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Marzà-Florensa A, Vaartjes I, Graham I, Klipstein-Grobusch K, Grobbee DE. A Global Perspective on Cardiovascular Risk Factors by Educational Level in CHD Patients: SURF CHD II. Glob Heart 2024; 19:60. [PMID: 39035775 PMCID: PMC11259115 DOI: 10.5334/gh.1340] [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: 04/18/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024] Open
Abstract
Background Clinical guidelines recommend lifestyle modifications and medication use to control cardiovascular risk factors in coronary heart disease (CHD) patients. However, risk factor control remains challenging especially in patients with lower educational level. Objective To assess inequalities by educational level in the secondary prevention of CHD in the Survey of Risk Factors in Coronary Heart Disease (SURF CHD II). Methods SURF CHD II is a cross-sectional clinical audit on secondary prevention of CHD, conducted during routine clinical visits in 29 countries. The easy-to-perform design of the survey facilitates its implementation in settings with limited resources. We reported risk factor recording, attainment of guideline-defined risk factor targets, and treatment in CHD patients. Differences by educational level in target attainment and treatment were assessed with logistic regression stratified for high- (HIC), upper middle- (UMIC), and lower middle-income (LMIC) countries. Results SURF CHD II included 13,884 patients from 2019 to 2022, of which 25.0% were female and 18.6% had achieved only primary school level. Risk factor recording ranged from 22.2% for waist circumference to 95.6% for smoking status, and target attainment from 15.9% for waist circumference to 78.7% for smoking. Most patients used cardioprotective medications and 50.5% attended cardiac rehabilitation.Patients with secondary or tertiary education were more likely to meet targets for smoking, LDL cholesterol and physical activity in HICs and LMICs; for physical activity and triglycerides in UMICs; but less likely to meet targets for blood pressure in HICs and LDL <1.4mmol/L in UMICs. Higher education was positively associated with medication use and cardiac rehabilitation participation. Conclusion CHD patients generally have poor attainment of risk factor targets, but patients with a higher educational level are generally more likely to participate in cardiac rehabilitation, use medication, and meet targets. Main messages Target attainment and participation in cardiac rehabilitation are poor in CHD patients globally.Patients with higher education are more likely to meet risk factor targets, showing health inequities in secondary prevention of CHD.The association between education and risk factor target attainment and treatment varies with country income level.
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Affiliation(s)
- Anna Marzà-Florensa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Lim LL, Hussein Z, Noor NM, Raof ASA, Mustafa N, Bidin MBL, Ghani RA, Samsuddin S, Yong SL, Foo SH, Raghuram K, Suwannasri P, W. B. WM, Chiew TK, Chan SP. Real-world evaluation of care for type 2 diabetes in Malaysia: A cross-sectional analysis of the treatment adherence to guideline evaluation in type 2 diabetes (TARGET-T2D) study. PLoS One 2024; 19:e0296298. [PMID: 38166049 PMCID: PMC10760741 DOI: 10.1371/journal.pone.0296298] [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: 07/25/2023] [Accepted: 12/08/2023] [Indexed: 01/04/2024] Open
Abstract
AIM Given a lack of data on diabetes care performance in Malaysia, we conducted a cross-sectional study to understand the clinical characteristics, control of cardiometabolic risk factors, and patterns of use of guideline-directed medical therapy (GDMT) among patients with type 2 diabetes (T2D), who were managed at publicly-funded hospitals between December 2021 and June 2022. METHODS Patients aged ≥18 years with T2D from eight publicly-funded hospitals in the Greater Kuala Lumpur region, who had ≥2 outpatient visits within the preceding year and irrespective of treatment regimen, were eligible. The primary outcome was ≥2 treatment target attainment (defined as either HbA1c <7.0%, blood pressure [BP] <130/80 mmHg, or low-density lipoprotein cholesterol [LDL-C] <1.8 mmol/L). The secondary outcomes were the individual treatment target, a combination of all three treatment targets, and patterns of GDMT use. To assess for potential heterogeneity of study findings, all outcomes were stratified according to prespecified baseline characteristics namely 1) history of atherosclerotic cardiovascular disease (ASCVD; yes/no) and 2) clinic type (Diabetes specialist versus General medicine). RESULTS Among 5094 patients (mean±SD age 59.0±13.2 years; T2D duration 14.8±9.2 years; HbA1c 8.2±1.9% (66±21 mmol/mol); BMI 29.6±6.2 kg/m2; 45.6% men), 99% were at high/very high cardiorenal risk. Attainment of ≥2 treatment targets was at 18%, being higher in General medicine than in Diabetes specialist clinics (20.8% versus 17.5%; p = 0.039). The overall statin coverage was 90%. More patients with prior ASCVD attained LDL-C <1.4 mmol/L than those without (13.5% versus 8.4%; p<0.001). Use of sodium-glucose cotransporter-2 (SGLT2) inhibitors (13.2% versus 43.2%), glucagon-like peptide-1 receptor agonists (GLP1-RAs) (1.0% versus 6.2%), and insulin (27.7% versus 58.1%) were lower in General medicine than in Diabetes specialist clinics. CONCLUSIONS Among high-risk patients with T2D, treatment target attainment and use of GDMT were suboptimal.
