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Huang TY, Chen LC, Li XP, Li WH, Xu SX, Nagy C, Ibrahim P, Nie ZW, Yang NY, Zeng L, Huang HW, Turecki G, Xie XH. Elevated triglycerides and low triiodothyronine: Key risk factors for coronary artery calcification in patients with schizophrenia. Schizophr Res 2024; 264:113-121. [PMID: 38128342 DOI: 10.1016/j.schres.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 11/04/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Coronary artery calcification (CAC) is a well-established independent predictor of coronary heart disease, and patients with schizophrenia have significantly higher rates compared to the general population. We performed this study to examine the population-specific risk factors associated with CAC in patients with schizophrenia. METHODS In this cross-sectional study, patients with schizophrenia who underwent low-dose chest CT scans between January 2020 and December 2021 were analyzed. Ordinary CAC scores and results of routine blood tests were obtained. Logistic regression was used to calculate the odds ratio (OR) for potential risk factors in patients with and without CAC, while the negative binomial additive model was used to explore the dose-response relationship between risk factors and CAC score. RESULTS Of the 916 patients, 233 (25.4 %) had CAC, while 683 (74.6 %) did not. After adjusting for confounding factors, higher triglyceride levels (OR = 1.20, 95 % confidence interval (CI): 1.04 to 1.38, p = 0.013) and low triiodothyronine levels (OR = 0.50, 95 % CI: 0.29 to 0.84; p = 0.010) were identified as risk factors for CAC. Both triglycerides (p = 0.021) and triiodothyronine (p = 0.010) were also found to have significant dose-response relationships with CAC scores according to the negative binomial additive model in the exploratory analysis. CONCLUSIONS This study highlights elevated serum triglycerides and decreased triiodothyronine levels as population-specific risk factors for CAC in patients with schizophrenia, suggest the need for close monitoring of CAC in patients with schizophrenia and further prospective trials to provide additional evidence on this topic.
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Affiliation(s)
- Tan-Yu Huang
- Department of Radiology, Second People's Hospital of Huizhou, Huizhou, China
| | - Li-Chang Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Ping Li
- Department of Psychiatry, Second People's Hospital of Huizhou, Huizhou, China
| | - Wu-Hao Li
- Department of Radiology, Second People's Hospital of Huizhou, Huizhou, China
| | - Shu-Xian Xu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Corina Nagy
- Department of Psychiatry, McGill University, Montreal, QC, Canada; McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Pascal Ibrahim
- Department of Psychiatry, McGill University, Montreal, QC, Canada; McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Zhao-Wen Nie
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Nai-Yan Yang
- Department of Psychiatry, Second People's Hospital of Huizhou, Huizhou, China
| | - Lun Zeng
- Department of Psychiatry, Second People's Hospital of Huizhou, Huizhou, China
| | - Hua-Wei Huang
- Department of Psychiatry, Second People's Hospital of Huizhou, Huizhou, China
| | - Gustavo Turecki
- Department of Psychiatry, McGill University, Montreal, QC, Canada; McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Xin-Hui Xie
- Brain Function and Psychosomatic Medicine Institute, Second People's Hospital of Huizhou, Huizhou, China; Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.
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Chang J, Gao H, Su D, Li H, Chen Y. Is there a change in the appropriateness of admission after patients were admitted? Evidence from four county hospitals in rural China. Front Public Health 2023; 11:1106499. [PMID: 37304120 PMCID: PMC10248166 DOI: 10.3389/fpubh.2023.1106499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
Objective This study aims to investigate the changes in admission appropriateness after patients were admitted and provide a reference for physicians to make admission decisions and for the supervision of medical service behavior by the medical insurance regulatory department. Methods Medical records of 4,343 inpatients were obtained based on the largest and most capable public comprehensive hospital in four counties in central and western China for this retrospective study. The binary logistic regression model was employed to examine the determinants of changes in admission appropriateness. Results Nearly two-in-thirds (65.39%) of the 3,401 inappropriate admissions changed to appropriate at discharge. Age, type of medical insurance, medical service type, severity of the patient upon admission, and disease category were found to be associated with the changes in the appropriateness of admission. Older patients (OR = 3.658, 95% CI [2.462-5.435]; P < 0.001) were more likely to go from "inappropriate" to "appropriate" than younger counterparts. Compared with circulatory diseases, the case evaluated as "appropriate" at discharge was more frequent in the urinary diseases (OR = 1.709, 95% CI [1.019-2.865]; P = 0.042) and genital diseases (OR = 2.998, 95% CI [1.737-5.174]; P < 0.001), whereas the opposite finding was observed for patients with respiratory diseases (OR = 0.347, 95% CI [0.268-0.451]; P < 0.001) and skeletal and muscular diseases (OR = 0.556, 95% CI [0.355-0.873]; P = 0.011). Conclusions Many disease characteristics gradually emerged after the patient was admitted, thus the appropriateness of admission changed. Physicians and regulators need to take a dynamic view of disease progression and inappropriate admission. Aside from referring to the appropriateness evaluation protocol (AEP), they both should pay attention to individual and disease characteristics to make a comprehensive judgment, and strict control and attention should be paid to the admission of respiratory, skeletal, and muscular diseases.
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Affiliation(s)
- Jingjing Chang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongxia Gao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Dai Su
- School of Public Health, Capital Medical University, Beijing, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Yingchun Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
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Azarbakhsh H, Baeradeh N, Dehghani SP, Hassanzadeh J, Janfada M, Razeghi A, Mirahmadizadeh A. Trend of Mortality Rate and Years of Life Lost due to Cerebrovascular Diseases in Fars Province, Iran (2004-2019). ARCHIVES OF IRANIAN MEDICINE 2023; 26:198-204. [PMID: 38301079 PMCID: PMC10685744 DOI: 10.34172/aim.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 02/08/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND According to the Global Burden of Disease Study (GBD), cerebrovascular diseases are the second leading cause of death in the world. This is a cross-sectional study on deaths due to cerebrovascular diseases in southern Iran. METHODS In this cross-sectional study, data on all deaths caused by cerebrovascular diseases in the Fars province between 2004 and 2019 was extracted from the Electronic Death Registry System (EDRS). To eliminate or minimize the influence of age composition, standardized mortality rate was used based on the 2013 Segi standard populations of low- and middle-income countries. In order to measure the years of life lost (YLL) from cerebrovascular diseases, the standardized life table was considered. The Joinpoint Regression method was used to examine the trend of the crude and standardized mortality rate and the YLL rate. RESULTS Over the study period, 24,051 deaths occurred due to cerebrovascular diseases in Fars with 12,586 cases in men (52.3%). The trend of standardized mortality rate in males and females was decreasing (P value=0.001 and<0.001 for males and females, respectively). All YLL due to premature mortality from cerebrovascular disease during the 16-year study period were 119,436 (3.8 per 1000 persons) in men, and 111,172 (3.6 per 1000 persons) in women. Based on the joinpoint regression, the 16-year trend of YLL rate due to premature death was decreasing: annual percent change (APC) was -1.6% (95% CI -3.4 to 0.3, P=0.098) for males, and -2.0% (95% CI -3.6 to -0.4, P=0.017) for females. CONCLUSION The trend of mortality rate and YLL caused by cerebrovascular diseases has decreased in our study. Necessary measures, mainly primary and secondary prevention, should be taken to continue the diminishing trend of cerebrovascular diseases.
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Affiliation(s)
| | - Najibullah Baeradeh
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Jafar Hassanzadeh
- Research Center for Health Sciences, Institute of Health, Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Janfada
- Department of Statistics, Health Vice-chancellor, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ahmadreza Razeghi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Mirahmadizadeh
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Tollár J, Vetrovsky T, SZéPHELYI K, Csutorás B, Prontvai N, Ács P, Hortobágyi T. Effects of 2-Year-Long Maintenance Training and Detraining on 558 Subacute Ischemic Stroke Patients' Clinical-Motor Symptoms. Med Sci Sports Exerc 2023; 55:607-613. [PMID: 36730024 DOI: 10.1249/mss.0000000000003092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE This study aimed to determine the effects of a 2-yr-long maintenance training (MT) exergaming and detraining (DT) on clinical-motor symptoms in subacute ischemic patients with stroke (PwST). The hypothesis was that MT motor rehabilitation program would further increase the effects of the initial rehabilitation. METHODS After high-intensity and high-frequency exergaming twice or once a day, 5 times per week for 5 wk (EX2: 50 sessions; EX1: 25 sessions, results reported previously), 558 PwST were randomized to EX2-MT, EX2-DT, EX1-MT, and EX1-DT. MT exergaming consisted of once a day, 3 times per week for 2 yr, and DT did not train. Outcomes were measured at 6, 12, 18, and 24 months. The data were analyzed using longitudinal linear mixed-effects models and general linear hypotheses testing. RESULTS Modified Rankin Score (primary outcome), body mass, Mini-Mental State Examination score, Beck Depression Inventory, measures of quality of life, Berg Balance Scale, 6-min walk test, and four measures of center of pressure path tended to retain the initial rehabilitation-induced gains in the MT patients in selected outcomes (especially walking capacity). The scores tended to mildly worsen after DT, partially supporting the hypothesis. CONCLUSIONS MT successfully maintained, but only in selected variables did it further increase the initial exergaming rehabilitation-induced robust improvements. DT modestly reduced the initial exergaming rehabilitation-induced improvements. MT programs might be needed after initial stroke rehabilitation to reduce subsequent losses of quality of life and further improve clinical-motor symptoms.
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Affiliation(s)
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, CZECH REPUBLIC
| | - Klaudia SZéPHELYI
- Faculty of Health Sciences, Department of Medical Imaging, University of Pécs, Pécs, HUNGARY
| | - Bence Csutorás
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HUNGARY
| | - Nándor Prontvai
- Somogy County Kaposi Mór Teaching Hospital, Kaposvár, HUNGARY
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Muacevic A, Adler JR, Alassaf L, Abd-Ellatif EE. Risk Assessment of Cardiovascular Disease Among Adults Attending Primary Healthcare Centers in Riyadh City 2015. Cureus 2022; 14:e32503. [PMID: 36654558 PMCID: PMC9839152 DOI: 10.7759/cureus.32503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The prevalence of cardiovascular disease (CVD) risk factors is expected to rise in Saudi Arabia as the prevalence of CVD risk factors rises. Effective primary CVD prevention necessitates risk assessment to categorize patients and select the most appropriate intervention for each category. OBJECTIVES To estimate the prevalence of CVD at primary healthcare (PHC) in Riyadh city and to categorize the at-risk population as a slow, intermediate, or high risk of CVD. METHODS A cross-sectional study was carried out at seven PHC centers in Riyadh. Seven hundred participants (half of whom were males and the other half females) were selected at random from PHCs visitors, and data was collected using a structured questionnaire, as well as required measurements and laboratory investigations. The World Health Organization risk prediction charts were used to calculate CVD risk. Participants were assigned to one of three CVD risk categories (low, intermediate, high). RESULTS Obesity was found to be the most common risk factor found in this study (53.2%). Overweight (31.2%), with females having higher BMI levels. The study found that 83.4% of participants had low CVD risk, 12.9% had intermediate risk, and 3.7% had high CVD risk category. Age, systolic blood pressure, cholesterol level, smoking, and prior diagnosis of diabetes were all statistically significant predictors of moderate and high CVD risk. CONCLUSION CVD risk factors were discovered to be common among study participants. It requires healthcare decision-makers to engage in community-based interventions to decrease the risk of CVD.
