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Joundi RA, Hu B, Rangarajan S, Leong DP, Islam S, Smith EE, Mirrakhimov E, Seron P, Alhabib KF, Assembekov B, Chifamba J, Yusuf R, Khatib R, Felix C, Yusufali A, Mohammadifard N, Rosengren A, Oguz A, Iqbal R, Yeates K, Avezum A, Kruger I, Anjana R, Pvm L, Gupta R, Zatońska K, Barbarash O, Pelliza E, Rammohan K, Li M, Li X, Ismail R, Lopez-Jaramillo P, Evans M, O'Donnell M, Yusuf S. Activity limitations, use of assistive devices, and mortality and clinical events in 25 high-income, middle-income, and low-income countries: an analysis of the PURE study. Lancet 2024; 404:554-569. [PMID: 39068950 DOI: 10.1016/s0140-6736(24)01050-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 04/04/2024] [Accepted: 05/16/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The focus of most epidemiological studies has been mortality or clinical events, with less information on activity limitations related to basic daily functions and their consequences. Standardised data from multiple countries at different economic levels in different regions of the world on activity limitations and their associations with clinical outcomes are sparse. We aimed to quantify the prevalence of activity limitations and use of assistive devices and the association of limitations with adverse outcomes in 25 countries grouped by different economic levels. METHODS In this analysis, we obtained data from individuals in 25 high-income, middle-income, and low-income countries from the Prospective Urban Rural Epidemiological (PURE) study (175 660 participants). In the PURE study, individuals aged 35-70 years who intended to continue living in their current home for a further 4 years were invited to complete a questionnaire on activity limitations. Participant follow-up was planned once every 3 years either by telephone or in person. The activity limitation screen consisted of questions on self-reported difficulty with walking, grasping, bending, seeing close, seeing far, speaking, hearing, and use of assistive devices (gait, vision, and hearing aids). We estimated crude prevalence of self-reported activity limitations and use of assistive devices, and prevalence standardised by age and sex. We used logistic regression to additionally adjust prevalence for education and socioeconomic factors and to estimate the probability of activity limitations and assistive devices by age, sex, and country income. We used Cox frailty models to evaluate the association between each activity limitation with mortality and clinical events (cardiovascular disease, heart failure, pneumonia, falls, and cancer). The PURE study is registered with ClinicalTrials.gov, NCT03225586. FINDINGS Between Jan 12, 2001, and May 6, 2019, 175 584 individuals completed at least one question on the activity limitation questionnaire (mean age 50·6 years [SD 9·8]; 103 625 [59%] women). Of the individuals who completed all questions, mean follow-up was 10·7 years (SD 4·4). The most common self-reported activity limitations were difficulty with bending (23 921 [13·6%] of 175 515 participants), seeing close (22 532 [13·4%] of 167 801 participants), and walking (22 805 [13·0%] of 175 554 participants); prevalence of limitations was higher with older age and among women. The prevalence of all limitations standardised by age and sex, with the exception of hearing, was highest in low-income countries and middle-income countries, and this remained consistent after adjustment for socioeconomic factors. The use of gait, visual, and hearing aids was lowest in low-income countries and middle-income countries, particularly among women. The prevalence of seeing close limitation was four times higher (6257 [16·5%] of 37 926 participants vs 717 [4·0%] of 18 039 participants) and the prevalence of seeing far limitation was five times higher (4003 [10·6%] of 37 923 participants vs 391 [2·2%] of 18 038 participants) in low-income countries than in high-income countries, but the prevalence of glasses use in low-income countries was half that in high-income countries. Walking limitation was most strongly associated with mortality (adjusted hazard ratio 1·32 [95% CI 1·25-1·39]) and most consistently associated with other clinical events, with other notable associations observed between seeing far limitation and mortality, grasping limitation and cardiovascular disease, bending limitation and falls, and between speaking limitation and stroke. INTERPRETATION The global prevalence of activity limitations is substantially higher in women than men and in low-income countries and middle-income countries compared with high-income countries, coupled with a much lower use of gait, visual, and hearing aids. Strategies are needed to prevent and mitigate activity limitations globally, with particular emphasis on low-income countries and women. FUNDING Funding sources are listed at the end of the Article.
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Affiliation(s)
- Raed A Joundi
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, ON, Canada.
| | - Bo Hu
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, ON, Canada
| | - Darryl P Leong
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, ON, Canada
| | | | | | | | | | | | | | | | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | - Rasha Khatib
- Advocate Aurora Research Institute, Milwaukee, WI, USA
| | | | | | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Centre, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Aytekin Oguz
- Istanbul Medeniyet University, Istanbul, Türkiye
| | | | | | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz and UNISA, São Paulo University, São Paulo, Brazil
| | | | | | - Lakshmi Pvm
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Rajasthan, India
| | | | | | | | | | - Mengya Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaocong Li
- Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rosnah Ismail
- Universiti Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Marc Evans
- Philippine General Hospital, Manila, Philippines
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences, ON, Canada
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Khetan AK, Palileo-Villanueva LM, Mat-Nasir N, Ismail R, Dans AM, Abat MEM, Islam S, Joseph P, Leong DP, Teo KK, Rangarajan S, Yusuf S. Mortality, Cardiovascular Disease, and Their Associations With Risk Factors in Southeast Asia: A PURE Substudy. JACC. ASIA 2024; 4:624-633. [PMID: 39156511 PMCID: PMC11328768 DOI: 10.1016/j.jacasi.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/31/2024] [Accepted: 05/31/2024] [Indexed: 08/20/2024]
Abstract
Background The drivers of cardiovascular disease (CVD) and all-cause mortality may differ around the world. Regional-level prospective data can help guide policies to reduce CVD and all-cause mortality. Objectives This study examined the incidence of CVD and mortality in Malaysia and the Philippines and estimated the population-level risks attributable to common risk factors for each outcome. Methods This prospective cohort study included 20,272 participants from Malaysia and the Philippines. The mean follow-up was 8.2 years. The incidences of CVD and mortality rates were calculated for the overall cohort and in key subgroups. For each outcome, population-attributable fractions (PAFs) were calculated to compare risks associated with 12 modifiable risk factors. Results The mean age of the cohort was 51.8 years (59% women). Leading causes of mortality were CVD (37.9%) and cancer (12.4%). The incidence of CVD (per 1,000 person-years) was higher in the Philippines (11.0) than Malaysia (8.3), and CVD contributed to a higher proportion of deaths in the Philippines (58% vs 36%). By contrast, all-cause mortality rates were higher in Malaysia (14.1) than in the Philippines (10.9). Approximately 78% of the PAF for CVD and 68% of the PAF for all-cause mortality were attributable to 12 modifiable risk factors. For CVD, the largest PAF was from hypertension (24.2%), whereas for all-cause mortality, the largest PAF was from low education (18.4%). Conclusions CVD and cancer account for one-half of adult mortality in Malaysia and the Philippines. Hypertension was the largest population driver of CVD, whereas low education was associated with the largest burden of overall mortality.
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Affiliation(s)
- Aditya K. Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Nafiza Mat-Nasir
- Department of Primary Care Medicine, Faculty of Medicine, MARA Technological University, Sungai Buloh Campus, Selangor, Malaysia
| | - Rosnah Ismail
- Faculty of Medicine, Kebangsaan University, Selangor, Malaysia
| | | | - Marc Evans M. Abat
- Department of Medicine, Philippine General Hospital, Manila, Philippines
| | - Shofiqul Islam
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Philip Joseph
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Darryl P. Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Koon K. Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
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Siddique AB, Hosen MS, Akter H, Hossain SM, Al Mamun M. Assessment of knowledge, attitudes, and practices regarding cardiovascular diseases (CVDs) among older individuals of rural Bangladesh: findings from a face-to-face interview. Front Public Health 2024; 12:1336531. [PMID: 38855451 PMCID: PMC11157036 DOI: 10.3389/fpubh.2024.1336531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Introduction Cardiovascular diseases (CVDs) stand as the foremost contributor to global mortality, claiming roughly 17.9 million lives each year, constituting 32.1% of total fatalities. Their impact is notably profound in economies such as Bangladesh, exacting a substantial economic burden. Consequently, grasping the landscape of knowledge, attitudes, and practices is essential for timely identification and prevention strategies. Methods This cross-sectional study, carried out between January and May 2023 in the rural regions of Zirani, Savar Upazila, Dhaka, Bangladesh, utilized convenient sampling and conducted face-to-face interviews using a semi-structured questionnaire. It encompassed socio-demographic factors, as well as knowledge, attitudes, and practices concerning CVDs. Data analysis employed descriptive statistics, chi-square tests, and regression analyses, utilizing both the R programming language and SPSS (Version 26). Result A total of 424 participants aged 60 years and above were included. The majority were male (60.8%), and the mean age was 71.21 ± 9.21 years, 57.3% were between 60 and 70 years old. Factors such as education, monthly family income, high blood pressure, diabetes, and non-smoking. Were significantly associated with higher knowledge, attitudes and practices scores. Conclusion This study illuminates CVD-related KAP among rural Older Individuals in Bangladesh, revealing significant associations between factors such as education, monthly family income, high blood pressure, and non-smoking, with higher scores in knowledge, attitudes, and practices regarding cardiovascular health. These insights underscore the importance of addressing socio-economic factors and health behaviors in developing targeted interventions for the prevention and management of cardiovascular diseases in this demographic.
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Affiliation(s)
- Abu Bakkar Siddique
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, Bangladesh
- International Centre for Research, Innovation, Training and Development (ICRITD), Savar, Dhaka, Bangladesh
- AMR Reference Laboratory (Research), Bangladesh Livestock Research Institute, Savar, Dhaka, Bangladesh
- Health and Environmental Epidemiology Laboratory (HEEL), Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Md. Shohag Hosen
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Hasna Akter
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Syed Mujakkir Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Md. Al Mamun
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
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Geldsetzer P, Tisdale RL, Stehr L, Michalik F, Lemp J, Aryal KK, Damasceno A, Houehanou C, Jørgensen JMA, Lunet N, Mayige M, Saeedi Moghaddam S, Mwangi KJ, Bommer C, Marcus ME, Theilmann M, Ebert C, Atun R, Davies JI, Flood D, Manne-Goehler J, Seiglie J, Bärnighausen T, Vollmer S. The prevalence of cardiovascular disease risk factors among adults living in extreme poverty. Nat Hum Behav 2024; 8:903-916. [PMID: 38480824 DOI: 10.1038/s41562-024-01840-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/24/2024] [Indexed: 04/10/2024]
Abstract
Evidence on cardiovascular disease (CVD) risk factor prevalence among adults living below the World Bank's international line for extreme poverty (those with income <$1.90 per day) globally is sparse. Here we pooled individual-level data from 105 nationally representative household surveys across 78 countries, representing 85% of people living in extreme poverty globally, and sorted individuals by country-specific measures of household income or wealth to identify those in extreme poverty. CVD risk factors (hypertension, diabetes, smoking, obesity and dyslipidaemia) were present among 17.5% (95% confidence interval (CI) 16.7-18.3%), 4.0% (95% CI 3.6-4.5%), 10.6% (95% CI 9.0-12.3%), 3.1% (95% CI 2.8-3.3%) and 1.4% (95% CI 0.9-1.9%) of adults in extreme poverty, respectively. Most were not treated for CVD-related conditions (for example, among those with hypertension earning <$1.90 per day, 15.2% (95% CI 13.3-17.1%) reported taking blood pressure-lowering medication). The main limitation of the study is likely measurement error of poverty level and CVD risk factors that could have led to an overestimation of CVD risk factor prevalence among adults in extreme poverty. Nonetheless, our results could inform equity discussions for resource allocation and design of effective interventions.
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Affiliation(s)
- Pascal Geldsetzer
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA.
- Chan Zuckerberg Biohub - San Francisco, San Francisco, CA, USA.
| | - Rebecca L Tisdale
- Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Lisa Stehr
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Felix Michalik
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Julia Lemp
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Krishna K Aryal
- Department for International Development/Nepal Health Sector Programme 3/Monitoring Evaluation and Operational Research, Abt Associates, Kathmandu, Nepal
| | - Albertino Damasceno
- Department of Public and Forensic Health Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Jutta Mari Adelin Jørgensen
- Institute of Global Health, Dept of Public Health and Epidemiology, Copenhagen University, Copenhagen, Denmark
| | - Nuno Lunet
- Department of Public and Forensic Health Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Christian Bommer
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Maja-Emilia Marcus
- Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Department of Economics, University of Goettingen, Göttingen, Germany
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Cara Ebert
- RWI-Leibniz Institute for Economic Research, Essen (Berlin Office), Berlin, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Justine Ina Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - David Flood
- Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacqueline Seiglie
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Sebastian Vollmer
- Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Department of Economics, University of Goettingen, Göttingen, Germany
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Miller V, Jenkins DA, Dehghan M, Srichaikul K, Rangarajan S, Mente A, Mohan V, Swaminathan S, Ismail R, Luz Diaz M, Ravindran RM, Zatonska K, Bahonar A, Altuntas Y, Khatib R, Lopez-Jaramillo P, Yusufali A, Yeates K, Chifamba J, Iqbal R, Yusuf R, Catherina Swart E, Bo H, Han G, Li X, Alhabib KF, Rosengren A, Avezum A, Lanas F, Yusuf S. Associations of the glycaemic index and the glycaemic load with risk of type 2 diabetes in 127 594 people from 20 countries (PURE): a prospective cohort study. Lancet Diabetes Endocrinol 2024; 12:330-338. [PMID: 38588684 DOI: 10.1016/s2213-8587(24)00069-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The association between the glycaemic index and the glycaemic load with type 2 diabetes incidence is controversial. We aimed to evaluate this association in an international cohort with diverse glycaemic index and glycaemic load diets. METHODS The PURE study is a prospective cohort study of 127 594 adults aged 35-70 years from 20 high-income, middle-income, and low-income countries. Diet was assessed at baseline using country-specific validated food frequency questionnaires. The glycaemic index and the glycaemic load were estimated on the basis of the intake of seven categories of carbohydrate-containing foods. Participants were categorised into quintiles of glycaemic index and glycaemic load. The primary outcome was incident type 2 diabetes. Multivariable Cox Frailty models with random intercepts for study centre were used to calculate hazard ratios (HRs). FINDINGS During a median follow-up of 11·8 years (IQR 9·0-13·0), 7326 (5·7%) incident cases of type 2 diabetes occurred. In multivariable adjusted analyses, a diet with a higher glycaemic index was significantly associated with a higher risk of diabetes (quintile 5 vs quintile 1; HR 1·15 [95% CI 1·03-1·29]). Participants in the highest quintile of the glycaemic load had a higher risk of incident type 2 diabetes compared with those in the lowest quintile (HR 1·21, 95% CI 1·06-1·37). The glycaemic index was more strongly associated with diabetes among individuals with a higher BMI (quintile 5 vs quintile 1; HR 1·23 [95% CI 1·08-1·41]) than those with a lower BMI (quintile 5 vs quintile 1; 1·10 [0·87-1·39]; p interaction=0·030). INTERPRETATION Diets with a high glycaemic index and a high glycaemic load were associated with a higher risk of incident type 2 diabetes in a multinational cohort spanning five continents. Our findings suggest that consuming low glycaemic index and low glycaemic load diets might prevent the development of type 2 diabetes. FUNDING Full funding sources are listed at the end of the Article.