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Affiliation(s)
- Lee-Ling Lim
- Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR
- Asia Diabetes Foundation, Shatin, Hong Kong, SAR
| | | | - Nurain Md Noor
- Department of Medicine, Hospital Putrajaya, Putrajaya, Malaysia
| | - Anis S. Abd Raof
- Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Norlaila Mustafa
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | | | - Rohana Abdul Ghani
- Faculty of Medicine, Department of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | | | - Sy-Liang Yong
- Department of Medicine, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
| | - Siew-Hui Foo
- Department of Medicine, Hospital Selayang, Selangor, Malaysia
| | | | | | - Wan Mohamad W. B.
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Thiam-Kian Chiew
- Faculty of Computer Science and Information Technology, Department of Software Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Siew-Pheng Chan
- Faculty of Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Grigorian-Shamagian L, Coca A, Morais J, Perez-Martinez P. The use of the CNIC-Polypill in real-life clinical practice: opportunities and challenges in patients at very high risk of atherosclerotic cardiovascular disease - expert panel meeting report. BMC Proc 2023; 17:20. [PMID: 37587509 PMCID: PMC10433542 DOI: 10.1186/s12919-023-00268-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/18/2023] Open
Abstract
Although the cardiovascular (CV) polypill concept is not new and several guidelines state that a CV polypill should be considered an integral part of a comprehensive CV disease (CVD) prevention strategy, there are still some barriers to its implementation in the real-world setting, mainly in secondary CV prevention. As the CNIC-polypill is the only one approved for secondary CV prevention in patients with atherosclerotic CVD in 27 countries worldwide, a panel of four discussants and 30 participants from 18 countries conveyed in a virtual meeting on April 21, 2022, to discuss key clinical questions regarding the practical use of the CNIC-Polypill and barriers to its implementation.Data presented showed that, although the use of the CV polypill is not explicitly mentioned in the current 2021 European Society of Cardiology guidelines on CVD prevention, it may be used in any patient for secondary CVD prevention tolerating all their components to improve outcomes through different aspects. The favourable results of the Secondary Prevention of Cardiovascular Disease in the Elderly (SECURE) trial now reinforce this recommendation. The panellists presented algorithms on how to switch from any baseline regimen when starting treatment with the CNIC-polypill in different situations, including patients with hypertension, dyslipidaemia, and a previous CV event; at discharge after a cardiovascular event; in chronic ischemic conditions; and in cases of polypharmacy. The panellists and expert discussants did agree that available studies conducted so far with the CNIC-polypill demonstrate that it is as efficacious as the monocomponents, equipotent drugs, or other therapies; reduces the risk of experiencing recurrent major CV events; improves medication adherence; reduces health care costs and resources compared to patients treated with loose drugs; and the patients prefer it over the multipill strategy.In conclusion, the data presented by the participants provided the evidence behind the use of the CNIC-polypill to help fulfil the goal of encouraging its adoption by physicians.
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Affiliation(s)
- Lilian Grigorian-Shamagian
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón and Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Joao Morais
- Leiria Hospital Centre, Leiria, Portugal
- ciTechCare - Center for Innovative Care and Health Technology, Polytechnique of Leiria, Leiria, Portugal
| | - Pablo Perez-Martinez
- Lipids and Atherosclerosis Unit, IMIBIC/Reina Sofia University Hospital/University of Córdoba, Córdoba, Spain
- CIBER Fisiopatologia Obesidad Y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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Gabulova R, Marzà-Florensa A, Rahimov U, Isayeva M, Alasgarli S, Musayeva A, Gahramanova S, Ibrahimov F, Aliyev F, Imanov G, Rasulova R, Vaartjes I, Klipstein-Grobusch K, Graham I, Grobbee DE. Risk factors in cardiovascular patients: Challenges and opportunities to improve secondary prevention. World J Cardiol 2023; 15:342-353. [PMID: 37576543 PMCID: PMC10415862 DOI: 10.4330/wjc.v15.i7.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/14/2023] [Accepted: 07/03/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease (CVD). The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II study is a clinical audit of the recording and management of CHD risk factors. It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology (ESC). Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate. Azerbaijan is a country in the South Caucasus, a region at a very high risk for CVD. AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku (Azerbaijan). METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021. Information on demographics, risk factors, physical and laboratory data, and medications was collected using a standard questionnaire in consecutive patients aged ≥ 18 years with established CHD during outpatient visits. Data from 687 patients (mean age 59.6 ± 9.58 years; 24.9% female) were included in the study. RESULTS Only 15.1% of participants were involved in cardiac rehabilitation programs. The rate of uncontrolled risk factors was high: Systolic blood pressure (BP) (SBP) (54.6%), low-density lipoprotein cholesterol (LDL-C) (86.8%), diabetes mellitus (DM) (60.6%), as well as overweight (66.6%) and obesity (25%). In addition, significant differences in the prevalence and control of some risk factors [smoking, body mass index (BMI), waist circumference, blood glucose (BG), and SBP] between female and male participants were found. The cardiovascular health index score (CHIS) was calculated from the six risk factors: Non- or ex-smoker, BMI < 25 kg/m2, moderate/vigorous physical activity, controlled BP (< 140/90 mmHg; 140/80 mmHg for patients with DM), controlled LDL-C (< 70 mg/dL), and controlled BG (glycohemoglobin < 7% or BG < 126 mg/dL). Good, intermediate, and poor categories of CHIS were identified in 6%, 58.3%, and 35.7% of patients, respectively (without statistical differences between female and male patients). CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and, in particular, the control rate of BP, are insufficient. Given the fact that patients with different comorbid pathologies are at a very high risk, this is of great importance in the management of such patients. This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures, especially in the regions at a high risk for CVD. A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.