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Gallego I, Villate-Beitia I, Saenz-Del-Burgo L, Puras G, Pedraz JL. Therapeutic Opportunities and Delivery Strategies for Brain Revascularization in Stroke, Neurodegeneration, and Aging. Pharmacol Rev 2022; 74:439-461. [PMID: 35302047 DOI: 10.1124/pharmrev.121.000418] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 12/25/2022] Open
Abstract
Central nervous system (CNS) diseases, especially acute ischemic events and neurodegenerative disorders, constitute a public health problem with no effective treatments to allow a persistent solution. Failed therapies targeting neuronal recovery have revealed the multifactorial and intricate pathophysiology underlying such CNS disorders as ischemic stroke, Alzheimeŕs disease, amyotrophic lateral sclerosis, vascular Parkisonism, vascular dementia, and aging, in which cerebral microvasculature impairment seems to play a key role. In fact, a reduction in vessel density and cerebral blood flow occurs in these scenarios, contributing to neuronal dysfunction and leading to loss of cognitive function. In this review, we provide an overview of healthy brain microvasculature structure and function in health and the effect of the aforementioned cerebral CNS diseases. We discuss the emerging new therapeutic opportunities, and their delivery approaches, aimed at recovering brain vascularization in this context. SIGNIFICANCE STATEMENT: The lack of effective treatments, mainly focused on neuron recovery, has prompted the search of other therapies to treat cerebral central nervous system diseases. The disruption and degeneration of cerebral microvasculature has been evidenced in neurodegenerative diseases, stroke, and aging, constituting a potential target for restoring vascularization, neuronal functioning, and cognitive capacities by the development of therapeutic pro-angiogenic strategies.
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Affiliation(s)
- Idoia Gallego
- NanoBioCel Research Group, Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P); Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine, Institute of Health Carlos III, Madrid, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.); and Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.)
| | - Ilia Villate-Beitia
- NanoBioCel Research Group, Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P); Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine, Institute of Health Carlos III, Madrid, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.); and Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.)
| | - Laura Saenz-Del-Burgo
- NanoBioCel Research Group, Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P); Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine, Institute of Health Carlos III, Madrid, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.); and Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.)
| | - Gustavo Puras
- NanoBioCel Research Group, Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P); Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine, Institute of Health Carlos III, Madrid, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.); and Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.)
| | - José Luis Pedraz
- NanoBioCel Research Group, Laboratory of Pharmacy and Pharmaceutical Technology, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P); Networking Research Centre of Bioengineering, Biomaterials and Nanomedicine, Institute of Health Carlos III, Madrid, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.); and Bioaraba, NanoBioCel Research Group, Vitoria-Gasteiz, Spain (I.G., I.V.-B., L.S.-B., G.P., J.L.P.)
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Fagerberg B, Barregard L. Review of cadmium exposure and smoking-independent effects on atherosclerotic cardiovascular disease in the general population. J Intern Med 2021; 290:1153-1179. [PMID: 34157165 DOI: 10.1111/joim.13350] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exposure to cadmium (Cd) via food and smoking is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). Blood and urine levels of Cd are established biomarkers of exposure. OBJECTIVES To review (1) the smoking-independent associations between Cd exposure and ASCVD, including the possible presence of a nonlinear dose-response relationship with Cd exposure and (2) the causal effects of Cd exposure on different stages of atherosclerosis. METHODS Narrative review. RESULTS Cd confers increased risk of ASCVD and asymptomatic atherosclerosis in the carotid and coronary arteries above B-Cd >0.5 μg/L or U-Cd >0.5 μg/g creatinine, but it has not been shown below a threshold of these exposure levels. Adjustment for smoking does not exclude the possibility of residual confounding, but several studies in never-smoking cohorts have shown associations between Cd and ASCVD, and experimental studies have demonstrated pro-atherosclerotic effects of Cd. Cd accumulates in arterial walls and atherosclerotic plaques, reaching levels shown to have proatherosclerotic effects. Suggested early effects are increased subendothelial retention of atherogenic lipoproteins, which become oxidized, and endothelial dysfunction and damage with increased permeability for monocytes, which in the intima turn to macrophages and then to foam cells. Later, Cd may contribute to plaque rupture and erosion by endothelial apoptosis and degradation of the fibrous cap. Finally, by having prothrombotic and antifibrinolytic effects, the CVD risk may be further increased. CONCLUSIONS There is strong evidence that Cd causes ASCVD above a suggested exposure level via mechanisms in early as well as the late stages of atherosclerotic disease.
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Affiliation(s)
- Björn Fagerberg
- Wallenberg Laboratory for Cardiovascular and Metabolic Research, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Occupational and Environmental Medicine, Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
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Arroyo-Quiroz C, O’Flaherty M, Guzman-Castillo M, Capewell S, Chuquiure-Valenzuela E, Jerjes-Sanchez C, Barrientos-Gutierrez T. Explaining the increment in coronary heart disease mortality in Mexico between 2000 and 2012. PLoS One 2020; 15:e0242930. [PMID: 33270684 PMCID: PMC7714134 DOI: 10.1371/journal.pone.0242930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors. METHODS We performed a retrospective analysis using the previously validated IMPACT model to explain observed changes in CHD mortality in Mexican adults. The model integrates nationwide data at two-time points (2000 and 2012) to quantify the effects on CHD mortality attributable to changes in risk factors and therapeutic trends. RESULTS From 2000 to 2012, CHD mortality rates increased by 33.8% in men and by 22.8% in women. The IMPACT model explained 71% of the CHD mortality increase. Most of the mortality increases could be attributed to increases in population risk factors, such as diabetes (43%), physical inactivity (28%) and total cholesterol (24%). Improvements in medical and surgical treatments together prevented or postponed 40.3% of deaths; 10% was attributable to improvements in secondary prevention treatments following MI, while 5.3% to community heart failure treatments. CONCLUSIONS CHD mortality in Mexico is increasing due to adverse trends in major risk factors and suboptimal use of CHD treatments. Population-level interventions to reduce CHD risk factors are urgently needed, along with increased access and equitable distribution of therapies.
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Affiliation(s)
- Carmen Arroyo-Quiroz
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
- Universidad Autonoma Metropolitana- Unidad Lerma, Lerma de Villada, Mexico
| | - Martin O’Flaherty
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Maria Guzman-Castillo
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Simon Capewell
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | | | - Carlos Jerjes-Sanchez
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico de Monterrey, Instituto de Cardiología y Medicina Vascular, TecSalud, Monterrey, Mexico
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Cirera L, Ballesta M, Márquez-Calderón S, Chirlaque MD, Saez M, Salmerón D. Partial contributions and temporal trends of leading causes of death during the last four decades in Spain. Public Health 2020; 189:81-90. [PMID: 33188998 DOI: 10.1016/j.puhe.2020.08.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/18/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The study was conducted to assess time trend shifts of leading causes of death and their partial contributions over the years 1975-2016 in Spain. STUDY DESIGN A longitudinal ecological epidemiologic design was conducted to analyse linear trend period shifts using joinpoint regression as the annual percentage of change (APC) in the period 1975-2016. The partial contributions were illustrated as the rate ratio of a singular-cause to their major-cause shift periods. RESULTS HIV/AIDS shaped the increasing trend period of infectious diseases in 1989-1995 (APC = 25.3, P < 0.05) and the decreasing trend in 1995-1999 and 1999-2016. Lung cancer fell gradually from 1994 in men (-0.4, P < 0.05); however, in women, the condition continued increasing from 1990 (P < 0.05). Dementia types influenced mental and neurological disease drifts. The recent trend for circulatory periods (1980-2016) was mainly modulated by cardiac ischaemia, with increased partial contributions (25%, 32% and 30%). Traffic accidents defined the descending tendency of external causes. CONCLUSIONS Spain showed a Western pattern in descended rates, including non-decreasing trends in mental and neurological diseases, pancreatic cancer, drug abuse and suicide. Trend shifts and partial contributions illustrated targets for further mortality reduction.
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Affiliation(s)
- L Cirera
- Department of Epidemiology, Regional Health Council of Murcia, Ronda de Levante, 11, 30011, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; Department of Health & Social Sciences, Murcia University, Campus de Espinardo, 30100, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - M Ballesta
- Department of Epidemiology, Regional Health Council of Murcia, Ronda de Levante, 11, 30011, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; Department of Health & Social Sciences, Murcia University, Campus de Espinardo, 30100, Murcia, Spain.
| | - S Márquez-Calderón
- Andalusian Ministry of Heatlh - Institute of Statistics and Cartography of Andalusia, Calle Leonardo da Vinci, 21, 41092, Seville, Spain.
| | - M-D Chirlaque
- Department of Epidemiology, Regional Health Council of Murcia, Ronda de Levante, 11, 30011, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; Department of Health & Social Sciences, Murcia University, Campus de Espinardo, 30100, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - M Saez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer Universitat de Girona, 10, 17071, Girona, Spain; Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain.
| | - D Salmerón
- IMIB-Arrixaca, Murcia, Spain; Department of Health & Social Sciences, Murcia University, Campus de Espinardo, 30100, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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Ding L, Liang Y, Tan ECK, Hu Y, Zhang C, Liu Y, Xue F, Wang R. Smoking, heavy drinking, physical inactivity, and obesity among middle-aged and older adults in China: cross-sectional findings from the baseline survey of CHARLS 2011-2012. BMC Public Health 2020; 20:1062. [PMID: 32631359 PMCID: PMC7336642 DOI: 10.1186/s12889-020-08625-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 03/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prevention and control of cardiometabolic conditions and cardiovascular disease (CVD) in China may contribute to sustainable CVD reduction globally, given the fact that one-fifth of the worldwide population is in China. Knowing the distribution of behavioral risk factors (e.g., smoking and physical inactivity), especially at a national level in China, would be extremely relevant to the field of public health and CVD prevention. The objectives of this study were to investigate the nationwide prevalence of obesity, smoking, heavy drinking, and physical inactivity in Chinese adults, and further explore whether cardiometabolic conditions would modify the distribution of behavioral risk factors. METHODS This population-based study is based on the China Health and Retirement Longitudinal Study (2011-2012), including 17,302 adults (≥45 years, mean age 59.67 years, female 51.66%) from 25 provinces in China. Data on demographics, lifestyle factors, health status and history of diseases were collected via structured interviews and laboratory tests. Smoking, heavy drinking, obesity, and physical inactivity were defined following standard guidelines. We performed descriptive analysis and logistic regressions in this study. RESULTS The overall prevalence of heavy drinking, obesity, current smoking, and physical inactivity among middle-aged and older adults was 7.23% (95% confidence interval 6.53-7.29%), 11.53% (10.43-12.62%), 27.46% (26.30-28.62%), and 44.06% (41.19-46.92%), respectively. The prevalence varied between rural and urban areas as well as among geographic areas, with higher prevalence in the Northern and Northeastern regions. Heavy drinking and obesity were significantly associated with incident hypertension, diabetes, and high cholesterol; while current smoking was significantly associated with incident hypertension. Compared with healthy individuals, participants who self-reported a diagnosis of hypertension, high cholesterol, or diabetes were less likely to smoke currently and drink alcohol heavily, but more likely to be physically inactive and obese. CONCLUSIONS Among Chinese middle-aged and older adults, the prevalence of behavioral risk factors varies by geographic region. Further effort is required to improve physical activity and fitness for Chinese adults, especially those with cardiometabolic conditions.
