by a multidisciplinary network of more than 400 healthcare professionals and scientists from 35 institutions in 21 countries worldwide. Phase I, conducted 2008-2015, consisted of nine complementary studies designed to describe optimal human growth and neurodevelopment, based conceptually on the WHO prescriptive approach. The studies generated a set of international standards for monitoring growth and neurodevelopment, which complement the existing WHO Child Growth Standards. Phase II aims to improve the functional classification of the highly heterogenous preterm birth and fetal growth restriction syndromes through a better understanding of how environmental exposures, clinical conditions and nutrition influence patterns of human growth from conception to childhood, as well as specific neurodevelopmental domains and associated behaviors at 2 years of age. Methods: In the INTERBIO-21
st Newborn Case-Control Study, a major component of Phase II, our objective is to investigate the mechanisms potentially responsible for preterm birth and small for gestational age and their interactions, using deep phenotyping of clinical, growth and epidemiological data and associated nutritional, biochemical, omic and histological profiles. Here we describe the study sites, population characteristics, study design, methodology and standardization procedures for the collection of longitudinal clinical data and biological samples (maternal blood, umbilical cord blood, placental tissue, maternal feces and infant buccal swabs) for the study that was conducted between 2012 and 2018 in Brazil, Kenya, Pakistan, South Africa, Thailand and the UK. Discussion: Our study provides a unique resource for the planned analyses given the range of potentially disadvantageous exposures (including poor nutrition, pregnancy complications and infections) in geographically diverse populations worldwide. The study should enhance current medical knowledge and provide new insights into environmental influences on human growth and neurodevelopment.
Collapse
Affiliation(s)
- Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Cesar G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Stephen Ash
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Ludwig Institute, University of Oxford, Oxford, UK
| | - Fernando C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Hellen C Barsosio
- KEMRI-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya
| | - James A Berkley
- KEMRI-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Michelle Fernandes
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton, UK
| | - Leila Cheikh Ismail
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ann Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Cecilia M Lindgren
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Shama Munim
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Christoffer Nellåker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Julia A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Shane A Norris
- SAMRC Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.,Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - William Stones
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya.,Departments of Public Health and Obstetrics & Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Chrystelle O O Tshivuila-Matala
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,SAMRC Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Health, Nutrition & Population Global Practice, World Bank Group, Washington, DC, USA
| | - Eleonora Staines Urias
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ghulam Zainab
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Krina T Zondervan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Ricardo Uauy
- Division of Paediatrics, Pontifical Universidad Catolica de Chile, Santiago, Chile.,Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| |
Collapse
|
24
|
Kennedy SH, Victora CG, Craik R, Ash S, Barros FC, Barsosio HC, Berkley JA, Carvalho M, Fernandes M, Cheikh Ismail L, Lambert A, Lindgren CM, McGready R, Munim S, Nellåker C, Noble JA, Norris SA, Nosten F, Ohuma EO, Papageorghiou AT, Stein A, Stones W, Tshivuila-Matala COO, Staines Urias E, Vatish M, Wulff K, Zainab G, Zondervan KT, Uauy R, Bhutta ZA, Villar J. Deep clinical and biological phenotyping of the preterm birth and small for gestational age syndromes: The INTERBIO-21 st Newborn Case-Control Study protocol. Gates Open Res 2019. [PMID: 31172050 DOI: 10.12688/gatesopenres.12869.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: INTERBIO-21 st is Phase II of the INTERGROWTH-21 st Project, the population-based, research initiative involving nearly 70,000 mothers and babies worldwide coordinated by Oxford University and performed by a multidisciplinary network of more than 400 healthcare professionals and scientists from 35 institutions in 21 countries worldwide. Phase I, conducted 2008-2015, consisted of nine complementary studies designed to describe optimal human growth and neurodevelopment, based conceptually on the WHO prescriptive approach. The studies generated a set of international standards for monitoring growth and neurodevelopment, which complement the existing WHO Child Growth Standards. Phase II aims to improve the functional classification of the highly heterogenous preterm birth and fetal growth restriction syndromes through a better understanding of how environmental exposures, clinical conditions and nutrition influence patterns of human growth from conception to childhood, as well as specific neurodevelopmental domains and associated behaviors at 2 years of age. Methods: In the INTERBIO-21 st Newborn Case-Control Study, a major component of Phase II, our objective is to investigate the mechanisms potentially responsible for preterm birth and small for gestational age and their interactions, using deep phenotyping of clinical, growth and epidemiological data and associated nutritional, biochemical, omic and histological profiles. Here we describe the study sites, population characteristics, study design, methodology and standardization procedures for the collection of longitudinal clinical data and biological samples (maternal blood, umbilical cord blood, placental tissue, maternal feces and infant buccal swabs) for the study that was conducted between 2012 and 2018 in Brazil, Kenya, Pakistan, South Africa, Thailand and the UK. Discussion: Our study provides a unique resource for the planned analyses given the range of potentially disadvantageous exposures (including poor nutrition, pregnancy complications and infections) in geographically diverse populations worldwide. The study should enhance current medical knowledge and provide new insights into environmental influences on human growth and neurodevelopment.
Collapse
Affiliation(s)
- Stephen H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Cesar G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Rachel Craik
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Stephen Ash
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Ludwig Institute, University of Oxford, Oxford, UK
| | - Fernando C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Hellen C Barsosio
- KEMRI-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya
| | - James A Berkley
- KEMRI-Coast Centre for Geographical Medicine and Research, University of Oxford, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Maria Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Michelle Fernandes
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Faculty of Medicine, Department of Paediatrics, University of Southampton, Southampton, UK
| | - Leila Cheikh Ismail
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Ann Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Cecilia M Lindgren
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Rose McGready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Shama Munim
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Christoffer Nellåker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Julia A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - Shane A Norris
- SAMRC Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Francois Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Eric O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK.,Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Aris T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - William Stones
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya.,Departments of Public Health and Obstetrics & Gynaecology, Malawi College of Medicine, Blantyre, Malawi
| | - Chrystelle O O Tshivuila-Matala
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,SAMRC Developmental Pathways For Health Research Unit, Department of Paediatrics & Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Health, Nutrition & Population Global Practice, World Bank Group, Washington, DC, USA
| | - Eleonora Staines Urias
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| | - Manu Vatish
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - Katharina Wulff
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ghulam Zainab
- Department of Obstetrics and Gynaecology, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Krina T Zondervan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Ricardo Uauy
- Division of Paediatrics, Pontifical Universidad Catolica de Chile, Santiago, Chile.,Department of Nutrition and Public Health Interventions Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Zulfiqar A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada.,Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - José Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK.,Oxford Maternal & Perinatal Health Institute, Green Templeton College, Oxford, UK
| |
Collapse
|
25
|
Modesti PA, Marzotti I, Rapi S, Rogolino A, Cappuccio FP, Zhao D, Costanzo G, Galanti G, Boddi M. Daily urinary sodium and potassium excretion in Chinese first-generation migrants in Italy. Int J Cardiol 2018; 286:175-180. [PMID: 30583922 DOI: 10.1016/j.ijcard.2018.12.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/04/2018] [Accepted: 12/10/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND China has one of the highest salt intake levels in the world, and Chinese people form one of the largest foreign-born communities now living in Europe. The present study was performed to assess 24-hour urinary sodium and potassium excretion in Chinese migrants in Italy and to explore possible associations with hypertension, hypertension awareness, and length of residence in Italy. METHODS A cross-sectional evaluation was conducted on 319 first-generation Chinese migrants (154 women and 165 men) aged 18-70 years. Subjects were asked to do a 24-hour urine collection and the relationships of urinary sodium and potassium and arterial blood pressure, hypertension (BP ≥ 140/90 mmHg or anti-hypertensive drug use), hypertension awareness, and years of residence in Italy were investigated with linear or logistic regression analysis. RESULTS Sodium excretion was 145.2 mmol/day (95%CI 138.0-152.3) in men, and 134.7 (95%CI 127.6-141.8) in women corresponding to a dietary salt intake of 9.4 g/day (95%CI 9.0-9.9) and 8.8 (95%CI 8.3-9.2) respectively. Potassium excretion was 35.1 mmol/day (95%CI 33.6-36.5), with no significant difference by gender. At multivariable adjusted linear regression analysis body mass index, low education level, and hypertension were positive predictors of sodium urinary excretion; gender (women), and body mass index were positive predictors of potassium excretion. Sodium and potassium excretion were unaffected by hypertension awareness or years of residence in Italy. CONCLUSIONS Sodium excretion in Chinese workers is higher than recommended and in line with high salt intake in Italy. Potassium consumption remains low.