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Affiliation(s)
- Rahima Gabulova
- Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan.
| | - Anna Marzà-Florensa
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Uzeyir Rahimov
- Department of Cardiology, Baku Medical Plaza, Baku AZ1014, Azerbaijan
| | - Mahluga Isayeva
- Department of CHD and Arrhythmias, Scientific-Research Institute of Cardiology, Baku AZ1072, Azerbaijan
| | - Shahana Alasgarli
- Department of Cardiology, Central Clinic Hospital, Baku AZ1006, Azerbaijan
| | - Afag Musayeva
- Heart Center, Baku Health Center, Baku AZ1072, Azerbaijan
| | - Sona Gahramanova
- Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Firdovsi Ibrahimov
- Department of Cardiology, Central Clinic Hospital, Baku AZ1006, Azerbaijan
| | - Farid Aliyev
- Heart Center, Baku Health Center, Baku AZ1072, Azerbaijan
| | - Galib Imanov
- Teaching-Surgical Hospital, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Rahmana Rasulova
- Department of Public Health, Azerbaijan Medical University, Baku AZ1022, Azerbaijan
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
| | - Ian Graham
- Department of Cardiology, Trinity College Dublin, Dublin Dublin-2, Ireland
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht 3508 GA, Netherlands
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Stefil M, Bell J, Calvert P, Lip GY. Heightened risks of cardiovascular disease in South Asian populations: causes and consequences. Expert Rev Cardiovasc Ther 2023; 21:281-291. [PMID: 36866613 DOI: 10.1080/14779072.2023.2187780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
INTRODUCTION South Asian individuals comprise almost a quarter of the world's population and have an excess risk of atherosclerotic cardiovascular disease (ASCVD) compared to other ethnicities. In part, this can be explained by higher prevalence, earlier onset, and suboptimal control of traditional cardiovascular risk factors, such as insulin resistance, metabolic syndrome, and dyslipidaemia. However, there remains a significant residual excess risk associated with South Asian ethnicity after controlling for traditional risk factors. AREAS COVERED In this review, we describe the epidemiology of ASCVD in both native and diaspora South Asian populations. We explore how traditional cardiovascular risk factors, novel cardiovascular risk factors, and social determinants of health may contribute to the excess ASCVD risk seen in South Asian populations. EXPERT OPINION There should be increased awareness of the relative importance of South Asian ethnicity and related social determinants of health, as risk factors for ASCVD. Systematic screening processes should be tailored to this population, and modifiable risk factors should be treated aggressively. Further research is required to quantify determinants of the excess ASCVD risk seen in South Asian populations and to develop targeted interventions to address these factors.
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Affiliation(s)
- Maria Stefil
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Jack Bell
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Peter Calvert
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Gregory Yh Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Prevalence of Cardioprotective Medication Use in Coronary Heart Disease Patients in South America: Systematic review and Meta-Analysis. Glob Heart 2022; 17:37. [PMID: 35837361 PMCID: PMC9187244 DOI: 10.5334/gh.1124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 05/09/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Coronary heart disease (CHD) is the most common cause of death globally, and clinical guidelines recommend cardioprotective medications for patients with established CHD. Suboptimal use of these medications has been reported, but information from South America is scarce. Methods: We conducted a systematic review on prevalence of secondary prevention medication in South America. We pooled prevalence estimates, analysed time-trends and guideline compliance, and identified factors associated with medication use with meta-regression models. Results: 73 publications were included. Medication prevalence varied by class: beta-blockers 73.4%(95%CI 66.8%–79.1%), ACEI/ARBs 55.8%(95%CI 49.7%–61.8), antiplatelets 84.6%(95%CI 79.6%–88.5%), aspirin 85.1%(95%CI 79.7%–89.3%) and statins 78.9%(95%CI 71.2%–84.9%). The use of beta-blockers, ACEI/ARBs and statins increased since 1993. Ten publications reported low medication use and nine reported adequate use. Medication use was lower in community, public and rehabilitation settings compared to tertiary centres. Conclusion: Cardioprotective medication use has increased, but could be further improved particularly in community settings.