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Affiliation(s)
- Victoria Miller
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - David A Jenkins
- Department of Nutritional Sciences and Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Toronto 3D Knowledge Synthesis and Clinical Trials Unit, Toronto, ON, Canada; Clinical Nutrition Risk Factor Modification Centre, St Michael's Hospital, Toronto, ON, Canada; Division of Endocrinology and Metabolism, St Michael's Hospital, Toronto, ON, Canada
| | - Mahshid Dehghan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Kristie Srichaikul
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Viswanathan Mohan
- Department of Diabetology, Madras Diabetes Research Foundation & Dr Mohan's Diabetes Specialties Centre, Chennai, India
| | - Sumathi Swaminathan
- St John's Research Institute, St John's National Academy of Health Sciences, Bangalore, India
| | - Rosnah Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan, Kuala Lumpur, Malaysia
| | | | - Rekha M Ravindran
- Department of Health Sciences, Government of Kerala, Kerala, India; Health Action by People, Trivandrum, Kerala, India
| | | | - Ahmad Bahonar
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yuksel Altuntas
- University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Health Training Research Hospital, Clinic of Endocrinology and Metabolism, Sisli/Istabul, Türkiye
| | - Rasha Khatib
- Advocate Aurora Research Institute, Milwaukee, WI, USA; Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
| | | | | | - Karen Yeates
- Division of Nephrology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Jephat Chifamba
- Department of Biomedical Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rita Yusuf
- Center for Health, Population and Development, Independent University, Dhaka, Bangladesh
| | | | - Hu Bo
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Guoliang Han
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaocong Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyaadh, Saudi Arabia
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alvaro Avezum
- International Research Center, Hospital Alemão-Oswaldo Cruz & UNISA, São Paulo, SP Brazil
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Aboyans V, Boutaleb AM. Cardiology off the map: the impact of remoteness on secondary prevention after myocardial infarction. Eur J Prev Cardiol 2024:zwae091. [PMID: 38527225 DOI: 10.1093/eurjpc/zwae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Affiliation(s)
- Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, Martin Luther King Ave., Limoges 87042, France
- EpiMaCT, Inserm 1094 & IRD 270, 2, Rue du Dr Marcland, Limoges University, Limoges, France
| | - Amine Mamoun Boutaleb
- Department of Cardiology, Dupuytren-2 University Hospital, Martin Luther King Ave., Limoges 87042, France
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Zhu Y, Wang Y, Shrikant B, Tse LA, Zhao Y, Liu Z, Wang C, Xiang Q, Rangarajan S, Li S, Liu W, Li M, Han A, Tang J, Hu B, Yusuf S, Li W. Socioeconomic disparity in mortality and the burden of cardiovascular disease: analysis of the Prospective Urban Rural Epidemiology (PURE)-China cohort study. Lancet Public Health 2023; 8:e968-e977. [PMID: 38000890 DOI: 10.1016/s2468-2667(23)00244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Although socioeconomic inequality in cardiovascular health has long been a public health focus, the differences in cardiovascular-disease burden and mortality between people with different socioeconomic statuses has yet to be adequately addressed. We aimed to assess the effects of socioeconomic status, measured via three socioeconomic-status indicators (ie, education, occupation, and household wealth and a composite socioeconomic-status disparity index, on mortality and cardiovascular-disease burden (ie, incidence, mortality, and admission to hospital) in China. METHODS For this analysis, we used data from the Prospective Urban Rural Epidemiology (PURE)-China cohort study, which enrolled adults aged 35-70 years from 115 urban and rural areas in 12 provinces in China between Jan 1, 2005, and Dec 31, 2009. Final follow-up was on Aug 30, 2021. Indicators of socioeconomic status were education, occupation, and household wealth; these individual indicators were also used to create an integrated socioeconomic-status index via latent class analysis. Standard questionnaires administered by trained researchers were used to obtain baseline data and were supplemeted by physical measurements. The primary outcomes were all-cause mortality, cardiovascular-disease mortality, non-cardiovascular-disease mortality, major cardiovascular disease, and cardiovascular-disease admission to hospital. Hazard ratios (HRs) and average marginal effects were used to assess the association between the primary outcomes and socioeconomic status. FINDINGS Of 47 931 participants enrolled in the PURE-China study, 47 278 (98·6%) had complete information on sex and follow-up. After excluding 1189 (2·5%) participants with missing data on education, household wealth, and occupation at baseline, 46 089 participants were included in this analysis. Median follow-up was 11·9 years (IQR 9·5-12·6); 26 860 (58·3%) of 46 089 participants were female and 19 229 (41·7%) were male. Having no or primary education, unskilled occupation, or being in the lowest third of household wealth was associated with a higher risk of all-cause mortality, cardiovascular-disease mortality, non-cardiovascular-disease mortality, major cardiovascular disease, and cardiovascular-disease admission to hospital compared with having higher education, a professional or managerial occupation, or more household wealth. After adjustment for confounders, people categorised as having low integrated socioeconomic status based on the index had a higher risk of all-cause mortality (HR 1·65 [95% CI 1·42-1·92]), cardiovascular-disease mortality (2·19 [1·68-2·85]), non-cardiovascular disease mortality (1·43 [1·18-1·72]), major cardiovascular disease (1·43 [1·27-1·61]) and cardiovascular-disease admission to hospital (1·14 [1·01-1·28]) compared with people categorised as having high integrated socioeconomic status. INTERPRETATION Socioeconomic-status inequalities in mortality and cardiovascular-disease outcomes exist in China. Targeted policies of equal health-care resource allocation should be promoted to equitably benefit people with fewer years of education and less household wealth. FUNDING Funding sources are listed at the end of the Article.
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Affiliation(s)
- Yingxuan Zhu
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bangdiwala Shrikant
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Lap Ah Tse
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiguang Liu
- Clinical Trial Unit, Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chuangshi Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Quanyong Xiang
- Centers for Disease Control and Prevention in Jiangsu Province, Nanjing, China
| | - Sumathy Rangarajan
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Sidong Li
- Institute of Public Health Sciences, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Weida Liu
- State Key Laboratory for Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Mengya Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Aiying Han
- Bayannao'er Center for Disease Control and Prevention, Bayannao'er, China
| | - Jinhua Tang
- Department of General Practice, Xiaohang Hospital, Nanjing, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute and Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Wei Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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Jain M, Sawant R, Panchal H, S A, Jena A, Gupta R, Kumar K, Jambunathan R, Modi S, Mullasari A, Sinha N, Shetty K, Kawatra P. Evaluating LDL-C control in Indian acute coronary syndrome (ACS) patients- A retrospective real-world study LDL-C control in ACS. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200210. [PMID: 37771607 PMCID: PMC10523158 DOI: 10.1016/j.ijcrp.2023.200210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/31/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
Background Low-density lipoprotein-cholesterol (LDL-C) is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) progression. Although lipid lowering therapies remain the cornerstone of secondary ACSVD prevention, there exists residual dyslipidemia. The current study aimed to evaluate the real-world experience related to the treatment patterns and LDL-C control in Indian Acute Coronary Syndrome (ACS) patients. Methods This was a real-world, descriptive, retrospective, observational, and multicentric study conducted across India. The data was collected for 1 year following the ACS event. The change in the levels of LDL-C from the baseline to the follow-up visits and the control of LDL-C, the change in lipid profile, lipoprotein levels, treatment patterns for lipid-lowering, and tolerability of existing treatments were evaluated. Results Overall, 575 patients were included from 11 centers across India. The mean age of the patients was 52.92 years, with male predominance (76.35%). Although there was a significant reduction in the mean levels of LDL-C from the baseline [(122.64 ± 42.01 mg/dl to 74.41 ± 26.45 mg/dl (p < 0.001)], it was observed that despite high-intensity statin therapy, only 20.87% patients managed to achieve target LDL-C of <55 mg/dL and 55.65% were unable to reach LDL-C levels of <70 mg/dl one year after the event. Six patients reported adverse events without treatment discontinuation. Conclusion The majority of the patients received high-intensity statins and did not attain target LDL-C levels, suggesting LDL-C control after an ACS event requires management with novel therapies having better efficacy as recommended by international and national guidelines.
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Affiliation(s)
| | | | | | - Anand S
- Kauvery Heart City, Tamil Nadu, India
| | | | | | | | | | - Sunil Modi
- Indraprasatha Apollo Hospital, New Delhi, India
| | | | | | - Kimi Shetty
- Medical Lead, Novartis Healthcare Private Limited, Mumbai, India
| | - Pallavi Kawatra
- Franchise Medical Head, Novartis Healthcare Private Limited, Mumbai, India
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9
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Sebastian IA, Gandhi DB, Sylaja PN, Paudel R, Kalkonde YV, Yangchen Y, Gunasekara H, Injety RJ, Vijayanand PJ, Chawla NS, Oo S, Hla KM, Tenzin T, Pandian JD. Stroke systems of care in South-East Asia Region (SEAR): commonalities and diversities. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 17:100289. [PMID: 37849930 PMCID: PMC10577144 DOI: 10.1016/j.lansea.2023.100289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023]
Abstract
The Southeast Asia Region (SEAR) accounts for nearly 50% of the developing world's stroke burden. With various commonalities across its countries concerning health services, user awareness, and healthcare-seeking behavior, SEAR still presents profound diversities in stroke-related services across the continuum of care. This review highlights the numerous systems and challenges in access to stroke care, acute stroke care services, and health care systems, including rehabilitation. The paper has also attempted to compile information on the availability of stroke specialized centers, Intravenous thrombolysis (IVT) ready centers, Endovascular therapy (EVT) ready centers, rehabilitation centers, and workforce against a backdrop of each country's population. Lastly, the efforts of WHO (SEARO)-CMCL (World Health Organization-South East Asia region, Christian Medical College & Hospital Ludhiana) collaboration towards improving stroke services and capacity among the SEAR have been described.
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Affiliation(s)
| | - Dorcas B.C. Gandhi
- Department of Neurology and Physiotherapy, Christian Medical College and Hospital, India
| | - Padmavati N. Sylaja
- Department of Neurology, Shree Chitra Thirunal Institute, Thiruvananthapuram, Kerala, India
| | - Raju Paudel
- Grande International Hospital, Kathmandu, Nepal
| | | | | | | | - Ranjit J. Injety
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Pranay J. Vijayanand
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Nistara S. Chawla
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - San Oo
- Department of Neurology, Yangon General Hospital, Yangon, Myanmar
| | - Khin Myo Hla
- Department of Physical Medicine & Rehabilitation, Yangon General Hospital, University of Medicine, Yangon, Myanmar
| | - Tashi Tenzin
- Jigme Dorji Wangchuck National Referral Hospital, Thimpu, Bhutan
| | - Jeyaraj D. Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
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10
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Rafiei S, Raoofi S, Baghaei A, Masoumi M, Doustmehraban M, Nejatifar Z, Sanaei M, Bagheribayati F, Vaziri Shahrebabak ES, Shayestehbonyan M, Javan Biparva A, Raoofi N, Mir M, Momeni Z, Yousefy S, Hashemi Khoonigh Z, Rezaei F, Pashazadeh Kan F, Ghashghaee A. Depression prevalence in cardiovascular disease: global systematic review and meta-analysis. BMJ Support Palliat Care 2023; 13:281-289. [PMID: 36898764 DOI: 10.1136/spcare-2022-003884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 01/11/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Sima Rafiei
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Samira Raoofi
- Student Research Committee, Faculty of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran
| | - Aryan Baghaei
- Student Research Committee, Guilan University of Medical Sciences, Guilan, Iran
| | - Maryam Masoumi
- Clinical Research and Development Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Zahra Nejatifar
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohaddeseh Sanaei
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Akbar Javan Biparva
- Student Research Committee, School of Health Management and Medical Informatics, Iranian Center of Excellence in Health Management, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Raoofi
- Cardiovascular Research Center Kermanshah, Kermanshah, Iran
| | - Maryam Mir
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Momeni
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sama Yousefy
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Fatemeh Rezaei
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fatemeh Pashazadeh Kan
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Ghashghaee
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
- The School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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11
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Tang X, Zhan ZY, Rao Z, Fang H, Jiang J, Hu X, Hu Z. A spatiotemporal analysis of the association between carbon productivity, socioeconomics, medical resources and cardiovascular diseases in southeast rural China. Front Public Health 2023; 11:1079702. [PMID: 37483926 PMCID: PMC10359911 DOI: 10.3389/fpubh.2023.1079702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/20/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction With China's rapid industrialization and urbanization, China has been increasing its carbon productivity annually. Understanding the association between carbon productivity, socioeconomics, and medical resources with cardiovascular diseases (CVDs) may help reduce CVDs burden. However, relevant studies are limited. Objectives The study aimed to describe the temporal and spatial distribution pattern of CVDs hospitalization in southeast rural China and to explore its influencing factors. Methods In this study, 1,925,129 hospitalization records of rural residents in southeast China with CVDs were analyzed from the New Rural Cooperative Medical Scheme (NRCMS). The spatial distribution patterns were explored using Global Moran's I and Local Indicators of Spatial Association (LISA). The relationships with influencing factors were detected using both a geographically and temporally weighted regression model (GTWR) and multiscale geographically weighted regression (MGWR). Results In southeast China, rural inpatients with CVDs increased by 95.29% from 2010 to 2016. The main groups affected were elderly and women, with essential hypertension (26.06%), cerebral infarction (17.97%), and chronic ischemic heart disease (13.81%) being the leading CVD subtypes. The results of LISA shows that central and midwestern counties, including Meilie, Sanyuan, Mingxi, Jiangle, and Shaxian, showed a high-high cluster pattern of CVDs hospitalization rates. Negative associations were observed between CVDs hospitalization rates and carbon productivity, and positive associations with per capita GDP and hospital beds in most counties (p < 0.05). The association between CVDs hospitalization rates and carbon productivity and per capita GDP was stronger in central and midwestern counties, while the relationship with hospital bed resources was stronger in northern counties. Conclusion Rural hospitalizations for CVDs have increased dramatically, with spatial heterogeneity observed in hospitalization rates. Negative associations were found with carbon productivity, and positive associations with socioeconomic status and medical resources. Based on our findings, we recommend low-carbon development, use of carbon productivity as an environmental health metric, and rational allocation of medical resources in rural China.
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Affiliation(s)
- Xuwei Tang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhi-Ying Zhan
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Zhixiang Rao
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Haiyin Fang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jian Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
- Medical Department of Fujian Provincial Hospital, Fuzhou, China
| | - Xiangju Hu
- Fujian Center for Disease Control and Prevention, Fuzhou, China
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
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12
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Xia Y, Liu Z, Hu B, Rangarajan S, Ah Tse L, Li Y, Wang J, Hu L, Wang Y, Xiang Q, Lin Y, Han G, Yusuf S, Li W. Associations of outdoor fine particulate air pollution and cardiovascular disease: Results from the Prospective Urban and Rural Epidemiology Study in China (PURE-China). ENVIRONMENT INTERNATIONAL 2023; 174:107829. [PMID: 36934571 DOI: 10.1016/j.envint.2023.107829] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Evidence on whether an excess risk of incidence and mortality of cardiovascular disease (CVD) among people exposed to a high level of ambient PM2.5 in low- and middle-income countries (LMICs) is lacking. This study aimed to investigate the associations between long-term exposure to ambient fine particulate matter<2.5 µm (PM2.5) concentrations and the risk of incidence and mortality of CVD in a large cohort study from 115 communities. METHODS In this cohort study, we followed 42 160 adults aged 35-75 years at baseline who enrolled in the Prospective Urban and Rural Epidemiology Study conducted in China (PURE-China) between 2005 and 2009 with ambient PM2.5 estimates, and followed up until August 2021. Cox proportional hazards frailty models were used to estimate the associations between long-term mean outdoor PM2.5 concentrations and CVD events, CVD mortality, and all-cause mortality. FINDINGS During a median follow-up period of 11.8 years, we documented 2 190 deaths, including 732 CVD deaths. There were 4 559 (10.8 %) of 42 160 participants who experienced incident total CVD, among them there were 861 myocardial infarctions (MI) and 2 338 S. The 3-year median concentration of ambient PM2.5 before the cohort commencement was 52.7 µg/m3 (interquartile range [IQR] 30.3-74.6). In full adjusted model, a 10 µg/m3 increase in PM2.5 was associated with a hazard ratio (HR) of 1.12 (95 % CI 1.11-1.14) for major CVD and 1.03 (95 % CI 1.01-1.05) for all-cause mortality. Besides, long-term PM2.5 concentrations had a significantly positive gradient association with total CVD and a similar pattern of associations with other CVD outcomes was observed. INTERPRETATION This study demonstrated that long-term ambient PM2.5 concentrations is positively associated with increased risks of CVD in adults aged 35-70 years from China. This finding reinforces the need for policymakers to adopt more effective strategies to improve air quality.
