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Ning C, Ling F, Liu D, Zhi Z. Ticagrelor monotherapy after a short course of dual antiplatelet therapy with ticagrelor plus aspirin following percutaneous coronary intervention in patients with versus without diabetes mellitus: a meta-analysis of randomized trials. BMC Cardiovasc Disord 2024; 24:166. [PMID: 38504170 PMCID: PMC10949623 DOI: 10.1186/s12872-024-03836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is one among the major causes of mortality all round the globe. Several anti-platelet regimens have been proposed following percutaneous coronary intervention (PCI). In this analysis, we aimed to show the adverse clinical outcomes associated with ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) with ticagrelor and aspirin following PCI in patients with versus without diabetes mellitus (DM). METHODS Electronic databases were searched by four authors from September to November 2023. Cardiovascular outcomes and bleeding events were the endpoints of this analysis. Revman 5.4 software was used to conduct this meta-analysis. Risk ratio (RR) and 95% confidence intervals (CI) were used to represent the results which were generated. RESULTS Three studies with a total number of 22,574 participants enrolled from years 2013 to 2019 were included in this analysis. Results of this analysis showed that DM was associated with significantly higher risks of major adverse cardiovascular events (RR: 1.73, 95% CI: 1.49 - 2.00; P = 0.00001), all-cause mortality (RR: 2.15, 95% CI: 1.73 - 2.66; P = 0.00001), cardiac death (RR: 2.82, 95% CI: 1.42 - 5.60; P = 0.003), stroke (RR: 1.78, 95% CI: 1.16 - 2.74; P = 0.009), myocardial infarction (RR: 1.63, 95% CI: 1.17 - 2.26; P = 0.004) and stent thrombosis (RR: 1.74, 95% CI: 1.03 - 2.94; P = 0.04) when compared to patients without DM. However, thrombolysis in myocardial infarction (TIMI) defined minor and major bleedings, bleeding defined according to the academic research consortium (BARC) type 3c (RR: 1.31, 95% CI: 0.14 - 11.90; P = 0.81) and BARC type 2, 3 or 5 (RR: 1.17, 95% CI: 0.85 - 1.62; P = 0.34) were not significantly different. CONCLUSION In patients who were treated with ticagrelor monotherapy after a short course of DAPT with ticagrelor and aspirin, DM was an independent risk factor for the significantly increased adverse cardiovascular outcomes. However, TIMI and BARC defined bleeding events were not significantly different in patients with versus without DM.
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Affiliation(s)
- Chen Ning
- Department of Cardiology, Shandong Tai An 88 Hospital, Shandong, Tai An, 271000, People's Republic of China
| | - Fang Ling
- Department of Cardiology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Hubei, Yichang, 443000, People's Republic of China
| | - Deyi Liu
- Department of Cardiology, Shandong Tai An 88 Hospital, Shandong, Tai An, 271000, People's Republic of China
| | - Zhang Zhi
- Department of Cardiology, Shandong Tai An 88 Hospital, Shandong, Tai An, 271000, People's Republic of China.
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Brnoliakova Z, Knezl V, Sotnikova R, Gasparova Z. Metabolic Syndrome in Hypertriglyceridemic Rats: Effects of Antioxidants. Physiol Res 2023; 72:S31-S35. [PMID: 37294116 DOI: 10.33549/physiolres.935021] [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: 06/23/2023] Open
Abstract
Long-lasting disturbances in lipid and glucose metabolism present in metabolic syndrome (MetS) lead to serious cardiovascular diseases. The study was aimed to evaluate the effect of natural antioxidant vitamin E (VitE, 100 mg/kg/day, p.o.) on basal biochemical and physiological parameters characterizing MetS and on the changed function of the heart. Furthermore, the possible potentiation of VitE effect by synthetic pyridoindole antioxidant SMe1EC2 (SMe, 15 mg/kg/day, p.o.) was also tested. MetS was induced in hereditary hypertriglyceridemic rats (HTG) by the 5 weeks administration of high-fat fructose diet (HFFD: 1 % cholesterol, 7.5 % pork lard, 10 % fructose). The heart function was tested using Langendorff preparation under constant pressure. The functional parameters of isolated heart, dysrhythmias and evoked fibrillations were evaluated in conditions of ischemia-reperfusion. The HFFD increased body weight gain and serum levels of total cholesterol, low-density lipoproteins and blood glucose. The HFFD significantly increased heart flow and force of contraction, compared to standard diet (SD). During the reperfusion, the HFFD caused the increase of the ventricular premature beats number at the expense of decreasing the duration of serious dysrhythmias (ventricular tachycardias and fibrillations). The addition of VitE, SMe or their combination to the HFFD decreased body weight gain, depressed blood pressure, improved particular biochemical parameters. The combination of VitE and SMe suppressed the occurrence of serious dysrhythmias. Our data indicate that the HFFD-related disturbances led to alterations within pathophysiology in HTG rats. The results showed that a combination of antioxidants might have the potential to amend disorders accompanying MetS.
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Affiliation(s)
- Z Brnoliakova
- Institute of Experimental Pharmacology and Toxicology, Center of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovak Republic.
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Wang W, Hu M, Liu H, Zhang X, Li H, Zhou F, Liu YM, Lei F, Qin JJ, Zhao YC, Chen Z, Liu W, Song X, Huang X, Zhu L, Ji YX, Zhang P, Zhang XJ, She ZG, Yang J, Yang H, Cai J, Li H. Global Burden of Disease Study 2019 suggests that metabolic risk factors are the leading drivers of the burden of ischemic heart disease. Cell Metab 2021; 33:1943-1956.e2. [PMID: 34478633 DOI: 10.1016/j.cmet.2021.08.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/21/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
Metabolic dysfunction is becoming a predominant risk for the development of many comorbidities. Ischemic heart disease (IHD) still imposes the highest disease burden among all cardiovascular diseases worldwide. However, the contributions of metabolic risk factors to IHD over time have not been fully characterized. Here, we analyzed the global disease burden of IHD and 15 associated general risk factors from 1990 to 2019 by applying the methodology framework of the Global Burden of Disease Study. We found that the global death cases due to IHD increased steadily during that time frame, while the mortality rate gradually declined. Notably, metabolic risk factors have become the leading driver of IHD, which also largely contributed to the majority of IHD-related deaths shifting from developed countries to developing countries. These findings suggest an urgent need to implement effective measures to control metabolic risk factors to prevent further increases in IHD-related deaths.
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Affiliation(s)
- Wenxin Wang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Manli Hu
- Institute of Model Animal, Wuhan University, Wuhan, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Department of Gastroenterology, Tongren Hospital of Wuhan University & Wuhan Third Hospital, Wuhan, China
| | - Xingyuan Zhang
- School of Basic Medical Science, Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Haomiao Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Feng Zhou
- Institute of Model Animal, Wuhan University, Wuhan, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Ye-Mao Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Fang Lei
- School of Basic Medical Science, Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Juan-Juan Qin
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Yan-Ci Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Ze Chen
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Weifang Liu
- School of Basic Medical Science, Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xiaohui Song
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xuewei Huang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Lihua Zhu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Yan-Xiao Ji
- School of Basic Medical Science, Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Peng Zhang
- School of Basic Medical Science, Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- School of Basic Medical Science, Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Zhi-Gang She
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China
| | - Juan Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China.
| | - Hailong Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China.
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, the Third Xiangya Hospital, Central South University, Changsha, China.
| | - Hongliang Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China; Institute of Model Animal, Wuhan University, Wuhan, China; Medical Science Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
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The Rise in Cardiovascular Risk Factors and Chronic Diseases in Guyana: A Narrative Review. Ann Glob Health 2021; 87:46. [PMID: 34131561 PMCID: PMC8176929 DOI: 10.5334/aogh.3060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Guyana experiences health challenges related to both communicable and non-communicable diseases. Cardiovascular disease (CVD) is the most common non-communicable disease in Guyana. The main causes of the increased prevalence of non-communicable diseases are modifiable risk factors (e.g. obesity, hypertension, elevated cholesterol, unhealthy dietary patterns) and non-modifiable risk factors (e.g. age and genetics). Objective The aim of this review is to understand CVD and risk factor data, in the context of ethnicity in Guyana. Methods A review of the published literature as well as government and international health agency reports was conducted. All publications from 2002-2018 describing CVD and related risk factors in Guyana were screened and extracted. Findings The population of Guyana is comprised of six ethnic groups, of which East Indian (39.8%) and African (29.3%) are the majority. CVD accounts for 526 deaths per 100,000 individuals per year. Among Indo-Guyanese and Afro-Guyanese, CVD is the primary cause of death affecting 32.6% and 22.7% of the populations, respectively. Within the Indo-Guyanese and Afro-Guyanese communities there is a high prevalence of hypertension and diabetes among individuals over the age of 50. There is a lack of available data describing ethnic disparities in CVD and related risk factors such as obesity, smoking, alcohol, physical activity and diet in Guyana. Conclusions Important knowledge gaps remain in understanding the ethnic disparities of CVD and related risk factors in Guyana. Future research should focus on high risk populations and implement widespread screening and treatment strategies of common risk factors such as hypertension, diabetes, and elevated cholesterol to curb the epidemic of CVD in Guyana.