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Wang C, Xie Z, Huang X, Wang Z, ShangGuan H, Wang S. Prevalence of cardiovascular disease risk factors in Chinese patients with type 2 diabetes mellitus, 2013-2018. Curr Med Res Opin 2022; 38:345-354. [PMID: 35012406 DOI: 10.1080/03007995.2021.2022382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Coronary heart disease (CHD) is the most common cause of death in patients with type 2 diabetes (T2DM). We aim to estimate the prevalence of CHD and cardiovascular risk factors in Chinese patients with T2DM. METHODS A total of 66,536 inpatients with diabetes treated from 2013 to 2018 were investigated, and demographic and clinical data were collected from 30,693 patients with T2DM. Age-standardized prevalence of CHD was calculated on the basis of data from the Chinese population census in 2010. Logistic regression analysis was used to analyze the risk factors. RESULTS The crude prevalence of CHD was estimated to be 23.5% and a standardized prevalence was 13.9% (16.0% in men and 11.9% in women). More than half of patients with CHD have four or more of the five traditional risk factors, much higher than the 38.96% of patients without CHD (p < .01). Multivariate regression analysis showed that diabetes duration, hypertension, smoking, underweight, overweight, obesity and hypoglycaemia were significantly associated with increased risk of CHD (all p < .05). The odds ratio of CHD in patients with three, four or five defined CHD risk factors (i.e. diabetes, hypertension, dyslipidaemia, overweight or obese, and smoking) were 2.35 (95% CI 1.81-3.04), 2.96 (95% CI 2.28-3.85) or 5.29 (95% CI 4.04-6.93), compared with diabetes patients without any other risk factors. CONCLUSIONS The prevalence of CHD was rather high in Chinese T2DM inpatients, and the aggregation of CHD risk factors was severe. Thus, hierarchical CHD prevention strategies based on risk factors are necessary.
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Affiliation(s)
- ChenChen Wang
- Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
| | - ZuoLing Xie
- Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, China
- School of Medicine, Southeast University, Nanjing, China
| | - Xi Huang
- Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, China
| | - Zheng Wang
- School of Medicine, Southeast University, Nanjing, China
| | - HaiYan ShangGuan
- School of Medicine, Southeast University, Nanjing, China
- Nanjing Central Hospital, Nanjing, China
| | - ShaoHua Wang
- Department of Endocrinology, The Affiliated Zhongda Hospital of Southeast University, Nanjing, China
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Wong ND, Budoff MJ, Ferdinand K, Graham IM, Michos ED, Reddy T, Shapiro MD, Toth PP. ATHEROSCLEROTIC CARDIOVASCULAR DISEASE RISK ASSESSMENT: An American Society for Preventive Cardiology Clinical Practice Statement. Am J Prev Cardiol 2022; 10:100335. [PMID: 35342890 PMCID: PMC8943256 DOI: 10.1016/j.ajpc.2022.100335] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 01/08/2023] Open
Abstract
Risk for atherosclerotic cardiovascular disease (ASCVD) shows considerable heterogeneity both in generally healthy persons and in those with known ASCVD. The foundation of preventive cardiology begins with assessing baseline ASCVD risk using global risk scores based on standard office-based measures. Persons at low risk are generally recommended for lifestyle management only and those at highest risk are recommended for both lifestyle and pharmacologic therapy. Additional “risk enhancing” factors, including both traditional risk factors and novel biomarkers and inflammatory factors can be used to further assess ASCVD risk, especially in those at borderline or intermediate risk. There are also female-specific risk enhancers, social determinants of health, and considerations for high-risk ethnic groups. Screening for subclinical atherosclerosis, especially with the use of coronary calcium screening, can further inform the treatment decision if uncertain based on the above strategies. Persons with pre-existing ASCVD also have variable risk, affected by the number of major ASCVD events, whether recurrent events have occurred recently, and the presence of other major risk factors or high-risk conditions. Current guidelines define high to very high risk ASCVD accordingly. Accurate ASCVD risk assessment is crucial for the appropriate targeting of preventive therapies to reduce ASCVD risk. Finally, the clinician-patient risk discussion focusing on lifestyle management and the risks and benefits of evidence-based pharmacologic therapies to best lower ASCVD risk is central to this process. This clinical practice statement provides the preventive cardiology specialist with guidance and tools for assessment of ASCVD risk with the goal of appropriately targeting treatment approaches for prevention of ASCVD events.