Collapse
Affiliation(s)
| | - Ilaria Marzotti
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| | - Stefano Rapi
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| | - Angela Rogolino
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| | - Francesco P Cappuccio
- University of Warwick, Warwick Medical School, Coventry, UK; University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Dong Zhao
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital, and National Institute of Heart, Lung & Blood Disease, Beijing, China
| | | | - Giorgio Galanti
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| | - Maria Boddi
- Dept. Experimental and Clinical Medicine, University of Florence, Italy
| |
Collapse
|
26
|
Msemo OA, Schmiegelow C, Nielsen BB, Kousholt H, Grunnet LG, Christensen DL, Lusingu JPA, Møller SL, Kavishe RA, Minja DTR, Bygbjerg IC. Risk factors of pre-hypertension and hypertension among non-pregnant women of reproductive age in northeastern Tanzania: a community based cross-sectional study. Trop Med Int Health 2018; 23:1176-1187. [PMID: 30280462 DOI: 10.1111/tmi.13149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine risk factors of pre-hypertension and hypertension in a cohort of 1247 rural Tanzanian women before conception. METHODS Demographic and socioeconomic data, anthropometric measurements, past medical and obstetric history and other risk factors for pre-hypertension and hypertension were collected using a structured questionnaire. Multiple logistic regression analysis was used to evaluate the associations between anthropometric indices and other risk factors of pre-hypertension and hypertension. The predictive power of different anthropometric indicators for identification of pre-hypertension and hypertension patients was determined by Receiver Operating Characteristic curves (ROC). RESULTS The median (range) age was 28.0 (18-40) years. The age-standardised prevalences of pre-hypertension and hypertension were 37.2 (95% CI 34.0-40.6) and 8.5% (95%CI 6.7-10.8), respectively. Of hypertensive patients (n = 98), only 20 (20.4%) were aware of their condition. In multivariate analysis, increasing age, obesity and haemoglobin levels were significantly associated with pre-hypertension and hypertension. CONCLUSION Despite a low prevalence of hypertension, over one third of the women had pre-hypertension. This poses a great challenge ahead as pre-hypertensive women may progress into hypertension as they grow older without appropriate interventions. Obesity was the single most important modifiable risk factor for pre-hypertension and hypertension.
Collapse
Affiliation(s)
- Omari A Msemo
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte B Nielsen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Hannah Kousholt
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Louise G Grunnet
- Department of Endocrinology, University of Copenhagen Hospital, Copenhagen, Denmark
| | - Dirk L Christensen
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Sofie L Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Daniel T R Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Ib C Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
27
|
Cardiovascular Risk Assessment in Angolan Adults: A Descriptive Analysis from CardioBengo, a Community-Based Survey. Int J Hypertens 2018; 2018:2532345. [PMID: 30258655 PMCID: PMC6146561 DOI: 10.1155/2018/2532345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/05/2018] [Accepted: 08/26/2018] [Indexed: 01/13/2023] Open
Abstract
From a community-based survey conducted in Angola, 468 individuals aged 40 to 64 years and not using drug therapy were evaluated according to the World Health Organisation STEPwise Approach to Chronic Disease Risk Factor Surveillance. Using data from tobacco use, blood pressure, blood glucose, and total cholesterol levels, we estimated the 10-year risk of a fatal or nonfatal major cardiovascular event and computed the proportion of untreated participants eligible for pharmacological treatment according to clinical values alone and total cardiovascular risk. The large majority of participants were classified as having a low (<10%) 10-year cardiovascular risk (87.6%), with only 4.5% having a high (≥ 20%) cardiovascular risk. If we consider the single criteria for hypertension, 48.7% of the population should be considered for treatment. This value decreases to 22.0% if we apply the risk prediction chart. The use of hypoglycaemic drugs does not present any differences (19.0% in both situations). The use of lipid-lowering drugs (3.8%) is only recommended by the risk prediction chart. This study reveals the need of integrated approaches for the treatment of cardiovascular disorders in this population. Risk prediction charts can be used as a way to promote a better use of limited resources.
Collapse
|
28
|
Palafox B, Seguin ML, McKee M, Dans AL, Yusoff K, Candari CJ, Idris K, Ismail JR, Krauss SE, Lasco G, Majid FA, Palileo-Villanueva LM, Razak AA, Renedo A, Balabanova D. Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines. BMJ Open 2018; 8:e024000. [PMID: 30061449 PMCID: PMC6067392 DOI: 10.1136/bmjopen-2018-024000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Hypertension is a leading contributor to the global burden of disease. While safe and effective treatment exists, blood pressure control is poor in many countries, often reflecting barriers at the levels of health systems and services as well as at the broader level of patients' sociocultural contexts. This study examines how these interact to facilitate or hinder hypertension control, taking into account characteristics of service provision components and social contexts. METHODS AND ANALYSIS The study, set in Malaysia and the Philippines, builds on two systematic reviews of barriers to effective hypertension management. People with hypertension (pre-existing and newly diagnosed) will be identified in poor households in 24-30 communities per country. Quantitative and qualitative methods will be used to examine their experiences of and pathways into seeking and obtaining care. These include two waves of household surveys of 20-25 participants per community 12-18 months apart, microcosting exercises to assess the cost of illness (including costs due to health seeking activities and inability to work (5 per community)), preliminary and follow-up in-depth interviews and digital diaries with hypertensive adults over the course of a year (40 per country, employing an innovative mobile phone technology), focus group discussions with study participants and structured assessments of health facilities (including formal and informal providers). ETHICS AND DISSEMINATION Ethical approval has been granted by the Observational Research Ethics Committee at the London School of Hygiene and Tropical Medicine and the Research Ethics Boards at the Universiti Putra Malaysia and the University of the Philippines Manila. The project team will disseminate findings and engage with a wide range of stakeholders to promote uptake and impact. Alongside publications in high-impact journals, dissemination activities include a comprehensive stakeholder analysis, engagement with traditional and social media and 'digital stories' coproduced with research participants.