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How Educational Inequalities in Cardiovascular Mortality Evolve While Healthcare Insurance Coverage Grows: Colombia, 1998 to 2015. Value Health Reg Issues 2020; 23:112-121. [DOI: 10.1016/j.vhri.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022]
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Duncan JP, Tulloch-Reid MK, Reid-Jones H, Figueroa JP. Use of a simplified clinical audit tool to evaluate hypertension and diabetes management in primary care clinics in Jamaica. J Clin Hypertens (Greenwich) 2020; 22:1275-1281. [PMID: 32516505 DOI: 10.1111/jch.13901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/27/2020] [Accepted: 04/30/2020] [Indexed: 11/27/2022]
Abstract
This study evaluates a simple clinical audit tool for assessing quality of care and blood pressure control among persons with hypertension in primary care clinics. A systematic random sampling of persons with diabetes mellitus (DM) and hypertension (HTN) attending five health centers in Kingston, Jamaica, was conducted. A modified Ministry of Health paper-based audit tool captured quality of care and outcome indicators (blood pressure and glycemic control). Additional chart audits were conducted by a physician and nurse to assess reliability. One hundred and forty-nine charts were audited between January and September 2017. One hundred and thirty-eight persons (92.6%) had hypertension (27 men and 111 women); 77 persons (51.7%) had DM (14 men and 63 women). The median age was 64 years old. Approximately two-thirds of persons with HTN and DM had electrolytes, lipid profile, and ECG done within the last year. One-fifth of persons with hypertension (18.5% men and 19.8% women, P = 1.000) had adequate blood pressure control with greater control among persons with HTN only compared to persons with both DM and HTN. Poor glycemic control was recorded for 69% of persons with DM (57% men and 71% women, P = .297). Moderate to substantial inter-rater agreement was observed for quality of care indicators. Our findings confirmed that hypertension and glycemic control are inadequate among persons attending primary care clinics in Jamaica's capital city. Simplified clinical audits can provide important quality of care and outcome indicators without losing the meaningfulness of the data collected.
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Affiliation(s)
- Jacqueline P Duncan
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Jamaica
| | | | | | - J Peter Figueroa
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Jamaica
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Lloyd-Sherlock P, Ebrahim S, Martinez R, McKee M, Ordunez P. Reducing the cardiovascular disease burden for people of all ages in the Americas region: analysis of mortality data, 2000-15. LANCET GLOBAL HEALTH 2020; 7:e604-e612. [PMID: 31000130 DOI: 10.1016/s2214-109x(19)30069-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/30/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND In accordance with the age parameters specified in Sustainable Development Goal target 3.4, current policy and monitoring of non-communicable disease (NCD) mortality trends focus on people aged 30-69 years. This approach excludes the majority of NCD deaths, which occur at older ages. We aimed to compare cardiovascular mortality for different age groups in the WHO Region of the Americas. METHODS We extracted mortality data from the Pan American Health Organization regional mortality database for 36 countries for the period 2000 to 2015. We calculated age-standardised mortality rates (ASMRs) from cardiovascular diseases for different age groups for these countries. Joinpoint regression models were used to estimate mortality trends, providing estimates of the average annual percentage change for the period 2000-15. FINDINGS Individuals aged 70 years or older accounted for the majority of cardiovascular disease deaths in all countries (range 52-82%). Considerable variation in cardiovascular deaths was observed between countries for all age categories. Between 2000 and 2015, in most countries, the largest reductions in ASMR were observed in the older age groups (aged ≥70 years). The total number of regional cardiovascular disease deaths that hypothetically could have been averted in 2015 for people aged 30-79 years was 440 777, of which 211 365 (48%) occurred among people aged 70-79 years. INTERPRETATION Data for the WHO Region of the Americas are sufficiently robust to permit comparative analysis of cardiovascular disease mortality trends for people aged 70 years and older over time and across countries. Although the reduction of cardiovascular disease mortality in individuals aged 30-69 years is a valid policy goal for the Americas region, this objective should be expanded to include people at older ages. FUNDING None.
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Affiliation(s)
| | - Shah Ebrahim
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Pedro Ordunez
- Pan American Health Organization, Washington, DC, USA
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Hosein A, Stoute V, Chadee S, Singh NR. Evaluating Cardiovascular Disease (CVD) risk scores for participants with known CVD and non-CVD in a multiracial/ethnic Caribbean sample. PeerJ 2020; 8:e8232. [PMID: 32195041 PMCID: PMC7067186 DOI: 10.7717/peerj.8232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 11/18/2019] [Indexed: 11/20/2022] Open
Abstract
Background Cardiovascular Disease (CVD) risk prediction models have been useful in estimating if individuals are at low, intermediate, or high risk, of experiencing a CVD event within some established time frame, usually 10 years. Central to this is the concern in Trinidad and Tobago of using pre-existing CVD risk prediction methods, based on populations in the developed world (e.g. ASSIGN, Framingham and QRISK®2), to establish risk for its multiracial/ethnic Caribbean population. The aim of this study was to determine which pre-existing CVD risk method is best suited for predicting CVD risk for individuals in this population. Method A survey was completed by 778 participants, 526 persons with no prior CVD, and 252 who previously reported a CVD event. Lifestyle and biometric data was collected from non-CVD participants, while for CVD participants, medical records were used to collect data at the first instance of CVD. The performances of three CVD risk prediction models (ASSIGN, Framingham and QRISK®2) were evaluated using their calculated risk scores. Results All three models (ASSIGN, Framingham and QRISK®2) identified less than 62% of cases (CVD participants) with a high proportion of false-positive predictions to true predictions as can be seen by positive predictabilities ranging from 78% (ASSIGN and Framingham) to 87% (QRISK®2). Further, for all three models, individuals whose scores fell into the misclassification range were 2X more likely to be individuals who had experienced a prior CVD event as opposed to healthy individuals. Conclusion The ASSIGN, Framingham and QRISK®2 models should be utilised with caution on a Trinidad and Tobago population of intermediate and high risk for CVD since these models were found to have underestimated the risk for individuals with CVD up to 2.5 times more often than they overestimated the risk for healthy persons.
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Affiliation(s)
- Amalia Hosein
- Biomedical Engineering, The University of Trinidad and Tobago, O'Meara, Arima, Trinidad & Tobago
| | - Valerie Stoute
- Environmental Studies, The University of Trinidad and Tobago, O'Meara, Arima, Trinidad & Tobago
| | - Samantha Chadee
- Environmental Studies, The University of Trinidad and Tobago, O'Meara, Arima, Trinidad & Tobago
| | - Natasha Ramroop Singh
- Biomedical Engineering, The University of Trinidad and Tobago, O'Meara, Arima, Trinidad & Tobago
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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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Cost-Effectiveness of Exercise-Based Cardiac Rehabilitation in Chilean Patients Surviving Acute Coronary Syndrome. J Cardiopulm Rehabil Prev 2019; 39:168-174. [PMID: 31021998 DOI: 10.1097/hcr.0000000000000356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the cost-effectiveness of 3 models of exercise-based cardiac rehabilitation (CR) compared with standard care in survivors of acute coronary syndrome (ACS) within the public health system in Chile. METHODS A Markov model was designed using 5 health states: ACS survivor, second ACS, complications, general mortality, and cardiovascular mortality. The transition probabilities between health states for standard care and corresponding relative risk for CR were calculated from a systematic review. Health benefits were measured with the EuroQol 5-dimensional 3-level (EQ-5D-3L) survey. Costs for each health state were quantified using the national cost verification study. The CR cost was estimated with a microcosting methodology. The time horizon was a lifetime and the discount rate was 3% per year for costs and benefits. Deterministic and probabilistic analyses were performed. Structural uncertainty was managed by designing 3 scenarios: CR as currently delivered in a specific Chilean public health center, CR as recommended by South American guidelines, and CR as proposed for low-resource settings. RESULTS Cardiac rehabilitation versus standard care showed an incremental cost-effectiveness ratio for the standard model of $722, for the South American model of $1247, and for the low-resource model of $666. The tornado diagram showed higher uncertainty in relative risk for the complications state and for the second ACS state. CONCLUSION Considering a cost-effectiveness threshold of 1 unit of gross domestic product per capita (∼$19 000), CR is highly cost-effective for the public health system in Chile.
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Hiemstra T, Lim K, Thadhani R, Manson JE. Vitamin D and Atherosclerotic Cardiovascular Disease. J Clin Endocrinol Metab 2019; 104:4033-4050. [PMID: 30946457 PMCID: PMC7112191 DOI: 10.1210/jc.2019-00194] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/29/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT A large body of experimental and observational data has implicated vitamin D deficiency in the development of cardiovascular disease. However, evidence to support routine vitamin D supplementation to prevent or treat cardiovascular disease is lacking. EVIDENCE ACQUISITION A comprehensive literature review was performed using Pubmed and other literature search engines. EVIDENCE SYNTHESIS Mounting epidemiological evidence and data from Mendelian randomization studies support a link between vitamin D deficiency and adverse cardiovascular health outcomes, but randomized trial evidence to support vitamin D supplementation is sparse. Current public health guidelines restrict vitamin D intake recommendations to the maintenance of bone health and prevention of fractures. Two recently published large trials (VITAL and ViDA) that assessed the role of moderate-to-high dose vitamin D supplementation as primary prevention for cardiovascular outcomes in the general population had null results, and previous randomized trials have also been generally negative. These findings from general population cohorts that are largely replete in vitamin D may not be applicable to chronic kidney disease (CKD) populations, in which the use of active (1α-hydroxylated) vitamin D compounds is prevalent, or to other high-risk populations. Additionally, recent trials in the CKD population, and trials using vitamin D analogues have been limited. CONCLUSIONS Current randomized trials of vitamin D supplementation do not support benefits for cardiovascular health, but the evidence remains inconclusive. Additional randomized trials assessing larger numbers of participants with low baseline vitamin D levels, having longer follow-up periods, and testing higher vitamin D dosages, are needed to guide clinical practice.