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Affiliation(s)
- Nathan D. Wong
- Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, United States
- Corresponding author.
| | - Matthew J. Budoff
- Division of Cardiology, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Keith Ferdinand
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | - Ian M. Graham
- Department of Cardiology, Trinity College, Dublin, Ireland
| | - Erin D. Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tina Reddy
- Tulane University Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA United States
| | | | - Peter P. Toth
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- CGH Medical Center, Sterling, IL, United States
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Vrablik M, Seifert B, Parkhomenko A, Banach M, Jóźwiak JJ, Kiss RG, Gaita D, Rašlová K, Zachlederova M, Bray S, Ray KK. Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study. Atherosclerosis 2021; 334:66-75. [PMID: 34482090 DOI: 10.1016/j.atherosclerosis.2021.08.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Central and Eastern Europe (CEE) is a largely understudied region, despite having the highest cardiovascular disease mortality in Europe. This analysis aimed to assess the proportion of patients in CEE who achieved their LDL-C goals based on individual cardiovascular risk recommended by the 2016 and 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines. METHODS The DA VINCI study was a cross-sectional observational study of primary and secondary prevention patients receiving lipid-lowering therapy across Europe between June 2017 and November 2018. RESULTS In total, 2154 patients were enrolled from the Czech Republic (n = 509), Hungary (n = 319), Poland (n = 460), Romania (n = 259), Slovakia (n = 123) and Ukraine (n = 484). At LDL-C measurement, most patients were on either moderate- or high-intensity statin monotherapy (53% and 32%, respectively). Despite this, only 44% of patients achieved risk-based LDL-C goals recommended by the 2016 ESC/EAS guidelines, ranging from 21% in Ukraine to 50% in Hungary and Romania. Only 24% of patients overall achieved the risk-based LDL-C goals recommended by the 2019 ESC/EAS guidelines, ranging from 11% in Ukraine to 32% in Poland. CONCLUSIONS Among patients receiving lipid-lowering therapy, more than half did not achieve their 2016 LDL-C goals. In one of the first comparative analyses evaluating 2019 risk-based goal attainment among countries in CEE, three-quarters of patients did not meet their 2019 LDL-C goals, highlighting a significant gap between guidelines and clinical practice for lipid management in CEE.
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Affiliation(s)
- Michal Vrablik
- Third Department of Internal Medicine, General University Hospital and Charles University, 12808, Prague 2, Czech Republic.
| | - Bohumil Seifert
- Institute of General Practice, Charles University, 128 00, Prague 2, Czech Republic
| | - Alexander Parkhomenko
- Emergency Cardiology Department, National Scientific Center M.D. Strazehesko Institute of Cardiology, 03680, Kiev, Ukraine
| | - Maciej Banach
- Department of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, 90-419, Lodz, Poland; Polish Mother's Memorial Hospital Research Institute (PMMHRI), 93-338, Lodz, Poland; Cardiovascular Research Centre, University of Zielona Góra, 65-417, Zielona Góra, Poland
| | - Jacek J Jóźwiak
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, 45-040, Opole, Poland
| | | | - Dan Gaita
- Institute of Cardiovascular Diseases, Cardioprevent Foundation, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, 300041, Romania
| | - Katarina Rašlová
- Coordination Center for Familial Hyperlipidemia, Slovak Medical University, 833 03, Bratislava, Slovakia
| | | | - Sarah Bray
- Global Biostatistical Science, Amgen Ltd, 240 Cambridge Science Park, Milton Road, Cambridge, CB4 0WD, UK
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention and Imperial Clinical Trials Unit, Imperial College London, Stadium House, 68 Wood Lane, London, W12 7RH, UK
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Semb AG, Rollefstad S, Ikdahl E, Wibetoe G, Sexton J, Crowson C, van Riel P, Kitas G, Graham I, Rantapää-Dahlqvist S, Karpouzas GA, Myasoedova E, Gonzalez-Gay MA, Sfikakis PP, Tektonidou MGG, Lazarini A, Vassilopoulos D, Kuriya B, Hitchon C, Stoenoiu MS, Durez P, Pascual-Ramos V, Galarza-Delgado DA, Faggiano P, Misra DP, Borg AA, Mu R, Mirrakhimov EM, Gheta D, Douglas K, Agarwal V, Myasoedova S, Krougly L, Valentinovna Popkova T, Tuchyňová A, Tomcik M, Vrablik M, Lastuvka J, Horak P, Medkova HK, Kerola AM. Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis: an international audit. RMD Open 2021; 7:rmdopen-2021-001724. [PMID: 34244381 PMCID: PMC8268901 DOI: 10.1136/rmdopen-2021-001724] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/20/2021] [Indexed: 01/21/2023] Open
Abstract
Aim The objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention. Methods The cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014–2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM. Results The study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM. Conclusion CVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA.