Collapse
Affiliation(s)
- Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - Maureen L Seguin
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio L Dans
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Khalid Yusoff
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
- Centre for Translational Research and Epidemiology, Faculty of Medicine, University Teknologi MARA, Shah Alam, Malaysia
| | - Christine J Candari
- College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Khairuddin Idris
- Institute for Social Science Studies, University Putra Malaysia, Serdang, Malaysia
| | - Johan Rizwal Ismail
- Centre for Translational Research and Epidemiology, Faculty of Medicine, University Teknologi MARA, Shah Alam, Malaysia
| | - Steven Eric Krauss
- Institute for Social Science Studies, University Putra Malaysia, Serdang, Malaysia
| | - Gideon Lasco
- Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
| | - Fadhlina A Majid
- Centre for Translational Research and Epidemiology, Faculty of Medicine, University Teknologi MARA, Shah Alam, Malaysia
| | | | - Azlina A Razak
- Faculty of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Alicia Renedo
- Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Dina Balabanova
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
29
|
Barrera L. Comment on the 2017 ACC/AHA interventions for high blood pressure with particular reference to middle- and low-income countries. Eur J Prev Cardiol 2018; 25:902-905. [PMID: 29726714 DOI: 10.1177/2047487318775168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lena Barrera
- Department of Internal Medicine, School of Public Health, Faculty of Health, Universidad del Valle, Colombia
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW Outline recent epidemiologic data regarding hypertension in developing countries, distinguish differences from developed countries, and identify challenges in management and future perspectives. RECENT FINDINGS Increased sugar intake, air and noise pollution, and low birth weight are emerging hypertension risk factors. The major challenges in management are difficulties in accurate diagnosis of hypertension and adequate blood pressure control. In contrast to developed countries, hypertension prevalence rates are on the rise in developing countries with no improvement in awareness or control rates. The increasing burden of hypertension is largely attributable to behavioral factors, urbanization, unhealthy diet, obesity, social stress, and inactivity. Health authorities, medical societies, and drug industry can collaborate to improve hypertension control through education programs, public awareness campaigns, legislation to limit salt intake, encourage generic drugs, development and dissemination of national guidelines, and involving nurses and pharmacists in hypertension management. More epidemiologic data are needed in the future to identify reasons behind increased prevalence and poor blood pressure control and examine trends in prevalence, awareness, treatment, and control. National programs for better hypertension control based on local culture, economic characteristics, and available resources in the population are needed. The role of new tools for hypertension management should be tested in developing world.
Collapse
Affiliation(s)
- M Mohsen Ibrahim
- Cardiology Department, Faculty of Medicine, Cairo University, 1 El-Sherifein Street, Abdeen, Cairo, 11111, Egypt.
| |
Collapse
|
31
|
Lee JT, Lawson KD, Wan Y, Majeed A, Morris S, Soljak M, Millett C. Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence. Prev Med 2017; 99:49-57. [PMID: 28087465 DOI: 10.1016/j.ypmed.2017.01.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 12/15/2016] [Accepted: 01/09/2017] [Indexed: 11/25/2022]
Abstract
The World Health Organization recommends that countries implement population-wide cardiovascular disease (CVD) risk assessment and management programmes. The aim of this study was to conduct a systematic review to evaluate whether this recommendation is supported by cost-effectiveness evidence. Published economic evaluations were identified via electronic medical and social science databases (including Medline, Web of Science, and the NHS Economic Evaluation Database) from inception to March 2016. Study quality was evaluated using a modified version of the Consolidated Health Economic Evaluation Reporting Standards. Fourteen economic evaluations were included: five studies based on randomised controlled trials, seven studies based on observational studies and two studies using hypothetical modelling synthesizing secondary data. Trial based studies measured CVD risk factor changes over 1 to 3years, with modelled projections of longer term events. Programmes were either not, or only, cost-effective under non-verified assumptions such as sustained risk factor changes. Most observational and hypothetical studies suggested programmes were likely to be cost-effective; however, study deigns are subject to bias and subsequent empirical evidence has contradicted key assumptions. No studies assessed impacts on inequalities. In conclusion, recommendations for population-wide risk assessment and management programmes lack a robust, real world, evidence basis. Given implementation is resource intensive there is a need for robust economic evaluation, ideally conducted alongside trials, to assess cost effectiveness. Further, the efficiency and equity impact of different delivery models should be investigated, and also the combination of targeted screening with whole population interventions recognising that there multiple approaches to prevention.
Collapse
Affiliation(s)
- John Tayu Lee
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
| | - Kenny D Lawson
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia; Centre for Research Excellence in Chronic Disease Prevention, Public Health and Tropical Medicine, James Cook University, Cairns, Australia
| | - Yizhou Wan
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Michael Soljak
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Christopher Millett
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| |
Collapse
|
32
|
Prevalence, Awareness, Treatment, and Control of Hypertension among Chinese First-Generation Migrants and Italians in Prato, Italy: The CHIP Study. Int J Hypertens 2017; 2017:6402085. [PMID: 28487768 PMCID: PMC5406722 DOI: 10.1155/2017/6402085] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/11/2017] [Accepted: 03/19/2017] [Indexed: 01/19/2023] Open
Abstract
Data on health needs of Chinese living in the South of Europe are lacking. To compare prevalence, awareness, treatment, control, and risk factors for hypertension between Chinese migrants and Italian adults, a sample of 1200 first-generation Chinese migrants and 291 native Italians aged 35–59 years living in Prato (Italy) was recruited in a community-based participatory cross-sectional survey. Primary outcome measure was hypertension, diagnosed for blood pressure values ≥ 140/90 mmHg or current use of antihypertensive medications. Associations with exposures (including age, gender, body mass index, waist, education level, total cholesterol, and triglycerides) were examined using logistic regression. When compared with Italians, Chinese had higher hypertension prevalence (27.2% versus 21.3%, p < 0.01), with comparable levels of awareness (57.4% and 48.4%) but lower treatment rates (70.6% and 90.0%, resp.). In both ethnic groups age and parental history of hypertension were predictors of awareness and treatment, body mass index being predictor of hypertension diagnosis. In Chinese participants, where the optimum cut-off point for body mass index was ≥23.9 kg/m2, the sensibility and specificity prediction for hypertension were 61.7% and 59.8%, respectively (area under the ROC curve = 0.629). Implementation of specific, culturally adapted health programs for the Chinese community is now needed.