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Affiliation(s)
- Yanjie Xia
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhiguang Liu
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bo Hu
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Yang Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Junying Wang
- Balingqiao Community Health Service Center, Xinghualing District, Taiyuan, Shanxi Province, China
| | - Lihua Hu
- Nanchang County Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Yang Wang
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quanyong Xiang
- Centers for Disease Control and Prevention in Jiangsu Province, Nanjing, Jiangsu Province, China
| | - Yang Lin
- Department of Pharmacy, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guoliang Han
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Wei Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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13
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Dehghan M, Mente A, Rangarajan S, Mohan V, Swaminathan S, Avezum A, Lear SA, Rosengren A, Poirier P, Lanas F, Lopez-Jaramillo P, Soman B, Wang C, Orlandini A, Mohammadifard N, AlHabib KF, Chifamba J, Yusufali AH, Iqbal R, Khatib R, Yeates K, Puoane T, Altuntas Y, Co HU, Li S, Liu W, Zatońska K, Yusuf R, Ismail N, Miller V, Yusuf S. Ultra-processed foods and mortality: analysis from the Prospective Urban and Rural Epidemiology study. Am J Clin Nutr 2023; 117:55-63. [PMID: 36789944 DOI: 10.1016/j.ajcnut.2022.10.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 09/26/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Higher intake of ultra-processed foods (UPFs) has been associated with increased risk of CVD and mortality in observational studies from Western countries but data from non-Western countries are limited. OBJECTIVES We aimed to assess the association between consumption of UPFs and risk of mortality and major CVD in a cohort from multiple world regions. DESIGN This analysis includes 138,076 participants without a history of CVD between the ages of 35 and 70 y living on 5 continents, with a median follow-up of 10.2 y. We used country-specific validated food-frequency questionnaires to determine individuals' food intake. We classified foods and beverages based on the NOVA classification into UPFs. The primary outcome was total mortality (CV and non-CV mortality) and secondary outcomes were incident major cardiovascular events. We calculated hazard ratios using multivariable Cox frailty models and evaluated the association of UPFs with total mortality, CV mortality, non-CV mortality, and major CVD events. RESULTS In this study, 9227 deaths and 7934 major cardiovascular events were recorded during the follow-up period. We found a diet high in UPFs (≥2 servings/d compared with 0 intake) was associated with higher risk of mortality (HR: 1.28; 95% CI: 1.15, 1.42; P-trend < 0.001), CV mortality (HR: 1.17; 95% CI: 0.98, 1.41; P-trend = 0.04), and non-CV mortality (HR: 1.32; 95% CI 1.17, 1.50; P-trend < 0.001). We did not find a significant association between UPF intake and risk of major CVD. CONCLUSIONS A diet with a high intake of UPFs was associated with a higher risk of mortality in a diverse multinational study. Globally, limiting the consumption of UPFs should be encouraged.
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Affiliation(s)
- Mahshid Dehghan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
| | - Andrew Mente
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | | | - Sumathi Swaminathan
- St John's Research Institute, St John's National Academy of Health Sciences, Sarjapur Road, Koramangala, Bangalore, Karnataka, India
| | - Alvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University c/o Healthy Heart Program, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR Region, Sweden
| | - Paul Poirier
- Heart and Lung Institute, Laval University, Quebec City, QC, Canad
| | | | | | - Biju Soman
- Health Action by People, Thiruvananthapuram, Kerala, India
| | - Chuangshi Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | | | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Jephat Chifamba
- University of Zimbabwe, Faculty of Medicine and Health Sciences, Unit of Physiology, Harare, Zimbabwe
| | - Afzal Hussein Yusufali
- Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Pakistan
| | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine & Advocate Research Institute, Advocate Health Care, IL, USA
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Canada
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Yuksel Altuntas
- University of Health Sciences Turkey, Faculty of Medicine, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Clinic of Endocrinology and Metabolism, Sisli, Istanbul, Turkey
| | - Homer Uy Co
- University of the Philippines College of Medicine, Manila, Philippines
| | - Sidong Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Weida Liu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | | | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan, Kuala Lumpur, Malaysia
| | - Victoria Miller
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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14
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Lang X, Liu Z, Islam S, Han G, Rangarajan S, Tse LA, Mushtaha M, Wang J, Hu L, Qiang D, Zhu Y, Yusuf S, Lin Y, Hu B. Interaction of Depression and Unhealthy Diets on the Risk of Cardiovascular Diseases and All-Cause Mortality in the Chinese Population: A PURE Cohort Substudy. Nutrients 2022; 14:nu14235172. [PMID: 36501202 PMCID: PMC9736353 DOI: 10.3390/nu14235172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
This study aimed to identify the interaction of depression and diets on cardiovascular diseases (CVD) incident and death in China and key subpopulations. We included 40,925 participants from the Prospective Urban Rural Epidemiology (PURE)-China cohort which recruited participants aged 35-70 years from 45 urban and 70 rural communities. Depression was measured by the adapted Short-Form (CIDI-SF). The unhealthy diet was considered when the score of Alternative Healthy Eating Index was below the lowest tertile. The primary outcome was a composite outcome of incident CVD and all-cause mortality. Cox frailty models were used to examine the associations. During a median follow-up of 11.9 years (IQR: 9.6-12.6 years), depression significantly increased the risk of the composite outcome (HR = 2.00; 95% CI, 1.16-3.27), major CVD (HR = 1.82; 95% CI, 1.48-2.23), and all-cause mortality (HR = 2.21; 95% CI, 1.51-3.24) for the unhealthy diet group, but not for the healthy diet group. The interaction between depression and diet for the composite outcome was statistically significant (RERI = 1.19; 95% CI, 0.66-1.72; AP = 0.42, 95% CI, 0.27-0.61; SI = 3.30, 95% CI, 1.42-7.66; multiplicative-scale = 1.74 95% CI, 1.27-2.39), even in the subgroup and sensitivity analyses. In addition, the intake of vegetable and polyunsaturated fatty acids contributed most to the interaction of diets and depression. Depressive participants should focus on healthy diets, especially vegetables and polyunsaturated fatty acids, to avoid premature death and CVD.
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Affiliation(s)
- Xinyue Lang
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, The National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102300, China
| | - Zhiguang Liu
- Department of Pharmacy and Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Shofiqul Islam
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8S 4L8, Canada
| | - Guoliang Han
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, The National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102300, China
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8S 4L8, Canada
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Maha Mushtaha
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8S 4L8, Canada
| | - Junying Wang
- Balingqiao Community Health Service Center, Xinghualing District, Taiyuan 030009, China
| | - Lihua Hu
- Nanchang Center for Disease Control and Prevention, Nanchang 330299, China
| | - Deren Qiang
- Wujin District Center for Disease Control and Prevention, Changzhou 213022, China
| | - Yingxuan Zhu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, The National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102300, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8S 4L8, Canada
| | - Yang Lin
- Department of Pharmacy and Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
- Correspondence: (Y.L.); (B.H.); Tel.: +86-13701073623 (Y.L.); +86-15530587011 (B.H.)
| | - Bo Hu
- Medical Research & Biometrics Center, National Center for Cardiovascular Diseases, The National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 102300, China
- Correspondence: (Y.L.); (B.H.); Tel.: +86-13701073623 (Y.L.); +86-15530587011 (B.H.)
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15
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Liu Z, Li M, Zhu Y, Hystad P, Ma Y, Rangarajan S, Zhao Q, Hu L, Yusuf S, Li Y, Tse LA. Association of Household Utility of Cleaner Fuel With Lower Hypertension Prevalence and Blood Pressure in Chinese Adults. Int J Public Health 2022; 67:1605193. [PMID: 36506713 PMCID: PMC9729250 DOI: 10.3389/ijph.2022.1605193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objectives: To investigate whether lower hypertension prevalence or blood pressure was associated with cleaner household fuel usage for cooking and heating among Chinese adults. Methods: We enrolled 44,862 Chinese adults at the baseline of the prospective urban and rural epidemiology (PURE) study in China during 2005-2009, as a subset of the PURE-global China site. Multilevel logistic regression and generalized linear mixed models were conducted to estimate the adjusted odds ratio (AOR) and regression coefficient for hypertension and blood pressure respectively, while subgroup analysis by ambient PM2.5 concentration and location was also examined. Results: Compared with the least clean household solid fuel group, gas (AOR = 0.91, 95% CI: 0.83, 0.99) or electricity (AOR = 0.72, 95% CI: 0.60, 0.87) was associated with significantly lower levels of hypertension prevalence and blood pressure, and a similar pattern of the association was consistently observed among participants with high ambient PM2.5 exposure and those living in urban areas. Conclusion: Household utility of cleaner fuel type was associated with lower hypertension prevalence and blood pressure in Chinese adults. Our study urges the utilization of cleaner household energy to mitigate the burden of hypertension.
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Affiliation(s)
- Zhiguang Liu
- Department of Pharmacy and Clinical Trial Unit, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mengya Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yibing Zhu
- Department of Emergency, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Perry Hystad
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, United States
| | - Yuanting Ma
- Dongguan street Community Health Service Center, Xining, China
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Qian Zhao
- General Practice Ward/International Medical Center Ward, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lihua Hu
- Nanchang Center for Disease Control and Prevention, Nanchang, China
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Yang Li
- Medical Research and Biometrics Center, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,*Correspondence: Lap Ah Tse, ; Yang Li,
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China,*Correspondence: Lap Ah Tse, ; Yang Li,
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16
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Reddy NK, Kaushal V, Kanaya AM, Kandula NR, Gujral UP, Shah NS. Cardiovascular risk factor profiles in North and South Indian and Pakistani Americans: The MASALA Study. Am Heart J 2022; 244:14-18. [PMID: 34688649 PMCID: PMC9060882 DOI: 10.1016/j.ahj.2021.10.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/05/2021] [Indexed: 02/03/2023]
Abstract
South Asians in the United States have disproportionately high burden of cardiovascular disease compared to other race/ethnic groups but are a heterogenous population, so we evaluated differences in prevalence and adjusted odds of cardiovascular risk factors including diabetes, hypertension, dyslipidemia, and obesity between North Indian, South Indian, and Pakistani immigrants in the United States in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Given cultural differences among residents of Indian regions, for example in dietary patterns, we categorized Indian participants as North or South Indian. In 1,018 participants (728 North Indian [47% women], 223 South Indian [43% women], 67 Pakistani [52% women]), unadjusted diabetes and obesity prevalence was highest in Pakistani participants (33% and 48%, respectively); hypertension prevalence was highest in North Indian participants (54%); dyslipidemia prevalence was highest in South Indian and Pakistani participants (55%); and South Indian participants had a higher odds of dyslipidemia (OR 1.77, 95% CI 1.27, 2.47) compared with North Indian participants in fully adjusted models. As differences in cardiovascular risk factors were observed across South Asian American subgroups, identifying the determinants of suboptimal cardiovascular health within South Asian American subgroups may help to better tailor cardiovascular disease prevention strategies.
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Affiliation(s)
- Neha K. Reddy
- Department of Medicine (General Internal Medicine and Geriatrics), Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, TX
| | - Vaidehi Kaushal
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Alka M. Kanaya
- Department of Medicine, University of California - San Francisco, San Francisco, CA
| | - Namratha R. Kandula
- Department of Medicine (General Internal Medicine and Geriatrics), Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Unjali P. Gujral
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA
| | - Nilay S. Shah
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, Chicago, IL
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17
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Khetan AK, Yusuf S, Lopez-Jaramillo P, Szuba A, Orlandini A, Mat-Nasir N, Oguz A, Gupta R, Avezum Á, Rosnah I, Poirier P, Teo KK, Wielgosz A, Lear SA, Palileo-Villanueva LM, Serón P, Chifamba J, Rangarajan S, Mushtaha M, Mohan D, Yeates K, McKee M, Mony PK, Walli-Attaei M, Khansaheb H, Rosengren A, Alhabib KF, Kruger IM, Paucar MJ, Mirrakhimov E, Assembekov B, Leong DP. Variations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis. EClinicalMedicine 2022; 44:101284. [PMID: 35106472 PMCID: PMC8794545 DOI: 10.1016/j.eclinm.2022.101284] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic. METHODS Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income. FINDINGS Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88-2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69-19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status. INTERPRETATION The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries. FUNDING Funding for this study was provided by the Canadian Institutes of Health Research and the International Development Research Centre.
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Affiliation(s)
- Aditya K Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Patricio Lopez-Jaramillo
- Medical School, Universidad de Santander (UDES), Masira Research Institute, Bucaramanga, Colombia
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | - Andres Orlandini
- ECLA (Estudios Clínicos Latino America) Instituto Cardiovascular de Rosario, Argentina
| | - Nafiza Mat-Nasir
- Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Aytekin Oguz
- Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Rajeev Gupta
- Eternal Heart Care Center and Research Institute, Jaipur, India
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Ismail Rosnah
- Faculty of Medicine of UKM, UKM Medical Center, Kuala Lumpur, Malaysia
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, Québec, Canada
| | - Koon K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | | | - Scott A. Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | | | - Pamela Serón
- Faculty of Medicine, Universidad de La Frontera, Claro Solar, Temuco, Chile
| | - Jephat Chifamba
- Department of Biomedical Sciences, Physiology Unit, Faculty of Medicine and Sciences, University of Zimbabwe, Zimbabwe
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Maha Mushtaha
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Deepa Mohan
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, India
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Marjan Walli-Attaei
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
| | | | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR region, Sweden
| | - Khalid F Alhabib
- King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Iolanthé M Kruger
- Potchefstroom Campus, Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, South Africa
| | - María-José Paucar
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE, Quito, Ecuador
| | | | | | - Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8L 2X2, Canada
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18
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Sigamani A, Gupta R. Revisiting secondary prevention in coronary heart disease. Indian Heart J 2022; 74:431-440. [PMID: 36455667 PMCID: PMC9773289 DOI: 10.1016/j.ihj.2022.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/22/2022] [Accepted: 11/21/2022] [Indexed: 11/30/2022] Open
Abstract
Secondary prevention in coronary heart disease is the prevention of occurrence of recurrent coronary events after clinical diagnosis. High level of adherence to secondary prevention interventions, especially aggressive lifestyle changes and pharmacotherapy can lead to significant decline in recurrent coronary events. Both international and Indian studies have reported low adherence to such therapies. Evidence-based useful interventions include regular physical activity, yoga, intake of healthy diet, smoking and tobacco use cessation and weight management. Pharmacotherapeutic interventions useful are anti-platelet therapy, target oriented lipid lowering therapy with statins, beta blockers and angiotensin converting enzyme inhibitors in patients with impaired left ventricular function. Hypertension and diabetes management with control to targets is important. Novel strategies include use of anticoagulants, anti-inflammatory drugs, and triglyceride lowering for residual risk. Physician and patient level interventions using multifaceted educational, socioeconomic and technological innovations are important to promote life-long adherence to these strategies.