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Affiliation(s)
- Thomas Hiemstra
- Cambridge Clinical Trials Unit, Addenbrookes Hospital, Cambridge, UK
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Kenneth Lim
- Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Ravi Thadhani
- Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, MA
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Hertz JT, Fu T, Vissoci JR, Rocha TAH, Carvalho E, Flanagan B, de Andrade L, Limkakeng AT, Staton CA. The distribution of cardiac diagnostic testing for acute coronary syndrome in the Brazilian healthcare system: A national geospatial evaluation of health access. PLoS One 2019; 14:e0210502. [PMID: 30629670 PMCID: PMC6328143 DOI: 10.1371/journal.pone.0210502] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the utilization of cardiac diagnostic testing in Brazil and how such testing is related with local rates of acute coronary syndrome (ACS)-related mortality. METHODS AND RESULTS Using data from DATASUS, the public national healthcare database, absolute counts of diagnostic tests performed were calculated for each of the 5570 municipalities and mapped. Spatial error regression and geographic weighted regression models were used to describe the geographic variation in the association between ACS mortality, income, and access to diagnostic testing. From 2008 to 2014, a total of 4,653,884 cardiac diagnostic procedures were performed in Brazil, at a total cost of $271 million USD. The overall ACS mortality rate during this time period was 133.8 deaths per 100,000 inhabitants aged 20 to 79. The most commonly utilized test was the stress ECG (3,015,993), followed by catheterization (862,627), scintigraphy (669,969) and stress echocardiography (105,295). The majority of these procedures were conducted in large urban centers in more economically developed regions of the country. Increased access to testing and increased income were not uniformly associated with decreased ACS mortality, and tremendous geographic heterogeneity was observed in the relationship between these variables. CONCLUSIONS The majority of testing for ACS in Brazil is conducted at referral centers in developed urban settings. Stress ECG is the dominant testing modality in use. Increased access to diagnostic testing was not consistently associated with decreased ACS mortality across the country.
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Affiliation(s)
- Julian T. Hertz
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Tommy Fu
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Joao Ricardo Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Medicine, Centro Universitario Inga, Maringa, Brazil
| | | | - Elias Carvalho
- Department of Computer Science, Pontifical University Catholic of Parana, Curitiba, Brazil
- Data Processing Department, State University of Maringa, Maringa, Brazil
| | - Brendan Flanagan
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | | | - Alex T. Limkakeng
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Catherine A. Staton
- Department of Surgery, Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
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Truesdell E, Schelske-Santos M, Nazario CM, Rosario-Rosado RV, McCann SE, Millen AE, Ramírez-Marrero FA, Freudenheim JL. Foods Contributing to Macronutrient Intake of Women Living in Puerto Rico Reflect Both Traditional Puerto Rican and Western-Type Diets. Nutrients 2018; 10:E1242. [PMID: 30200564 PMCID: PMC6163587 DOI: 10.3390/nu10091242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/30/2018] [Accepted: 09/02/2018] [Indexed: 11/24/2022] Open
Abstract
Lack of variability in dietary intake within a population makes identification of relationships between diet and disease difficult. Studies in populations with greater interindividual variation can provide important insights. The Puerto Rican diet is in transition from a traditional to a more Western-type diet, resulting in greater interindividual variability. We identified foods contributing to absolute intake and variability in the intake of macronutrients among Puerto Rican women. One hundred women, aged 30⁻79, residents of San Juan, Puerto Rico, completed three, interviewer-administered, 24-h dietary recalls from which foods contributing to absolute intake and intake variability in intake of energy, fat, protein, carbohydrate and dietary fiber were determined. The overall prevalence of intake of foods was also calculated. Traditional Puerto Rican foods such as legumes, rice, and plantains were important contributors to the intake of calories and macronutrients as were foods more typical of Western diets including white bread and sweetened carbonated beverages. Identification of food sources of nutrients for this population with a diet in transition can contribute to the development of instruments to measure dietary intake and to understand the contribution of diet to the etiology of chronic disease among Puerto Rican women.
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Affiliation(s)
- Emily Truesdell
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY 14214, USA.
| | - Michelle Schelske-Santos
- Nutrition and Dietetics Program, University of Puerto Rico Rio Piedras Campus, Rio Piedras, San Juan, PR 00925, USA.
| | - Cruz María Nazario
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00935, USA.
| | - Rosa V Rosario-Rosado
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, PR 00935, USA.
| | - Susan E McCann
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA.
| | - Amy E Millen
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY 14214, USA.
| | - Farah A Ramírez-Marrero
- Department of Physical Education and Recreation, University of Puerto Rico Rio Piedras Campus, Rio Piedras, San Juan, PR 00931, USA.
| | - Jo L Freudenheim
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY 14214, USA.
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Wu XY, Yang M, Xie YS, Xiao WG, Lin J, Zhou B, Guan X, Luo CN, Che N, Liu XZ, Wang C, Teng JL, Cheng XB, Ye JN, Su YT, Shi H, Yin YF, Liu MR, Sun Y, Hu QY, Zhou ZC, Chi HH, Liu Y, Zhang X, Chen JW, Zhang MJ, Zhao DB, Yang CD, Wu LJ, Liu HL. Causes of death in hospitalized patients with systemic lupus erythematosus: a 10-year multicenter nationwide Chinese cohort. Clin Rheumatol 2018; 38:107-115. [PMID: 30123930 DOI: 10.1007/s10067-018-4259-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 05/28/2018] [Accepted: 08/08/2018] [Indexed: 02/05/2023]
Abstract
To estimate the mortality and describe the causes of death in a large multicenter cohort of hospitalized patients with SLE in China. This was a retrospective study of a nationwide SLE cohort (10 centers, 29,510 hospitalized patients) from 2005 to 2014 in China. Standardized mortality ratios (SMRs) were calculated for all death and were stratified by sex and age. Chi-square test was used to determine whether the major causes of death vary in age, sex, duration of SLE, disease activity, or medications. Comparison between dead patients and survival controls was used to identify the risk factors for mortality. Logistic regression analysis was used to evaluate the risk factors for mortality. A total of 360 patients died during the study period, accounting for 1.22%. The overall SMR was 2.13 (95% CI 1.96, 2.30), with a particularly high SMR seen in subgroups characterized by younger age. Infection (65.8%) was the most common cause of death, followed by lupus nephritis (48.6%), hematological abnormality (18.1%), neuropsychiatric lupus/NPSLE (15.8%), and interstitial pneumonia (13.1%). Cardiovascular disease and malignancy contributed little to the causes of death. Infection, in particular severe pulmonary infection, emerged as the foremost risk factor for mortality, followed by lupus encephalopathy. However, lupus nephritis and hematological abnormalities occurred more frequently in survival patients. SLE patients at a younger age of diagnosis have a poorer prognosis. Infection dominated the causes of death in recent China. Ethnicity and medications might account for the differences in causes of death compared with western populations.
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Affiliation(s)
- Xin-Yao Wu
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Min Yang
- Department of Rheumatology and Immunology, Sichuan University West China Hospital, Chengdu, China
| | - Yue-Sheng Xie
- Department of Rheumatology and Immunology, Guangdong General Hospital, Guangzhou, China
| | - Wei-Guo Xiao
- Department of Rheumatology and Immunology, The First Hospital Affiliated to China Medical University, Shenyang, China
| | - Jin Lin
- Department of Rheumatology and Immunology, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou, China
| | - Bin Zhou
- Department of Rheumatology and Immunology, Sichuan People's Hospital, Chengdu, China
| | - Xin Guan
- Department of Rheumatology and Immunology, Second Xiangya Hospital, Changsha, China
| | - Cai-Nan Luo
- Department of Rheumatology and Immunology, Xinjiang Uygur People's Hospital, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Nan Che
- Department of Rheumatology and Immunology, Jiangsu People's Hospital, Nanjing, China
| | - Xing-Zhen Liu
- Department of Rheumatology and Immunology, Changhai Hospital, Shanghai, China
| | - Chao Wang
- Beijing Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Fourth Clinical Medical College, Peking University, Beijing, China
| | - Jia-Lin Teng
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Xiao-Bing Cheng
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Jun-Na Ye
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Yu-Tong Su
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Hui Shi
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Yu-Feng Yin
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Meng-Ru Liu
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Yue Sun
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Qiong-Yi Hu
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Zhuo-Chao Zhou
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Hui-Hui Chi
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China
| | - Yi Liu
- Department of Rheumatology and Immunology, Sichuan University West China Hospital, Chengdu, China
| | - Xiao Zhang
- Department of Rheumatology and Immunology, Guangdong General Hospital, Guangzhou, China
| | - Jin-Wei Chen
- Department of Rheumatology and Immunology, Second Xiangya Hospital, Changsha, China
| | - Miao-Jia Zhang
- Department of Rheumatology and Immunology, Jiangsu People's Hospital, Nanjing, China
| | - Dong-Bao Zhao
- Department of Rheumatology and Immunology, Changhai Hospital, Shanghai, China
| | - Cheng-de Yang
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China.
| | - Li-Jun Wu
- Department of Rheumatology and Immunology, Xinjiang Uygur People's Hospital, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, Xinjiang Uygur Autonomous Region, China.
| | - Hong-Lei Liu
- Department of Rheumatology and Immunology, Shanghai Jiao Tong University School of Medicine Affiliated Ruijin Hospital, No. 197 Ruijin Second Road, Huangpu District, Shanghai, 200025, China.
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Nazif-Muñoz JI, Nandi A, Ruiz-Casares M. Protecting only white children: the impact of child restraint legislation in Brazil. J Public Health (Oxf) 2018; 41:287-295. [PMID: 29931193 DOI: 10.1093/pubmed/fdy105] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/26/2018] [Indexed: 01/26/2023] Open
Abstract
Abstract
Background
In 2010, Brazil introduced child restraint legislation (CRL). We assessed the effectiveness of CRL in reducing child (aged 0–8 years) injuries and fatalities by race. We performed an evaluation study with an interrupted time–series design.
Methods
We measured the effect of CRL on two outcomes—number of child deaths and number of child injured in traffic collisions per child population, stratified by race, from 2008 to 2014. We controlled for time, unemployment rate and oil consumption (barrels/day in thousands).
Results
The CRL was associated with a 3% reduction in the rate of child injuries among whites (incidence rate ratio (IRR): 0.97; 95% CI: 0.96–0.99), but no reduction in child injuries among non-whites (IRR: 0.99; 95% CI: 0.99–1.00). In the first month after the implementation of Brazil’s CRL we observed a 39% reduction in all child fatalities (IRR: 0.61; 95% CI: 0.44–0.84), including a 52% reduction among whites (IRR: 0.48; 95% CI: 0.33–0.68), but no reduction in non-white fatalities (IRR: 0.87; 95% CI: 0.55–1.37).