Collapse
|
33
|
Salem K, Kinsara AJ. Hypertension in low and middle-income countries: Challenges, gaps and limited resources specific strategies. World J Hypertens 2017; 7:19-23. [DOI: 10.5494/wjh.v7.i1.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 09/29/2016] [Accepted: 11/29/2016] [Indexed: 02/06/2023] Open
Abstract
In this article we aim to discuss the burden of hypertension in middle-income countries, the challenges and opportunities, identify some implementation gaps in some of the published initiatives and propose a few pillars that could benefit an upstream population health and health promotion. One billion people suffer from hypertension worldwide; however, the prevalence of hypertension in low and middle-income countries is higher than that in the industrialized countries. Hypertension affects 45% of African adults aged 25 and above, compared to the 36% North American prevalence rate; moreover, the death rate from hypertension in LMICs is higher the than that of the European countries (141 vs 93 per 10000, respectively). The association between increased systolic blood pressure and income reversed between the early 80s and the first decade of the 20th century; the higher the per capita income the lower the risk of hypertension. Hence, unless an effective interventions, such as improving diagnosis and treatment, lowering salt intake, enhancing access and availability of fresh fruit and vegetable, and increasing leisure time physical activities are implemented, then low income countries epidemic is inevitable. In this article we aim to discuss the global burden of hypertension in low and middle-income countries, the gaps and challenges, identify the high-risk groups and propose a prevention and cost effective treatment strategic framework.
Collapse
|
34
|
Maurizi N, Faragli A, Imberti J, Briante N, Targetti M, Baldini K, Sall A, Cisse A, Berzolari FG, Borrelli P, Avvantaggiato F, Perlini S, Marchionni N, Cecchi F, Parigi G, Olivotto I. Cardiovascular screening in low-income settings using a novel 4-lead smartphone-based electrocardiograph (D-Heart®). Int J Cardiol 2017; 236:249-252. [PMID: 28215467 DOI: 10.1016/j.ijcard.2017.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/07/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND MHealth technologies are revolutionizing cardiovascular medicine. However, a low-cost, user-friendly smartphone-based electrocardiograph is still lacking. D-Heart® is a portable device that enables the acquisition of the ECG on multiple leads which streams via Bluetooth to any smartphone. Because of the potential impact of this technology in low-income settings, we determined the accuracy of D-Heart® tracings in the stratification of ECG morphological abnormalities, compared with 12-lead ECGs. METHODS Consecutive African patients referred to the Ziguinchor Regional Hospital (Senegal) were enrolled (n=117; 69 males, age 39±11years). D-Heart® recordings (3 peripheral leads plus V5) were obtained immediately followed by 12 lead ECGs and were assessed blindly by 2 independent observers. Global burden of ECG abnormalities was defined by a semi-quantitative score based on the sum of 9 criteria, identifying four classes of increasing severity. RESULTS D-Heart® and 12-lead ECG tracings were respectively classified as: normal: 72 (61%) vs 69 (59%); mildly abnormal: 42 (36%) vs 45 (38%); moderately abnormal: 3 (3%) vs 3 (3%). None had markedly abnormal tracings. Cohen's weighted kappa (kw) test demonstrated a concordance of 0,952 (p<0,001, agreement 98,72%). Concordance was high as well for the Romhilt-Estes score (kw=0,893; p<0,001 agreement 97,35%). PR and QRS intervals comparison with Bland-Altman method showed good accuracy for D-Heart® measurements (95% limit of agreement ±20ms for PR and ±10ms for QRS). CONCLUSIONS D-Heart® proved effective and accurate stratification of ECG abnormalities comparable to the 12-lead electrocardiographs, thereby opening new perspectives for low-cost community cardiovascular screening programs in low-income settings.
Collapse
Affiliation(s)
- Niccolo' Maurizi
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy.
| | | | - Jacopo Imberti
- Center for International Cooperation, University of Pavia, Italy
| | - Nicolò Briante
- Center for International Cooperation, University of Pavia, Italy
| | - Mattia Targetti
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Katia Baldini
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| | - Amadou Sall
- Dept. of Cardiology, Regional Hospital of Ziguinchor, Senegal
| | | | - Francesca Gigli Berzolari
- Biostastic and Clinical Epidemiology Unit, Dept. of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Paola Borrelli
- Biostastic and Clinical Epidemiology Unit, Dept. of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | | | - Stefano Perlini
- Internal Medicine Unit, Cardiovascular and Metabolic Diseases, IRCCS San Matteo, Pavia, Italy
| | | | - Franco Cecchi
- Dept. of Clinical and Experimental Medicine, University of Florence, Italy
| | | | - Iacopo Olivotto
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy
| |
Collapse
|
35
|
Modesti PA, Calabrese M, Malandrino D, Colella A, Galanti G, Zhao D. New findings on type 2 diabetes in first-generation Chinese migrants settled in Italy: Chinese in Prato (CHIP) cross-sectional survey. Diabetes Metab Res Rev 2017; 33. [PMID: 27336676 DOI: 10.1002/dmrr.2835] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Chinese people are one of the fastest growing immigrant populations in Europe, and their health has become a key issue to host nations. Although type 2 diabetes (T2DM) is a big burden among migrant populations, data on Chinese immigrants in Europe are limited. METHODS A cross-sectional survey was performed in 2014, adopting principles of community-based participatory research to investigate T2DM, diagnosed by the American Diabetes Association fasting criteria, in Chinese first-generation migrants aged 16 to 59 years settled in Prato (Italy). Association with different factors was investigated using logistic regression. RESULTS Of the 1608 participants, 177 had T2DM (11.0%), 119 being newly diagnosed (7.4%). Among subjects with diabetes, 58 (32.8%) were aware of the disease; among subjects with diabetes aware of their condition, 46 (79%) were treated with glucose lowering drugs. Age-standardized (World Health Organization 2001 population) prevalence of T2DM was 9.6% (95% CI 9.1 to 10.2%), being 12.0% (95% CI 11.0 to 12.9%) in men, and 7.8% (95% CI 7.1 to 8.4%) in women. At adjusted logistic regression, diabetes was associated with hypertension, current smoking, adiposity indices (waist circumference, waist-to-hip ratio, waist-to-height ratio, and body mass index), and high triglycerides. T2DM, adiposity indices, and high triglycerides were not associated with duration of stay in Italy. CONCLUSIONS The high prevalence of T2DM among first-generation Chinese immigrants in Europe stresses the need for specific health programs for T2DM early diagnosis, treatment, and prevention. There is an urgent need for policies to support this group because current policies will produce major social and economic costs. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Pietro A Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Calabrese
- Diabetology Unit, Ospedale Misericordia e Dolce, Prato, Italy
| | - Danilo Malandrino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Colella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giorgio Galanti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Dong Zhao
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital, National Institute of Heart, Lung and Blood Disease, Beijing, China
| |
Collapse
|
36
|
Lacruz ME, Kluttig A, Kuss O, Tiller D, Medenwald D, Nuding S, Greiser KH, Frantz S, Haerting J. Short-term blood pressure variability - variation between arm side, body position and successive measurements: a population-based cohort study. BMC Cardiovasc Disord 2017; 17:31. [PMID: 28100183 PMCID: PMC5241970 DOI: 10.1186/s12872-017-0468-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 01/06/2017] [Indexed: 11/18/2022] Open
Abstract
Background Precise blood pressure (BP) measurements are central for the diagnosis of hypertension in clinical and epidemiological studies. The purpose of this study was to quantify the variability in BP associated with arm side, body position, and successive measurements in the setting of a population-based observational study. Additionally, we aimed to evaluate the influence of different measurement conditions on prevalence of hypertension. Methods The sample included 967 men and 812 women aged 45 to 83 years at baseline. BP was measured according to a standardized protocol with oscillometric devices including three sitting measurements at left arm, one simultaneous supine measurement at both arms, and four supine measurements at the arm with the higher BP. Hypertension was defined as systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg. Variability in SBP and DBP were analysed with sex-stratified linear covariance pattern models. Results We found that overall, no mean BP differences were measured according to arm-side, but substantial higher DBP and for men also higher SBP was observed in sitting than in supine position and there was a clear BP decline by consecutive measurement. Accordingly, the prevalence of hypertension depends strongly on the number and scheme of BP measurements taken to calculate the index values. Conclusions Thus, BP measurements should only be compared between studies applying equal measurement conditions and index calculation. Moreover, the first BP measurement should not be used to define hypertension since it overestimates BP. The mean of second and third measurement offers the advantage of better reproducibility over single measurements. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0468-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Maria Elena Lacruz
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany.