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Affiliation(s)
- Alben Sigamani
- Numen Health, Bengaluru, Karnataka, 560095, India,Corresponding author. Numen Health, Bengaluru, Karnataka, 560095, India.
| | - Rajeev Gupta
- Department of Preventive Cardiology and Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, Rajasthan, 302017, India
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19
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Khetan AK, Leong DP, Gupta R, Zhu Y, Li S, Liu W, Kruger IM, Teo KK, Wielgosz A, Yusuf R, Noor Khan NAM, Khatib R, Alhabib KF, Karsidag K, Chifamba J, Mohammadifard N, Serón P, Lopez-Jaramillo P, Orlandini A, Szuba A, Yusufali A, Nair S, Rosengren A, Yeates K, Dans AM, Iqbal R, Avezum Á, Rangarajan S, Yusuf S. Variations in the association of height with mortality, cardiovascular disease and cancer in low-, middle- and high-income countries. Int J Epidemiol 2021; 51:1304-1316. [PMID: 34939099 DOI: 10.1093/ije/dyab268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Final adult height is a useful proxy measure of childhood nutrition and disease burden. Tall stature has been previously associated with decreased risk of all-cause mortality, decreased risk of major cardiovascular events and an increased risk of cancer. However, these associations have primarily been derived from people of European and East Asian backgrounds, and there are sparse data from other regions of the world. METHODS The Prospective Urban-Rural Epidemiology study is a large, longitudinal population study done in 21 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35-70 years. Height was measured in a standardized manner, without shoes, to the nearest 0.1 cm. During a median follow-up of 10.1 years (interquartile range 8.3-12.0), we assessed the risk of all-cause mortality, major cardiovascular events and cancer. RESULTS A total of 154 610 participants, enrolled since January 2003, with known height and vital status, were included in this analysis. Follow-up event data until March 2021 were used; 11 487 (7.4%) participants died, whereas 9291 (6.0%) participants had a major cardiovascular event and 5873 (3.8%) participants had a new diagnosis of cancer. After adjustment, taller individuals had lower hazards of all-cause mortality [hazard ratio (HR) per 10-cm increase in height 0.93, 95% confidence interval (CI) 0.90-0.96] and major cardiovascular events (HR 0.97, 95% CI 0.94-1.00), whereas the hazard of cancer was higher in taller participants (HR 1.23, 95% CI 1.18-1.28). The interaction p-values between height and country-income level for all three outcomes were <0.001, suggesting that the association with height varied by country-income level for these outcomes. In low-income countries, height was inversely associated with all-cause mortality (HR 0.88, 95% CI 0.84-0.92) and major cardiovascular events (HR 0.87, 95% CI 0.82-0.93). There was no association of height with these outcomes in middle- and high-income countries. The respective HRs for cancer in low-, middle- and high-income countries were 1.14 (95% CI 0.99-1.32), 1.12 (95% CI 1.04-1.22) and 1.20 (95% CI 1.14-1.26). CONCLUSIONS Unlike high- and middle-income countries, tall stature has a strong inverse association with all-cause mortality and major cardiovascular events in low-income countries. Improved childhood physical development and advances in population-wide cardiovascular treatments in high- and middle-income countries may contribute to this gap. From a life-course perspective, we hypothesize that optimizing maternal and child health in low-income countries may improve rates of premature mortality and cardiovascular events in these countries, at a population level.
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Affiliation(s)
- Aditya K Khetan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Darryl P Leong
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Rajeev Gupta
- Eternal Heart Care Center and Research Institute, Jaipur, India
| | - Yibing Zhu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Sidong Li
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Weida Liu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P. R. China
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom Campus, South Africa
| | - Koon K Teo
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Rita Yusuf
- Independent University, Dhaka, Bangladesh
| | | | - Rasha Khatib
- Institute for Community and Public Health, Birzeit University, Birzeit, Palestine; Advocate Aurora Health, Downers Grove, IL, USA
| | - Khalid F Alhabib
- King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kubilay Karsidag
- Department of Internal Medicine, Medical Faculty of Istanbul University, Istanbul, Turkey
| | - Jephat Chifamba
- Department of Biomedical Sciences, Physiology Unit, Faculty of Medicine and Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pamela Serón
- Faculty of Medicine, Universidad de La Frontera, Claro Solar, Temuco, Chile
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Andres Orlandini
- ECLA (Estudios Clínicos Latino America), Instituto Cardiovascular de Rosario, Rosario, Argentina
| | - Andrzej Szuba
- Department of Angiology, Hypertension and Diabetology, Wroclaw Medical University, Wroclaw, Poland
| | | | - Sanjeev Nair
- Health Action by People, Trivandrum and Government Medical College, Thrissur, India
| | - Annika Rosengren
- Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, VGR Region, Gothenburg, Sweden
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Álvaro Avezum
- International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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20
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Chen L, Tan Y, Yu C, Guo Y, Pei P, Yang L, Chen Y, Du H, Wang X, Chen J, Chen Z, Lv J, Li L. Educational disparities in ischaemic heart disease among 0.5 million Chinese adults: a cohort study. J Epidemiol Community Health 2021; 75:1033-1043. [PMID: 33782052 PMCID: PMC8515104 DOI: 10.1136/jech-2020-216314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The relationship between educational attainment and ischaemic heart disease (IHD) is limited in evidence in middle-income countries like China. Exploring lifestyle-related mediators, which might be not universal between socioeconomic status and health outcomes in diverse regions, can contribute to interventions targeted at the Chinese to narrow the educational gap in IHD. METHODS Based on the China Kadoorie Biobank of 489 594 participants aged 30-79 years who did not have heart disease or stroke at baseline, this study examined the association of educational attainment with IHD. Total IHD cases were further divided into acute myocardial infarction (AMI) cases and non-AMI cases. The Cox proportional hazard model was performed to estimate the HRs and 95% CIs for mortality and incidence of IHD. Logistic regression was used to estimate the ORs and 95% CIs for case fatality. RESULTS During the median follow-up period of 11.1 years, this study documented 45 946 (6668) incident IHD (AMI) cases and 5948 (3689) deaths altogether. Lower educational attainment was associated with increased risk of incident AMI as well as death and fatality of total IHD including its subtypes (ptrend <0.001). Although the risk of incident non-AMI was greater for participants with higher levels of education in the whole population (ptrend <0.001), an inverse association of education with its incidence was found in participants from <50 years age group and rural areas. Smoking and dietary habits were the two most potent mediating factors in the associations of education with mortality and AMI incidence; whereas, physical activity was the major mediating factor for non-AMI incidence in the whole population. DISCUSSION Interventions targeting unhealthy lifestyles are ideal ways to narrow the educational gap in IHD while solving 'upstream' causes of health behaviours might be the most fundamental ones.
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Affiliation(s)
- Lu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Yunlong Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xiaohuan Wang
- Hainan Center for Disease Control and Prevention, Haikou, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
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21
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Santi RL, Martinez F, Baranchuk A, Liprandi AS, Piskorz D, Lorenzatti A, Santi MPL, Kaski JC. Management of Dyslipidaemia in Real-world Clinical Practice: Rationale and Design of the VIPFARMA ISCP Project. Eur Cardiol 2021; 16:e16. [PMID: 33995586 PMCID: PMC8117136 DOI: 10.15420/ecr.2020.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
Dyslipidaemia plays a major role in the pathogenesis of atherosclerosis. Every year, scientific institutions publish cardiovascular prevention guidelines with updated goals and recommendations based on new evidence. However, medical barriers exist that make achieving these goals difficult and gaps between guidelines and best daily clinical practice still persist. The International Society of Cardiovascular Pharmacotherapy designed the Surveillance of Prescription Drugs in the Real World Project (VIPFARMA ISCP), a survey for physicians who manage lipid disorders in high-risk patients. Seven clusters of questions will be analysed comprising demographics, institution profile, access to continuing medical education, clinical practice profile, attitude regarding use of statins, knowledge regarding proprotein convertase subtilisin/kexin type 9 inhibitors and attitudes regarding medical decisions about triglycerides. The present study will be the first part of a larger programme and aims to shed light on barriers between lipid-lowering drug therapy recommendations in the 2019 European Society of Cardiology guidelines and clinical practice in different countries.
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Affiliation(s)
- Ricardo Lopez Santi
- Division of Cardiology, Hospital Italiano de La Argentina La Plata, Buenos Aires, Argentina
| | - Felipe Martinez
- Instituto Médico DAMIC-Fundacion Rusculleda Cordoba, Argentina
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston Ontario, Canada
| | | | - Daniel Piskorz
- Cardiovascular Institute of the Rosario British Sanatorium Santa Fe, Argentina
| | - Alberto Lorenzatti
- DAMIC-Rusculleda Foundation, National University of Córdoba Cordoba, Argentina
| | | | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London London, UK
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22
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Liu J, Lin Q, Gao Y, Zhang X, Qi D, Wang C, Tu J, Wang Y, Ning X, Wang J. Health care reform and stroke prognosis in low-income Chinese populations from 1992 to 2018. J Glob Health 2021; 11:08002. [PMID: 33884194 PMCID: PMC8053405 DOI: 10.7189/jogh.11.08002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background To assess the impact of the health care reform on stroke prognoses among low-income Chinese residents. Methods Stroke events and all-cause deaths were registered during 1992-2018 in Tianjin, China. Trends in stroke management and prognoses were compared during the study periods1992-2008 and 2009-2018. Results A total of 1462 patients were diagnosed with first-ever stroke during the study periods. For patients aged ≥45 years, the rates of neuroimaging-based diagnoses and hospitalization were greater in 2009-2018 than in 1992-2008, regardless of patient sex or stroke type. Overall, the one-year case fatality rate was significantly lower in 2009-2018 than in the earlier period; the case fatality rate for women aged ≥65 years decreased by 30.0%. Between both periods, the stroke recurrence rate increased 1.9-fold, including a 2.5-fold increase in men (all P < 0.05). During the 2009-2018 period, the one-year case fatality rate was higher among elderly male patients not using medical insurance than among those using it (32.8% vs 20.7%; P = 0.050). After 2009, a significant decline in the recurrence rate (P = 0.001) and a significant increase in the hospitalization rate (P = 0.004) were observed in the interrupted time-series analysis. Conclusions These findings suggest that the implementation of universal medical insurance for residents in urban and rural China played a major role in improving the prognoses of low-income, rural, first-ever stroke patients, especially for elderly (≥65 years old) residents. However, elderly male patients not using medical insurance benefits had a high case fatality rate. Thus, restructuring of the government medical insurance policy to facilitate its use by low-income, rural residents is crucial for reducing the stroke burden in China.
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Affiliation(s)
- Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Qiuxing Lin
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Ying Gao
- Health Management Centre, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinxin Zhang
- Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China
| | - Dongwang Qi
- Department of Neurology, Yiwu Central Hospital, Yiwu, Zhejiang Province, China
| | - Conglin Wang
- Department of Geriatrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Yaogang Wang
- School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, China
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23
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Secondary prevention of stroke by a primary health care approach: An open-label cluster randomised trial. J Clin Neurosci 2021; 84:53-59. [PMID: 33485600 DOI: 10.1016/j.jocn.2020.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 11/04/2020] [Accepted: 12/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Increasing stroke burden in developing countries necessitates measures to strengthen health systems. We aimed to evaluate whether a Community Health Worker (CHW) based educational intervention will improve risk factor control among stroke survivors and enhance behavior change communication. METHOD An open-label, cluster-randomized trial was conducted in rural area of Thiruvananthapuram district, Kerala from December 2017 to December 2018. A CHW-based educational intervention in addition to standard of care was provided in intervention arm and compared to standard clinical care in the control arm with follow-up at three and six months. The primary outcome measures were risk factor control and quality of behavior change communication provided by CHWs. RESULTS Of the 234 Stroke/TIA survivors enrolled, the mean age (SD) was 59.43 (11.07) years. At 6-month follow up, all patients with smokeless tobacco consumption had quit in the intervention arm (5 at baseline and 0 at six months) and no relapse in smoking was found (as compared to control arm wherein 9 at baseline and one at 6 months). The control of hypertension and diabetes was not significant at 3 months and 6 months in both intervention and control groups. Home visits as well as health education on risk factors by CHWs in the intervention arm were significantly higher. CONCLUSION Community health worker-based intervention is feasible in resource constrained settings for secondary stroke prevention. Training of CHW on risk factor control and lifestyle modifications for stroke survivors enhances quality of health education provided by health services.
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24
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Gupta R, Gaur K. Epidemiology of Ischemic Heart Disease and Diabetes in South Asia: An Overview of the Twin Epidemic. Curr Diabetes Rev 2021; 17:e100620186664. [PMID: 33023450 DOI: 10.2174/1573399816666201006144606] [Citation(s) in RCA: 3] [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: 04/25/2020] [Revised: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND & OBJECTIVES Ischemic heart disease (IHD) is one of the most important causes of death and disability in the world and diabetes is an important risk factor. This review was performed to describe the mortality and morbidity burden from this twin epidemic in South Asian countries. METHODS Country-level data on the epidemiology of IHD and diabetes were obtained from the Global Burden of Disease (GBD) study. Sub-national data were available only for India. We also retrieved epidemiological studies from published reviews on IHD and diabetes in India. These were supplemented with MEDLINE search. RESULTS GBD study and regional epidemiological studies have reported that there are significant regional variations in IHD mortality and disease burden within South Asian countries. IHD burden has increased significantly from 2000 to 2017. Prospective Urban Rural Epidemiology study has reported that diabetes is an important IHD risk factor in the South Asian region. GBD Study and International Diabetes Federation have reported increasing diabetes-related mortality and disease burden in South Asian countries, especially India. There are regional variations in diabetes-related mortality, disease burden, and prevalence in South Asia. At the macrolevel, rapid food and nutrition transition along with increasing physical inactivity is responsible for this twin epidemic. CONCLUSION Increasing trends in IHD and diabetes-related mortality and disease burden with regional variations are observed in South Asian countries.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology & Internal Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Kiran Gaur
- Department of Statistics, Mathematics and Computer Science, Government SKN Agriculture College, SKN Agriculture University, Jobner, Jaipur, India
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25
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Anjana RM, Mohan V, Rangarajan S, Gerstein HC, Venkatesan U, Sheridan P, Dagenais GR, Lear SA, Teo K, Karsidag K, Alhabib KF, Yusoff K, Ismail N, Mony PK, Lopez-Jaramillo P, Chifamba J, Palileo-Villanueva LM, Iqbal R, Yusufali A, Kruger IM, Rosengren A, Bahonar A, Zatonska K, Yeates K, Gupta R, Li W, Hu L, Rahman MO, Lakshmi PVM, Iype T, Avezum A, Diaz R, Lanas F, Yusuf S. Contrasting Associations Between Diabetes and Cardiovascular Mortality Rates in Low-, Middle-, and High-Income Countries: Cohort Study Data From 143,567 Individuals in 21 Countries in the PURE Study. Diabetes Care 2020; 43:3094-3101. [PMID: 33060076 PMCID: PMC7770267 DOI: 10.2337/dc20-0886] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35-70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 ± 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 person-years, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 person-years, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58-2.27] to 1.78 [1.36-2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.