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Affiliation(s)
- Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Grunde Wibetoe
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Cindy Crowson
- Health Sciences Research, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Piet van Riel
- Rheumatology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - George Kitas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Ian Graham
- Cardiology, Trinity College Dublin, Dublin, Ireland
| | - Solbritt Rantapää-Dahlqvist
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå Universitet Medicinska Fakulteten, Umea, Sweden
| | | | - Elena Myasoedova
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | | | - Petros P Sfikakis
- First Department of Propedeutic Medicine, Medical School of University of Athens, Athens, Greece
| | - Maria G G Tektonidou
- First Department of Propaedeutic Internal Medicine, University of Athens, Athens, Greece
| | - Argyro Lazarini
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Clinical Immunology-Rheumatology Unit, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
| | - Bindee Kuriya
- Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Carol Hitchon
- Rheumatology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Patrick Durez
- Rheumatology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Virginia Pascual-Ramos
- Immunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Pompilio Faggiano
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Durga Prasanna Misra
- Krajska zdravotni a.s, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic
| | - Andrew A Borg
- First Medical Faculty, Charles University, Praha, Czech Republic
| | - Rong Mu
- Department of Internal Medicine III-Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Olomoucký, Czech Republic
| | - Erkin M Mirrakhimov
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Diane Gheta
- Medicine, Tallaght University Hospital, Dublin, Ireland
| | - Karen Douglas
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Svetlana Myasoedova
- Rheumatology, Ivanovo State Medical Academy, Ivanovo, Ivanovskaa oblast', Russian Federation
| | - Lev Krougly
- Rheumatology, FSBI National Medical and Surgical Center named after N I Pirogov of the Ministry of Healthcare of the Russian Federation, Moskva, Moskva, Russian Federation
| | | | - Alena Tuchyňová
- Rheumatology, Narodny Ustav Reumatickych Chorob, Piestany, Slovakia
| | - Michal Tomcik
- Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Michal Vrablik
- Third Department of Internal Medicine, Department of Endocrinology and Metabolism, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Jiri Lastuvka
- Krajska zdravotni a.s, Masaryk Hospital in Usti nad Labem, Usti nad Labem, Czech Republic.,First Medical Faculty, Charles University, Praha, Czech Republic
| | - Pavel Horak
- Department of Internal Medicine III-Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Olomoucký, Czech Republic
| | - Helena Kaspar Medkova
- Division of Rheumatology, 2nd Department of Internal Medicine-Gastroenterology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Anne M Kerola
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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11
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Szoeke C, Downie SJ, Parker AF, Phillips S. Sex hormones, vascular factors and cognition. Front Neuroendocrinol 2021; 62:100927. [PMID: 34119528 DOI: 10.1016/j.yfrne.2021.100927] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 05/27/2021] [Accepted: 06/06/2021] [Indexed: 11/25/2022]
Abstract
After more than a century of research, we have failed to develop a pharmacological prevention or cure for dementia. There are strong indicators that sex hormones influence cognition. In this paper we discuss the role of these hormones at the intersection between vascular disease and dementia, in light of the mounting literature covering the shared risk factors, pathological features alongside the timeline of hormonal change with the evolution of vascular and neurodegenerative disease. Interactive risk factors and the role of inflammation over the duration of disease evolution are highlighted. Our summary tables assessing the impact of estrogen-based hormone therapy on cognition over the past 45 years illustrate the effort expended to determine the ideal age for intervention and the type, dose, administration, and duration of therapy that might improve or protect cognition as well as alleviate menopausal symptoms. As the prevalence of dementia is rising and is higher in women, it is crucial we advance our knowledge from the "inconclusive" position statement on menopausal hormone therapy of the US Preventive Services Task Force.
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Affiliation(s)
- C Szoeke
- Healthy Ageing Program, Centre for Medical Research (Royal Melbourne Hospital), Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia.
| | - S J Downie
- Healthy Ageing Program, Centre for Medical Research (Royal Melbourne Hospital), Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - A F Parker
- Department of Psychology, University of Victoria, Victoria, British Columbia, Canada
| | - S Phillips
- Healthy Ageing Program, Centre for Medical Research (Royal Melbourne Hospital), Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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12
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Koskinas KC, Catapano AL, Baigent C, Tokgozoglu L, Mach F. Current perceptions and practices in lipid management: results of a European Society of Cardiology/European Atherosclerosis Society Survey. Eur J Prev Cardiol 2021; 28:2030-2037. [PMID: 33580792 DOI: 10.1093/eurjpc/zwaa156] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 12/18/2022]
Abstract
AIMS We sought to evaluate physicians' opinions and practices in lipid management. METHODS AND RESULTS A web-based survey by the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) was distributed to 70 696 individuals at two time points, before and after publication of the 2019 ESC/EAS dyslipidaemia guidelines. Respondents (1271 in the first and 1056 in the second part) were most commonly cardiologists in Europe. More than 90% of participants reported that they regularly measure lipid levels and discuss lipid-lowering treatment with patients. More than 87% found the use of LDL-C goals useful or potentially useful, although it was acknowledged that recommended goals are frequently not achieved. Regarding the LDL-C goal according to the 2019 guidelines (<1.4 mmol/L for very high-risk patients), more than 70% of respondents felt that it is based on solid scientific evidence, but 31% noted that implementation should also consider available local resources and patient preferences. Statin intolerance was perceived as infrequent, affecting 1-5% of patients according to most respondents but was the main reason for not prescribing a statin to secondary-prevention patients, followed by patient non-adherence. Although most respondents reported that 11-20% of secondary-prevention patients have an indication to add a non-statin medication, fewer patients (<10% according to most respondents) receive these medications. CONCLUSIONS This survey shows a high level of acceptance of the LDL-C treatment goals recommended by current ESC/EAS guidelines. Although patient-related factors were the main reported reasons for suboptimal lipid-lowering therapy, physician inertia to intensify treatment cannot be excluded as an additional contributing factor.