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany
| | - Oliver Kuss
- Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Tiller
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany
| | - Daniel Medenwald
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany
| | - Sebastian Nuding
- Department of Medicine III, Martin-Luther University Halle-Wittenberg, Halle Saale, Germany
| | - Karin Halina Greiser
- German Cancer Research Centre, Division of Cancer Epidemiology, Heidelberg, Germany
| | - Stefan Frantz
- Department of Medicine III, Martin-Luther University Halle-Wittenberg, Halle Saale, Germany
| | - Johannes Haerting
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther University Halle-Wittenberg, Magdeburger Str. 8, 06112, Halle Saale, Germany
| |
Collapse
|
37
|
Fiorini G, Cerri C, Bini S, Rigamonti AE, Perlini S, Marazzi N, Sartorio A, Cella SG. The burden of chronic noncommunicable diseases in undocumented migrants: a 1-year survey of drugs dispensation by a non-governmental organization in Italy. Public Health 2016; 141:26-31. [PMID: 27932012 DOI: 10.1016/j.puhe.2016.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study was carried out with two objectives. The first one was to have an insight into the prevalence of chronic noncommunicable diseases (CNCD) in undocumented migrants, and the second one was to evaluate if differences existed among different ethnic groups. STUDY DESIGN The study is based on the collection of data on drug dispensation by a non-governmental organization (NGO) providing free medical assistance to undocumented migrants in Milan, Italy. All the prescriptions to adult subjects from January 1 to December 31 2014 (total 8438) were recorded and analyzed. All the data available for the patients receiving prescriptions (age, gender and country of birth) were also collected in anonymous form. Ethical approval for the study was given by the Ethics Committee of the NGO. METHODS Drugs were grouped according to the anatomical therapeutic chemical (ATC) classification and their quantities expressed as daily defined doses (DDDs)/1000 patients/day. The 56 ATC levels were divided into three groups according to their use for acute, chronic, or both acute and chronic diseases. The statistical analysis of drug dispensation was performed for the whole population and for the five ethnic groups into which it had been divided. RESULTS Prescription of medicines for chronic conditions was significantly greater than for acute (154.2 ± 45.9 vs 51.3 ± 18.4 DDD/1000 patients/day, P < 0.02) and for both acute and chronic conditions (57.9 ± 12.8 DDD/1000 patients/day, P < 0.02). Five ATC classes accounted for 60% of all chronic prescriptions. They were differently distributed among the five ethnic groups (e.g., Asians required more antihypertensives and antidiabetics, East Europeans required more lipid modifying drugs, antihypertensives and antithrombotics). CONCLUSIONS Our data show an important use of medicines for chronic diseases in a population of undocumented migrants. Though with some limitations, this could be an indicator of a high prevalence of CNCD in this population, with significant differences among different ethnic groups. This situation should be considered when planning health interventions, also in consideration of the fact that it could have an impact on European Health Services in a short time.
Collapse
Affiliation(s)
- G Fiorini
- Istituti Clinici Zucchi, Carate, Italy; Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - C Cerri
- Department of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - S Bini
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - A E Rigamonti
- Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - S Perlini
- Department of Internal Medicine, Fondazione IRCCS San Matteo, University of Pavia, Italy
| | - N Marazzi
- IRCCS - Istituto Auxologico Italiano, Experimental Laboratory for Auxo-endocrinological Research, Milan, Verbania, Italy
| | - A Sartorio
- IRCCS - Istituto Auxologico Italiano, Experimental Laboratory for Auxo-endocrinological Research, Milan, Verbania, Italy
| | - S G Cella
- Department of Clinical Sciences and Community Health, University of Milan, Italy.
| |
Collapse
|
38
|
Akunne OO, Godman B, Adedapo AD, Truter I, Fadare J. Statin prescribing among hypertensive patients in southwest Nigeria: findings and implications for the future. J Comp Eff Res 2016; 5:281-8. [DOI: 10.2217/cer.15.65] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Statins reduce cardiovascular risk, especially in patients with hypertension due to their concomitant blood pressure reducing effects. Prescribing generic statins minimizes cost and improves access. Aims: Ascertain current prescribing of statins in Nigeria and potential savings from the increased use of generic statins. Methods: Prospective study involving hypertensive patients attending University College Hospital (Ibadan, Nigeria). Results: In total, 228 hypertensive patients received statins. Atorvastatin was the most prescribed statin, followed by simvastatin, rosuvastatin and finally fluvastatin. Prescribed doses were less than one defined daily dose in the majority, with high use of originators. Average monthly potential savings from increased prescribing of generic statins was US$2635 for atorvastatin and US$10,578 for rosuvastatin. Conclusion: A shift toward increased prescribing generic statins is recommended to minimize costs.