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Affiliation(s)
- Ranjit Mohan Anjana
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Hertzel C Gerstein
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ulagamadesan Venkatesan
- Madras Diabetes Research Foundation and Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | - Patrick Sheridan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Gilles R Dagenais
- Institut universitaire de Cardiologie et Pneumologie de Québec-Université Laval, Québec, Québec, Canada
| | - Scott A Lear
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.,Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kubilay Karsidag
- Department of Internal Medicine, Division of Endocrinology, Istanbul, Turkey
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Yusoff
- Department of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.,Department of Medicine, UCSI University, Cheras, Selangor, Malaysia
| | - Noorhassim Ismail
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
| | - Prem K Mony
- Division of Epidemiology and Population Health, St. John's Medical College and Research Institute, Bangalore, India
| | | | - Jephat Chifamba
- College of Health Sciences, Physiology Department, University of Zimbabwe, Harare, Zimbabwe
| | | | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Afzalhussein Yusufali
- Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Iolanthe M Kruger
- Africa Unit for Transdisciplinary Health Research, Department of Medicine, Faculty of Health Sciences, North-West University, Mmabatho, South Africa
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ahmad Bahonar
- Hypertension Research Center, Cardiovascular Research Institute, Department of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Wei Li
- Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Beijing, China
| | - Lihua Hu
- Nanchang County Center for Disease Prevention and Control, Nanchang, Jiangxi Province, China
| | | | - P V M Lakshmi
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Thomas Iype
- Health Action by People and Government Medical College, Thiruvanthapuram, Kerala, India
| | - Alvaro Avezum
- Hospital Alemão Oswaldo Cruz and UNISA, São Paulo, Brazil
| | - Rafael Diaz
- Estudios Clínicos Latino America, Instituto Cardiovascular de Rosario, Rosario, Santa Fe, Argentina
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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26
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Yang Y, Man X, Nicholas S, Li S, Bai Q, Huang L, Ma Y, Shi X. Utilisation of health services among urban patients who had an ischaemic stroke with different health insurance - a cross-sectional study in China. BMJ Open 2020; 10:e040437. [PMID: 33040017 PMCID: PMC7549448 DOI: 10.1136/bmjopen-2020-040437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study investigates the disparities in the utilisation of patient health services for patients who had a stroke covered by different urban basic health insurance schemes in China. DESIGN We conducted descriptive analysis based on a 5% random sample from claims data of China Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents' Basic Medical Insurance (URBMI) in 2015, supplied by the China Health Insurance Research Association. SETTING Chinese urban social insurance system. PARTICIPANTS A total of 56 485 patients who had a stroke were identified, including 36 487 UEBMI patients and 19 998 URBMI patients. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures include annual number of hospitalisations, average length of stay (ALOS) and average hospitalisation cost. Out-of-pocket (OOP) cost is the secondary outcome measure. RESULTS The annual mean number of hospitalisations of UEBMI patients was 1.21 and 1.15 for URBMI patients. The ALOS was significantly longer for UEBMI than for URBMI patients (13.93 vs 10.82, p<0.001). Hospital costs were significantly higher for UEBMI than for URBMI patients (US$1724.02 vs US$986.59 (p<0.001), while the OOP costs were significantly higher for URBMI than for UEBMI patients (US$423.17 vs US$407.81 (p<0.001). Patients with UEBMI had higher reimbursement rate than URBMI patients (79.41% vs 66.92%, p<0.001) and a lower self-paid ratio than URBMI patients (23.65% vs 42.89%, p<0.001). CONCLUSIONS Significant disparities were found in the utilisation of hospital services between UEBMI and URBMI patients. Our results call for a systemic strategy to improve the fragmented social health insurance system and narrow the gaps in China's health insurance schemes.
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Affiliation(s)
- Yong Yang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowei Man
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Eveleigh Sydney NSW 2015, New South Wales, Australia
- Guangdong Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Newcastle Business School, University of Newcastle, Newcastle, Callaghan, Australia
| | - Shuo Li
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Qian Bai
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Lieyu Huang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yong Ma
- China Health Insurance Research Association, Beijing, China
| | - Xuefeng Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
- National Institute of Traditional Chinese Medicine Strategy and Development, Beijing University of Chinese Medicine, Beijing, China
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27
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Sudevan R, Vasudevan D, Raj M, Thachathodiyl R, Vijayakumar M, Abdullakutty J, Thomas P, George V, Kabali C. Compliance to secondary prevention strategies for coronary artery disease: a hospital-based cross-sectional survey from Ernakulam, South India. BMJ Open 2020; 10:e037618. [PMID: 33039999 PMCID: PMC7549465 DOI: 10.1136/bmjopen-2020-037618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/24/2020] [Accepted: 09/10/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES The primary objective of the study was to report the compliance to secondary prevention strategies for coronary artery disease (CAD), such as smoking cessation, weight management, low-density lipoprotein (LDL) cholesterol control, blood pressure control, glycaemic control, physical activity and cardiovascular drug therapy from a resource-limited setting. DESIGN Analytical cross-sectional survey with data collection using questionnaire administered by study personnel. SETTING Institutional-two tertiary care hospitals and two cardiology clinics. PARTICIPANTS Patients in the age group of 30-80 years with documented CAD with a minimum of 1 year and a maximum of 6 years of follow-up after diagnosis. MAIN OUTCOME MEASURES The main outcome measures were the prevalence of individual compliance to secondary prevention strategies for CAD such as smoking cessation, weight management, LDL cholesterol control, blood pressure control, glycaemic control, physical activity and cardiovascular drug therapy. The secondary outcomes were the association of secondary prevention strategies with age, sex, domicile, socioeconomic status, insurance and type of treatment. RESULTS We recruited a total of 1206 patients among whom 879 (72.9%) were males. The median age of patients was 62 (14) years. The compliance to smoking cessation was 93.86% (95% CI 91.66% to 96.06%), ideal body mass index was 63.76% (95% CI 61.05% to 66.47%), blood pressure control was 65.11% (95% CI 62.42% to 67.80%), LDL compliance was 36.50% (95% CI 33.18% to 39.82%), diabetes control was 51.23% (95% CI 46.10% to 56.36%) and adequate physical activity was 39.22% (95% CI 36.46% to 41.98%)respectively. Reported compliance for cardiovascular drugs therapy was 96% for antiplatelets, 89.4% for statins, 68.2% for beta blockers, 37.7% for renin angiotensin aldosterone system blockers, 81.28% for oral hypoglycaemic agents and 22% for insulin therapy. CONCLUSION Compliance to secondary prevention strategies for CAD in resource limited settings are moderate. This needs further improvement for better outcomes related to CAD in future.
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Affiliation(s)
- Remya Sudevan
- Departments of Health Sciences Research & Cardiology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Damodaran Vasudevan
- Department of Health Sciences Research, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Manu Raj
- Pediatrics, Pediatric Cardiology & Public Health Research, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Rajesh Thachathodiyl
- Department of Cardiology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Maniyal Vijayakumar
- Department of Cardiology, Amrita Institute of Medical Sciences & Research Centre, Amrita Vishwa Vidyapeetham, Kochi, India
| | | | | | | | - Conrad Kabali
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Sherin A, Ul-Haq Z, Fazid S, Shah BH, Khattak MI, Nabi F. Prevalence of stroke in Pakistan: Findings from Khyber Pakhtunkhwa integrated population health survey (KP-IPHS) 2016-17. Pak J Med Sci 2020; 36:1435-1440. [PMID: 33235553 PMCID: PMC7674892 DOI: 10.12669/pjms.36.7.2824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective To study the prevalence of stroke and associated risk factors in Khyber Pakhtunkhwa (KP) province of Pakistan. Methods This study was a part of cross-sectional KP Integrated Population Health Survey 2016-17 conducted on population aging ≥18 years at 24 districts of KP. Primary (n=1061) and secondary sampling units (n=15724) were developed, based on urban/rural and socio-economic status. Each primary-unit comprised of 250-300 households. Sample was selected through a multi-staged stratified systematic cluster sampling technique by taking every 16th household per rural and every 12th household per urban-unit. A validated "Cincinnati Stroke Scale" for identification of stroke patients in community was used along with demographics and potential risk factors. Results Among the 15724 randomly selected households, 22500 participants (51.4% females; 74.6% rural areas, mean age 42±12.6 years) were interviewed. Stroke was identified in 271 cases (137 males, 134 females; Mean age=43.39±0.85 years) and prevalence of stroke was 1.2% (1200 per 100,000 population). Obesity/overweight (38.8%), hypertension (21.8%), smoking (6.6%) and known diabetes mellitus (5.9%) were the common associated risk factors of stroke. Age groups >60 years (adjusted OR=1.68; 95% CI: 1.05-2.68); urban area (adjusted OR=1.68; 95% CI: 1.29-2.19); unemployment (adjusted OR=3.78; 95% CI: 2.49-5.73) and lower formal (primary) education (adjusted OR 2.18; 95% CI: 1.30-3.64) were significantly associated with stroke (p <0.05). Conclusion Prevalence of stroke is 1.2% in the province of KP. Obesity, hypertension, smoking and Diabetes Mellitus are the common associated risk factors of stroke. Higher age, urban area, unemployment and lower formal education are significantly associated with stroke.
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Affiliation(s)
- Akhtar Sherin
- Akhtar Sherin Khyber Medical University, Institute of Medical Sciences, DHQ Hospital Kohat, Pakistan. Khyber Medical University, Institute of Public Health & Social Sciences, Peshawar, Pakistan
| | - Zia Ul-Haq
- Zia Ul-Haq, Vice Chancellor/ Professor & Dean, Institute of Public Health. Visiting Professor Institute of Health & Well-being, University of Glasgow, UK. Khyber Medical University, Institute of Public Health & Social Sciences, Peshawar, Pakistan
| | - Sheraz Fazid
- Sheraz Fazid Institute of Public Health, KMU Khyber Medical University, Institute of Public Health & Social Sciences, Peshawar, Pakistan
| | - Basharat Hussain Shah
- Basharat Hussain Shah Khyber Medical University, Institute of Public Health & Social Sciences, Peshawar, Pakistan
| | - Maria Ishaq Khattak
- Maria Ishaq Khattak Lecturer, Institute of Public Health, KMU Khyber Medical University, Institute of Public Health & Social Sciences, Peshawar, Pakistan
| | - Fazal Nabi
- Fazal Nabi Population Welfare Department, Government of Khyber Pakhtunkhwa, Peshawar, Pakistan
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29
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Saeed S, Kanaya AM, Bennet L, Nilsson PM. Cardiovascular risk assessment in South and Middle-East Asians living in the Western countries. Pak J Med Sci 2020; 36:1719-1725. [PMID: 33235604 PMCID: PMC7674869 DOI: 10.12669/pjms.36.7.3292] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Nearly a quarter of the world population lives in the South Asian region (India, Pakistan, Bangladesh, Sri Lanka, Nepal, Bhutan, and the Maldives). Due to rapid demographic and epidemiological transition in these countries, the burden of non-communicable diseases is growing, which is a serious public health concern. Particularly, the prevalence of pre-diabetes, diabetes and atherosclerotic cardiovascular disease (CVD) is increasing. South Asians living in the West have also substantially higher risk of CVD and mortality compared with white Europeans and Americans. Further, as a result of global displacement over the past three decades, Middle-Eastern immigrants now represent the largest group of non-European immigrants in Northern Europe. This vulnerable population has been less studied. Hence, the aim of the present review was to address cardiovascular risk assessment in South Asians (primarily people from India, Pakistan and Bangladesh), and Middle-East Asians living in Western countries compared with whites (Caucasians) and present results from some major intervention studies. A systematic search was conducted in PubMed to identify major cardiovascular health studies of South Asian and Middle-Eastern populations living in the West, relevant for this review. Results indicated an increased risk of CVD. In conclusion, both South Asian and Middle-Eastern populations living in the West carry significantly higher risk of diabetes and CVD compared with native white Europeans. Lifestyle interventions have been shown to have beneficial effects in terms of reduction in the risk of diabetes by increasing insulin sensitivity, weight loss as well as better glycemic and lipid control.
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Affiliation(s)
- Sahrai Saeed
- Sahrai Saeed, Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Alka M Kanaya
- Alka M. Kanaya, Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Louise Bennet
- Louise Bennet, Department of Clinical Sciences, Family Medicine, Lund University Malmo, Sweden
| | - Peter M Nilsson
- Peter M Nilsson, Department of Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden
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30
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Rajan S, McKee M, Rangarajan S, Bangdiwala S, Rosengren A, Gupta R, Kutty VR, Wielgosz A, Lear S, AlHabib KF, Co HU, Lopez-Jaramillo P, Avezum A, Seron P, Oguz A, Kruger IM, Diaz R, Nafiza MN, Chifamba J, Yeates K, Kelishadi R, Sharief WM, Szuba A, Khatib R, Rahman O, Iqbal R, Bo H, Yibing Z, Wei L, Yusuf S. Association of Symptoms of Depression With Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries. JAMA Psychiatry 2020; 77:1052-1063. [PMID: 32520341 PMCID: PMC7287938 DOI: 10.1001/jamapsychiatry.2020.1351] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. OBJECTIVE To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. DESIGN, SETTING, AND PARTICIPANTS This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. EXPOSURES Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. MAIN OUTCOMES AND MEASURES Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. RESULTS Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). CONCLUSIONS AND RELEVANCE In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.
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Affiliation(s)
- Selina Rajan
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, United Kingdom,Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, Tavistock Place, London, United Kingdom
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Shrikant Bangdiwala
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Sweden
| | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | | | | | - Scott Lear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Division of Cardiology, Providence Health Care, Vancouver, British Columbia, Canada
| | - Khalid F. AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Homer U. Co
- University of the Philippines College of Medicine, Manila, Philippines
| | - Patricio Lopez-Jaramillo
- Masira Research Institute, Medical School, Universidad de Santander (UDES), FOSCAL, Bucaramanga, Colombia
| | - Alvaro Avezum
- Department of Medicine, Universidade de Santo Amaro, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | - Aytekin Oguz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica (ECLA), Rosario, Santa Fe, Argentina
| | | | - Jephat Chifamba
- University of Zimbabwe College of Health Sciences, Department of Physiology, Harare, Zimbabwe
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Wadeia Mohammed Sharief
- Department of Medicine, Dubai Medical University, Hatta Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Andrzej Szuba
- Department of Angiology, Wroclaw Medical University, Poland
| | - Rasha Khatib
- Advocate Research Institute, Advocate Health Care, Downers Grove, Illinois,Institute for Community and Public Health, Birzeit University, Birzeit, Palestine
| | - Omar Rahman
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Romaina Iqbal
- Independent University, Bangladesh, Dhaka, Bangladesh
| | - Hu Bo
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhu Yibing
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Wei
- National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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Enas EA, Varkey B, Gupta R. Expanding statin use for prevention of ASCVD in Indians: Reasoned and simplified proposals. Indian Heart J 2020; 72:65-69. [PMID: 32534692 PMCID: PMC7296246 DOI: 10.1016/j.ihj.2020.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/28/2020] [Indexed: 01/21/2023] Open
Abstract
Atherosclerosis, a systemic disease, is the predominant cause of cardiovascular disease (CVD) that far exceeds other causes (egs: congenital, hypertension, arrhythmia). CVD is the leading cause of mortality globally (18 million lives, including 9 million from coronary artery disease (CAD) annually).1 The Global Burden of Disease study reported that in the year 2017, India had one of the highest mortality, most of them premature, from CVD (2.64 million, women 1.18, men 1.45) and CAD (1.54 million, women 0.62, men 0.92) in the world.2 A systemic disease of this magnitude and impact warrants a proactive preventive strategy and not a reactive, invasive and focal approach. In this editorial, we call for a wider use of statins in Indians, explain our rationale based on risk factors and risk-enhancing factors, and present a simplified and cost effective approach to combat CVD.
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Affiliation(s)
- Enas A Enas
- Coronary Artery Disease in Indians (CADI) Research Foundation, Lisle, IL, USA.
| | - Basil Varkey
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rajeev Gupta
- Department of Preventive Cardiology & Internal Medicine, Eternal Heart Care Centre & Research Institute, Jaipur, India
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Wekesah FM, Klipstein-Grobusch K, Grobbee DE, Kadengye D, Asiki G, Kyobutungi CK. Determinants of Mortality from Cardiovascular Disease in the Slums of Nairobi, Kenya. Glob Heart 2020; 15:33. [PMID: 32489806 PMCID: PMC7218782 DOI: 10.5334/gh.787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular diseases (CVD) comprise eighty percent of non-communicable disease (NCD) burden in low- and middle-income countries and are increasingly impacting the poor inequitably. Traditional and socioeconomic factors were analyzed for their association with CVD mortality over 10 years of baseline assessment in an urban slum of Nairobi, Kenya. Methods and results A 2008 survey on CVD risk factors was linked to cause of death data collected between 2008 and 2018. Cox proportional hazards on relative risk of dying from CVD over a 10-year period following the assessment of cardiovascular disease risk factors were computed. Population attributable fraction (PAF) of incident CVD death was estimated for key risk factors. In total, 4,290 individuals, 44.0% female, mean age 48.4 years in 2008 were included in the analysis. Diabetes and hypertension were 7.8% and 24.9% respectively in 2008. Of 385 deaths recorded between 2008 and 2018, 101 (26%) were caused by CVD. Age (hazard ratio (HR) 1.11; 95% confidence interval (CI) 1.03-1.20, p = 0.005) and hypertension (HR 2.19, 95% CI 1.44-3.33, p <0.001) were positively associated with CVD mortality. Primary school education and higher (HR 0.57, 95% CI 0.33-0.99, p = 0.044) and formal employment (HR 0.22, 95% CI 0.06-0.75, p = 0.015) were negatively associated with CVD mortality. Controlling hypertension would avert 27% (95% CI 9%-42%, p = 0.004) CVD deaths, while if every member of the community attained primary school education and unemployment was eradicated, 39% (95% CI 5% - 60%, p = 0.026), and 17% (95% CI 5%-27%, p = 0.030) of CVD deaths, would be averted respectively. Conclusions A holistic approach in addressing socioeconomic factors in the broader context of social determinants of health at the policy, population and individual level will enhance prevention and treatment-adherence for CVD in underserved settings.