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Affiliation(s)
- Lijie Ding
- Division of health management, School of sport social science, Shandong Sport University, Room 1415, 10600 Shijidadao Road, Jinan, 250102, China.
| | - Yajun Liang
- Department of Public Health Sciences, Karolinska Institutet (KI), Stockholm, Sweden
| | - Edwin C K Tan
- The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia.,Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Yin Hu
- Södertälje Hospital, Stockholm, Sweden
| | - Chi Zhang
- Energy Processes, Royal Institute of Technology, Stockholm, Sweden
| | - Yanxun Liu
- Department of Biostatistics, School of Public Health, Shandong University, Box 100, 44 Wenhua Xi Road, Jinan, 250012, PO, China
| | - Fuzhong Xue
- Department of Biostatistics, School of Public Health, Shandong University, Box 100, 44 Wenhua Xi Road, Jinan, 250012, PO, China.
| | - Rui Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden. .,The Swedish School of Sport and Health Sciences, GIH, Lidingövägen 1, Box 5626, SE-11486, Stockholm, Sweden. .,Department of Medicine and Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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11
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Persson CU, Collén AC, Rosengren A, Mandalenakis Z, Zverkova Sandström T, Fu M, Dellborg M, Johansson S, Hansson PO. Secular trends in cardiovascular risk factors among women aged 45-54 years in Gothenburg, Sweden, from 1980 to 2014. BMC Public Health 2020; 20:1042. [PMID: 32611406 PMCID: PMC7329532 DOI: 10.1186/s12889-020-09098-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/12/2020] [Indexed: 11/20/2022] Open
Abstract
Background A declining trend in mean cholesterol levels and smoking has been observed in high-income western countries during the last few decades, whereas obesity rates have increased. Simultaneously, mortality from coronary heart disease has decreased. The aim of the present study was to determine whether the trends in cardiovascular risk factors have continued in successive cohorts of middle-aged women over a period of 34 years. Methods Six population-based, cross-sectional samples of women (n = 2294) mean age: 49.8 years (range: 45–54), living in Gothenburg, Sweden, were investigated between 1980 and 2014. Results Body mass index (BMI) increased over time, with a mean BMI of 24.7 kg/m2 in 1980 to 25.7 kg/m2 in 2013–2014, corresponding to a weight gain of 4.5 kg, together with an increase in the proportion of obese individuals (BMI ≥ 30 kg/m2) from 10.4 to 16.6% (p = 0.0012). The proportion of smokers and women with hypertension decreased from 34.5 to 12.8% (p = 0.0006) and from 37.7 to 24.5% (p < 0.0001) respectively. Mean total serum cholesterol levels decreased from 6.23 (SD 1.09) mmol/L in 1980 to 5.43 (SD 0.98) mmol/L in 2013–2014 (p < 0.0001). Self-reported leisure time regular exercise increased from 7.8% in 1980 to 35.6% in 2013–2014 (p < 0.0001). For women born in 1963, the prevalence ratio of not having any of five major cardiovascular risk factors was 1.82 (95% confidence interval (CI) 1.38–2.41), compared with women born in 1925–1934. Conclusion The trend towards increasing obesity, more leisure-time physical activity and less smoking remains, while the decrease in serum cholesterol appears to have abated.
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Affiliation(s)
- Carina U Persson
- Department of Clinical Neuroscience, Rehabilitation Medicine, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Region Västra Götaland, Department of Physiotherapy, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden.
| | - Anna-Clara Collén
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine Geriatric and Emergency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine Geriatric and Emergency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine Geriatric and Emergency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tatiana Zverkova Sandström
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine Geriatric and Emergency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine Geriatric and Emergency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Dellborg
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine Geriatric and Emergency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Saga Johansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Department of Medicine Geriatric and Emergency, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Kugathasan P, Johansen MB, Jensen MB, Aagaard J, Nielsen RE, Jensen SE. Coronary Artery Calcification and Mortality Risk in Patients With Severe Mental Illness. Circ Cardiovasc Imaging 2020; 12:e008236. [PMID: 30866646 DOI: 10.1161/circimaging.118.008236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Cardiovascular mortality is the leading contributor to the shortened life expectancy in patients with severe mental illness (SMI), but efforts to predict cardiovascular outcomes in these patients have been lacking. In this study, we aimed to determine the severity of coronary artery calcification (CAC), and its effect on mortality rates in patients with SMI, compared with the general population. Methods All individuals with a registered cardiac computed tomography for calcium scoring in the Western Denmark Heart Registry, from January 1, 2008 to December 31, 2016, were included. We identified patients diagnosed with SMI ( International Classification of Diseases, Tenth Revision: F20, F30, F31), whereas the remaining individuals were used as a comparison group. Results Among 48 757 individuals, including 564 patients with SMI (1.2%), we found no difference in CAC score between patients with SMI and the comparison group. SMI patients with CAC >100 had an increased mortality rate (hazard ratio, 3.16; 95% CI, 1.41-7.06), as well as SMI patients with CAC <100 (hazard ratio, 3.95; 95% CI, 2.36-6.62), compared with the comparison group with CAC <100 as reference, adjusted for age, sex, and calendar period. Conclusions Patients with SMI have increased cardiovascular risks, but show no difference in CAC score, compared with the comparison group. Mortality rates were increased in patients with SMI, independent of CAC severity; however, the relatively large number of noncardiovascular causes of death in this sample might indicate other contributing factors to death than coronary artery disease in this sample of SMI patients.
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Affiliation(s)
- Pirathiv Kugathasan
- Psychiatry, Aalborg University Hospital, Denmark (P.K., M.B. Jensen, J.A., R.E.N.)
| | - Martin Berg Johansen
- Department of Clinical Medicine, Aalborg University, Denmark (M.B. Johansen, S.E.J.).,Unit of Clinical Biostatistics, Aalborg University Hospital, Denmark (M.B. Johansen)
| | - Mikkel Bak Jensen
- Psychiatry, Aalborg University Hospital, Denmark (P.K., M.B. Jensen, J.A., R.E.N.)
| | - Jørgen Aagaard
- Psychiatry, Aalborg University Hospital, Denmark (P.K., M.B. Jensen, J.A., R.E.N.)
| | - René Ernst Nielsen
- Psychiatry, Aalborg University Hospital, Denmark (P.K., M.B. Jensen, J.A., R.E.N.)
| | - Svend Eggert Jensen
- Department of Clinical Medicine, Aalborg University, Denmark (M.B. Johansen, S.E.J.).,Department of Cardiology (S.E.J.)
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13
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Coronary heart disease mortality is decreasing in Argentina, and Colombia, but keeps increasing in Mexico: a time trend study. BMC Public Health 2020; 20:162. [PMID: 32013918 PMCID: PMC6998818 DOI: 10.1186/s12889-020-8297-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Mortality rates due to coronary heart disease (CHD) have decreased in most countries, but increased in low and middle-income countries. Few studies have analyzed the trends of coronary heart disease mortality in Latin America, specifically the trends in young-adults and the effect of correcting these comparisons for nonspecific causes of death (garbage codes). The objective of this study was to describe and compare standardized, age-specific, and garbage-code corrected mortality trends for coronary heart disease from 1985 to 2015 in Argentina, Colombia, and Mexico. Methods Deaths from coronary heart disease were grouped by country, year of registration, sex, and 10-year age bands to calculate age-adjusted and age and sex-specific rates for adults aged ≥25. We corrected for garbage-codes using the methodology proposed by the Global Burden of Disease. Finally, we fitted Joinpoint regression models. Results In 1985, age-standardized mortality rates per 100,000 population were 136.6 in Argentina, 160.6 in Colombia, and 87.51 in Mexico; by 2015 rates decreased 51% in Argentina and 6.5% in Colombia, yet increased by 61% in Mexico, where an upward trend in mortality was observed in young adults. Garbage-code corrections produced increases in mortality rates, particularly in Argentina with approximately 80 additional deaths per 100,000, 14 in Colombia and 13 in Mexico. Conclusions Latin American countries are at different stages of the cardiovascular disease epidemic. Garbage code correction produce large changes in the mortality rates in Argentina, yet smaller in Mexico and Colombia, suggesting garbage code corrections may be needed for specific countries. While coronary heart disease (CHD) mortality is falling in Argentina, modest falls in Colombia and substantial increases in Mexico highlight the need for the region to propose and implement population-wide prevention policies.
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14
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Zhang Z, Liu H, Liu J. Akt activation: A potential strategy to ameliorate insulin resistance. Diabetes Res Clin Pract 2019; 156:107092. [PMID: 29111280 DOI: 10.1016/j.diabres.2017.10.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 09/24/2017] [Accepted: 10/02/2017] [Indexed: 02/08/2023]
Abstract
Insulin resistance is a hallmark of type 2 diabetes and obesity while the mechanism remains unclear. Current therapy to treat type 2 diabetes is metformin, the 5'-monophosphate-activated protein kinase (AMPK) activator, owing to the ability to augment peripheral glucose uptake. However, metformin also displays limitations, as AMPK activation remains intact and regular in most type 2 diabetes and metformin does not seem to facilitate peripheral insulin resistance. Evidence has shown that PI3K-Akt/PKB pathway could be induced via insulin and act as an important effector. Akt/PKB is capable of inducing a great number of downstream molecules, such as translocating glucose transporters GLUTs to the cell membrane thus increase glucose uptake. Hence, any defect in Akt/PKB pathway along with the downstream molecules could lead to insulin resistance. Inositol pyrophosphates, synthesized by inositol hexakisphosphate (IP6) kinase 1 (IP6K1) and competitive with 3,4,5-bisphosphate (PIP3) to bind the PH domain of Akt/PKB, demonstrate the ability to inhibit Akt signaling. In addition, IP6K1 knockout mice present increased insulin sensitivity and obesity resistance, indicating a novel therapeutic target in confronting insulin resistance. Taken together, we conclude that Akt activation is another potential strategy to ameliorate insulin resistance.
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Affiliation(s)
- Zhengyi Zhang
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Huadong Liu
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Jiankang Liu
- Center for Mitochondrial Biology and Medicine, The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology and Frontier Institute of Science and Technology, Xi'an Jiaotong University, Xi'an, China.