Conclusions
Our results support the hypothesis that socially advantaged populations were more likely to consistently adopt and employ restraint devices following the reform. Countries should also consider complementary policies that facilitate an equitable distribution of safety devices that reach vulnerable populations.
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Affiliation(s)
- José Ignacio Nazif-Muñoz
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Arijit Nandi
- Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Schmucker A, Abberger B, Boecker M, Baumeister H. Parallel short forms for the assessment of activities of daily living in cardiovascular rehabilitation patients (PADL-cardio): development and validation. Disabil Rehabil 2017; 41:826-832. [PMID: 29172750 DOI: 10.1080/09638288.2017.1407967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To develop and validate parallel short forms for the assessment of activities of daily living in cardiac rehabilitation patients (PADL-cardio I & II). METHOD PADL-cardio I & II were developed based on a sample of 106 patients [mean age = 57.6; standard deviation (SD) = 11.1; 72.6% males] using Rasch analysis and validated with a sample of 81 patients (mean age = 59.1; SD = 11.1; 88.9% males). All patients answered PADL-cardio and the Short Form 12 Health Survey. RESULTS Both versions of PADL-cardio are composed of 10 items. The fit to the Rasch model was given documented by a non-significant Item-trait interaction score (PADL-cardio I: χ2 = 31.08, df = 30, p = 0.41; PADL-cardio II: χ2 = 45.6, df = 40, p = 0.25). The two versions were free of differential item functioning. Person-separation reliability was 0.72/0.78 and unidimensionality was given. The two versions correlated with r = 0.98 and the correlation between PADL-cardio and the underlying item bank was 0.99 for both versions. Concurrent validity is indicated through correlations with the Short Form 12 Health Survey (r = -0.37 to -0.40). CONCLUSION PADL-cardio provides a short and psychometrically sound option for the assessment of activities of daily living in cardiovascular rehabilitation patients. The two versions of PADL-cardio are equivalent. Hence, they can be used to reduce practice and retest effects in repeated measurement, facilitating the longitudinal assessment of activities of daily living. Implications for Rehabilitation New parallel test forms for the assessment of activities of daily living in cardiac rehabilitation (PADL-cardio I & PADL-cardio II) are available. PADL-cardio I & II consist of 10 items and are therefore especially timesaving. Concurrent validity is given through correlations with the Short Form Health Survey 12. Therapeutic success could be determined more precisely by the parallel forms reducing practice and retest effects.
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Affiliation(s)
- Andreas Schmucker
- a Faculty of Engineering Science, Computer Science and Psychology, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy , University of Ulm , Ulm , Germany
| | - Birgit Abberger
- a Faculty of Engineering Science, Computer Science and Psychology, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy , University of Ulm , Ulm , Germany
| | - Maren Boecker
- b Institute of Medical Psychology and Medical Sociology , RWTH Aachen University , Aachen , Germany
| | - Harald Baumeister
- a Faculty of Engineering Science, Computer Science and Psychology, Institute of Psychology and Education, Department of Clinical Psychology and Psychotherapy , University of Ulm , Ulm , Germany
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17
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Avezum Á, Perel P, Oliveira GBF, Lopez-Jaramillo P, Restrepo G, Loustalot F, Srur A, de La Noval R, Connell KI, Cruz-Flores S, de Moura L, Castellac G, Mattos AC, Ordunez P. Challenges and Opportunities to Scale Up Cardiovascular Disease Secondary Prevention in Latin America and the Caribbean. Glob Heart 2017; 13:83-91. [PMID: 29032937 DOI: 10.1016/j.gheart.2017.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 05/04/2017] [Accepted: 05/08/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Álvaro Avezum
- Dante Pazzanese Institute of Cardiology, São Paulo, Brazil.
| | | | | | | | | | | | | | | | - Kenneth I Connell
- Caribbean Public Health Agency Hypertension Guidelines Committee, Port of Spain, Trinidad and Tobago
| | | | | | | | | | - Pedro Ordunez
- Pan American Health Organization, Washington, DC, USA
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18
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Lopes M, Cavaleiro C, Ramos F. Sodium Reduction in Bread: A Role for Glasswort (Salicornia ramosissimaJ. Woods). Compr Rev Food Sci Food Saf 2017; 16:1056-1071. [DOI: 10.1111/1541-4337.12277] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/25/2017] [Accepted: 05/27/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Maria Lopes
- Pharmacy Faculty; Univ. of Coimbra; Azinhaga de Santa Comba 3000-548 Coimbra Portugal
| | - Carlos Cavaleiro
- Pharmacy Faculty, CNC - Center for Neuroscience and Cell Biology; Univ. of Coimbra; Azinhaga de Santa Comba 3000-548 Coimbra Portugal
| | - Fernando Ramos
- Pharmacy Faculty, CNC - Center for Neuroscience and Cell Biology; Univ. of Coimbra; Azinhaga de Santa Comba 3000-548 Coimbra Portugal
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19
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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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Carrión Donderis M, Moreno Velásquez I, Castro F, Zúñiga J, Gómez B, Motta J. Analysis of mortality trends due to cardiovascular diseases in Panama, 2001-2014. Open Heart 2016; 3:e000510. [PMID: 28123756 PMCID: PMC5237747 DOI: 10.1136/openhrt-2016-000510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/20/2016] [Accepted: 11/08/2016] [Indexed: 11/17/2022] Open
Abstract
Objective Cardiovascular diseases (CVDs) are still the leading cause of death worldwide despite the recent decline in mortality rates attributable to CVD in Western Europe and the Americas. The aim of this study is to investigate mortality trends due to ischaemic heart disease (IHD) and stroke in Panama from 2001 to 2014, as well as the mortality differences by sex and age groups. Methods Data were obtained from the National Mortality Register. The International Classification of Diseases 10th revision codes (ICD-10) I20–I25 and I60–I69 were used for IHD and stroke, respectively. Age-adjusted mortality rates were calculated using the world population of the WHO as standard. Trends were analysed using Joinpoint Regression Program and annual percentage changes (APC) were estimated. Results From 2010, the IHD mortality trend began to decline in the whole population of Panama (APC −4.7%, p<0.05). From 2001 to 2014, a decline in the trend for IHD mortality was observed (APC −1.7%, p<0.05) in women, but not in men. Stroke mortality showed a significant annual decline during the study period (APC −3.8%, p<0.05) and it was more pronounced in women (APC −4.5%, p<0.05) than in men (APC −3.3%, p<0.05). Conclusions In Panama, the mortality rates from IHD and stroke have declined in recent years. Better access to healthcare, improved treatment of acute IHD and stroke, low tobacco consumption and better control of hypertension probably account for a significant part of this mortality reduction.
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Affiliation(s)
| | | | - Franz Castro
- Gorgas Memorial Institute for Health Studies , Panama City , Panama
| | - Julio Zúñiga
- Gorgas Memorial Institute for Health Studies , Panama City , Panama
| | - Beatriz Gómez
- Gorgas Memorial Institute for Health Studies , Panama City , Panama
| | - Jorge Motta
- Gorgas Memorial Institute for Health Studies, Panama City, Panama; National Secretariat for Science and Technology, Panama City, Panama
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Lanas F, Bazzano L, Rubinstein A, Calandrelli M, Chen CS, Elorriaga N, Gutierrez L, Manfredi JA, Seron P, Mores N, Poggio R, Ponzo J, Olivera H, He J, Irazola VE. Prevalence, Distributions and Determinants of Obesity and Central Obesity in the Southern Cone of America. PLoS One 2016; 11:e0163727. [PMID: 27741247 PMCID: PMC5065193 DOI: 10.1371/journal.pone.0163727] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obesity is a major determinant of cardiovascular disease in South America. However, population-based data are limited. METHODS A total of 7,524 women and men, aged 35 to 74 years old, were randomly selected from 4 cities in the Southern Cone of Latin America between February 2010 and December 2011. Obesity clinical measurements and cardiovascular risk factors were measured using standard methodology. RESULTS The prevalence of obesity and central obesity were 35.7% and 52.9%, respectively. The prevalence of obesity and central obesity were higher in women, and even higher in women with lower education compared with women with higher education. In men and women obesity was associated with a higher prevalence of diabetes, odds ratio (OR) 2.38 (95% Confidence Interval [CI]: 1.86 to 3.05) and 3.01 (95%CI 2.42 to 3.74) respectively, hypertension (OR 2.79 (95%CI 2.32 to 3.36) and 2.40 (95%CI 2.05 to 2.80) respectively, dyslipidemia (OR 1.83 (95%CI 1.50 to 2.24) and 1.69 (95%CI 1.45 to 1.98), respectively, low physical activity (OR 1.38(95%CI 1.14 to 1.68) and 1.38 (95%CI 1.18 to 1.62) respectively and a lower prevalence of smoking (OR, 0.65 (95%CI 0.53 to 0.80) and 0.58(95%CI 0.48 to 0.70) respectively. CONCLUSIONS Obesity and central obesity are highly prevalent in the general population in the Southern Cone of Latin America and are strongly associated with cardiovascular risk factor prevalence. These data suggest that efforts toward prevention, treatment, and control of obesity should be a public health priority in the Southern Cone of Latin America.