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Affiliation(s)
- Frederick M. Wekesah
- African Population and Health Research Center, 2 Floor APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, KE
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, NL
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, US
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, NL
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, ZA
| | - Diederick E. Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, NL
| | - Damazo Kadengye
- African Population and Health Research Center, 2 Floor APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, KE
| | - Gershim Asiki
- African Population and Health Research Center, 2 Floor APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, KE
| | - Catherine K. Kyobutungi
- African Population and Health Research Center, 2 Floor APHRC Campus, Manga Close, Off Kirawa Road, Kitisuru, Nairobi, KE
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33
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Gupta R, Yusuf S. Challenges in management and prevention of ischemic heart disease in low socioeconomic status people in LLMICs. BMC Med 2019; 17:209. [PMID: 31767015 PMCID: PMC6878693 DOI: 10.1186/s12916-019-1454-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cardiovascular diseases, principally ischemic heart disease (IHD), are the most important cause of death and disability in the majority of low- and lower-middle-income countries (LLMICs). In these countries, IHD mortality rates are significantly greater in individuals of a low socioeconomic status (SES). MAIN TEXT Three important focus areas for decreasing IHD mortality among those of low SES in LLMICs are (1) acute coronary care; (2) cardiac rehabilitation and secondary prevention; and (3) primary prevention. Greater mortality in low SES patients with acute coronary syndrome is due to lack of awareness of symptoms in patients and primary care physicians, delay in reaching healthcare facilities, non-availability of thrombolysis and coronary revascularization, and the non-affordability of expensive medicines (statins, dual anti-platelets, renin-angiotensin system blockers). Facilities for rapid diagnosis and accessible and affordable long-term care at secondary and tertiary care hospitals for IHD care are needed. A strong focus on the social determinants of health (low education, poverty, working and living conditions), greater healthcare financing, and efficient primary care is required. The quality of primary prevention needs to be improved with initiatives to eliminate tobacco and trans-fats and to reduce the consumption of alcohol, refined carbohydrates, and salt along with the promotion of healthy foods and physical activity. Efficient primary care with a focus on management of blood pressure, lipids and diabetes is needed. Task sharing with community health workers, electronic decision support systems, and use of fixed-dose combinations of blood pressure-lowering drugs and statins can substantially reduce risk factors and potentially lead to large reductions in IHD. Finally, training of physicians, nurses, and health workers in IHD prevention should be strengthened. CONCLUSION The management and prevention of IHD in individuals with a low SES in LLMICs are poor. Greater availability, access, and affordability for acute coronary syndrome management and secondary prevention are important. Primary prevention should focus on tackling the social determinants of health as well as policy and individual interventions for risk factor control, supported by task sharing and use of technology.
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Affiliation(s)
- Rajeev Gupta
- Department of Preventive Cardiology M-Floor, Eternal Heart Care Centre & Research Institute, Jawahar Circle, Jaipur, 302017, India. .,Academic Research Development Unit, Rajasthan University of Health Sciences, Jaipur, India.
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
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34
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Rosengren A, Smyth A, Rangarajan S, Ramasundarahettige C, Bangdiwala SI, AlHabib KF, Avezum A, Bengtsson Boström K, Chifamba J, Gulec S, Gupta R, Igumbor EU, Iqbal R, Ismail N, Joseph P, Kaur M, Khatib R, Kruger IM, Lamelas P, Lanas F, Lear SA, Li W, Wang C, Quiang D, Wang Y, Lopez-Jaramillo P, Mohammadifard N, Mohan V, Mony PK, Poirier P, Srilatha S, Szuba A, Teo K, Wielgosz A, Yeates KE, Yusoff K, Yusuf R, Yusufali AH, Attaei MW, McKee M, Yusuf S. Socioeconomic status and risk of cardiovascular disease in 20 low-income, middle-income, and high-income countries: the Prospective Urban Rural Epidemiologic (PURE) study. LANCET GLOBAL HEALTH 2019; 7:e748-e760. [PMID: 31028013 DOI: 10.1016/s2214-109x(19)30045-2] [Citation(s) in RCA: 298] [Impact Index Per Article: 59.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 12/28/2018] [Accepted: 01/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Socioeconomic status is associated with differences in risk factors for cardiovascular disease incidence and outcomes, including mortality. However, it is unclear whether the associations between cardiovascular disease and common measures of socioeconomic status-wealth and education-differ among high-income, middle-income, and low-income countries, and, if so, why these differences exist. We explored the association between education and household wealth and cardiovascular disease and mortality to assess which marker is the stronger predictor of outcomes, and examined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management. METHODS In this large-scale prospective cohort study, we recruited adults aged between 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. We collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. We assessed socioeconomic status using education and a household wealth index. Education was categorised as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics. Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family. FINDINGS Recruitment to the study began on Jan 12, 2001, with most participants enrolled between Jan 6, 2005, and Dec 4, 2014. 160 299 (87·9%) of 182 375 participants with baseline data had available follow-up event data and were eligible for inclusion. After exclusion of 6130 (3·8%) participants without complete baseline or follow-up data, 154 169 individuals remained for analysis, from five low-income, 11 middle-income, and four high-income countries. Participants were followed-up for a mean of 7·5 years. Major cardiovascular events were more common among those with low levels of education in all types of country studied, but much more so in low-income countries. After adjustment for wealth and other factors, the HR (low level of education vs high level of education) was 1·23 (95% CI 0·96-1·58) for high-income countries, 1·59 (1·42-1·78) in middle-income countries, and 2·23 (1·79-2·77) in low-income countries (pinteraction<0·0001). We observed similar results for all-cause mortality, with HRs of 1·50 (1·14-1·98) for high-income countries, 1·80 (1·58-2·06) in middle-income countries, and 2·76 (2·29-3·31) in low-income countries (pinteraction<0·0001). By contrast, we found no or weak associations between wealth and these two outcomes. Differences in outcomes between educational groups were not explained by differences in risk factors, which decreased as the level of education increased in high-income countries, but increased as the level of education increased in low-income countries (pinteraction<0·0001). Medical care (eg, management of hypertension, diabetes, and secondary prevention) seemed to play an important part in adverse cardiovascular disease outcomes because such care is likely to be poorer in people with the lowest levels of education compared to those with higher levels of education in low-income countries; however, we observed less marked differences in care based on level of education in middle-income countries and no or minor differences in high-income countries. INTERPRETATION Although people with a lower level of education in low-income and middle-income countries have higher incidence of and mortality from cardiovascular disease, they have better overall risk factor profiles. However, these individuals have markedly poorer health care. Policies to reduce health inequities globally must include strategies to overcome barriers to care, especially for those with lower levels of education. FUNDING Full funding sources are listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Andrew Smyth
- HRB Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Shrikant I Bangdiwala
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Dante Pazzanese Institute of Cardiology and University Santo Amaro, São Paulo, Brazil
| | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Sadi Gulec
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Ehi U Igumbor
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Norhassim Ismail
- Department of Community Health, Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Philip Joseph
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rasha Khatib
- Public Health Sciences, Stritch School of Medicine, Maywood, IL, USA
| | - Iolanthé M Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | - Pablo Lamelas
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, BC, Canada
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Chuangshi Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Deren Quiang
- Wujin District Center for Disease Control and Prevention, Changzhou, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Patricio Lopez-Jaramillo
- Research Institute, FOSCAL International Clinic, Bucaramanga, Colombia; Eugenio Espejo Medical School, Universidad UTE, Quito, Ecuador
| | - Noushin Mohammadifard
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India
| | - Prem K Mony
- St John's Medical College & Research Institute, Bangalore, India
| | - Paul Poirier
- Faculté de pharmacie, Université Laval, Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, QC, Canada
| | | | - Andrzej Szuba
- Division of Angiology, Wroclaw Medical University, Wroclaw, Poland
| | - Koon Teo
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | | | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selayang Campus, Selangor, Malaysia; UCSI University, Kuala Lumpur, Malaysia
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh
| | - Afzalhusein H Yusufali
- Hatta Hospital, Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Marjan W Attaei
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Salim Yusuf
- Population Health Research Institute, McMaster University, Hamilton Health Sciences Centre, Hamilton, ON, Canada
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Gupta R, Khedar RS, Gaur K, Xavier D. Low quality cardiovascular care is important coronary risk factor in India. Indian Heart J 2018; 70 Suppl 3:S419-S430. [PMID: 30595301 PMCID: PMC6309144 DOI: 10.1016/j.ihj.2018.05.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 05/03/2018] [Indexed: 01/12/2023] Open
Abstract
Global Burden of Disease study has reported that cardiovascular and ischemic heart disease (IHD) mortality has increased by 34% in last 25 years in India. It has also been reported that despite having lower coronary risk factors compared to developed countries, incident cardiovascular mortality, cardiovascular events and case-fatality are greater in India. Reasons for the increasing trends and high mortality have not been studied. There is evidence that social determinants of IHD risk factors are widely prevalent and increasing. Epidemiological studies have reported low control rates of hypertension, hypercholesterolemia, diabetes and smoking/tobacco. Registries have reported greater mortality of acute coronary syndrome in India compared to developed countries. Secondary prevention therapies have significant gaps. Low quality cardiovascular care is an important risk factor in India. Package of interventions focusing on fiscal, intersectoral and public health measures, improvement of health services at community, primary and secondary healthcare levels and appropriate referral systems to specialized hospitals is urgently required.
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Affiliation(s)
- Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India.
| | - Raghubir S Khedar
- Eternal Heart Care Centre & Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Kiran Gaur
- Department of Statistics, SKN Agricultural University, Jobner, Jaipur, India
| | - Denis Xavier
- Department of Pharmacology, St John's Medical College, Bangalore, India
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Murphy A, Palafox B, O'Donnell O, Stuckler D, Perel P, AlHabib KF, Avezum A, Bai X, Chifamba J, Chow CK, Corsi DJ, Dagenais GR, Dans AL, Diaz R, Erbakan AN, Ismail N, Iqbal R, Kelishadi R, Khatib R, Lanas F, Lear SA, Li W, Liu J, Lopez-Jaramillo P, Mohan V, Monsef N, Mony PK, Puoane T, Rangarajan S, Rosengren A, Schutte AE, Sintaha M, Teo KK, Wielgosz A, Yeates K, Yin L, Yusoff K, Zatońska K, Yusuf S, McKee M. Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study. Lancet Glob Health 2018; 6:e292-e301. [PMID: 29433667 PMCID: PMC5905400 DOI: 10.1016/s2214-109x(18)30031-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 11/30/2017] [Accepted: 01/16/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. METHODS We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. FINDINGS The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0-1·7), Tanzania (0-3·6), and Zimbabwe (0-5·1), to 49·3% in Canada (44·4-54·3). Proportions receiving at least one drug varied from 2·0% (95% CI 0·5-6·9) in Tanzania to 91·4% (86·6-94·6) in Sweden. There was significant (p<0·05) pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. INTERPRETATION Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. FUNDING Full funding sources listed at the end of the paper (see Acknowledgments).
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Affiliation(s)
- Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK.
| | - Benjamin Palafox
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Owen O'Donnell
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, Netherlands; Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
| | - David Stuckler
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alvaro Avezum
- Institute of Cardiology, University of Santo Amaro, Sao Paulo, Brazil
| | - Xiulin Bai
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jephat Chifamba
- Department of Physiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Clara K Chow
- The University of Sydney and The George Institute for Global Health, Camperdown, NSW, Australia
| | - Daniel J Corsi
- Ottawa Hospital Research Institute, OMNI Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, QC, Canada
| | - Antonio L Dans
- University of the Philippines-Manila, Manila, Philippines
| | - Rafael Diaz
- Estudios Clínicos Latinoamérica (ECLA) International, Rosario, Santa Fe, Argentina
| | | | - Noorhassim Ismail
- Department of Community Health, UKM Medical Centre, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Romaina Iqbal
- Departments of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Chamran Hospital, Isfahan, Iran
| | - Rasha Khatib
- Department of Public Health Sciences, Loyola Medical Center, Maywood, IL, USA
| | | | | | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jia Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Patricio Lopez-Jaramillo
- Fundación Oftalmológica de Santander-FOSCAL-FOSCAL Internacional, Floridablanca, Santander, Colombia
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation and DrMohan's Diabetes Specialities Centre, Gopalapuram, Chennai, India
| | - Nahed Monsef
- Dubai Health Authority, Dubai, United Arab Emirates
| | - Prem K Mony
- St John's Medical College and Research Insitute, Bangalore, India
| | - Thandi Puoane
- School of Public Health, University of the Western Cape, Cape Town, Western Cape Province, South Africa
| | - Sumathy Rangarajan
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
| | - Aletta E Schutte
- South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, Hypertension in Africa Research Team (HART), North-West University, Potchefstroom, South Africa
| | - Mariz Sintaha
- Independent University, Bangladesh, Dhaka, Bangladesh
| | - Koon K Teo
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | | | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Khalid Yusoff
- Universiti Teknologi MARA, Selyang Campus, Selayang, Selangor and UCSI University, Cheras, Malaysia
| | | | - Salim Yusuf
- Population Health Research Institute, McMaster University, C2-106 DBCVSRI Hamilton General Hospital, Hamilton, ON, Canada
| | - Martin McKee
- Centre for Global Chronic Conditions, London School of Tropical Medicine, London, UK
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Abstract
Cardiovascular diseases, especially coronary heart disease (CHD), are epidemic in India. The Registrar General of India reported that CHD led to 17% of total deaths and 26% of adult deaths in 2001-2003, which increased to 23% of total and 32% of adult deaths in 2010-2013. The World Health Organization (WHO) and Global Burden of Disease Study also have highlighted increasing trends in years of life lost (YLLs) and disability-adjusted life years (DALYs) from CHD in India. In India, studies have reported increasing CHD prevalence over the last 60 years, from 1% to 9%-10% in urban populations and <1% to 4%-6% in rural populations. Using more stringent criteria (clinical ± Q waves), the prevalence varies from 1%-2% in rural populations and 2%-4% in urban populations. This may be a more realistic prevalence of CHD in India. Case-control studies have reported that important risk factors for CHD in India are dyslipidemias, smoking, diabetes, hypertension, abdominal obesity, psychosocial stress, unhealthy diet, and physical inactivity. Suitable preventive strategies are required to combat this epidemic.