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15
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Desmond MA, Sobiecki J, Fewtrell M, Wells JCK. Plant-based diets for children as a means of improving adult cardiometabolic health. Nutr Rev 2019; 76:260-273. [PMID: 29506219 DOI: 10.1093/nutrit/nux079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease (CVD) is the largest contributor to global mortality, and this trend is expected to continue. Although mortality rates have been falling, adverse developments in obesity and diabetes threaten to reverse this. It has been estimated that the only viable strategy to reduce the epidemic is to focus on population-wide risk factor reduction. Primordial prevention, a strategy aimed at avoiding the development of risk factors before the disease onset, has been shown to reduce the CVD epidemic substantially. Plant-based diets appear beneficial for prevention of cardiometabolic diseases, with adult vegetarians and vegans having lower CVD risk than omnivores. Atherosclerosis starts in childhood and progresses in relation to classical CVD risk factors, which, along with dietary habits, track to adulthood. Based on this evidence, it is proposed that plant-based diets in childhood could promote cardiometabolic health in adults and thereby reduce CVD and promote longevity and health. However, the need for additional research to establish the safety of predominantly or exclusively plant-based diets in children is noted.
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Affiliation(s)
- Malgorzata A Desmond
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,Department of Paediatrics, Nutrition and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland
| | - Jakub Sobiecki
- Department of Paediatrics, Nutrition and Metabolic Diseases, Children's Memorial Health Institute, Warsaw, Poland.,School of Public Health, Imperial College, London, United Kingdom
| | - Mary Fewtrell
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Jonathan C K Wells
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
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16
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Kieneker LM, Eisenga MF, Bakker SJL. In reply-Low-Sodium Intake: A Risk Factor for Stroke? Mayo Clin Proc 2019; 94:729-730. [PMID: 30947839 DOI: 10.1016/j.mayocp.2018.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 12/14/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Lyanne M Kieneker
- Department of Internal Medicine, University Medical Center, University of Groningen, The Netherlands
| | - Michele F Eisenga
- Department of Internal Medicine, University Medical Center, University of Groningen, The Netherlands
| | - Stephan J L Bakker
- Department of Internal Medicine, University Medical Center, University of Groningen, The Netherlands
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17
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Szőcs I, Bereczki D, Ajtay A, Oberfrank F, Vastagh I. Socioeconomic gap between neighborhoods of Budapest: Striking impact on stroke and possible explanations. PLoS One 2019; 14:e0212519. [PMID: 30785925 PMCID: PMC6382147 DOI: 10.1371/journal.pone.0212519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 02/04/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction Hungary has a single payer health insurance system offering free healthcare for acute cerebrovascular disorders. Within the capital, Budapest, however there are considerable microregional socioeconomic differences. We hypothesized that socioeconomic deprivation reflects in less favorable stroke characteristics despite universal access to care. Methods From the database of the National Health Insurance Fund, we identified 4779 patients hospitalized between 2002 and 2007 for acute cerebrovascular disease (hereafter ACV, i.e. ischemic stroke, intracerebral hemorrhage, or transient ischemia), among residents of the poorest (District 8, n = 2618) and the wealthiest (District 12, n = 2161) neighborhoods of Budapest. Follow-up was until March 2013. Results Mean age at onset of ACV was 70±12 and 74±12 years for District 8 and 12 (p<0.01). Age-standardized incidence was higher in District 8 than in District 12 (680/100,000/year versus 518/100,000/year for ACV and 486/100,000/year versus 259/100,000/year for ischemic stroke). Age-standardized mortality of ACV overall and of ischemic stroke specifically was 157/100,000/year versus 100/100,000/year and 122/100,000/year versus 75/100,000/year for District 8 and 12. Long-term case fatality (at 1,5, and 10 years) for ACV and for ischemic stroke was higher in younger District 8 residents (41–70 years of age at the index event) compared to D12 residents of the same age. This gap between the districts increased with the length of follow-up. Of the risk diseases the prevalence of hypertension and diabetes was higher in District 8 than in District 12 (75% versus 66%, p<0.001; and 26% versus 16%, p<0.001). Discussion Despite universal healthcare coverage, the disadvantaged district has higher ACV incidence and mortality than the wealthier neighborhood. This difference affects primarily the younger age groups. Long-term follow-up data suggest that inequity in institutional rehabilitation and home-care should be investigated and improved in disadvantaged neighborhoods.
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Affiliation(s)
- Ildikó Szőcs
- Semmelweis University, Department of Neurology, Budapest, Hungary
- * E-mail:
| | - Dániel Bereczki
- Semmelweis University, Department of Neurology, Budapest, Hungary
| | - András Ajtay
- Semmelweis University, Department of Neurology, Budapest, Hungary
| | - Ferenc Oberfrank
- Institute of Experimental Medicine of the Hungarian Academy of Sciences, Budapest, Hungary
| | - Ildikó Vastagh
- Semmelweis University, Department of Neurology, Budapest, Hungary
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18
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Abstract
OBJECTIVES Over the last decades, mortality from cerebrovascular diseases (CVDs) has decreased in many countries. The aim of this study was to assess the trends of CVDs mortality in Serbia. METHODS Descriptive epidemiological study. Age-standardised rates (ASRs) for CVDs mortality were assessed by joinpoint regression analysis to identify significant changes in trends and estimate annual per cent changes with 95% CI. The age-period-cohort analysis has been used to describe variations in mortality. RESULTS Over this 20-year period, there were 312 847 deaths from CVDs, with the overall average annual ASR of 148.4 per 100 000. The trend of ASRs from CVDs mortality in males in Serbia showed a significant joinpoint: rates insignificantly decreased from 1997 to 2005 by -0.8% per year (95% CI -1.7% to 0.2%) and thereafter rapidly decreased by -5.0% per year (95% CI -5.6% to -4.5%). A joinpoint for females was found in 2006: the mortality trend was first significantly decreasing by -1.0% per year (95% CI -1.9% to -0.0%) and then sharply falling down by -6.0% per year (95% CI -6.8% to -5.3%). Results of age-period-cohort analysis indicated that the relative risk for CVDs mortality showed statistically significant (p<0.05) cohort and period effects, as well as the net drift and local drifts in Serbian population. The trends in mortality for all subtypes of CVDs were similar in both sexes: trends significantly decreased for most subtypes, with the exception of a significant increase for cerebral infarction. CONCLUSIONS After a decade of increase, CVDs mortality rates are declining in last decade in Serbia. However, mortality rates from CVDs remain exceedingly high in Serbia. Differences in mortality trends of the stroke subtypes should be taken into account in the creation of both prevention and treatment guidelines.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Saar A, Läll K, Alver M, Marandi T, Ainla T, Eha J, Metspalu A, Fischer K. Estimating the performance of three cardiovascular disease risk scores: the Estonian Biobank cohort study. J Epidemiol Community Health 2019; 73:272-277. [PMID: 30635435 DOI: 10.1136/jech-2017-209965] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND We aim to investigate the predictive ability of PCE (Pooled Cohort Equations), QRISK2 and SCORE (Systematic COronary Risk Estimation) scoring systems for atherosclerotic cardiovascular disease (ASCVD) risk prediction in Estonia, a country with one of the highest ASCVD event rates in Europe. METHODS Seven-year risk estimates were calculated in risk score-specific subsets of the Estonian Biobank cohort. Calibration was assessed by standardised incidence ratios (SIRs) and discrimination by Harrell's C-statistics. In addition, a head-to-head comparison of the scores was performed in the intersection of the three score-specific subcohorts. RESULTS PCE, QRISK2 and SCORE risk estimates were calculated for 4356, 7191 and 3987 eligible individuals, respectively. During the 7-year follow-up, 220 hard ASCVD events (PCE outcome), 671 ASCVD events (QRISK2 outcome) and 94 ASCVD deaths (SCORE outcome) occurred among the score-specific subsets of the cohort. While PCE (SIR 1.03, 95% CI 0.90 to 1.18) and SCORE (SIR 0.99, 95% CI 0.81 to 1.21) were calibrated well for the cohort, QRISK2 underestimated the risk by 48% (SIR 0.52, 95% CI 0.48 to 0.56). In terms of discrimination, PCE (C-statistic 0.778) was inferior to QRISK2 (C-statistic 0.812) and SCORE (C-statistic 0.865). All three risk scores performed at similar level in the head-to-head comparison. CONCLUSION Of three widely used ASCVD risk scores, PCE and SCORE performed at acceptable level, while QRISK2 underestimated ASCVD risk markedly. These results highlight the need for evaluating the accuracy of ASCVD risk scores prior to use in high-risk populations.
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Affiliation(s)
- Aet Saar
- Heart Clinic, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Cardiology Centre, North Estonia Medical Centre, Tallinn, Estonia
| | - Kristi Läll
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia.,Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Maris Alver
- Institute of Genomics, University of Tartu, Tartu, Estonia.,Department of Biotechnology, Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Toomas Marandi
- Heart Clinic, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Cardiology Centre, North Estonia Medical Centre, Tallinn, Estonia
| | - Tiia Ainla
- Heart Clinic, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Cardiology Centre, North Estonia Medical Centre, Tallinn, Estonia
| | - Jaan Eha
- Heart Clinic, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.,Heart Clinic, Tartu University Hospital, Tartu, Estonia
| | - Andres Metspalu
- Institute of Genomics, University of Tartu, Tartu, Estonia.,Department of Biotechnology, Institute of Molecular and Cell Biology, University of Tartu, Tartu, Estonia
| | - Krista Fischer
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia.,Institute of Genomics, University of Tartu, Tartu, Estonia
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20
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Cruise SM, Hughes J, Bennett K, Kouvonen A, Kee F. The Impact of Risk Factors for Coronary Heart Disease on Related Disability in Older Irish Adults. J Aging Health 2019; 31:165-184. [PMID: 28823193 DOI: 10.1177/0898264317726242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study is to examine the prevalence of coronary heart disease (CHD)-related disability (hereafter also "disability") and the impact of CHD risk factors on disability in older adults in the Republic of Ireland (ROI) and Northern Ireland (NI). METHOD Population attributable fractions were calculated using risk factor relative risks and disability prevalence derived from The Irish Longitudinal Study on Ageing and the Northern Ireland Health Survey. RESULTS Disability was significantly lower in ROI (4.1% vs. 8.8%). Smoking and diabetes prevalence rates, and the fraction of disability that could be attributed to smoking (ROI: 6.6%; NI: 6.1%), obesity (ROI: 13.8%; NI: 11.3%), and diabetes (ROI: 6.2%; NI: 7.2%), were comparable in both countries. Physical inactivity (31.3% vs. 54.8%) and depression (10.2% vs. 17.6%) were lower in ROI. Disability attributable to depression (ROI: 16.3%; NI: 25.2%) and physical inactivity (ROI: 27.5%; NI: 39.9%) was lower in ROI. DISCUSSION Country-specific similarities and differences in the prevalence of disability and associated risk factors will inform public health and social care policy in both countries.
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Affiliation(s)
| | - John Hughes
- 1 Queen's University Belfast, Northern Ireland, UK
- 2 Northern Ireland Statistics and Research Agency, Belfast, UK
| | | | - Anne Kouvonen
- 1 Queen's University Belfast, Northern Ireland, UK
- 4 University of Helsinki, Finland
- 5 SWPS University of Humanities and Social Sciences, Wroclaw, Poland
| | - Frank Kee
- 1 Queen's University Belfast, Northern Ireland, UK
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Park JH, Moon SW, Kim TY, Ro YS, Cha WC, Kim YJ, Shin SD. Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study. Clin Exp Emerg Med 2018; 5:264-271. [PMID: 30571905 PMCID: PMC6301859 DOI: 10.15441/ceem.17.257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/26/2017] [Indexed: 12/13/2022] Open
Abstract
Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.