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Affiliation(s)
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Colin Baigent
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lale Tokgozoglu
- Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Francois Mach
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
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13
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Vynckier P, Ferrannini G, Rydén L, Jankowski P, De Backer T, Gevaert S, De Bacquer D, De Smedt D. Gender gap in risk factor control of coronary patients far from closing: results from the European Society of Cardiology EUROASPIRE V registry. Eur J Prev Cardiol 2020; 29:344-351. [PMID: 33624111 DOI: 10.1093/eurjpc/zwaa144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 12/25/2022]
Abstract
AIMS This study aims to provide an overview on contemporary gender differences in the risk factor control of coronary heart disease (CHD) patients. METHODS AND RESULTS Analyses were based on the cross-sectional ESC (European Society of Cardiology) EORP (EurObservational Research Programme) EUROASPIRE V (European Survey of Cardiovascular Disease Prevention and Diabetes) survey including data on CHD patients across 27 European countries. Men and women between 18 and 80 years old, hospitalized for a first or recurrent coronary event were included in the study. Data were available for 8261 patients of which 25.8% women. Overall, women had a worse risk factor control compared with men. Whereas women were more likely to be non-smokers (79.3% vs. 87.2%; P < 0.001), they were less likely to reach recommended levels of physical activity (36.8% vs. 27.5%; P < 0.001), and they were less likely to be non-obese (65.1% vs. 54.3%; P < 0.001). There is indication that risk factors such as smoking behaviour and obesity differed depending on country income level. No gender differences could be observed in blood pressure on target (P > 0.05). Moreover, a lower proportion of women reached low-density lipoprotein cholesterol (LDL-C) target levels (31.4% vs. 22.1%; P < 0.001), and they were less likely to reach glycated haemoglobin (HbA1c) targets if having self-reported diabetes (56.7% vs. 48.6%; P < 0.001). CONCLUSION The risk factor control of CHD women is substantial worse compared with men despite little gender differences in cardiovascular medication intake. Further actions are needed to increase the awareness of the worse risk factor control in female CHD patients.
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Affiliation(s)
- Pieter Vynckier
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Giulia Ferrannini
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Lars Rydén
- Cardiology Unit, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden
| | - Piotr Jankowski
- Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland
| | - Tine De Backer
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Sofie Gevaert
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Dirk De Bacquer
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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14
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Frank-Tewaag J, Bleek J, Horenkamp-Sonntag D, Marschall U, Zeymer U, Donner-Banzhoff N, Sundmacher L. Use of guideline-recommended drug therapy in patients undergoing percutaneous coronary intervention for stable coronary heart disease in Germany: a multilevel analysis of nationwide routine data. BMJ Open 2020; 10:e042886. [PMID: 33318120 PMCID: PMC7737102 DOI: 10.1136/bmjopen-2020-042886] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the prescription of guideline recommended drug therapy in patients with stable coronary heart disease (sCHD) prior to percutaneous coronary intervention (PCI) in Germany and to examine the role of patient characteristics and features of regional healthcare supply in a multilevel model. DESIGN Secondary data analysis of factors associated with the prescription of guideline recommended drug therapy using a multilevel model to analyse regional-level effects, over and above the effects of patient-level demographic and health status. SETTING Office-based prescriptions in the year prior to the invasive procedure. PARTICIPANTS A linked nationwide dataset from Germany's three largest statutory health insurance funds of all patients receiving PCI in the year 2016. MAIN OUTCOME MEASURES Patients' odds of receiving optimal medical therapy and symptom-oriented therapy within 1 year prior to PCI. RESULTS 68.6% of patients received at least one lipid-lowering drug and one symptom-oriented therapy prior to PCI. 43.6% received at least two agents to control their symptoms. Patients who received treatment in accordance with the recommendations had a greater number of diagnosed risk factors, a more severe history of cardiac disease and used a higher volume of ambulatory office-based physician services. The prescriptions prevalence for the symptom-oriented therapies differed significantly between eastern and western Germany, with a higher prevalence in the eastern districts. CONCLUSIONS Guidelines can only provide decision-making corridors, and the applicability of recommendations must always be assessed on a case by case basis. Nevertheless, our analysis indicates that the prevalence of prescriptions in routine practice is subject to substantial variation and that conservative therapy options are not fully exhausted prior to PCI. This suggests that there might be room for improvement in the care of patients with sCHD.