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Affiliation(s)
| | - Lydia Bazzano
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Adolfo Rubinstein
- Instituto de Efectividad Clínica y Sanitaria (IECS), Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS), Buenos Aires, Argentina
| | | | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| | - Natalia Elorriaga
- Instituto de Efectividad Clínica y Sanitaria (IECS), Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS), Buenos Aires, Argentina
| | - Laura Gutierrez
- Instituto de Efectividad Clínica y Sanitaria (IECS), Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS), Buenos Aires, Argentina
| | - Jose A Manfredi
- Departamento de Medicina Familiar, Universidad de la República, Montevideo, Uruguay
| | - Pamela Seron
- CIGES. Universidad de La Frontera (UFRO), Temuco, Chile
| | - Nora Mores
- Municipalidad de Marcos Paz, Pcia de Buenos Aires, Argentina
| | - Rosana Poggio
- Instituto de Efectividad Clínica y Sanitaria (IECS), Centro de Excelencia en Salud Cardiovascular para el Cono Sur (CESCAS), Buenos Aires, Argentina
| | - Jacqueline Ponzo
- Departamento de Medicina Familiar, Universidad de la República, Montevideo, Uruguay
| | - Hector Olivera
- Municipalidad de Marcos Paz, Pcia de Buenos Aires, Argentina
| | - Jiang He
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
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Mansur ADP, Favarato D. Trends in Mortality Rate from Cardiovascular Disease in Brazil, 1980-2012. Arq Bras Cardiol 2016; 107:20-5. [PMID: 27223642 PMCID: PMC4976952 DOI: 10.5935/abc.20160077] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/21/2015] [Accepted: 02/19/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Studies have questioned the downward trend in mortality from cardiovascular diseases (CVD) in Brazil in recent years. OBJECTIVE to analyze recent trends in mortality from ischemic heart disease (IHD) and stroke in the Brazilian population. METHODS Mortality and population data were obtained from the Brazilian Institute of Geography and Statistics and the Ministry of Health. Risk of death was adjusted by the direct method, using as reference the world population of 2000. We analyzed trends in mortality from CVD, IHD and stroke in women and men in the periods of 1980-2006 and 2007-2012. RESULTS there was a decrease in CVD mortality and stroke in women and men for both periods (p < 0.001). Annual mortality variations for periods 1980-2006 and 2007-2012 were, respectively: CVD (total): -1.5% and -0.8%; CVD men: -1.4% and -0.6%; CVD women: -1.7% and -1.0%; DIC (men): -1.1% and 0.1%; stroke (men): -1.7% and -1.4%; DIC (women): -1.5% and 0.4%; stroke (women): -2.0% and -1.9%. From 1980 to 2006, there was a decrease in IHD mortality in men and women (p < 0.001), but from 2007 to 2012, changes in IHD mortality were not significant in men [y = 151 + 0.04 (R2 = 0.02; p = 0.779)] and women [y = 88-0.54 (R2 = 0.24; p = 0.320). CONCLUSION Trend in mortality from IHD stopped falling in Brazil from 2007 to 2012.
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Ordunez P, Prieto-Lara E, Pinheiro Gawryszewski V, Hennis AJM, Cooper RS. Premature Mortality from Cardiovascular Disease in the Americas - Will the Goal of a Decline of "25% by 2025" be Met? PLoS One 2015; 10:e0141685. [PMID: 26512989 PMCID: PMC4626103 DOI: 10.1371/journal.pone.0141685] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 10/07/2015] [Indexed: 12/03/2022] Open
Abstract
Background Cardiovascular diseases (CVD) are the underlying cause 1.6 million deaths per year in the Americas, accounting for 30% of total mortality and 38% of by non-communicable deaths diseases (NCDs). A 25% reduction in premature mortality due four main NCDs was targeted by the 2011 High-level Meeting of the General Assembly on the Prevention and Control of NCDs. While overall CVD mortality fell in the Americas during the past decade, trends in premature CVD mortality during the same period have not been described, particularly in the countries of Latin America and the Caribbean. Methods This is a population-based trend-series study based on a total of 6,133,666 deaths to describe the trends and characteristics of premature mortality due to CVD and to estimates of the average annual percentage of change during the period 2000–2010 in the Americas. Findings Premature mortality due to CVD in the Americas fell by 21% in the period 2000–2010 with a -2.5% average annual rate of change in the last 5 year—a statistically significant reduction of mortality—. Mortality from ischemic diseases, declined by 25% - 24% among men and 26% among women. Cerebrovascular diseases declined by 27% -26% among men and 28% among women. Guyana, Trinidad and Tobago, the Dominican Republic, Bahamas, and Brazil had CVD premature mortality rates over 200 per 100,000 population, while the average for the Region was 132.7. US and Canada will meet the 25% reduction target before 2025. Mexico, Costa Rica, Venezuela, Dominican Republic, Panama, Guyana, and El Salvador did not significantly reduce premature mortality among men and Guyana, the Dominican Republic, and Panama did not achieve the required annual reduction in women. Conclusions Trends in premature mortality due to CVD observed in last decade in the Americas would indicate that if these trends continue, the Region as a whole and a majority of its countries will be able to reach the goal of a 25% relative reduction in premature mortality even before 2025.
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Affiliation(s)
- Pedro Ordunez
- Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health, 525 23rd Street, NW, Washington, D.C., 20037, United States of America
- * E-mail:
| | - Elisa Prieto-Lara
- Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health, 525 23rd Street, NW, Washington, D.C., 20037, United States of America
| | - Vilma Pinheiro Gawryszewski
- Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health, 525 23rd Street, NW, Washington, D.C., 20037, United States of America
| | - Anselm J. M. Hennis
- Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health, 525 23rd Street, NW, Washington, D.C., 20037, United States of America
| | - Richard S. Cooper
- Loyola University Chicago, Stritch School of Medicine, Department of Public Health Sciences, Maywood, IL, 60153, United States of America
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Okwuosa IS, Lewsey SC, Adesiyun T, Blumenthal RS, Yancy CW. Worldwide disparities in cardiovascular disease: Challenges and solutions. Int J Cardiol 2015; 202:433-40. [PMID: 26433167 DOI: 10.1016/j.ijcard.2015.08.172] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/21/2015] [Indexed: 12/20/2022]
Abstract
The 20th century saw cardiovascular disease ascend as the leading cause of death in the world. In response to the new challenge that heart disease imposed, the cardiovascular community responded with ground breaking innovations in the form of evidence based medications that have improved survival, imaging modalities that allow for precise diagnosis and guide treatment; revascularization strategies that have not only reduced morbidity, but also improved survival following an acute myocardial infarction. However the benefits have not been distributed equitably and as a result disparities have arisen in cardiovascular care. There is tremendous data from the United States demonstrating the many phenotypical forms of disparities. This paper takes a global view of disparities and highlights that disparate care is not limited to the United States and it is another challenge that the medical community should rise and face head on.
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Affiliation(s)
- Ike S Okwuosa
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - Sabra C Lewsey
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Tolulope Adesiyun
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Roger S Blumenthal
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Clyde W Yancy
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Auger N, Le Serbon E, Rasella D, Aquino R, Barreto ML. Impact of homicide and traffic crashes on life expectancy in the largest Latin American country. J Public Health (Oxf) 2015; 38:467-473. [DOI: 10.1093/pubmed/fdv111] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Moon JR, Song J, Huh J, Kang IS, Park SW, Chang SA, Yang JH, Jun TG. Analysis of Cardiovascular Risk Factors in Adults with Congenital Heart Disease. Korean Circ J 2015; 45:416-23. [PMID: 26413110 PMCID: PMC4580701 DOI: 10.4070/kcj.2015.45.5.416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/21/2015] [Accepted: 04/14/2015] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives The objective of this study was to analyze cardiovascular risk factors in adults with congenital heart disease (ACHD). Subjects and Methods The subjects for this study comprised 135 patients, aged 18 years and above, who visited the ACHD clinic at the Samsung Medical Center and 135 adults with a structurally normal heart who were randomly selected from the Center for Health Promotion during the same period. For the analysis, the ACHD group was further divided into an ACHD group that underwent correction by cardiac surgery and a cyanotic group. Results The mean (standard diviation) age (years) of patients in the surgically corrected group was 48.4 (10.9) years, while that of patients in the cyanotic group was 43.1 (9.0) years and that of patients in the control group was 47.1 (10.3) years (p=0.042). The adjusted odds ratios (ORs) for past smoking, hypertension, diabetes mellitus, hypercholesterolemia, obesity, and metabolic syndrome were significantly higher in the surgically corrected patients than in the controls. However, the ORs for all variables excluding past smoking were significantly lower in the cyanotic group compared with the control group. After adjustment for age, gender, smoking, alcohol use, and exercise, the ORs for metabolic syndrome were 0.46 (0.35-0.57, p<0.001) and 1.48 (1.14-1.92, p=0.003) in the cyanotic and surgically corrected groups, respectively. Conclusion Cardiovascular risk factors need to be considered in surgically corrected ACHD patients as well as in adults with a structurally normal heart. A further study with a long-term follow-up is needed for developing guidelines for prevention.
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Affiliation(s)
- Ju Ryoung Moon
- Grown-Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Grown-Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Grown-Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Grown-Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Grown-Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Seoul, Korea
| | - Sung-A Chang
- Division of Cardiology, Grown-Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Seoul, Korea
| | - Ji-Hyuk Yang
- Department of Thoracic & Cardiovascular Surgery, Grown-Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae-Gook Jun
- Department of Thoracic & Cardiovascular Surgery, Grown-Up Congenital Heart Clinic, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ordunez P, Mize V, Barbosa M, Legetic B, Hennis AJM. A Rapid Assessment Study on the Implementation of a Core Set of Interventions to Improve Cardiovascular Health in Latin America and the Caribbean. Glob Heart 2015; 10:235-240.e2. [PMID: 26271553 DOI: 10.1016/j.gheart.2015.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 04/16/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Pedro Ordunez
- Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health, Washington, DC, USA.