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Affiliation(s)
- Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Woo Moon
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Tae Yun Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Won Chul Cha
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Jin Kim
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.,Department of Emergency Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Rücker V, Wiedmann S, O’Flaherty M, Busch MA, Heuschmann PU. Decline in Regional Trends in Mortality of Stroke Subtypes in Germany From 1998 to 2015. Stroke 2018; 49:2577-2583. [DOI: 10.1161/strokeaha.118.023193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Viktoria Rücker
- From the Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (V.R., S.W., P.U.H.)
| | - Silke Wiedmann
- From the Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (V.R., S.W., P.U.H.)
| | - Martin O’Flaherty
- Department of Public Health and Policy, Institute of Psychology, Health, and Society, University of Liverpool, United Kingdom (M.O.)
| | - Markus A. Busch
- Department of Epidemiology, Robert Koch Institute, Berlin, Germany (M.A.B.)
| | - Peter U. Heuschmann
- From the Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (V.R., S.W., P.U.H.)
- Comprehensive Heart Failure, University of Würzburg, Germany (P.U.H.)
- Center for Clinical Studies, University Hospital Würzburg, Germany (P.U.H.)
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Rospleszcz S, Thorand B, de las Heras Gala T, Meisinger C, Holle R, Koenig W, Mansmann U, Peters A. Temporal trends in cardiovascular risk factors and performance of the Framingham Risk Score and the Pooled Cohort Equations. J Epidemiol Community Health 2018; 73:19-25. [DOI: 10.1136/jech-2018-211102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/01/2018] [Accepted: 08/31/2018] [Indexed: 11/03/2022]
Abstract
BackgroundThe Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE) are established tools for the prediction of cardiovascular disease (CVD) risk. In the Western world, decreases in incidence rates of CVD were observed over the last 30 years. Thus, we hypothesise that there are also temporal trends in the risk prediction performance of the FRS and PCE from 1990 to 2000.MethodsWe used data from n=7789 men and women aged 40–74 years from three prospective population-based cohort studies enrolled in Southern Germany in 1989/1990, 1994/1995 and 1999/2000. 10-year CVD risk was calculated by recalibrated equations of the FRS or PCE. Calibration was evaluated by percentage of overestimation and Hosmer-Lemeshow tests. Discrimination performance was assessed by receiver operating characteristic (ROC) curves and corresponding area under the curve (AUC).ResultsAcross the three studies, we found significant temporal trends in risk factor distributions and predicted risks by both risk scores (men: 18.0%, 15.4%, 14.9%; women: 8.7%, 11.2%, 10.8%). Furthermore, also the discrimination performance evolved differently for men (AUC PCE: 76.4, 76.1, 72.8) and women (AUC PCE: 75.9, 79.5, 80.5). Both risk scores overestimated actual CVD risk.ConclusionThere are temporal trends in the performance of the FRS and PCE. Although the overall performance remains adequate, sex-specific trends have to be taken into account for further refinement of risk prediction models.
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Gonzalez AJ, Sanchez F, Benlloch JM. Organ-Dedicated Molecular Imaging Systems. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2018. [DOI: 10.1109/trpms.2018.2846745] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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25
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Andrade N, Alves E, Costa AR, Moura-Ferreira P, Azevedo A, Lunet N. Knowledge about cardiovascular disease in Portugal. Rev Port Cardiol 2018; 37:669-677. [DOI: 10.1016/j.repc.2017.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/08/2017] [Indexed: 10/28/2022] Open
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26
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Knowledge about cardiovascular disease in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Cottel D, Montaye M, Marécaux N, Amouyel P, Dallongeville J, Meirhaeghe A. Comparison of the rates of stroke and acute coronary events in northern France. Eur J Prev Cardiol 2018; 25:1534-1542. [PMID: 30019921 DOI: 10.1177/2047487318788921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although stroke and acute coronary events share several risk factors, few studies have compared population-level epidemiological surveillance indicators of the two diseases in the same age range and in the same geographical area. Design The objective of the present study was to compare the rate of acute coronary events with that of stroke among inhabitants aged from 35-74 years in Northern France (Lille). Methods All incident and recurrent acute coronary events and stroke events occurring in men and women over 2008-2014 were recorded using two population-based registries with several overlapping sources of case ascertainment for hospitalised/non-hospitalised and fatal/non-fatal events. Log-linear Poisson regression models were used to compare the event and mortality rates. Results The results showed that the incident rates of acute coronary event and stroke were similar except under 60 years. In this group (35-59 years), the incident rate of acute coronary events was 1.6-fold higher than that of stroke. In contrast, the attack (incident and recurrent) rates were higher for acute coronary events than for stroke (1.5-fold; p < 0.0001) - especially in men (1.8-fold; p < 0.0001). The mortality rate was 2.2-fold higher for acute coronary events than for stroke, independent of sex and age group ( p < 0.0001), as was the case-fatality rate (1.5-fold, p < 0.0001). Conclusion In Lille, the overall acute coronary event rate was higher than the stroke rate - especially among men, due to a higher risk of incident acute coronary event under the age of 65 and a higher risk of recurrent acute coronary event in the 65-74 year-old age range. Further efforts should be devoted to primary and secondary prevention strategies after acute coronary events.
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Affiliation(s)
- Dominique Cottel
- Inserm, Univ. Lille, Institut Pasteur de Lille, Centre Hosp. Univ Lille, France
| | - Michèle Montaye
- Inserm, Univ. Lille, Institut Pasteur de Lille, Centre Hosp. Univ Lille, France
| | - Nadine Marécaux
- Inserm, Univ. Lille, Institut Pasteur de Lille, Centre Hosp. Univ Lille, France
| | - Philippe Amouyel
- Inserm, Univ. Lille, Institut Pasteur de Lille, Centre Hosp. Univ Lille, France
| | - Jean Dallongeville
- Inserm, Univ. Lille, Institut Pasteur de Lille, Centre Hosp. Univ Lille, France
| | - Aline Meirhaeghe
- Inserm, Univ. Lille, Institut Pasteur de Lille, Centre Hosp. Univ Lille, France
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Relation between mortality trends of cardiovascular diseases and selected cancers in the European Union, in 1970-2017. Focus on cohort and period effects. Eur J Cancer 2018; 103:341-355. [PMID: 30029971 DOI: 10.1016/j.ejca.2018.06.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 01/01/2023]
Abstract
AIM To characterise mortality trends from major non-communicable diseases in the European Union (EU) analysing data from the World Health Organization (WHO) Mortality Database. METHODS We obtained EU population and death certification data for major non-communicable diseases, i.e. seven cancer sites (stomach, intestine, pancreas, lung, breast, prostate and haematopoietic), total cancers, coronary heart diseases (CHDs) and cerebrovascular diseases (CVDs) from the WHO Mortality Database over the 1970 and 2012 period. We computed age-standardised rates (world standard population) and applied joinpoint regression models to identify temporal trends and age period cohort (APC) models to disentangle the effects of age, period of death and cohort of birth on mortality. RESULTS In 2012, 2.4 million deaths were recorded in the EU (1.3 million from cancers and 1.1 million from CHD and CVD combined). Over the last decade, mortality from cancer fell by 14% in men and 8% in women, resulting in age-standardised rates of 144 and 88/100,000 persons, respectively, in 2012. The only exceptions to the general downward trends were pancreatic cancer and female lung cancer. Both cardiovascular diseases mortality fell over 35% in both sexes with rates of 60 and 28/100,000 for CHD, and of 30 and 23/100,000 for CVD, in men and women, respectively, in 2012. CONCLUSIONS Overall trends in mortality rates from non-communicable diseases in the EU were favourable, and the joinpoint and APC models indicated these trends are likely to continue in the near future. Lack of progress in tobacco-related mortality in women underlines the importance of female-specific anti-tobacco policies.
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Di Folco U, Pollakova D, De Falco D, Nardone MR, Tubili F, Tubili C. Effects of a nutraceutical multicompound including bergamot (Citrus Bergamia Risso) juice on metabolic syndrome: A pilot study. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2018. [DOI: 10.3233/mnm-17186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The role of lipid-lowering and hypoglycemic nutraceuticals in cardiovascular disease prevention is the focus in recent years. The most studied compounds and plants are sterols, soy, red fermented rice, policosanols, artichoke, berberine. Epidemiological and experimental evidences suggest that dietary polyphenols, especially flavonoids, might play a role in preventing atherosclerosis, owing to their pleiotropic metabolic, anti-inflammatory and antioxidant effects. Recent studies have shown that bergamot juice and albedo (Citrus Bergamia Risso et Poiteau), an endemic plant growing in a limited part of the Ionian coast of Calabria (Italy) has a unique content of flavonoids and glycosides, such as neoeriocytrine, neoesperidine, naringenine, routine, neodesmine, polyphenol and poncirine. OBJECTIVE: The aim of this study was to investigate the effects of a phytocomplex from bergamot fruit (EP3116520A1) as dietary supplement to a Mediterranean diet on body weight, body mass index (BMI), waist circumference, plasmatic lipid fractions, glucose and C – reactive protein (CRP) in subjects with the metabolic syndrome (MetS; according to NCEP-ATP III criteria) without pharmacological treatment, exept for basic treatment. METHODS: 80 overweight adults (54% females, 46% males) with the diagnosis of Metabolic Syndrome (MetS), aged 45 ± 5 years, were enrolled and randomized to 2 groups: group A) followed a personalized low calorie Mediterranean diet (control group) and group B) enriched the same diet therapy with 1 tablet of a phytocomplex from bergamot fruit per day for 6 months (intervention group). RESULTS: After 6 months patients in the intervention group showed a significant reduction of total cholesterol (–15% ), LDL-Cholesterol (–22% ), triglycerides (–23% ), blood glucose (–15% ), CRP (–40% ) and a significant increase in the HDL-Cholesterol (+ 14% ) levels compared to the control group (diet alone) where the changes were not significant, with not much significance in reduced body weight. CONCLUSION: Our findings suggest that bergamot supplementation improves significantly all aspects of metabolic profile in patients with MetS and is superior to diet alone.