Collapse
Affiliation(s)
| | - Brian Godman
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | | | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela Metropolitan University, Port Elizabeth 6031, South Africa
| | - Joseph Fadare
- Department of Pharmacology, Ekiti State University, Ado-Ekiti, Nigeria
| |
Collapse
|
39
|
Hariram V, Arramraju SK. Assessment of cardiovascular risk in low resource settings "So much to do - So little done". Indian Heart J 2016; 68:260-2. [PMID: 27316475 PMCID: PMC4911433 DOI: 10.1016/j.ihj.2015.07.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/24/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- V Hariram
- Cardiologist, Department of Cardiology, Citizens Hospital, Serilingampally, Hyderabad, Telangana, India.
| | - Sreenivas Kumar Arramraju
- Chief Cardiologist, Department of Cardiology, Citizens Hospital, Serilingampally, Hyderabad, Telangana, India
| |
Collapse
|
40
|
Modesti PA, Colella A, Zhao D. Atrial fibrillation in first generation Chinese migrants living in Europe: A proof of concept study. Int J Cardiol 2016; 215:269-72. [PMID: 27128544 DOI: 10.1016/j.ijcard.2016.04.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 04/11/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Despite the public health burden of atrial fibrillation (AF) and its complications in China, there is no literature on AF among Chinese living in Europe. The present study was performed to investigate the prevalence of and risk factors for AF in Chinese first generation migrants settled in Europe. METHODS A cross-sectional survey was performed in 2014 on Chinese first generation migrants aged 16 to 59years settled in Prato (Italy) adopting principles of community based participatory research. All participants underwent recording of 30s of a single-channel ECG and associations of AF with socio-demographic, anthropometric, clinical factors, and sleep history were examined using logistic regression. RESULTS Of the 1608 participants, 12 had AF (0.75%; 95% CI 0.33 to 1.17) - four men and eight women. All subjects with AF had a CHA2DS2VASc index≥1. Although no participant with AF had contraindications to oral anticoagulation, none was treated with oral anticoagulants. At multivariable adjusted logistic regression AF was associated with hypertension with an OR of 4.40 (95% CI 1.09-17.81; p=0.038). CONCLUSIONS Chinese are one of the fastest growing migrant populations in Europe and their health has become a key issue to host nations. The issue of AF is to be considered in future prevention programs for elusive ethnic minorities and adequately powered trials specifically designed to investigate AF prevalence and to test prevention approaches are now needed.
Collapse
Affiliation(s)
- Pietro A Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Andrea Colella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Dong Zhao
- Department of Epidemiology, Capital Medical University Beijing Anzhen Hospital, Beijing, China; National Institute of Heart, Lung & Blood Disease, Beijing, China
| |
Collapse
|
41
|
Modesti PA, Calabrese M, Perruolo E, Bussotti A, Malandrino D, Bamoshmoosh M, Biggeri A, Zhao D. Sleep History and Hypertension Burden in First-Generation Chinese Migrants Settled in Italy: The CHIinese In Prato Cross-Sectional Survey. Medicine (Baltimore) 2016; 95:e3229. [PMID: 27057856 PMCID: PMC4998772 DOI: 10.1097/md.0000000000003229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 12/31/2022] Open
Abstract
Migration flows from China are largely directed towards the South of Europe, Chinese being now the third largest overseas-born population in Italy. The aim of the study was to investigate hypertension burden and self-reported sleep disorders among 1608 first-generation Chinese migrants aged 16 to 59 years settled in Prato and recruited in a cross-sectional survey. Hypertension was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg or self-reported antihypertensive treatment; potential impact of sleep disorders was analyzed by logistic regression adjusted for age, sex, marital status, education, health insurance, current smoking, parental hypertension, alcohol drinking, overweight or obesity, central obesity, diabetes, high total cholesterol, and high triglycerides. Among the 1608 participants, 21.7% were hypertensive (age-standardized prevalence 19.2%; 95% Cl: 18.5-20.0); 54% of hypertensive subjects were aware of their condition; 70% of aware hypertensive subjects received drugs, and 39% of treated subjects had blood pressure controlled. Self-reported snoring increased the risk of hypertension; when compared with no snoring, the age- and sex-adjusted OR for hypertension of snoring 3 to 6 d/week was 2.11 (95% Cl: 1.48-3.01) and 2.48 (95% Cl: 1.79-3.46) of snoring every day. When compared with a sleep duration ≤ 5 hours, subjects with sleep duration of 7 hours had reduced risk of high triglycerides (adjusted OR: 0.66; 95% Cl: 0.43-0.95).Despite a high level of awareness, low treatment rates for hypertension were observed among Chinese participants, independently of health insurance. Sleep history is to be considered in screening and prevention programs.
Collapse
Affiliation(s)
- Pietro A Modesti
- From the Department of Experimental and Clinical Medicine (PAM, EP, ABus, DM, MB), University of Florence; Diabetology Unit, Ospedale Misericordia e Dolce, Prato (MC); Department of Statistics (ABig), University of Florence and ISPO Cancer Prevention and Research Institute, Florence, Italy; and Department of Epidemiology (DZ), Capital Medical University Beijing Anzhen Hospital, National Institute of Heart, Lung & Blood Disease, Beijing, China
| | | | | | | | | | | | | | | |
Collapse
|
42
|
Modesti PA, Perticone F, Parati G, Agabiti Rosei E, Prisco D. Chronic disease in the ethnic minority and migrant groups: time for a paradigm shift in Europe. Intern Emerg Med 2016; 11:295-7. [PMID: 27021388 DOI: 10.1007/s11739-016-1444-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 03/19/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Pietro Amedeo Modesti
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, Catanzaro, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Health Sciences, University of Milan Bicocca, Milan, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Azienda Spedali Civili, Brescia, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| |
Collapse
|
43
|
Cappuccio FP, Miller MA. Cardiovascular disease and hypertension in sub-Saharan Africa: burden, risk and interventions. Intern Emerg Med 2016; 11:299-305. [PMID: 27001886 PMCID: PMC4820479 DOI: 10.1007/s11739-016-1423-9] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/22/2016] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease, including stroke, heart failure and kidney disease, has been common in sub-Saharan Africa for many years, and rapid urbanization is causing an upsurge of ischaemic heart disease and metabolic disorders. At least two-thirds of cardiovascular deaths now occur in low- and middle-income countries, bringing a double burden of disease to poor and developing world economies. High blood pressure (or hypertension) is by far the commonest underlying risk factor for cardiovascular disease. Its prevention, detection, treatment and control in sub-Saharan Africa are haphazard and suboptimal. This is due to a combination of lack of resources and health-care systems, non-existent effective preventive strategies at a population level, lack of sustainable drug therapy, and barriers to complete compliance with prescribed medications. The economic impact for loss of productive years of life and the need to divert scarce resources to tertiary care are substantial.
Collapse
Affiliation(s)
- Francesco Paolo Cappuccio
- Division of Health Sciences (Mental Health and Wellbeing), WHO Collaborating Centre, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK.
| | - Michelle Avril Miller
- Division of Health Sciences (Mental Health and Wellbeing), WHO Collaborating Centre, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, UK
| |
Collapse
|
44
|
Testa R, Bonfigli AR, Genovese S, Ceriello A. Focus on migrants with type 2 diabetes mellitus in European Countries. Intern Emerg Med 2016; 11:319-26. [PMID: 26688327 DOI: 10.1007/s11739-015-1350-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 10/29/2015] [Indexed: 12/27/2022]
Abstract
The prevalence of type 2 diabetes mellitus, one of the major causes of morbility and mortality in Europe, is increasing in all European countries. Diabetes is not distributed equally among all population groups, as higher incidence, appearance of complications, and different mortality rates have been observed among migrants and the native population. These differences may be due to genetic profiles, lifestyle, and utilization of the health care system in different ways. Taking into account that the quantity of migrants is nowadays increasing, mainly in the southern part of Europe, the knowledge of diabetes in migrants through a better collection of data is necessary, considering that few limited epidemiological studies have evaluated the importance of this problem in EU countries. A special effort in developing a comprehensive management for native and immigrant populations in order to prevent and cure diabetes should be mandatory. This activity could be helpful to limit the incidence of future diabetes complications and to avoid the consequent burden of the health care system along with a control on its costs. It is clear that diabetes complication prevention is essential for long-term sustainability of the health care system.