| | - Valerie Mize
- Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health, Washington, DC, USA
| | - Marcia Barbosa
- Inter-American Society of Cardiology, Mexico, Mexico City, Mexico
| | - Branka Legetic
- Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health, Washington, DC, USA
| | - Anselm J M Hennis
- Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health, Washington, DC, USA
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Ordunez P, Martinez R, Niebylski ML, Campbell NR. Hypertension Prevention and Control in Latin America and the Caribbean. J Clin Hypertens (Greenwich) 2015; 17:499-502. [PMID: 25727743 PMCID: PMC8032080 DOI: 10.1111/jch.12518] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rubinstein A, Elorriaga N, Garay OU, Poggio R, Caporale J, Matta MG, Augustovski F, Pichon-Riviere A, Mozaffarian D. Eliminating artificial trans fatty acids in Argentina: estimated effects on the burden of coronary heart disease and costs. Bull World Health Organ 2015; 93:614-22. [PMID: 26478625 PMCID: PMC4581646 DOI: 10.2471/blt.14.150516] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 03/15/2015] [Accepted: 04/10/2015] [Indexed: 11/27/2022] Open
Abstract
Objective To estimate the impact of Argentine policies to reduce trans fatty acids (TFA) on coronary heart disease (CHD), disability-adjusted life years (DALYs) and associated health-care costs. Methods We estimated the baseline intake of TFA before 2004 to be 1.5% of total energy intake. We built a policy model including baseline intake of TFA, the oils and fats used to replace artificial TFAs, the clinical effect of reducing artificial TFAs and the costs and DALYs saved due to averted CHD events. To calculate the percentage of reduction of CHD, we calculated CHD risks on a population-based sample before and after implementation. The effect of the policies was modelled in three ways, based on projected changes: (i) in plasma lipid profiles; (ii) in lipid and inflammatory biomarkers; and (iii) the results of prospective cohort studies. We also estimated the present economic value of DALYs and associated health-care costs of coronary heart disease averted. Findings We estimated that projected changes in lipid profile would avert 301 deaths, 1066 acute CHD events, 5237 DALYs and 17 million United States dollars (US$) in health-care costs annually. Based on the adverse effects of TFA intake reported in prospective cohort studies, 1517 deaths, 5373 acute CHD events, 26 394 DALYs and US$ 87 million would be averted annually. Conclusion Even under the most conservative scenario, reduction of TFA intake had a substantial effect on public health. These findings will help inform decision-makers in Argentina and other countries on the potential public health and economic impact of this policy.
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Affiliation(s)
- Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Natalia Elorriaga
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Osvaldo U Garay
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Rosana Poggio
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Joaquin Caporale
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Maria G Matta
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Federico Augustovski
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Andres Pichon-Riviere
- Institute for Clinical Effectiveness and Health Policy (IECS), Ravignani 2024, Buenos Aires, C1414CPV, Argentina
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, United States of America
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Wang Z, Wang Y, Zhu R, Tian X, Xu D, Wang Q, Wu C, Zhang S, Zhao J, Zhao Y, Li M, Zeng X. Long-term survival and death causes of systemic lupus erythematosus in China: a systemic review of observational studies. Medicine (Baltimore) 2015; 94:e794. [PMID: 25929930 PMCID: PMC4603034 DOI: 10.1097/md.0000000000000794] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 03/21/2015] [Accepted: 03/29/2015] [Indexed: 02/07/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with an increased risk of death compared to general population. Although previous studies showed improvement in survival of SLE, the long-term prognosis has not been elaborated in China.This study aims to integrate the observational studies estimating current long-term survival of Chinese SLE patients and analyze the death-cause situation of SLE in China.The study is a systemic review of English and non-English articles using MEDLINE, EMBASE, CNKI, WANFANG, and SINOMED databases. Additional studies were found by consultation with clinical experts, browse of references in selected papers, and search of related textbooks. Our major search terms were SLE, follow-up, prognosis, survival, mortality, and China.We included cohort studies for survival analysis, and both cohort studies and case series for death-cause analysis in China.The extraction of the articles were done by 2 authors independently using predesigned charts, including characteristics of study, clinical data, analyzing data, and study quality indicators.All pooled analyses were conducted both for random-effects model and fixed-effects model. Funnel plots and Egger regression tests were applied to check potential publication bias. Heterogeneity was tested by sensitivity analysis. We identified 5 studies for survival analysis comprising 4469 Chinese patients with SLE (380 observed deaths). Thirty-six studies were suitable for death-cause analysis with 2179 observed deaths (derived from more than 20,000 Chinese patients with SLE). The overall pooled survival rates for SLE in China were 94% for 5-year survival rate and 89% for 10-year survival rate after disease onset from the year 1995 to 2013, which were similar with previous publications in Asia-Pacific area. The proportions of different causes of death showed infection (33.2%), renal involvement (18.7%), lupus encephalopathy (13.8%), and cardiovascular disease (11.5%) as the top 4 causes.The overall survival rates for Chinese patients with SLE resembled previous publications in Asia-Pacific area. But the death causes of SLE in China were of some differences indicating relatively higher proportion of infection and lupus encephalopathy and lower cardiovascular disease. Ethnicity and more aggressive treatment might have contributed to the difference in death composition.
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Affiliation(s)
- Ziqian Wang
- From the Department of Rheumatology (ZW, RZ, XT, DX, QW, CW, SZ, JZ, YZ, ML, XZ), Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, ; and Department of Epidemiology and Bio-statistics (YW), Institute of Basic Medical Sciences, China Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Bahall M. Complementary and alternative medicine usage among cardiac patients: a descriptive study. Altern Ther Health Med 2015; 15:100. [PMID: 25888160 PMCID: PMC4394556 DOI: 10.1186/s12906-015-0610-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 03/13/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) persists, despite the availability of conventional medicine (CM), modernisation, globalisation, technological advancement, and limited scientific evidence supporting CAM. People with cardiovascular diseases often use CAM, despite possible major adverse effects and lack of evidence supporting CAM claims. This study explored CAM use among cardiac patients, the types of CAM used, reasons and factors that influence its use, and the association between patient demographics and CAM use. METHODS This cross-sectional quantitative study was conducted using quota sampling to survey 329 public clinic adult cardiac patients within the South-West Regional Health Authority (SWRHA) of Trinidad and Tobago. From 1 July 2012 to 31August 2012, each participant completed questionnaires, after consenting to participate. Data analysis included χ(2) tests and binary logistic regression. RESULTS One hundred eighty-five (56.2%; standard error [SE] = 2.74%) patients used CAM. Herbal medicine was the most common CAM (85.9%; SE = 2.56%), followed by spiritual therapy/mind-body systems (61.6%; SE = 3.58%), physical therapy/body manipulation (13.5%; SE = 2.51%), alternative systems (8.1%; SE = 2.01%), and other methods (3.8%; SE = 1. 41%). The patients believed that CAM promotes health and wellness (79.5%; SE = 2.97%), assists in fighting illness (78.9%; SE = 3.00%), addresses the limitations of CM (69.2%; SE = 3.56%), alleviates symptoms (21.6%; SE = 6.51%), costs less than CM (21.6 %, SE = 3.03), and has fewer adverse/damaging effects than CM (29.7, SE =3.36), or they were disappointed with CM (12.4%, SE = 2.42). Ethnicity and religion were associated with CAM usage, but only ethnicity was a useful predictor of CAM use. CONCLUSIONS Complementary and alternative medicine use was high among cardiac patients (56.2%, SE = 2.74%), and associated with ethnicity and religion. Friends, family, and perceived mode of action influenced a patient's use of CAM.
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Bahall M, Edwards M. Perceptions of complementary and alternative medicine among cardiac patients in South Trinidad: a qualitative study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:99. [PMID: 25887906 PMCID: PMC4392733 DOI: 10.1186/s12906-015-0577-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 02/21/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) has been practiced for centuries owing to the absence or limited availability of conventional medicine. CAM has persisted globally with over USD34 billion spent annually, despite modernization, globalization, technological advancement, and limited supportive evidence. The present qualitative study explores the perception of CAM among cardiac patients with respect to rationale, perceived outcomes, influences, and public health concerns. METHODS This study used a qualitative, interpretative approach. Twelve cardiac disease patients were recruited from private clinics in South Trinidad and interviewed. The study obtained ethical approval, and all participants provided written consent. The semi-structured interviews were digitally recorded, transcribed, and thematically analyzed. Participants with poor cognitive function, difficulty speaking, and those not understandable owing to language barriers were excluded. RESULTS CAM use was based largely on patient perception regardless of the clinical reality. The perceived mode of action and its natural character was responsible for the therapeutic outcomes and uses. Participants reported that CAM provided holistic care, improved the quality of life, overcame the limitations of conventional medicine, satisfied their increased expectation for comprehensive care, and prevented or counteracted adverse effects caused by conventional medicine. Participants reported a lack of scientific information on CAM and stated that policy makers should assist patients through increased research, public health education, and improved integration of CAM and conventional medicine. CONCLUSIONS The participants' use of CAM was largely based on perception. CAM was thought to improve therapeutic outcomes, provide holistic care, decrease or prevent complications from conventional medicine, and improve quality of life. Participants acknowledged that they may be ill-informed about the basic concepts or actions of CAM. They urged policymakers to create an environment that assists the public and health care providers in promoting safe and effective CAM practice.
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Affiliation(s)
- Mandreker Bahall
- Arthur Lok Jack Graduate School of Business, Max Richards Drive, Champ Fleurs, Mount Hope, Trinidad.
- Faculty of Medicine, University of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Mark Edwards
- University of Liverpool, London, UK.
- University of Roehampton, London, UK.