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Affiliation(s)
- Ugo Di Folco
- Diabetes Unit, “S. Camillo-Forlanini” Hospital, Rome, Italy
| | | | | | | | - Flavia Tubili
- “A. Meyer” Children’s Hospital, University of Florence, Italy
| | - Claudio Tubili
- Diabetes Unit, “S. Camillo-Forlanini” Hospital, Rome, Italy
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Blackburn R, Zhao H, Pebody R, Hayward A, Warren-Gash C. Laboratory-Confirmed Respiratory Infections as Predictors of Hospital Admission for Myocardial Infarction and Stroke: Time-Series Analysis of English Data for 2004-2015. Clin Infect Dis 2018; 67:8-17. [PMID: 29324996 PMCID: PMC6005111 DOI: 10.1093/cid/cix1144] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 01/05/2018] [Indexed: 01/01/2023] Open
Abstract
Background Acute respiratory infections are associated with increased risk of myocardial infarction (MI) and stroke; however, the role of different organisms is poorly characterized. Methods Time-series analysis of English hospital admissions for MI and stroke (age-stratified: 45-64, 65-74, ≥75 years), laboratory-confirmed viral respiratory infections, and environmental data for 2004-2015. Weekly counts of admissions were modeled using multivariable Poisson regression with weekly counts of respiratory viruses (influenza, parainfluenza, rhinovirus, respiratory syncytial virus [RSV], adenovirus, or human metapneumovirus [HMPV]) investigated as predictors. We controlled for seasonality, long-term trends, and environmental factors. Results Weekly hospital admissions in adults aged ≥45 years averaged 1347 (interquartile range [IQR], 1217-1541) for MI and 1175 (IQR, 1023-1395) for stroke. Respiratory infections ranged from 11 cases per week (IQR, 5-53) for influenza to 55 (IQR, 7-127) for rhinovirus. In the adjusted models, all viruses except parainfluenza were significantly associated with MI and ischemic stroke admissions in those aged ≥75. Among 65- to 74-year-olds, adenovirus, rhinovirus, and RSV were associated with MI but not ischemic stroke admissions. Respiratory infections were not associated with MI or ischemic stroke in people aged 45-64 years, nor with hemorrhagic stroke in any age group. An estimated 0.4%-5.7% of MI and ischemic stroke admissions may be attributable to respiratory infection. Conclusions We identified small but strongly significant associations in the timing of respiratory infection (with HMPV, RSV, influenza, rhinovirus, and adenovirus) and MI or ischemic stroke hospitalizations in the elderly. Clinical Trials Registration NCT02984280.
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Affiliation(s)
- Ruth Blackburn
- Farr Institute of Health Informatics Research, University College London
| | - Honxin Zhao
- National Infection Service Colindale, Public Health England
| | - Richard Pebody
- National Infection Service Colindale, Public Health England
| | - Andrew Hayward
- Farr Institute of Health Informatics Research, University College London
| | - Charlotte Warren-Gash
- Farr Institute of Health Informatics Research, University College London
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, United Kingdom
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Abstract
The World Health Organization suggests that the cardiovascular diseases (CVDs) are the major cause of mortality and account for two-thirds of the deaths all over the world. These diseases kill about 17 million people every year and 3 in every 10 deaths are due to these diseases. The past decade has seen considerable improvements in diagnosis as well as treatment of various heart diseases. Various new therapeutic targets are being identified through in-depth knowledge of the disease mechanisms which has favored the testing of new strategies leading to newer treatment options. Opioid peptides and G-protein-coupled opioid receptors (ORs) have been previously studied widely in terms of central nervous system actions in mitigating the pain and drug abuse. The OR agonism or antagonism induces cytoprotective states in the myocardium, rendering these receptors as an attractive target for protection of heart from the fatal heart diseases. The opioids can provide an extended window of protection of the heart from various diseases. Although the mechanisms may not be fully understood, they seem to play a crucial role in various CVDs such as hypertension, hyperlipidemia, ischemic heart disease myocardial ischemia, and congestive heart failure. Since these compounds are already being used in acute and chronic pain, soon these compounds might be approved for use as cardioprotective agents. The following review focuses on the new information acquired on the role of the ORs in various CVDs.
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Affiliation(s)
- Hemangi Rawal
- Institute of Pharmacy, Nirma University, Ahmedabad, Gujarat, India
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Dyrbuś K, Osadnik T, Desperak P, Desperak A, Gąsior M, Banach M. Evaluation of dyslipidaemia and the impact of hypolipidemic therapy on prognosis in high and very high risk patients through the Hyperlipidaemia Therapy in tERtiary Cardiological cEnTer (TERCET) Registry. Pharmacol Res 2017; 132:204-210. [PMID: 29258913 DOI: 10.1016/j.phrs.2017.12.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/15/2017] [Indexed: 02/09/2023]
Abstract
The use of statins in the treatment of hyperlipidaemia leads to a significant decrease in cardiovascular (CV) endpoints, and therapy effects are proportional to the reduction of cholesterol levels. In Poland, information about the effects of statin therapy is scarcely available. The information gathered in the Hyperlipidaemia Therapy in the tERtiary Cardiological cEnTer (TERCET) Registry on high-risk and very high-risk patients might improve our knowledge on this issue and help to introduce suitable activities. The main aim of the TERCET Registry is to achieve the target value of low density lipoprotein cholesterol (LDL-C) during a 1-year follow-up: LDL-C <70 mg/dL in very high-risk patients and LDL-C <100 mg/dL in high-risk patients. All consecutive patients with either stable coronary artery disease (sCAD) or acute coronary syndrome (ACS) have been included in the Registry, and the information on all-cause mortality, nonfatal myocardial infarction (MI), and planned or ACS-caused revascularisation have been being gathered within 12-month follow-up. At the moment, the TERCET Registry includes 14,873 patients (66.8% male) at an average age of 64.8 ± 10.2 with a significantly higher age of women (67.5 ± 10.3 vs. 63.5 ± 9.7; p < .001). The causes of hospitalisation were as the following: sCAD (n = 9375 patients, 63% of the investigated population), ST-elevated myocardial infarction (n = 2328 [15.6%]), non-ST-elevated myocardial infarction (n = 1700 [11.4%]), and unstable coronary artery disease (n = 1466 [10%]). 62,7% (n = 9144) of the patients were diagnosed with hyperlipidaemia before hospital admission, with no significant difference between male and female patients. The TERCET registry will allow unveiling real lipid profiles of the high- and very-high risk patients treated in the tertiary hospital. The results may play an essential role in establishing the patients' future clinical outcomes and help to assess if the lipid lowering therapy modifications changed the occurrence of CV endpoints. The registry data will summarize the number of patients unable to reach their LDL-C goals, and who in the future might become candidates suitable for new hypolipidemic therapies (ID: NCT03065543).
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Affiliation(s)
- Krzysztof Dyrbuś
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with The Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland.
| | - Tadeusz Osadnik
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with The Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Piotr Desperak
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with The Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Aneta Desperak
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with The Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Chair and Department of Cardiology, Medical University of Silesia in Katowice, School of Medicine with The Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Zeromskiego 113, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
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Ilic M, Ilic I. Ischaemic heart disease mortality in Serbia, 1991-2013; a joinpoint analysis. Indian J Med Res 2017; 146:746-753. [PMID: 29664033 PMCID: PMC5926346 DOI: 10.4103/ijmr.ijmr_1935_15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND & OBJECTIVES Ischaemic heart disease (IHD) has been one of the leading causes of mortality in the world. In many European countries the mortality rates due to IHD have been rising rapidly. This study was aimed to assess the IHD mortality trend in Serbia. METHODS A population-based cross-sectional study analyzing IHD mortality in Serbia in the period 1991-2013 was carried out based on official data. The age-standardized rates (ASRs, per 100,000) were calculated using the direct method, according to the European standard population. Joinpoint analysis was used to estimate the average annual percentage change (AAPC) with the corresponding 95 per cent confidence interval (CI). RESULTS More than 253,000 people (143,420 men and 110,276 women) died due to IHD in Serbia during the observed period, and most of them (over 160,000 people) were patients with myocardial infarction (MI). Average annual ASR for IHD was 113.6/100,000. There was no overall significant trend for mortality due to IHD (AAPC=+0.1%, 95% CI -0.8-1.0), but there was one joinpoint: the trend significantly increased by +2.3 per cent per year from 1991 to 2006 and then significantly decreased by -6.4 per cent from 2006 to onwards. Significantly decreased mortality trends for MI in both genders were observed: according to the comparability test, mortality trends in men and women were parallel (final selected model failed to reject parallelism, P=0.0567). INTERPRETATION & CONCLUSIONS No significant trend for mortality due to IHD was observed in Serbia during the study period. The substantial decline of mortality from IHD seen in most developed countries during the past decades was not observed in Serbia. Further efforts are required to reduce mortality from IHD in Serbian population.
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Affiliation(s)
- Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Irena Ilic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Jakovljevic V, Djordjevic D. Physical Activity for the Prevention of Cardiovascular Diseases. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2017. [DOI: 10.1515/sjecr-2016-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Abstract
Over the last decade, the quantity and quality of scientific literature examining the relationship between physical activity (PA) and cardiovascular diseases (CVD) have significantly increased. Data from the literature now unequivocally show that physical inactivity is one of the major risk factors for CVD. It is believed that obesity, the prevalence of which has tripled over the last three decades, and physical inactivity among children are the main factors that will increase the prevalence of CVD in this century. The cardiovascular benefits of exercise are multifactorial and include important systemic effects on skeletal muscle, the peripheral vasculature, metabolism, and neurohumoral systems, as well as beneficial alterations within the myocardium itself. Thus, exercise does much more than change traditional risk factors, such as blood pressure, blood lipids, glucose tolerance and insulin resistance, metabolic syndrome, and overweight and obesity. Evidence from epidemiologic studies suggests that the preventive effects of PA may be achieved by 150 minutes of moderate PA a week, while increases in the intensity and volume of exercise lead to further health benefits. This dose–response gradient is curvilinear, with the largest gains from the first hour of weekly exercise. However, although much progress has been made in this field, existing studies performed on human subjects do not clearly show what type, intensity, and duration of exercise is most beneficial to cardiovascular fitness and metabolic optimization. Animal-based exercise studies may provide more information and help to elucidate the abilities of different training regimens to reduce the risk of CVD.
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Affiliation(s)
- Vladimir Jakovljevic
- Department of Physiology , Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
| | - Dusica Djordjevic
- Department of Physiology , Faculty of Medical Sciences , University of Kragujevac , Kragujevac , Serbia
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Torlasco C, Faini A, Makil E, Ferri C, Borghi C, Veglio F, Desideri G, Agabiti Rosei E, Ghiadoni L, Pauletto P, Pontremoli R, Stornello M, Tocci G, Galletti F, Trimarco B, Parati G. Cardiovascular risk and hypertension control in Italy. Data from the 2015 World Hypertension Day. Int J Cardiol 2017; 243:529-532. [PMID: 28571620 DOI: 10.1016/j.ijcard.2017.03.151] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) are the first cause of death and disability in western countries. Despite therapeutic advances, their prevalence is constantly increasing. Detailed assessment of modifiable CV risk factors could improve CVD prevention and management. METHODS to assess CV risk and hypertension control in a sample of the Italian population, individuals participating to the 2015 "World Hypertension Day" were interviewed in 62sites all over Italy. Blood pressure was measured with a validated auscultatory or oscillometric device and information on demography and prevalence of CVD risk factors was collected by an anonymous questionnaire. An ad-hoc modified version of the Systematic COronary Risk Evaluation (SCORE) system was then applied. RESULTS 8657 recruited individuals (43%women, aged 56.68±16years) were subdivided into 3 age groups (40-49y, 50-59y, 60-69y) for analysis. CV risk was low in 62.4%, 18.0% and 0%; moderate in 26.0%, 66.0% and 62.5%; high/very high in 11.6%, 16% and 37.4%, respectively. Smoking was mainly responsible for increased CV risk among those aged 40-49y (26%smokers), while hypertension was the main factor in the whole sample and in subjects over 50y (36% and 42% respectively). Overall, BP control was unsatisfactory in 36% of individuals (28%, 48% and 31% of those who declared to be normotensive, hypertensive on treatment or unaware of their BP condition, respectively). CONCLUSIONS In this sample of the Italian population, CV risk was alarmingly high, irrespectively of age, mostly due to presence of modifiable risk factors, including hypertension, which should thus be better addressed, especially in the youngsters.