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Affiliation(s)
- Rajeev Gupta
- Academic and Research Development Unit, Rajasthan University of Health Sciences, Jaipur, India.
| | - Indu Mohan
- Department of Community Medicine, RUHS College of Medical Sciences, Jaipur, India
| | - Jagat Narula
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Sankaran S, Ravi PS, Wu YE, Shanabogue S, Ashok S, Agnew K, Fang MC, Khanna RA, Dandu M, Harrison JD. An NGO-Implemented Community-Clinic Health Worker Approach to Providing Long-Term Care for Hypertension in a Remote Region of Southern India. GLOBAL HEALTH: SCIENCE AND PRACTICE 2017; 5:668-677. [PMID: 29284700 PMCID: PMC5752612 DOI: 10.9745/ghsp-d-17-00192] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 10/24/2017] [Indexed: 01/13/2023]
Abstract
Poor blood pressure control results in tremendous morbidity and mortality in India where the leading cause of death among adults is from coronary heart disease. Despite having little formal education, community health workers (CHWs) are integral to successful public health interventions in India and other low- and middle-income countries that have a shortage of trained health professionals. Training CHWs to screen for and manage chronic hypertension, with support from trained clinicians, offers an excellent opportunity for effecting systemwide change in hypertension-related burden of disease. In this article, we describe the development of a program that trained CHWs between 2014 and 2015 in the tribal region of the Sittilingi Valley in southern India, to identify hypertensive patients in the community, refer them for diagnosis and initial management in a physician-staffed clinic, and provide them with sustained lifestyle interventions and medications over multiple visits. We found that after 2 years, the CHWs had screened 7,176 people over age 18 for hypertension, 1,184 (16.5%) of whom were screened as hypertensive. Of the 1,184 patients screened as hypertensive, 898 (75.8%) had achieved blood pressure control, defined as a systolic blood pressure less than 140 and a diastolic blood pressure less than 90 sustained over 3 consecutive visits. While all of the 24 trained CHWs reported confidence in checking blood pressure with a manual blood pressure cuff, 4 of the 24 CHWs reported occasional difficulty documenting blood pressure values because they were unable to write numbers properly. They compensated by asking other CHWs or members of their community to help with documentation. Our experience and findings suggest that a CHW blood pressure screening system linked to a central clinic can be a promising avenue for improving hypertension control rates in low- and middle-income countries.
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Affiliation(s)
- Sujatha Sankaran
- University of California at San Francisco, San Francisco, CA, USA.
| | - Prema S Ravi
- Tribal Health Initiative, Sittilingi, Tamil Nadu, India
| | - Yichen Ethel Wu
- University of California at San Francisco, San Francisco, CA, USA
| | - Sharan Shanabogue
- St. John's National Academy of Health Sciences, Bangalore, Karnataka, India
| | | | - Kaylan Agnew
- University of California at San Francisco, San Francisco, CA, USA
| | - Margaret C Fang
- University of California at San Francisco, San Francisco, CA, USA
| | - Raman A Khanna
- University of California at San Francisco, San Francisco, CA, USA
| | - Madhavi Dandu
- University of California at San Francisco, San Francisco, CA, USA
| | - James D Harrison
- University of California at San Francisco, San Francisco, CA, USA
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Goyal A, Kahlon P, Jain D, Soni RK, Gulati R, Chhabra ST, Aslam N, Mohan B, Anand IS, Patel V, Wander GS. Trend in prevalence of coronary artery disease and risk factors over two decades in rural Punjab. HEART ASIA 2017; 9:e010938. [PMID: 29469907 PMCID: PMC5818047 DOI: 10.1136/heartasia-2017-010938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/13/2017] [Accepted: 07/26/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVES The burden of coronary artery disease (CAD) has increased in the last three decades in low-income and middle-income countries including India. CAD is responsible for 20% deaths in India. The burden of CAD has increased due to a higher prevalence of risk factors related to the changing lifestyle. We studied the change in prevalence of CAD and risk factors over 20 years in a rural area. METHODS A rural population of adults over the age of 30 years from three villages of Punjab was surveyed for the prevalence of CAD and its risk factors in 1994 and 2014 using similar research methodology. CAD was diagnosed by Epstein and clinical criteria. Blood pressure, anthropometry, ECG and biochemical analysis were carried out. The findings of two surveys were compared with a look at the change in the prevalence of CAD and its risk factors over 20 years. RESULTS The overall age standardised prevalence of CAD increased from 2.79% in 1994 to 4.06% (p<0.05) in 2014. There was a significant increase in the prevalence of several risk factors including sedentary lifestyle (8.2% vs 41.3%, p<0.001), hypertension (14.5% vs 26.5%, p<0.001), diabetes (4.7% vs 9.7%, p<0.001), obesity (16.6% vs 35.4, p<0.001) and hypercholesterolaemia (7% vs 9.6%, p 0.011). In contrast, cigarette smoking (8.9% vs 3%, p<0.001) and use of desi ghee (51.4% vs 28.5%, p<0.001) decreased. CONCLUSIONS In a rural population of Punjab, the prevalence of several CAD risk factors like sedentary lifestyle, hypertension, diabetes, obesity and hypercholesterolaemia increased over 20 years. These changes in risk factors were associated with a modest increase in prevalence of CAD.
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Affiliation(s)
- Abhishek Goyal
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Praneet Kahlon
- Department of Medicine, Punjab Civil Medical Services, Civil Hospital, Barnala, Punjab, India
| | - Dinesh Jain
- Department of Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - R K Soni
- Department of Community Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Rohit Gulati
- WVU Medicine, University Healthcare, Martinsburg, West Virginia, USA
| | - Shibba Takkar Chhabra
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Naved Aslam
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Bishav Mohan
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Inder S Anand
- University of Minnesota Medical School, VA Medical Center, Minneapolis, Minnesota, USA
| | - Vikram Patel
- Centre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UK
- Sangath, Goa, India
| | - Gurpreet Singh Wander
- Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
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40
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Gupta R, Kaur M, Islam S, Mohan V, Mony P, Kumar R, Kutty VR, Iqbal R, Rahman O, Deepa M, Antony J, Vijaykumar K, Kazmi K, Yusuf R, Mohan I, Panwar RB, Rangarajan S, Yusuf S. Association of Household Wealth Index, Educational Status, and Social Capital with Hypertension Awareness, Treatment, and Control in South Asia. Am J Hypertens 2017; 30:373-381. [PMID: 28096145 DOI: 10.1093/ajh/hpw169] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/22/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Hypertension control rates are low in South Asia. To determine association of measures of socioeconomic status (wealth, education, and social capital) with hypertension awareness, treatment, and control among urban and rural subjects in these countries we performed the present study. METHODS We enrolled 33,423 subjects aged 35-70 years (women 56%, rural 53%, low-education status 51%, low household wealth 25%, low-social capital 33%) in 150 communities in India, Pakistan, and Bangladesh during 2003-2009. Prevalence of hypertension and its awareness, treatment, and control status and their association with wealth, education, and social capital were determined. RESULTS Age-, sex-, and location-adjusted prevalence of hypertension in men was 31.5% (23.9-40.2%) and women was 32.6% (24.9-41.5%) with variations in prevalence across study sites (urban 30-56%, rural 11-43%). Prevalence was significantly greater in urban locations, older subjects, and participants with more wealth, greater education, and lower social capital index. Hypertension awareness was in 40.4% (urban 45.9, rural 32.5), treatment in 31.9% (urban 37.6, rural 23.6), and control in 12.9% (urban 15.4, rural 9.3). Control was lower in men and younger subjects. Hypertension awareness, treatment, and control were significantly lower, respectively, in lowest vs. highest wealth index tertile (26.2 vs. 50.6%, 16.9 vs. 44.0%, and 6.9 vs. 17.3%, P < 0.001) and lowest vs. highest educational status tertile (31.2 vs. 48.4%, 21.8 vs. 42.1%, and 7.8 vs. 19.2%, P < 0.001) while insignificant differences were observed in lowest vs. highest social capital index (38.2 vs. 36.1%, 35.1 vs. 27.8%, and 12.5 vs. 9.1%). CONCLUSIONS This study shows low hypertension awareness, treatment, and control in South Asia. Lower wealth and educational status are important in low hypertension awareness, treatment, and control.
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Affiliation(s)
- Rajeev Gupta
- Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shofiqul Islam
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | | | - Prem Mony
- Department of Community Medicine, St John's Medical College and Research Institute, Bangalore, India
| | - Rajesh Kumar
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omar Rahman
- School of Life Sciences, Independent University, Dhaka, Bangladesh; and
| | - Mohan Deepa
- Madras Diabetes Research Foundation, Chennai, India
| | - Justy Antony
- Department of Community Medicine, St John's Medical College and Research Institute, Bangalore, India
| | | | - Khawar Kazmi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rita Yusuf
- School of Life Sciences, Independent University, Dhaka, Bangladesh; and
| | - Indu Mohan
- Department of Medicine, Eternal Heart Care Centre and Research Institute, Mount Sinai New York Affiliate, Jaipur, India
| | - Raja Babu Panwar
- Administrative Office, Rajasthan University of Health Sciences, Jaipur, India
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
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41
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Guha S, Sethi R, Ray S, Bahl VK, Shanmugasundaram S, Kerkar P, Ramakrishnan S, Yadav R, Chaudhary G, Kapoor A, Mahajan A, Sinha AK, Mullasari A, Pradhan A, Banerjee AK, Singh BP, Balachander J, Pinto B, Manjunath CN, Makhale C, Roy D, Kahali D, Zachariah G, Wander GS, Kalita HC, Chopra HK, Jabir A, Tharakan J, Paul J, Venogopal K, Baksi KB, Ganguly K, Goswami KC, Somasundaram M, Chhetri MK, Hiremath MS, Ravi MS, Das MK, Khanna NN, Jayagopal PB, Asokan PK, Deb PK, Mohanan PP, Chandra P, Girish CR, Rabindra Nath O, Gupta R, Raghu C, Dani S, Bansal S, Tyagi S, Routray S, Tewari S, Chandra S, Mishra SS, Datta S, Chaterjee SS, Kumar S, Mookerjee S, Victor SM, Mishra S, Alexander T, Samal UC, Trehan V. Cardiological Society of India: Position statement for the management of ST elevation myocardial infarction in India. Indian Heart J 2017; 69 Suppl 1:S63-S97. [PMID: 28400042 PMCID: PMC5388060 DOI: 10.1016/j.ihj.2017.03.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Rishi Sethi
- King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumitra Ray
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Vinay K Bahl
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Prafula Kerkar
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Aditya Kapoor
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajay Mahajan
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, Maharashtra, India
| | | | | | | | - Amal Kumar Banerjee
- Institute of Post Graduate Medical Education & Research and Memorial Hospital, Kolkata, West Bengal, India
| | - B P Singh
- Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - J Balachander
- Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India
| | - Brian Pinto
- Holy family Hospital, Mumbai, Maharashtra, India
| | - C N Manjunath
- Sri Jaydeva Institute of Cardiovascular Sciences & Research, Bangaluru, Karnataka, India
| | | | | | - Dhiman Kahali
- BM Birla Heart Research Center, Kolkata, West Bengal, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, Punjab, India
| | - H C Kalita
- Assam Medical College, Dibrugarh, Assam, India
| | | | - A Jabir
- Lisie Hospital, Kochi, Kerala, India
| | - JagMohan Tharakan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Justin Paul
- Madras Medical College, Chennai, Tamil Nadu, India
| | - K Venogopal
- Pushpagiri Institute of Medical Sciences, Tiruvalla, Kerala, India
| | - K B Baksi
- Belle Vue Clinic, Kolkata, West Bengal, India
| | | | - Kewal C Goswami
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - M K Chhetri
- IPGMER & SSKM Hospital, Kolkata, West Bengal, India
| | | | - M S Ravi
- Madras Medical College, Chennai, Tamil Nadu, India
| | | | | | | | - P K Asokan
- The Fatima Hospital, Calicut, Kerala, India
| | - P K Deb
- ESI Hospital, Manicktala, Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - Col R Girish
- Command Hospital, Central Command, Lucknow, India
| | - O Rabindra Nath
- Apollo Gleneagles Heart Institute, Kolkata, West Bengal, India
| | | | - C Raghu
- Prime Hospitals, Hyderabad, India
| | | | | | - Sanjay Tyagi
- GB Pant Institute of Post Graduate Medical Education & Research, New Delhi, India
| | | | - Satyendra Tewari
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | | | | | | | - S S Chaterjee
- Indra Gandhi Institute of Cardiology, Patna, Bihar, India
| | - Soumitra Kumar
- Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | | | | | - Sundeep Mishra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | | | - Vijay Trehan
- Indo-US Super Speciality Hospital, Hyderabad, India
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42
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Yusuf S, Joseph P. The epidemic of cardiovascular disease in South Asians: Time for action. Am Heart J 2017; 185:150-153. [PMID: 28267468 DOI: 10.1016/j.ahj.2016.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
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Geary L, Aronius J, Wettermark B, Hasselström J, Sjöborg B, von Euler M. Sociodemographic factors are associated with utilisation of statins after ischaemic stroke/TIA. Int J Clin Pract 2017; 71. [PMID: 28371022 DOI: 10.1111/ijcp.12936] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/12/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To analyse if there are sociodemographic differences in the utilisation of statins 9-12 months after ischaemic stroke or transitory ischaemic attack. METHODS Anonymised linkage of registry data on all patients >18 years discharged from the hospitals in Stockholm, Sweden 2006-2010 with diagnosis of ischaemic stroke (ICD-10: I63.0-9) or TIA (ICD-10: G45.9) was performed. Data on hospitalisations and diagnoses were collected from the Stockholm County Council administrative databases on healthcare consumption. Dispensed prescriptions with statins and, for comparative purposes, antihypertensive agents 9-12 months after discharge were acquired from the National Swedish Prescribed Drug Register. Data about socioeconomic factors were obtained from Statistics Sweden. The dispensing of statins and antihypertensive agents, relative to sociodemographic variables were analysed. Using logistic regression odds ratios, crude, and adjusted with education, income, origin of birth, age, and sex as predictors where calculated. RESULTS Of 24 312 patients with ischaemic stroke/TIA, 19 335 were alive 12 months after discharge. Statins were dispensed to 44% of all patients in the cohort, more frequently to men of all age groups, to patients with higher education, and to those with higher income. Antihypertensive agents were dispensed to 68% of all patients and there were no differences related to sex and income whilst patients with lower education were dispensed with antihypertensives more frequently. CONCLUSION We find a low utilisation of statins one year after ischaemic stroke/TIA. Patients with low education, low income, and female sex were dispensed fewer prescriptions of statins indicating a need for improvement.
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Affiliation(s)
- Lukas Geary
- Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Unit of Medicine, Capio S:t Görans Sjukhus, Stockholm, Sweden
| | - Jonas Aronius
- Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden
- Public Healthcare Services Committee, Department of Healthcare development, Stockholm County Council, Stockholm, Sweden
| | - Björn Wettermark
- Public Healthcare Services Committee, Department of Healthcare development, Stockholm County Council, Stockholm, Sweden
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Jan Hasselström
- Section of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Centre, Stockholm County Council, Stockholm, Sweden
| | - Bengt Sjöborg
- Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden
| | - Mia von Euler
- Karolinska Institutet Stroke Research Network at Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
- Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden
- Section of Neurology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
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Oommen AM, Nand K, Abraham VJ, George K, Jose VJ. Prevalence of statin use among high-risk patients in urban and rural Vellore, Tamil Nadu: A population-based cross-sectional study. Indian J Pharmacol 2017; 49:201-204. [PMID: 28706335 PMCID: PMC5497444 DOI: 10.4103/ijp.ijp_747_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/22/2017] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES This study assessed statin use among diabetics and those with coronary heart disease (CHD) in Vellore, Tamil Nadu. METHODS A cross-sectional survey was conducted in rural and urban Vellore, among 6196 participants (30-64 years), in 2010-2012. Statin use among those with known CHD and diabetes (on diabetic medication) was recorded. A randomly selected sample of rural diabetics was resurveyed in 2016 to reassess statin use. RESULTS Among 61 with CHD, 23 (37.7%) were on statins. Statin use among 422 diabetics aged ≥40 years with low-density lipoprotein ≥70 mg/dl was 13.4% in urban and 7.6% among rural. Statin usage among rural diabetics aged ≥40 years increased from 7.7% in 2010-2012 to 16.6% in 2016. CONCLUSIONS Statin use for CHD was below 50% although higher than the use among diabetics, indicating the need to address this low rate of usage among these high-risk groups.