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Garcia-Larsen V, Bustos P, Amigo H, Potts J, Rona RJ. Ventilatory function and cardiovascular disease risk factors: a cross-sectional study in young adults. BMC Pulm Med 2014; 14:206. [PMID: 25524286 PMCID: PMC4320557 DOI: 10.1186/1471-2466-14-206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/24/2014] [Indexed: 11/29/2022] Open
Abstract
Background The association between impaired lung function and cardiovascular disease (CVD) risk factors has been shown in adults. However, there is little evidence of such an association in young adults, particularly from South America, where the burden of CVD and chronic obstructive pulmonary disease (COPD) is as high as that observed in more developed countries. We therefore investigated the relation between CVD risk factors including metabolic syndrome (MS), and lung function status in young adults from Chile. Methods 970 subjects from a sample of 998 adults born between 1974 and 1978 in Limache, Chile, were studied. A Spanish translation of the European Community Respiratory Health Survey (ECRHS) questionnaire was used. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were measured. Weight, height, waist circumference (WC), blood pressure, Homeostatic model assessment (HOMA-IR), triglycerides, high density lipoprotein (HDL), glycaemia, and metabolic syndrome (MS) were also assessed. Results The prevalence of MS was 11.8%. A lower FEV1 and lower FVC were associated with having MS (β-coefficient -0.13; 95% Confidence Interval [CI] -0.21 to -0.05, and β-coefficient -0.18; 95% CI -0.27 to -0.09, respectively). Both spirometric measures were also negatively associated with having an elevated HOMA-IR (β-coefficient for FEV1 -0.08; 95% CI -0.13 to -0.03, and β-coefficient for FVC -0.11; 95% CI -0.17 to -0.05). In males only, a lower FEV1 and FVC were associated with having elevated triglycerides (β-coefficient highest vs. lowest tertile -0.13, 95% CI -0.24 to -0.03, and β-coefficient -0.13, 95% CI -0.25 to -0.01, respectively). In women, a higher FEV1 and FVC were statistically significantly related to having higher levels of HDL. Ventilatory function was unrelated to hypertension or WC in this population. Conclusion In this population-based study of young adults, a poorer ventilatory function was associated with many CVD risk factors. Endeavours to understand better causality issues of such associations are warranted.
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Affiliation(s)
- Vanessa Garcia-Larsen
- Respiratory Epidemiology, Occupational Medicine, and Public Health Group, National Heart & Lung Institute Imperial College London, Emmanuel Kaye Building, Manresa Road, London SW3 6LR, UK.
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Rivera-Andrade A, Luna MA. Trends and heterogeneity of cardiovascular disease and risk factors across Latin American and Caribbean countries. Prog Cardiovasc Dis 2014; 57:276-85. [PMID: 25218566 DOI: 10.1016/j.pcad.2014.09.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Aging, globalization and urbanization in Latina America and the Caribbean (LAC) have made cardiovascular disease (CVD) the number one cause of death and disability, while communicable diseases have decreased. This epidemiological transition has been more heterogeneous than in other areas of the world. While countries like Argentina, Chile, Brazil and Colombia have seen a significant decrease in CVD mortality, the rest of the countries have seen an increase, particularly Central American and Caribbean countries. These latter countries have now coexisting high prevalence of communicable and non-communicable diseases, threatening the socioeconomic development. Recent multinational cross sectional studies have provided a better perspective of the prevalence and distribution of cardiovascular risk factors in the region. While there has been a decrease in prevalence of smoking in the region, obesity, diabetes and physical inactivity continue to increase the CVD disease burden in LAC.
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Affiliation(s)
- Alvaro Rivera-Andrade
- INCAP Comprehensive Center for the Prevention of Chronic Diseases/Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Max A Luna
- Department of Medicine, University of Virginia, Charlottesville, VA.
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Hosey GM, Samo M, Gregg EW, Padden D, Bibb SG. Socioeconomic and demographic predictors of selected cardiovascular risk factors among adults living in Pohnpei, Federated States of Micronesia. BMC Public Health 2014; 14:895. [PMID: 25175388 PMCID: PMC4158138 DOI: 10.1186/1471-2458-14-895] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 07/29/2014] [Indexed: 12/20/2022] Open
Abstract
Background The burden of cardiovascular disease (CVD) is increasing in low-to-middle income countries (LMIC). Although strong evidence for inverse associations between socioeconomic position and health outcomes in high-income countries exists, less is known about LMIC. Understanding country-level differences is critical to tailoring effective population health policy and interventions. We examined the association of socioeconomic position and demographic characteristics in determining CVD risk factors among adults living in Pohnpei, Federated States of Micronesia. Methods We used data from the cross-sectional World Health Organization’s STEPwise approach to surveillance 2002 Pohnpei dataset and logistic regression analyses to examine the association of socioeconomic position (education, income, employment) and demographics (age, sex) with selected behavioral and anthropometric CVD risk factors. The study sample consisted of 1638 adults (642 men, 996 women; 25–64 years). Results In general, we found that higher education (≥13 years) was associated with lower odds for daily tobacco use (odds ratio [OR]: 0.46, confidence interval [CI]: 0.29–0.75, p = 0.004) and low physical activity (OR: 0.55, CI: 0.34–0.87, p = 0.027). Men had over three times the odds of daily tobacco use than women (OR: 3.18, CI: 2.29–4.43, p < 0.001). Among women, paid employment nearly doubled the odds of daily tobacco use (OR: 1.72, CI: 1.08–2.73, p = 0.006) than unemployment. For all participants, income > $10,000 was associated with over twice the odds of high blood pressure (BP) (OR: 2.24, CI: 1.43–3.51, p = 0.003), versus lower-income (<$5,000). Men had over twice the odds of high BP (OR: 2.01, CI: 1.43–2.83, p < 0.001) than women. Paid employment nearly doubled the odds of central obesity with the magnitude of association increasing by more than 20% adjusted for sex and age. Men reporting paid employment had three times the odds of central obesity (OR: 3.00, CI: 1.56–5.78, p < 0.001) than those unemployed. Conclusion Our analysis revealed associations between socioeconomic position and selected CVD risk factors, which varied by risk-factor, sex and age characteristics, and direction of association. The 2002 Pohnpei dataset provides country-level baseline information; further population health surveillance might define trends. Stronger country-level data might help decision-makers tailor population-based prevention strategies. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-895) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gwendolyn M Hosey
- Division of Diabetes Translation, Centers for Disease Control and Prevention, National Center for Chronic Disease and Health Promotion, Mailstop K10, 2877 Brandywine Rd, Atlanta, GA 30341, USA.
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Abstract
Cardiovascular diseases (CVD) produce almost a million deaths a year in Latin America (LA), becoming the main cause of death in the last years, and it is estimated that the number of deaths in the region attributable to CVD will increase in the near future. This new epidemic is a consequence of the demographic, economic and social changes observed in LA in recent years. Coronary heart disease and stroke causes 42.5% and 28.8%, respectively of the CVD mortality in the region. Chagas heart involvement and rheumatic heart disease, once a major health problem, are responsible of only 1% of the mortality each. Improving in socioeconomic status, increased life expectancy and high prevalence of risk factors for atherosclerosis have been the major determinants of this marked epidemiologic change.
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Affiliation(s)
- Lanas Fernando
- Universidad de La Frontera, Facultad de Medicina, Temuco, Chile.
| | - Serón Pamela
- Universidad de La Frontera, Facultad de Medicina, Temuco, Chile.
| | - Lanas Alejandra
- Universidad de Chile, Facultad de Medicina, Santiago, Chile.
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Phrommintikul A, Wongcharoen W, Kuanprasert S, Prasertwitayakij N, Kanjanavanit R, Gunaparn S, Sukonthasarn A. Safety and tolerability of intradermal influenza vaccination in patients with cardiovascular disease. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2014; 11:131-5. [PMID: 25009563 PMCID: PMC4076453 DOI: 10.3969/j.issn.1671-5411.2014.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 04/23/2014] [Accepted: 05/10/2014] [Indexed: 11/18/2022]
Abstract
Background It is well-established that influenza vaccination reduces adverse cardiovascular outcomes in patients with cardiovascular diseases (CVD), however, the vaccine coverage rate in most countries remains low. The concern about the local adverse effects of intramuscular injection, particularly in CVD patients receiving antithrombotic therapy, is one of the important impediments. This study was conducted to assess the safety, side effects and tolerability of intradermal influenza vaccine in CVD patients. Methods This was an observational study in adult CVD patients who had undergone vaccination against seasonal influenza by intradermal vaccination between May 16th and May 30th, 2012 at Maharaj Nakorn Chiang Mai Hospital. The medical history, patients' acceptability and adverse effects were collected using a written questionnaire completed by the patient immediately following vaccination and by a telephone survey eight days later. Results Among 169 patients, 52.1% were women and the mean age was 63 ± 12 years. Coronary artery disease, valvular heart disease and dilated cardiomyopathy were present in 121 (71.6%), 40 (23.7%) and 8 (4.7%), respectively. Antithrombotics were used in 89.3%. After vaccination, the pain score was 0, 1 or 2 (out of 10) in 44.4%, 15.1%, and 27.6% of the patients, respectively. Eight days after vaccination, the common adverse reactions were itching 19 (11.9%), swelling 9 (5.7%) and fatigue (4.7%). No hematoma or bruising was reported. Conclusions The intradermal influenza vaccination is safe and well tolerates with high rates of satisfaction in CVD patients. This technique should be useful in expanding influenza vaccine coverage.
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Affiliation(s)
- Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50210, Thailand
| | - Wanwarang Wongcharoen
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50210, Thailand
| | - Srun Kuanprasert
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50210, Thailand
| | - Narawudt Prasertwitayakij
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50210, Thailand
| | - Rungsrit Kanjanavanit
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50210, Thailand
| | - Siriluck Gunaparn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50210, Thailand
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50210, Thailand
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Rasella D, Harhay MO, Pamponet ML, Aquino R, Barreto ML. Impact of primary health care on mortality from heart and cerebrovascular diseases in Brazil: a nationwide analysis of longitudinal data. BMJ 2014; 349:g4014. [PMID: 24994807 PMCID: PMC4080829 DOI: 10.1136/bmj.g4014] [Citation(s) in RCA: 173] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the impact of Brazil's recently implemented Family Health Program (FHP), the largest primary health care programme in the world, on heart and cerebrovascular disease mortality across Brazil from 2000 to 2009. DESIGN Ecological longitudinal design, evaluating the impact of FHP using negative binomial regression models for panel data with fixed effects specifications. SETTING Nationwide analysis of data from Brazilian municipalities covering the period from 2000 to 2009. DATA SOURCES 1622 Brazilian municipalities with vital statistics of adequate quality. MAIN OUTCOME MEASURES The annual FHP coverage and the average FHP coverage in previous years were used as main independent variables and classified as none (0%), incipient (<30%), intermediate (30-69%), or consolidated (≥ 70%). Age standardised mortality rates from causes in the group of cerebrovascular (ICD-10 codes I60-69), ischaemic (ICD-10 I20-25), and other forms of heart diseases (ICD-10 I30-52), which were included in the national list of ambulatory care-sensitive conditions, were calculated for each municipality for each year. They accounted for 40% of all deaths from these groups during the study period. RESULTS FHP coverage was negatively associated with mortality rates from cerebrovascular and heart diseases (ambulatory care-sensitive conditions) in both unadjusted and adjusted models for demographic, social, and economic confounders. The FHP had no effect on the mortality rate for accidents, used as a control. The rate ratio for the effect of consolidated annual FHP coverage on cerebrovascular disease mortality and on heart disease mortality was 0.82 (95% confidence interval 0.79 to 0.86) and 0.79 (0.75 to 0.80) respectively, reaching the value of 0.69 (0.66 to 0.73) and 0.64 (0.59 to 0.68) when the coverage was consolidated during all the previous eight years. Moreover, FHP coverage increased the number of health education activities, domiciliary visits, and medical consultations and reduced hospitalisation rates for cerebrovascular and heart disease. Several complementary analyses showed quantitatively similar results. CONCLUSIONS Comprehensive and community based primary health care programmes, such as the FHP in Brazil, acting through cardiovascular disease prevention, care, and follow-up can contribute to decreased cardiovascular disease morbidity and mortality in a developing country such as Brazil.