Collapse
Affiliation(s)
- Roberto Testa
- Experimental Models in Clinical Pathology, INRCA-IRCCS National Institute, Ancona, Italy
| | | | - Stefano Genovese
- Department of Cardiovascular and Metabolic Diseases, IRCCS Gruppo Multimedica, Sesto San Giovanni, Italy
| | - Antonio Ceriello
- Insititut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), C/Rosselló, 149-153, 08036, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain.
| |
Collapse
|
45
|
Panethnic Differences in Blood Pressure in Europe: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0147601. [PMID: 26808317 PMCID: PMC4725677 DOI: 10.1371/journal.pone.0147601] [Citation(s) in RCA: 826] [Impact Index Per Article: 103.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 11/24/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People of Sub Saharan Africa (SSA) and South Asians(SA) ethnic minorities living in Europe have higher risk of stroke than native Europeans(EU). Study objective is to provide an assessment of gender specific absolute differences in office systolic(SBP) and diastolic(DBP) blood pressure(BP) levels between SSA, SA, and EU. METHODS AND FINDINGS We performed a systematic review and meta-analysis of observational studies conducted in Europe that examined BP in non-selected adult SSA, SA and EU subjects. Medline, PubMed, Embase, Web of Science, and Scopus were searched from their inception through January 31st 2015, for relevant articles. Outcome measures were mean SBP and DBP differences between minorities and EU, using a random effects model and tested for heterogeneity. Twenty-one studies involving 9,070 SSA, 18,421 SA, and 130,380 EU were included. Compared with EU, SSA had higher values of both SBP (3.38 mmHg, 95% CI 1.28 to 5.48 mmHg; and 6.00 mmHg, 95% CI 2.22 to 9.78 in men and women respectively) and DBP (3.29 mmHg, 95% CI 1.80 to 4.78; 5.35 mmHg, 95% CI 3.04 to 7.66). SA had lower SBP than EU(-4.57 mmHg, 95% CI -6.20 to -2.93; -2.97 mmHg, 95% CI -5.45 to -0.49) but similar DBP values. Meta-analysis by subgroup showed that SA originating from countries where Islam is the main religion had lower SBP and DBP values than EU. In multivariate meta-regression analyses, SBP difference between minorities and EU populations, was influenced by panethnicity and diabetes prevalence. CONCLUSIONS 1) The higher BP in SSA is maintained over decades, suggesting limited efficacy of prevention strategies in such group in Europe;2) The lower BP in Muslim populations suggests that yet untapped lifestyle and behavioral habits may reveal advantages towards the development of hypertension;3) The additive effect of diabetes, emphasizes the need of new strategies for the control of hypertension in groups at high prevalence of diabetes.
Collapse
|
46
|
Omech B, Tshikuka JG, Mwita JC, Tsima B, Nkomazana O, Amone-P’Olak K. Prevalence and determinants of metabolic syndrome: a cross-sectional survey of general medical outpatient clinics using National Cholesterol Education Program-Adult Treatment Panel III criteria in Botswana. Diabetes Metab Syndr Obes 2016; 9:273-9. [PMID: 27616893 PMCID: PMC5008444 DOI: 10.2147/dmso.s109007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low- and middle-income countries, including Botswana, are facing rising prevalence of obesity and obesity-related cardiometabolic complications. Very little information is known about clustering of cardiovascular risk factors in the outpatient setting during routine visits. We aimed to assess the prevalence and identify the determinants of metabolic syndrome among the general outpatients' attendances in Botswana. METHODS A cross-sectional study was conducted from August to October 2014 involving outpatients aged ≥20 years without diagnosis of diabetes mellitus. A precoded questionnaire was used to collect data on participants' sociodemographics, risk factors, and anthropometric indices. Fasting blood samples were drawn and analyzed for glucose and lipid profile. Metabolic syndrome was assessed using National Cholesterol Education Program-Adult Treatment Panel III criteria. RESULTS In total, 291 participants were analyzed, of whom 216 (74.2%) were females. The mean age of the total population was 50.1 (±11) years. The overall prevalence of metabolic syndrome was 27.1% (n=79), with no significant difference between the sexes (female =29.6%, males =20%, P=0.11). A triad of central obesity, low high-density lipoprotein-cholesterol, and elevated blood pressure constituted the largest proportion (38 [13.1%]) of cases of metabolic syndrome, followed by a combination of low high-density lipoprotein, elevated triglycerides, central obesity, and elevated blood pressure, with 17 (5.8%) cases. Independent determinants of metabolic syndrome were antihypertensive use and increased waist circumference. CONCLUSION Metabolic syndrome is highly prevalent in the general medical outpatients clinics. Proactive approaches are needed to screen and manage cases targeting its most important predictors.
Collapse
Affiliation(s)
- Bernard Omech
- Department of Internal Medicine
- Correspondence: Bernard Omech, Department of Internal Medicine, University of Botswana, Private Bag UB 00713 Gaborone, Botswana, Tel +267 3 55 4915, Email
| | | | | | - Billy Tsima
- Department of Family Medicine and Public Health
| | | | | |
Collapse
|
47
|
Spatz ES, Jiang X, Lu J, Masoudi FA, Spertus JA, Wang Y, Li X, Downing NS, Nasir K, Du X, Li J, Krumholz HM, Liu X, Jiang L. Qingdao Port Cardiovascular Health Study: a prospective cohort study. BMJ Open 2015; 5:e008403. [PMID: 26656011 PMCID: PMC4679897 DOI: 10.1136/bmjopen-2015-008403] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE In China, efforts are underway to respond to rapidly increasing rates of heart disease and stroke. Yet the epidemiology of cardiovascular disease in China may be different from that of other populations. Thus, there is a critical need for population-based studies that provide insight into the risk factors, incidence and outcomes of cardiovascular disease in China. The Qingdao Port Cardiovascular Health Study is designed to investigate the burden of cardiovascular disease and the sociodemographic, biological, environmental and clinical risk factors associated with disease onset and outcomes. PARTICIPANTS For this study, from 2000 through 2013, 32,404 employees aged 18 years or older were recruited from the Qingdao Port Group in China, contributing 221,923 annual health assessments. The mean age at recruitment was 43.4 (SD=12.9); 79% were male. In this ongoing study, annual health assessments, governed by extensive quality control mechanisms, include a questionnaire (capturing demographic and employment information, medical history, medication use, health behaviours and health outcomes), physical examination, ECG, and blood and urine analysis. Additional non-annual assessments include an X-ray, echocardiogram and carotid ultrasound; bio-samples will be collected for future genetic and proteomic analyses. Cardiovascular outcomes are accessed via self-report and are actively being verified with medical insurance claims; efforts are underway to adjudicate outcomes with hospital medical records. FINDINGS TO DATE Early findings reveal a significant increase in cardiovascular risk factors from 2000 to 2010 (hypertension: 26.4-39.4%; diabetes: 3.3-8.9%; hyperlipidaemia: 5.0-33.6%; body mass index >28 m/kg(2): 14.1-18.6%). FUTURE PLANS We aim to generate novel insights about the epidemiology and outcomes of cardiovascular disease in China, with specific emphasis on the potentially unique risk factor profiles of this Chinese population. Knowledge generated will be disseminated in the peer-reviewed literature, and will inform population-based strategies to improve cardiovascular health in China. TRIAL REGISTRATION NUMBER NCT02329886.