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Affiliation(s)
- Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital, Milan, Italy
| | - Andrea Faini
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital, Milan, Italy
| | - Elhassan Makil
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital, Milan, Italy
| | - Claudio Ferri
- Department of Medicine, Life and Environmental Sciences, L'Aquila University, Coppito, Italy
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, Faculty of Medicine, University of Bologna, Bologna, Italy
| | - Franco Veglio
- Division of Internal Medicine and Hypertension Unit, Department of Medical Sciences, University of Turin, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Enrico Agabiti Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili di Brescia, Italy
| | - Lorenzo Ghiadoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Paolo Pauletto
- Department of Medicine, University of Padova, Padova, Italy; Medicina I, Ospedale Ca' Foncello, Treviso, Italy
| | - Roberto Pontremoli
- Università degli Studi di Genova and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Michele Stornello
- Centro per la Diagnosi, la Cura e la Prevenzione delle Cardio e Cerebrovasculopatie - Ospedale "Umberto I" - ASP Siracusa, Italy
| | - Giuliano Tocci
- Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome "Sapienza", Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli (IS), Italy
| | - Ferruccio Galletti
- Department of Medicine and Surgery, Federico II University of Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Auxologico, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Italy.
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Cruz C, Campuzano-Rincón JC, Calleja-Castillo JM, Hernández-Álvarez A, Parra MDS, Moreno-Macias H, Hernández-Girón C. Temporal Trends in Mortality from Ischemic and Hemorrhagic Stroke in Mexico, 1980-2012. J Stroke Cerebrovasc Dis 2017; 26:725-732. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/22/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022] Open
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Comparison of Trends in Mortality from Coronary Heart and Cerebrovascular Diseases in North and South America: 1980 to 2013. Am J Cardiol 2017; 119:862-871. [PMID: 28139222 DOI: 10.1016/j.amjcard.2016.11.040] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 11/24/2022]
Abstract
Until the past century, mortality trends from coronary heart disease (CHD) and cerebrovascular disease (CVD) were less favorable in Latin than in North America. We calculated age-standardized mortality rates using data from the World Health Organization database over the period 1980 to 2013. To identify significant changes in trends, we performed joinpoint analysis. Since the early 2000's, CHD mortality rates decreased by about 35% in the USA and Canada in both genders; similar decreases were observed in some Latin American countries (i.e., Ecuador, Puerto Rico, and Chile), whereas the decreases were smaller in the other countries. In 2011 to 2013, the highest rates were in Venezuela (114.4/100,000 men) and Colombia (86.1/100,000 men) and the lowest ones (apart from Ecuador) in Panama, Chile, and Argentina (from 41 to 46/100,000 men and 18 to 19/100,000 women). For CVD mortality, a decrease by about 30% was observed in Argentina, Panama, and Uruguay plus Colombia for women, in addition to the USA and Canada. Smaller declines were observed in the other Latin American countries (from 23% in Colombian men to 5% in Venezuelan men). Throughout the period, rates in Latin America remained appreciably higher than those in North America. The highest CVD rates were observed in Brazil (51.6/100,000 men) and the lowest ones in Canada (12.9/100,000 women). In conclusion, trends in CHD and CVD mortality continue to be less favorable in Latin America than in Canada and the USA. The marked excess of CVD mortality is partly or largely attributable to inadequate control of dyslipidemia and hypertension.
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Faggiano P, Gaibazzi N, Faden G, Guidetti F. Is anti-platelet therapy always necessary in asymptomatic 30-40% carotid stenosis? J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1: Special Issue on The State of the Art for the Practicing Cardiologist: The 2016 Conoscere E Curare Il Cuore (CCC) Proceedings from the CLI Foundation:e112-e116. [PMID: 27828829 DOI: 10.2459/jcm.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Asymptomatic mild carotid artery stenosis is relatively frequent and associated with an increased risk of cardiovascular events. Its recognition is clinically relevant for appropriate prevention strategies. These include a healthy lifestyle approach and a careful pharmacologic control of cardiovascular risk factors, such as hypertension, hypercholesterolemia, and diabetes. Furthermore, interventions able to reduce the risk of atherothrombotic events, such as antiplatelet drugs, should be considered. Noninvasive imaging of carotid artery plaque and stenosis severity and morphology may add relevant information for the risk stratification of these subjects.
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Affiliation(s)
- Pompilio Faggiano
- aCardiology Division, Spedali Civili and University of Brescia bNon Invasive Cardiology, Parma University Hospital, Parma cCardiology Division, Poliambulanza, Brescia, Italy
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Christen T, de Mutsert R, Gast KB, Rensen PC, de Koning E, Rosendaal FR, Trompet S, Jukema JW. Association of fasting triglyceride concentration and postprandial triglyceride response with the carotid intima-media thickness in the middle aged: The Netherlands Epidemiology of Obesity study. J Clin Lipidol 2017; 11:377-385.e1. [DOI: 10.1016/j.jacl.2016.12.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/23/2016] [Accepted: 12/29/2016] [Indexed: 01/10/2023]
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Ladwig KH, Baumert J, Marten-Mittag B, Lukaschek K, Johar H, Fang X, Ronel J, Meisinger C, Peters A. Room for depressed and exhausted mood as a risk predictor for all-cause and cardiovascular mortality beyond the contribution of the classical somatic risk factors in men. Atherosclerosis 2017; 257:224-231. [PMID: 28110940 DOI: 10.1016/j.atherosclerosis.2016.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 11/17/2016] [Accepted: 12/01/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Depressed mood and exhaustion (DEEX) have gained attention as a risk predictor for cardiovascular disease (CVD). Studies to estimate its ranking in prediction models are sparse. METHODS The study included 3428 men aged 45-74 years who participated in one of three population-based MONICA/KORA Augsburg surveys conducted between 1984 and 1995. Within a follow-up time of 10 years (31,791 person-years), 557 cases of all-cause mortality and 269 fatal CVD events were observed. Adjusted Cox proportional hazards models were used to assess mortality risks for DEEX and five classical cardiovascular risk factors. The predictive ability was evaluated by the area under the receiver-operating characteristic curve, the integrated discrimination improvement statistics and the net classification improvement. RESULTS The (crude) absolute mortality risk for DEEX was 23.1 cases per 1000 person-years for all-cause and 11.2 for CVD mortality. The adjusted hazard ratios of 1.52 for all-cause and 1.52 for CVD mortality (p < 0.01) were higher than those for hypercholesterolemia and obesity, but lower than for hypertension, smoking and diabetes. The improvements in risk prediction from DEEX were comparable to those of hypercholesterolemia and obesity, but substantially lower than those of hypertension, smoking and diabetes. The adjusted population-attributable risk (PAR) for DEEX accounted for about 15% for all-cause and CVD mortality, which gives DEEX a middle ranking amongst the classical risk factors. CONCLUSIONS DEEX is a strong predictor of mortality risk, ranking in a medium position amongst classical somatic risk factors.
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Affiliation(s)
- Karl-Heinz Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | - Jens Baumert
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Birgitt Marten-Mittag
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karoline Lukaschek
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University of Marburg and Gießen, Germany
| | - Hamimatunnisa Johar
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Xioayan Fang
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Joram Ronel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany
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Fowokan AO, Lesser IA, Humphries KH, Mancini JGB, Lear SA. The predictive relationship between baseline insulin and glucose with subclinical carotid atherosclerosis after 5 years in a multi-ethnic cohort. Atherosclerosis 2017; 257:146-151. [PMID: 28135624 DOI: 10.1016/j.atherosclerosis.2016.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/09/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIMS We aimed at exploring the relationship between baseline insulin and glucose and the progression of carotid atherosclerosis in a multi-ethnic cohort. METHODS Males and females (n = 797) of European, Chinese, South Asian and Aboriginal origin were assessed as part of the Multicultural Community Health Assessment Trial (MCHAT) study for socio-demographics, smoking status, fasting insulin and glucose at baseline. IMT, plaque area and total area were assessed after 5 years. RESULTS A total of 545 participants returned after 5 years for a follow-up assessment. Average age of the study participants was 47.5 (SD 8.9) years. At baseline, the median and interquartile range for insulin was 62.0 (49.5) pmol/L, and glucose was 5.2 (0.60) mmol/L. Baseline glucose and insulin predicted the 5-year progression of atherosclerosis in our models, after adjusting for covariates. We found significant insulin-ethnicity interactions in the IMT model (p = 0.044) with the slope of the relationship showing that for every percentage change in insulin the Europeans experienced 7.3% more increase in IMT at 5 years than the Aboriginals. In the plaque area and total area models, there were significant glucose-ethnicity interactions (p = 0.009 and p=0.016 respectively), with the slope showing a 101% and 121% increase for plaque area and total area, respectively, in Europeans, at 5 years per percent change in glucose at baseline. Logistic regression found a significant glucose-ethnicity interaction with the presence of plaques (OR = 0.31, p = 0.03) such that compared to the Europeans, the South Asians had a lower odds of developing plaque presence. Similarly, we found glucose-ethnicity interactions in the logistic regression when comparing the Chinese to the Europeans (OR = 0.2, p=0.005), with the Chinese being less likely to develop plaque presence. CONCLUSIONS Ethnicity modifies the predictive relationship between insulin and glucose with sub-clinical indicators of carotid atherosclerosis but not consistently so.
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Affiliation(s)
- Adeleke O Fowokan
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, V6B 5K3 Vancouver, BC, Canada
| | - Iris A Lesser
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, V6B 5K3 Vancouver, BC, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - John G B Mancini
- UBC Division of Cardiology, Department of Medicine, University of British Columbia, V5Z 1M9 Vancouver, BC, Canada
| | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, V6B 5K3 Vancouver, BC, Canada; Faculty of Health Sciences, Simon Fraser University, V5A 1S6 Burnaby, BC, Canada; Division of Cardiology, Providence Health Care, V6Z 1Y6 Vancouver, BC, Canada.
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Strömbäck U, Vikman I, Lundblad D, Lundqvist R, Engström Å. The second myocardial infarction: Higher risk factor burden and earlier second myocardial infarction in women compared with men. The Northern Sweden MONICA study. Eur J Cardiovasc Nurs 2016; 16:418-424. [PMID: 28029268 DOI: 10.1177/1474515116686229] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several studies have examined various parameters and experiences when patients suffer their first myocardial infarction (MI), but knowledge about when they suffer their second MI is limited. AIM To compare risk factors for MI, that is, diabetes, hypertension and smoking, for the first and second MI events in men and women affected by two MIs and to analyse the time intervals between the first and second MIs. METHODS A retrospective cohort study of 1017 patients aged 25-74 years with first and second MIs from 1990 through 2009 registered in the Northern Sweden MONICA registry. RESULTS More women than men have diabetes and hypertension and are smokers at the first MI. Similar differences between the genders remain at the time of the second MI for diabetes and hypertension, although both risk factors have increased. Smoking decreased at the second MI without any remaining difference between genders. Women suffer their second MI within a shorter time interval than men do. Within 16 months of their first MI, 50% of women had a second MI. The corresponding time interval for men was 33 months. CONCLUSION Patients affected by an MI should be made aware of their risk of recurrent MI and that the risk of recurrence is highest during the first few years after an MI. In patients affected by two MIs, women have a higher risk factor burden and suffer their second MI earlier than men do and thus may need more aggressive and more prompt secondary prevention.