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Affiliation(s)
- Davide Rasella
- Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, Brazil
| | - Michael O Harhay
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Marina L Pamponet
- Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, Brazil
| | - Rosana Aquino
- Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, Brazil Ciência, Tecnologia e Inovação em Saúde, INCT-CITECS, Salvador, Bahia, Brazil
| | - Mauricio L Barreto
- Instituto de Saúde Coletiva, Federal University of Bahia, Rua Basílio da Gama, s/n, Salvador, Bahia, Brazil Ciência, Tecnologia e Inovação em Saúde, INCT-CITECS, Salvador, Bahia, Brazil
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Gawryszewski VP, de Souza MDFM. Mortality due to cardiovascular diseases in the Americas by region, 2000-2009. SAO PAULO MED J 2014; 132:105-10. [PMID: 24714991 PMCID: PMC10896582 DOI: 10.1590/1516-3180.2014.1322604] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 06/18/2013] [Accepted: 07/05/2013] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Cardiovascular diseases are the leading cause of death worldwide. The aim here was to evaluate trends in mortality due to cardiovascular diseases in three different regions of the Americas. DESIGN AND SETTING This was a time series study in which mortality data from three different regions in the Americas from 2000 to the latest year available were analyzed. METHODS The source of data was the Mortality Information System of the Pan-American Health Organization (PAHO). Data from 27 countries were included. Joinpoint regression analysis was used to analyze trends. RESULTS During the study period, the age-adjusted mortality rates for men were higher than those of females in all regions. North America (NA) showed lower rates than Latin America countries (LAC) and the Non-Latin Caribbean (NLC). Premature deaths (30-69 years old) accounted for 22.8% of all deaths in NA, 38.0% in LAC and 41.8% in NLC. The trend analysis also showed a significant decline in the three regions. NA accumulated the largest decline. The average annual percentage change (AAPC) and 95% confidence interval was -3.9% [-4.2; -3.7] in NA; -1.8% [-2.2; -1.5] in LAC; and -1.8% [-2.7; -0.9] in NLC. CONCLUSION Different mortality rates and reductions were observed among the three regions.
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Affiliation(s)
- Vilma Pinheiro Gawryszewski
- MD, MSc, PhD. Advisor, Health Information and Analysis, Health Information and Analysis Unit, Pan-American Health Organization, Washington DC, United States
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Lanas F, Serón P, Lanas A. Coronary Heart Disease and Risk Factors in Latin America. Glob Heart 2013; 8:341-8. [DOI: 10.1016/j.gheart.2013.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/06/2013] [Accepted: 11/21/2013] [Indexed: 11/25/2022] Open
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Singh JA, Kwoh CK, Richardson D, Chen W, Ibrahim SA. Sex and surgical outcomes and mortality after primary total knee arthroplasty: a risk-adjusted analysis. Arthritis Care Res (Hoboken) 2013; 65:1095-102. [PMID: 23335560 DOI: 10.1002/acr.21953] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 12/21/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Total knee arthroplasty (TKA) is a widely utilized and effective treatment option for end-stage knee osteoarthritis (OA). Knee OA is more prevalent among women compared to men, but there are limited data on the sex differences in surgical outcomes after primary TKA. METHODS Our sample consisted of all primary TKAs performed in Pennsylvania during the fiscal year 2002. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify major complications and surgical revision. We used mixed-effects logistic regression models to examine the associations between sex and all-cause mortality, readmissions, and major surgical complications. We used proportional hazards models to assess the risk of surgical revision after index arthroplasty. We adjusted for race, age, hospital teaching status, hospital procedure volume, insurance status, and risk of mortality. RESULTS In 17,994 primary TKAs, there were 46 and 220 deaths at 30 days and 1 year, respectively. Compared to women, men had higher adjusted odds of 1-year mortality (odds ratio [OR] 1.48 [95% confidence interval (95% CI) 1.13-1.94]) after primary TKA. The overall odds of most major 30-day complications did not differ by sex except for surgical wound infections, which were higher in men compared to women (OR 1.31 [95% CI 1.08-1.60]); 30-day readmission was higher in men (OR 1.25 [95% CI 1.10-1.43]). Men had significantly higher rates of revision of index knee arthroplasty at 5 years (hazard ratio 1.20 [95% CI 1.05-1.36]) compared to women. CONCLUSION The higher rates of mortality, hospital readmissions, revision surgery, and wound infections in men undergoing elective primary TKA compared to women indicate there is a sex disparity in these outcomes.
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Baena CP, Chowdhury R, Schio NA, Sabbag AE, Guarita-Souza LC, Olandoski M, Franco OH, Faria-Neto JR. Ischaemic heart disease deaths in Brazil: current trends, regional disparities and future projections. Heart 2013; 99:1359-64. [PMID: 23886609 DOI: 10.1136/heartjnl-2013-303617] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To quantify the trend of ischaemic heart disease (IHD) deaths in Brazil during the last decade (2000-2010) for various population characteristics and to forecast the upcoming mortality trends across regions in Brazil until the year 2015. DESIGN Nationwide comparative observational study. PATIENTS AND METHODS The population studied encompassed all adult residents (≥ 20 years) living in five Brazilian regions between 2000 and 2010. Demographic, economic and mortality data were obtained from Brazilian National Mortality Data System and National Applied Economics Research Institute. Subnotified deaths were redistributed proportionally to IHD deaths. Age-standardised mortality rates (ASMRs) per 100 000 inhabitants, by sex and region, were calculated employing a standard Brazilian population and constructing multivariate regression models to quantify and to project temporal trends. MAIN OUTCOME MEASURES Absolute numbers of death due to IHD and region-specific death rates in Brazil by age and sex. RESULTS During the study period, 627 786 men and 452 690 women died due to IHD in Brazil. ASMR trends across all regions for men and women converged, driven by a declining trend in the South and Southeast and an opposite incline in the North and Northeast (p < 0.05). Future projections demonstrated potential widening of the observed North-South gap in coming years. CONCLUSIONS The IHD death trend in Brazil has changed from a decline to a stagnant state. However, a significant discrepancy in mortality trends exists between the northern and southern regions, which is likely to widen further. Reappraisal of the public health policies tailored to populations with diverse socioeconomic structures is urgently required.
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Affiliation(s)
- Cristina P Baena
- Pontificia Universidade Catolica do Paraná, School of Medicine Curitiba, Curitiba, Paraná, Brazil.
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Gan LM, Wikström J, Fritsche-Danielson R. Coronary flow reserve from mouse to man--from mechanistic understanding to future interventions. J Cardiovasc Transl Res 2013; 6:715-28. [PMID: 23877202 PMCID: PMC3790920 DOI: 10.1007/s12265-013-9497-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/01/2013] [Indexed: 11/29/2022]
Abstract
Myocardial ischemia is recognized as an important mechanism increasing the risk for cardiovascular events in both symptomatic and asymptomatic patients. In addition to obstructive coronary diseases, systemic inflammation, macro- and microvascular function are additional important mechanisms contributing to the ischemic myocardium. Accumulating evidence indicates that coronary flow reserve (CFR) is a quantitative measurement of ischemia including integrated information on structure and function of the coronary artery at all levels. Not surprisingly, CFR has been shown to confer strong prognostic value for hard cardiovascular (CV) events in a number of relevant patient cohorts. Using high-resolution imaging, it is now possible to study coronary arteries from mouse to man. Therefore, CFR may be an important translational tool to risk-stratify patients and to perform both preclinical and clinical proof-of-concept studies before investing in large-scale outcome trials, thus improving the translational value for novel CV targets.
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Affiliation(s)
- Li-Ming Gan
- Department of Molecular and Clinical Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göteborg, Sweden,
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De Decker K, Beese U, Staal MJ, Dejongste MJL. Electrical neuromodulation for patients with cardiac diseases. Neth Heart J 2013. [PMID: 23197049 DOI: 10.1007/s12471-012-0356-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In this review we discuss the position of electrical neuromodulation as a safe and reversible adjuvant therapy for treatment of patients with chronic cardiac diseases who have become refractory to conventional strategies. In patients with chronic refractory angina, electrical neuromodulation, independent of the applied modality, has shown to reduce complaints of angina, to enhance exercise capacity, to improve quality of life and to employ anti-ischaemic effects. To date, electrical neuromodulation seems to be one of the best adjuvant therapies for these patients. In addition, neuromodulation in the treatment of heart failure and resistant arrhythmias is the subject of several ongoing studies.
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Affiliation(s)
- K De Decker
- University Medical Centre of Groningen and University of Groningen, 9700 RB, Groningen, the Netherlands
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