Collapse
Affiliation(s)
- Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xianyan Jiang
- Section of Cardiovascular Medicine, Qingdao Fuwai Hospital, Qingdao, People's Republic of China
| | - Jiapeng Lu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - John A Spertus
- Department of Health Outcomes Research, Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Nicholas S Downing
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut, USA
| | - Khurram Nasir
- Center for Healthcare Advancement & Outcomes, Baptist Health South Florida, Miami, Florida, USA
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Xue Du
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- The Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | - Xiancheng Liu
- Section of Cardiovascular Medicine, Qingdao Fuwai Hospital, Qingdao, People's Republic of China
- Qingdao Fuwai Hospital, Qingdao, People's Republic of China
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| |
Collapse
|
48
|
Bovet P, Chiolero A, Paccaud F, Banatvala N. Screening for cardiovascular disease risk and subsequent management in low and middle income countries: challenges and opportunities. Public Health Rev 2015; 36:13. [PMID: 29450041 PMCID: PMC5804497 DOI: 10.1186/s40985-015-0013-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 11/18/2015] [Indexed: 11/30/2022] Open
Abstract
Background Cardiovascular disease (CVD), mainly heart attack and stroke, is the leading cause of premature mortality in low and middle income countries (LMICs). Identifying and managing individuals at high risk of CVD is an important strategy to prevent and control CVD, in addition to multisectoral population-based interventions to reduce CVD risk factors in the entire population. Methods We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs. Results A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability of affordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). This also emphasises the need to re-orient health systems in LMICs towards chronic diseases management. Conclusion The large burden of CVD in LMICs and the fact that persons with high CVD can be identified and managed along cost-effective interventions mean that health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
Collapse
Affiliation(s)
- Pascal Bovet
- 1Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Rue de la Corniche 10, 2013 Lausanne, Switzerland
| | - Arnaud Chiolero
- 1Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Rue de la Corniche 10, 2013 Lausanne, Switzerland
| | - Fred Paccaud
- 1Institute of Social and Preventive Medicine (IUMSP), University Hospital Centre, Rue de la Corniche 10, 2013 Lausanne, Switzerland
| | - Nick Banatvala
- 2Noncommunicable Diseases and Mental Health Cluster, World Health Organization, Geneva, Switzerland
| |
Collapse
|
49
|
Herath HMM, Weerarathna TP, Umesha D. Cardiovascular risk assessment in type 2 diabetes mellitus: comparison of the World Health Organization/International Society of Hypertension risk prediction charts versus UK Prospective Diabetes Study risk engine. Vasc Health Risk Manag 2015; 11:583-9. [PMID: 26622181 PMCID: PMC4654532 DOI: 10.2147/vhrm.s90126] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Patients with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular diseases, and assessment of their cardiac risk is important for preventive strategies. PURPOSE The Ministry of Health of Sri Lanka has recommended World Health Organization/International Society of Hypertension (WHO/ISH) charts for cardiac risk assessment in individuals with T2DM. However, the most suitable cardiac risk assessment tool for Sri Lankans with T2DM has not been studied. This study was designed to evaluate the performance of two cardiac risk assessments tools; WHO/ISH charts and UK Prospective Diabetes Study (UKPDS) risk engine. METHODS Cardiac risk assessments were done in 2,432 patients with T2DM attending a diabetes clinic in Southern Sri Lanka using the two risk assessment tools. Validity of two assessment tools was further assessed by their ability to recognize individuals with raised low-density lipoprotein (LDL) and raised diastolic blood pressure in a cohort of newly diagnosed T2DM patients (n=332). RESULTS WHO/ISH charts identified 78.4% of subjects as low cardiac risk whereas the UKPDS risk engine categorized 52.3% as low cardiac risk (P<0.001). In the risk categories of 10%-<20%, the UKPDS risk engine identified higher proportions of patients (28%) compared to WHO/ISH charts (7%). Approximately 6% of subjects were classified as low cardiac risk (<10%) by WHO/ISH when UKPDS recognized them as cardiac risk of >20%. Agreement between the two tools was poor (κ value =0.144, P<0.01). Approximately 82% of individuals categorized as low cardiac risk by WHO/ISH had higher LDL cholesterol than the therapeutic target of 100 mg/dL. CONCLUSION There is a significant discrepancy between the two assessment tools with WHO/ISH risk chart recognizing higher proportions of patients having low cardiac risk than the UKPDS risk engine. Risk assessment by both assessment tools demonstrated poor sensitivity in identifying those with treatable levels of LDL cholesterol and diastolic blood pressure.
Collapse
Affiliation(s)
| | | | - Dilini Umesha
- Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| |
Collapse
|
50
|
Wändell P, Carlsson AC, Gasevic D, Sundquist J, Sundquist K. Neighbourhood socio-economic status and all-cause mortality in adults with atrial fibrillation: A cohort study of patients treated in primary care in Sweden. Int J Cardiol 2015; 202:776-81. [PMID: 26474468 DOI: 10.1016/j.ijcard.2015.09.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 08/31/2015] [Accepted: 09/19/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Our aim was to study the potential impact of neighbourhood socio-economic status (SES) on all-cause mortality in patients with atrial fibrillation (AF) treated in primary care. METHODS Study population included adults (n=12,283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. Association between neighbourhood SES and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs), and by Laplace regression where years to death (95% CI) of the first 10% of the participants were used as an outcome. All models were conducted in both men and women and adjusted for age, educational level, marital status, change of neighbourhood status, cardiovascular co-morbidities, anticoagulant treatment and statin treatment. High- and low-neighbourhood SES were compared with middle SES as reference group. RESULTS After adjustments for potential confounders, higher relative risk of all-cause mortality (HR 1.49, 95% CI 1.13-1.96) was observed in men living in low SES neighbourhoods compared to those from middle SES neighbourhoods. The results were confirmed using Laplace regression; the time until the first 10% of the men in low SES neighbourhoods died was 1.45 (95% CI 0.48-2.42) years shorter than for the men in middle SES neighbourhoods. CONCLUSIONS Increased rates of heart disease and subsequent mortality among adults in deprived neighbourhoods raise important clinical and public health concerns. These findings could serve as an aid to policy-makers when allocating resources in primary health care settings as well as to clinicians who encounter patients in deprived neighbourhoods.
Collapse
Affiliation(s)
- Per Wändell
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Academic Primary Healthcare Centre, Stockholm County Council, Huddinge, Sweden.
| | - Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
| | - Danijela Gasevic
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | |
Collapse
|