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Affiliation(s)
- Ulrica Strömbäck
- 1 Department of Health Science, Luleå University of Technology, Sweden
| | - Irene Vikman
- 1 Department of Health Science, Luleå University of Technology, Sweden
| | - Dan Lundblad
- 2 Sunderby Research Unit, Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Robert Lundqvist
- 3 Department of Research, Norrbotten County Council, Luleå, Sweden
| | - Åsa Engström
- 1 Department of Health Science, Luleå University of Technology, Sweden
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Pereira M, Lopes-Conceição L, Bennett K, Dias P, Laszczynska O, Lunet N, Azevedo A. Trends in pharmacological therapy following an acute coronary syndrome in Portugal. J Cardiovasc Med (Hagerstown) 2016; 17:639-46. [DOI: 10.2459/jcm.0000000000000258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Appiah D, Schreiner PJ, Durant RW, Kiefe CI, Loria C, Lewis CE, Williams OD, Person SD, Sidney S. Relation of longitudinal changes in body mass index with atherosclerotic cardiovascular disease risk scores in middle-aged black and white adults: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Ann Epidemiol 2016; 26:521-526. [PMID: 27402259 PMCID: PMC4993671 DOI: 10.1016/j.annepidem.2016.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/04/2016] [Accepted: 06/09/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE We assessed whether longitudinal changes in body mass index (BMI) are positively associated with changes in 10-year American College of Cardiology/American Heart Association atherosclerotic cardiovascular disease (ASCVD) risk scores in middle-aged blacks compared to whites. METHODS Data were from 1691 participants enrolled in the Coronary Artery Risk Development in Young Adults Study aged 40 years or more in 2000-2001, who had follow-up examinations 5 and 10 years later. RESULTS The prevalence of obesity increased from 32.3% in 2000-2001 (mean age: 42.8 years) to 41.7% in 2010-2011, higher in blacks than whites. The corresponding change in 10-year ASCVD risk was significantly higher for blacks (men: 4.5%-9.6%, women: 1.7%-5.0%) than whites (men: 2.4%-5.2%, women: 0.7%-1.6%). In 2010-2011, 57.5% of black men had ASCVD risk scores of 7.5% or more compared to white men (14.7%), black women (17.4%), and white women (1.6%). Although BMI trends were positively associated with 10-year change in ASCVD risk scores (0.07% per 1 kg/m(2) increase), it explained very little variance in risk score trends in all race-sex groups. CONCLUSIONS In middle-aged adults, longitudinal changes in BMI had little independent influence on changes in 10-year ASCVD risk scores as its effect may be largely mediated through ASCVD risk factors already accounted for in the risk score.
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Affiliation(s)
- Duke Appiah
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis.
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis
| | - Raegan W Durant
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham
| | - Catarina I Kiefe
- Quantitative Health Sciences, University of Massachusetts, Worcester
| | - Catherine Loria
- Division of Cardiovascular Sciences, NIH/NHLBI, Bethesda, MD
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham
| | - O Dale Williams
- Department of Biostatistics, Florida International University, Miami
| | - Sharina D Person
- Quantitative Health Sciences, University of Massachusetts, Worcester
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland
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Kazlauskas HA, Raskauskiene N, Radziuviene R, Janusonis V. Twenty years trends in mortality rates from stroke in Klaipeda. Brain Behav 2016; 6:e00499. [PMID: 27547501 PMCID: PMC4893389 DOI: 10.1002/brb3.499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 04/02/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND During the past decades, mortality from stroke decreased in many western European countries; however, changes concerning long-term stroke mortality in eastern European countries are less evident. OBJECTIVE To assess age- and gender-specific trends in stroke mortality in Klaipeda (Lithuania) from 1994 to 2013. DESIGN Descriptive epidemiological study. SETTING/SUBJECTS Permanent population of Klaipeda. METHODS Data on 2509 permanent residents of Klaipeda aged 35-79 years who died from stroke between 1994 and 2013 were gathered. Directly, age-standardized (European population) stroke mortality rates were analyzed using joinpoint regression separately for specific age groups (35-64, 65-79, and 35-79 years) and by gender. Annual percentage change (APC) and 95% CIs were presented. RESULTS Stroke mortality in the 35- to 79-year-old age group peaked in 1994-1997, it then decreased by -9.9% (95% CI: -18.7, -0.2) yearly up until 2001 and leveled off by -0.2% (-5.1, 4.9) between 2001 and 2013. Among men aged 35-64 years, mortality decreased substantially by 12.8% (-21.5, -3.3) per year from 1994 to 2001 and turned positive by 6.3% (0.8, 12.1) between 2000 and 2013. Among women aged 35-64 years, mortality decreased significantly by 15.5% (-28.1, -0.7) from 1994 to 2000. There was evidence of recent plateauing of trends for 35- to 64-year-old women between 2000 and 2013. In the 65- to 79-year-old age group, mortality decreased from 1994 onward yearly by -5.5% (-7.9, -3.0) in women and by -3.3% (-5.6, -0.9) in men. CONCLUSIONS Joinpoint regression revealed steadily decreasing trend in stroke mortality between 1994 and 2001. The decline in death rates flattened out in the recent decade. Mortality rates varied among age groups and were more pronounced in adults aged 35-64 years. It is essential to monitor and manage stroke risk factors, especially among middle-aged population.
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Affiliation(s)
- Henrikas A. Kazlauskas
- Department of Neurology and RehabilitationKlaipeda University HospitalKlaipedaLithuania
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Nijole Raskauskiene
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Rima Radziuviene
- Behavioral Medicine Institute Lithuanian University of Health SciencesPalangaLithuania
| | - Vinsas Janusonis
- Klaipeda University HospitalKlaipeda UniversityKlaipedaLithuania
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Lee SW, Kim HC, Lee HS, Suh I. Thirty-Year Trends in Mortality from Cerebrovascular Diseases in Korea. Korean Circ J 2016; 46:507-14. [PMID: 27482259 PMCID: PMC4965429 DOI: 10.4070/kcj.2016.46.4.507] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/10/2015] [Accepted: 12/29/2015] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Cerebrovascular disease is a leading cause of mortality and morbidity in Korea. Understanding of cerebrovascular disease mortality trends is important to reduce the health burden from cerebrovascular diseases. We examined the changing pattern of mortality related to cerebrovascular disease in Korea over 30 years from 1983 to 2012. Subjects and Methods Numbers of deaths from cerebrovascular disease, hemorrhagic stroke, and cerebral infarction were obtained from the national Cause of Death Statistics. Crude and age-adjusted mortality rates were calculated for men and women for each year. Penalized B-spline methods, which reduce bias and variability in curve fitting, were used to identify the trends of 30-year mortality and identify the year of highest mortality. Results During the 30 years, cerebrovascular disease mortality has markedly declined. The age-adjusted cerebrovascular disease mortality rate has decreased by 78% in men and by 68% in women. In the case of hemorrhagic stroke, crude mortality peaked in 2001 but age-adjusted mortality peaked in 1994. Between 1994 and 2012, age-adjusted mortality from hemorrhagic stroke has decreased by 68% in men and 59% in women. In the case of cerebral infarction, crude and age-adjusted mortality rates steeply increased until 2004 and 2003, respectively, and both rates decreased rapidly thereafter. Conclusion Cerebrovascular disease mortality rate has significantly decreased over the last 30 years in Korea, but remains a health burden. The prevalence of major cardiovascular risk factors are still highly prevalent in Korea.
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Affiliation(s)
- Seung Won Lee
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea.; Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Chang Kim
- Cardiovascular and Metabolic Diseases Etiology Research Center, Yonsei University College of Medicine, Seoul, Korea.; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Il Suh
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
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Campolongo G, Riccioni CV, Raparelli V, Spoletini I, Marazzi G, Vitale C, Volterrani M. The combination of nutraceutical and simvastatin enhances the effect of simvastatin alone in normalising lipid profile without side effects in patients with ischemic heart disease. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ijcme.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Hartley A, Marshall DC, Salciccioli JD, Sikkel MB, Maruthappu M, Shalhoub J. Trends in Mortality From Ischemic Heart Disease and Cerebrovascular Disease in Europe. Circulation 2016; 133:1916-26. [DOI: 10.1161/circulationaha.115.018931] [Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 03/18/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Adam Hartley
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Dominic C. Marshall
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Justin D. Salciccioli
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Markus B. Sikkel
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Mahiben Maruthappu
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
| | - Joseph Shalhoub
- From Imperial College London, United Kingdom (A.H., D.C.M., J.D.S., M.B.S., J.S.); and Foundation School, Imperial College London, United Kingdom (M.M.)
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Todd MA, Shkolnikov VM, Goldman N. Why are well-educated Muscovites more likely to survive? Understanding the biological pathways. Soc Sci Med 2016; 157:138-47. [PMID: 27085072 PMCID: PMC5282593 DOI: 10.1016/j.socscimed.2016.02.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 12/25/2022]
Abstract
There are large socioeconomic disparities in adult mortality in Russia, although the biological mechanisms are not well understood. With data from the study of Stress, Aging, and Health in Russia (SAHR), we use Gompertz hazard models to assess the relationship between educational attainment and mortality among older adults in Moscow and to evaluate biomarkers associated with inflammation, neuroendocrine function, heart rate variability, and clinical cardiovascular and metabolic risk as potential mediators of that relationship. We do this by assessing the extent to which the addition of biomarker variables into hazard models of mortality attenuates the association between educational attainment and mortality. We find that an additional year of education is associated with about 5% lower risk of age-specific all-cause and cardiovascular mortality. Inflammation biomarkers are best able to account for this relationship, explaining 25% of the education-all-cause mortality association, and 35% of the education-cardiovascular mortality association. Clinical markers perform next best, accounting for 13% and 23% of the relationship between education and all-cause and cardiovascular mortality, respectively. Although heart rate biomarkers are strongly associated with subsequent mortality, they explain very little of the education-mortality link. Neuroendocrine biomarkers fail to account for any portion of the link. These findings suggest that inflammation may be important for understanding mortality disparities by socioeconomic status.
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Affiliation(s)
- Megan A Todd
- Office of Population Research and the Woodrow Wilson School of Public and International Affairs, Princeton University, USA.
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str., 1, Rostock, 18057, Germany; New Economic School, ul. Novaya, 100A, Moscow, 143026, Skolkovo, Russia.
| | - Noreen Goldman
- Office of Population Research and the Woodrow Wilson School of Public and International Affairs, Princeton University, Wallace Hall, Princeton, NJ, 08544, USA.
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