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Affiliation(s)
- Anu Mary Oommen
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Khushboo Nand
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinod Joseph Abraham
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Kuryan George
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - V. Jacob Jose
- Department of Cardiology, Christian Medical College, Vellore, Tamil Nadu, India
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Feinberg L, Menon J, Smith R, Rajeev JG, Kumar RK, Banerjee A. Potential for mobile health (mHealth) prevention of cardiovascular diseases in Kerala: A population-based survey. Indian Heart J 2016; 69:182-199. [PMID: 28460766 PMCID: PMC5414958 DOI: 10.1016/j.ihj.2016.11.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 10/19/2016] [Accepted: 11/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND India's southern state of Kerala stands at the forefront of India's epidemic of cardiovascular disease (CVD), among other non-communicable diseases (NCDs). Mobile phone use in healthcare (mHealth) has shown promise in India, including NCDs. However, suitability and acceptability of m-Health interventions is poorly researched, particularly in rural settings. OBJECTIVES METHODS: A questionnaire regarding mobile phone usage and possible use in healthcare was verbally administered in five primary health centres and by home visits in five village councils ("panchayats") of Ernakulam, Kerala. Adults who spoke Malayalam or English, with access to a mobile phone were recruited by convenience sampling in partnership with accredited social health activists (ASHAs). Quantitative data analysis was conducted using SPSS software. RESULTS 262 participants were recruited. 87% routinely used and 88% owned a mobile phone. 92% were willing to receive mHealth advice, and 94% favoured mobile medication reminders. 70.3% and 73% preferred voice calls over short messaging service (SMS) for delivering health information and medication reminders, respectively. 85.9% would send home recorded information on their blood pressure, weight, medication use and lifestyle to a doctor or ASHA. 75.2% trusted the confidentiality of mHealth data, while 77.1% had no concerns about the privacy of their information. CONCLUSIONS The majority of this population approve mHealth interventions. While further investigation of mHealth as a health education tool is warranted, SMS interventions may fail to maximise equity and penetration across all patient groups.
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Affiliation(s)
- Leo Feinberg
- University of Birmingham, Medical School, Birmingham, United Kingdom.
| | - Jaideep Menon
- Amrita Institute of Medical Sciences & Research Centre, Department of Preventive Cardiology, Kochi, India.
| | - Rebecca Smith
- University of Birmingham, Medical School, Birmingham, United Kingdom.
| | | | - Raman Krishan Kumar
- Amrita Institute of Medical Sciences & Research Centre, Department of Paediatric Cardiology, Kochi, India.
| | - Amitava Banerjee
- University of Birmingham Centre for Cardiovascular Sciences, Birmingham, United Kingdom; Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
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Newman C, Ajay VS, Srinivas R, Bhalla S, Prabhakaran D, Banerjee A. Drugs for cardiovascular disease in India: perspectives of pharmaceutical executives and government officials on access and development-a qualitative analysis. J Pharm Policy Pract 2016; 9:16. [PMID: 27141309 PMCID: PMC4852445 DOI: 10.1186/s40545-016-0065-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 04/10/2016] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND India shoulders the greatest global burden of cardiovascular diseases (CVDs), which are the leading cause of mortality worldwide. Drugs are the bedrock of treatment and prevention of CVD. India's pharmaceutical industry is the third largest, by volume, globally, but access to CVD drugs in India is poor. There is a lack of qualitative data from government and pharmaceutical sectors regarding CVD drug development and access in India. METHODS By purposive sampling, we recruited either Indian government officials, or pharmaceutical company executives. We conducted a stakeholder analysis via semi-structured, face-to-face interviews in India. Topic guides allow for the exploration of key issues across multiple interviews, along with affording the interviewer the flexibility to examine matters arising from the discussions themselves. After transcription, interviews underwent inductive thematic analysis. RESULTS Ten participants were interviewed (Government Officials: n = 5, and Pharmaceutical Executives: n = 5). Two themes emerged: i) 'Policy-derived Factors'; ii) 'Patient- derived Factors' with three findings. First, both government and pharmaceutical participants felt that the focus of Indian pharma is shifting to more complex, high-quality generics and to new drug development, but production of generic drugs rather than new molecular entities will remain a major activity. Second, current trial regulations in India may restrict India's potential role in the future development of CVD drugs. Third, it is likely that the Indian government will tighten its intellectual property regime in future, with potentially far-reaching implications on CVD drug development and access. CONCLUSIONS Our stakeholder analysis provides some support for present patent regulations, whilst suggesting areas for further research in order to inform future policy decisions regarding CVD drug development and availability. Whilst interviewees suggested government policy plays an important role in shaping the industry, a significant force for change was ascribed to patient-derived factors. This suggests a potential role for Indian initiatives that market the unique advantages of its patient population for drug research in influencing national and multinational pharmaceutical companies to undertake CVD drug development in India, rather than simply IP policy-directed factors.
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Affiliation(s)
- Charles Newman
- />University of Birmingham, Medical School, Birmingham, UK
| | | | - Ravi Srinivas
- />Research and Information Systems for Developing Countries (RIS), New Delhi, India
| | | | | | - Amitava Banerjee
- />University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK
- />Present address: Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London, NW1 2DA UK
- />School of Health, University of Central Lancashire, Preston, UK
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Sharma KK, Gupta R, Mathur M, Natani V, Lodha S, Roy S, Xavier D. Non-physician health workers for improving adherence to medications and healthy lifestyle following acute coronary syndrome: 24-month follow-up study. Indian Heart J 2016; 68:832-840. [PMID: 27931556 PMCID: PMC5143810 DOI: 10.1016/j.ihj.2016.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 01/15/2016] [Accepted: 03/22/2016] [Indexed: 01/01/2023] Open
Abstract
Objective To evaluate usefulness of non-physician health workers (NPHW) to improve adherence to medications and lifestyles following acute coronary syndrome (ACS). Methods We randomized 100 patients at hospital discharge following ACS to NPHW intervention (n = 50) or standard care (n = 50) in an open label study. NPHW was trained for interventions to improve adherence to medicines – antiplatelets, β-blockers, renin–angiotensin system (RAS) blockers and statins and healthy lifestyles. Intervention lasted 12 months with passive follow-up for another 12. Both groups were assessed for adherence using a standardized questionnaire. Results ST elevation myocardial infarction (STEMI) was in 49 and non-STEMI in 51, mean age was 59.0 ± 11 years. 57% STEMI were thrombolyzed. On admission majority were physically inactive (71%), consumed unhealthy diets (high fat 77%, high salt 58%, low fiber 57%) and 21% were smokers/tobacco users. Coronary revascularization was performed in 90% (percutaneous intervention 79%, bypass surgery 11%). Drugs at discharge were antiplatelets 100%, β-blockers 71%, RAS blockers 71% and statins 99%. Intervention and control groups had similar characteristics. At 12 and 24 months, respectively, in intervention vs control groups adherence (>80%) was: anti platelets 92.0% vs 77.1% and 83.3% vs 40.9%, β blockers 97.2% vs 90.3% and 84.8% vs 45.0%), RAS blockers 95.1% vs 82.3% and 89.5% vs 46.1%, and statins 94.0% vs 70.8% and 87.5% vs 29.5%; smoking rates were 0.0% vs 12.5% and 4.2% vs 20.5%, regular physical activity 96.0% vs 50.0%, and 37.5% vs 34.1%, and healthy diet score 5.0 vs 3.0, and 4.0 vs 2.0 (p < 0.01 for all). Intervention vs standard group at 12 months had significantly lower mean systolic BP, heart rate, body mass index, waist:hip ratio, total cholesterol, triglyceride, and LDL cholesterol (p < 0.01). Conclusions NPHW-led educational intervention for 12 months improved adherence to evidence based medicines and healthy lifestyles. Efficacy continued for 24 months with attrition.
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Affiliation(s)
- Krishna Kumar Sharma
- Department of Pharmacology, SMS Medical College, Jaipur 302004, India; Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India
| | - Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India; Department of Medicine, Eternal Heart Care Centre and Research Institute, Jaipur 302020, India.
| | - Mukul Mathur
- Department of Pharmacology, SMS Medical College, Jaipur 302004, India
| | - Vishnu Natani
- Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India
| | - Sailesh Lodha
- Department of Endocrinology, Fortis Escorts Hospital, Jaipur 302017, India
| | - Sanjeeb Roy
- Department of Cardiology, Fortis Escorts Hospital, Jaipur 302017, India
| | - Denis Xavier
- Department of Pharmacology, St John's Medical College, Bangalore 560068, India
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Xavier D, Gupta R, Kamath D, Sigamani A, Devereaux PJ, George N, Joshi R, Pogue J, Pais P, Yusuf S. Community health worker-based intervention for adherence to drugs and lifestyle change after acute coronary syndrome: a multicentre, open, randomised controlled trial. Lancet Diabetes Endocrinol 2016; 4:244-253. [PMID: 26857999 DOI: 10.1016/s2213-8587(15)00480-5] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 11/06/2015] [Accepted: 12/01/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND Adherence to drugs and healthy lifestyles is low after acute coronary syndrome. We assessed whether trained community health workers could improve adherence to drugs, lifestyle changes, and clinical risk markers in patients with acute coronary syndrome in India. METHODS In this study done at 14 hospitals in India we randomly assigned (1:1) patients with acute coronary syndrome 1 or 2 days before discharge from hospital to a community health worker-based intervention group or a standard care group. Patients were randomly assigned with a telephone randomisation service. In the intervention group, during four in-hospital and two home visits, community health workers used unstructured discussions, visual methods, and patient diaries to educate patients on healthy lifestyle and drugs, and measures to enhance adherence. The primary outcome was adherence to proven secondary prevention drugs (antiplatelet drugs, β blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and statins) estimated using a Composite Medication Adherence Scale at 1 year. The secondary outcomes were difference in lifestyle factors (diet, exercise, and tobacco and alcohol use), and clinical risk markers (blood pressure, bodyweight, BMI, heart rate, and lipids). All analyses were by intention to treat. This trial is registered with the Clinical Trial Registry of India, number REF/2013/03/004737, and ClinicalTrials.gov, number NCT01207700. RESULTS Between Aug 23, 2011, and June 25, 2012, 806 participants were randomly assigned (405 to a community health worker-based intervention group and 401 to a standard care group). At 1 year, 40 patients had died and 15 had discontinued or been lost to follow-up, so 750 (93%) were included in the analyses (375 in each group). Secondary prevention drugs prescribed at discharge were 98% (786/803) for any antiplatelet drug, 79% (638/803) for dual antiplatelet drugs, 69% (555/803) for β blockers, 69% (552/803) for angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and 95% (762/803) for statins. At one year, overall adherence (≥80%) to prescribed evidence-based drugs was higher in the intervention group than in the control group (97% vs 92%, odds ratio [OR] 2·62, 95% CI 1·32-5·19; p=0·006). For individual drugs, we recorded significant differences for angiotensin-converting enzyme inhibitors and angiotensin receptor blockers (97% [233/240] in the intervention group vs 93% [223/240] in the control group; p=0·036) and statins (97% [346/356] vs 93% [321/345]; p=0·011). The intervention group had significantly greater adherence to smoking cessation (85% [110/129] vs 52% [71/138], OR 5·46, 95% CI 3·03-9·86; p<0·0001), regular physical activity (89% [333/375] vs 60% [226/375], OR 5·23, 95% CI 3·57-7·66; p<0·0001), and healthy diet (score 5·0 vs 3·0, OR 2·47, 95% CI 1·88-3·25; p<0·0001). More patients in the intervention group had stopped alcohol use at 1 year (87% [64/74] vs 46% [46/67], OR 2·92, 95% CI 1·26-6·79; p =0·010). At 1 year, the mean systolic blood pressure (124·4 mm Hg [SD 13·5] vs 128·0 mm Hg [15·9]; p=0·002), weight (65·0 kg [11·0] vs 66·5 kg [11·5]; p<0·0001), cholesterol (157·0 [40·2] vs 166·9 [48·4]; p=0·184), LDL (81·0 [20·6] vs 87·3 [29·9]; p=0·191), HDL (42·0 [11·4] vs 38·2 [6·5]; p=0·042), and BMI (24·4 kg/m(2) [SD 3·7] vs 25·0 kg/m(2) [3·8]; p<0·0001) were lower in the intervention group than in the control group. However, we noted no significant difference in diastolic blood pressure and heart rate. INTERPRETATION A community health worker-based personalised intervention strategy in patients with acute coronary syndrome improved adherence to evidence-based drugs and healthy lifestyles, and resulted in an improvement in clinical risk markers. Integration of trained community health workers can improve secondary prevention in coronary artery disease. FUNDING US National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health, Department of Health and Human Services, and the UnitedHealth group, USA.
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Affiliation(s)
- Denis Xavier
- Department of Pharmacology, St John's Medical College, Bangalore, India; Division of Clinical Research and Training, St John's Research Institute, Bangalore, India.
| | - Rajeev Gupta
- Department of Preventive Cardiology and Internal Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Deepak Kamath
- Department of Pharmacology, St John's Medical College, Bangalore, India; Division of Clinical Research and Training, St John's Research Institute, Bangalore, India
| | - Alben Sigamani
- Clinical Research, Narayana Hrudayalaya Limited, Bangalore, India
| | - P J Devereaux
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Nisha George
- Division of Clinical Research and Training, St John's Research Institute, Bangalore, India
| | - Rajnish Joshi
- Department of Internal Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Janice Pogue
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Prem Pais
- Division of Clinical Research and Training, St John's Research Institute, Bangalore, India
| | - Salim Yusuf
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON, Canada
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Gallagher J, Parenti G, Doyle F. Psychological Aspects of Cardiac Care and Rehabilitation: Time to Wake Up to Sleep? Curr Cardiol Rep 2015; 17:111. [DOI: 10.1007/s11886-015-0667-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Murphy C, Bennett K, Fahey T, Shelley E, Graham I, Kenny RA. Statin use in adults at high risk of cardiovascular disease mortality: cross-sectional analysis of baseline data from The Irish Longitudinal Study on Ageing (TILDA). BMJ Open 2015; 5:e008017. [PMID: 26169806 PMCID: PMC4513517 DOI: 10.1136/bmjopen-2015-008017] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aims to examine the extent to which statins are used by adults at high risk of cardiovascular disease (CVD) compared to European clinical guidelines. The high-risk groups examined are those with (1) known CVD, (2) known diabetes and (3) a high or very high risk (≥5%) of CVD mortality based on Systematic COronary Risk Evaluation (SCORE). DESIGN This study is cross-sectional in design using data from the first wave (2009-2011) of The Irish Longitudinal Study on Ageing (TILDA). SETTING AND PARTICIPANTS The sample (n=3372) is representative of community living adults aged 50-64 years in Ireland. RESULTS Statins were used by 68.6% (95% CI 61.5% to 75.8%) of those with known CVD, 57.4% (95% CI 49.1% to 65.7%) of those with known diabetes and by 19.7% (95% CI 13.0% to 26.3%) of adults with a SCORE risk ≥5%. Over a third (38.5%, 95% CI 31.0% to 46.0%) of those with known CVD, 46.8% (95% CI 38.4% to 55.1%) of those with known diabetes and 85.2% (95% CI 79.3% to 91.1%) of those with a SCORE risk ≥5% were at or above the low-density lipoprotein cholesterol (LDL-C) target of 2.5 mmol/L specified in the 2007 European guidelines. CONCLUSIONS Despite strong evidence and clinical guidelines recommending the use of statins for secondary prevention, a gap exists between guidelines and practice in this cohort. It is also of concern that a low proportion of adults with a SCORE risk ≥5% were taking statins. A policy response that strengthens secondary prevention, and improves risk assessment and shared decision-making in the primary prevention of CVD is required.
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Affiliation(s)
- Catriona Murphy
- Department of Medical Gerontology, Trinity College, Dublin, Ireland
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity College, Dublin, Ireland
| | - Tom Fahey
- Department of General Practice, HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland Medical School, Dublin, Ireland
| | - Emer Shelley
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - Ian Graham
- Department of Cardiology, Tallaght Hospital, Dublin, Ireland
| | - Rose Anne Kenny
- Department of Medical Gerontology, Trinity College, Dublin, Ireland
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