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Affiliation(s)
- Julia Frank-Tewaag
- Department of Health Services Management, Munich School of Management, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | | | | | | | - Uwe Zeymer
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, Philipps-University Marburg, Marburg, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University Munich, Munich, Germany
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15
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Current lipid lowering treatment and attainment of LDL targets recommended by ESC/EAS guidelines in very high-risk patients with established atherosclerotic cardiovascular disease: Insights from the START registry. Int J Cardiol 2020; 316:229-235. [DOI: 10.1016/j.ijcard.2020.05.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/06/2020] [Accepted: 05/18/2020] [Indexed: 12/31/2022]
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16
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Zhao M, Hoek G, Strak M, Grobbee DE, Graham I, Klipstein-Grobusch K, Vaartjes I. A Global Analysis of Associations between Fine Particle Air Pollution and Cardiovascular Risk Factors: Feasibility Study on Data Linkage. Glob Heart 2020; 15:53. [PMID: 32923347 PMCID: PMC7427684 DOI: 10.5334/gh.877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 01/10/2023] Open
Abstract
Background This paper presents a feasibility study of data linkage between global air pollution data and clinical medical data to assess the associations of PM2.5 with cardiovascular risk factors. Methods Cardiovascular risk factor data were obtained from the SUrvey of Risk Factors (SURF) for coronary heart disease (CHD) patients from 10 countries in Europe, Asia, and the Middle-East. Annual average PM2.5 concentrations were estimated using recent global WHO PM2.5 maps combining satellite and surface monitoring data for the location of the 71 participating centers. Associations of PM2.5 with risk factors were assessed by mixed-effect generalized estimation equation models adjusted by sex, age, exercise, body mass index, and smoking. In the final model there was further adjustment for country. Results Linkage between cardiovascular risk factor data and PM2.5 via the postal address of participating hospitals was shown to be feasible, however with several limitations noted.Eight thousand three hundred and ninety two patients (30% women) were included. Globally, an increase of 10 μg/m3 in PM2.5 was significantly associated with decreased BP and increased glucose. After controlling for country, an increase of 10 μg/m3 in PM2.5 was associated with decreased BP and increased LDL (SBP: -0.45 mmHg [95% CI: -0.85, -0.06]; DBP: -0.47 mmHg [-0.73, -0.20]; LDL: 0.04 mmol/L [0.01, 0.08]). The association with glucose attenuated (0.08 mmol/L [-0.23, 0.16]). Conclusion It is feasible to link PM2.5 and cardiovascular risk factors but it is still challenging to interpret these observed associations due to unavailability of potential confounders. After country adjustment, PM2.5 was associated with small increases in LDL and small decreases in BP. Highlights - There are limited studies on the association between air pollution and cardiovascular risk factors for patients with established coronary heart disease in low- and middle-income countries;- Data linkage is an efficient and cost-effective method to maximize the use of existing data to investigate more health related research questions;- It is feasible to determine global associations of air pollution and cardiovascular risk factors by data linkage but it is still challenging in terms of interpretation.
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Affiliation(s)
- Min Zhao
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht, Utrecht University, Utrecht, NL
| | - Maciej Strak
- Institute for Risk Assessment Sciences, Utrecht, Utrecht University, Utrecht, NL
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL
- Global Geo and Health Data Center, Utrecht University, Utrecht, NL
| | | | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, ZA
| | - Ilonca Vaartjes
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, NL
- Global Geo and Health Data Center, Utrecht University, Utrecht, NL
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17
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Athyros VG, Stavropoulos K, Imprialos KP, Doumas M. Suboptimal management of dyslipidemia in everyday clinical practice: Alarming signals from real-world data. Int J Cardiol 2020; 316:240-241. [PMID: 32634493 PMCID: PMC7334918 DOI: 10.1016/j.ijcard.2020.06.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/26/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Vasilios G Athyros
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece.
| | | | | | - Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University, Thessaloniki, Greece
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18
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Uchmanowicz I, Hoes A, Perk J, McKee G, Svavarsdóttir MH, Czerwińska-Jelonkiewicz K, Janssen A, Oleksiak A, Dendale P, Graham IM. Optimising implementation of European guidelines on cardiovascular disease prevention in clinical practice: what is needed? Eur J Prev Cardiol 2020; 28:426-431. [PMID: 33611449 DOI: 10.1177/2047487320926776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/24/2020] [Indexed: 11/16/2022]
Abstract
Abstract
Cardiovascular disease is a model example of a preventable condition for which practice guidelines are particularly important. In 2016, the joint task force created by the European Society of Cardiology (ESC) together with 10 other societies released the new version of the European guidelines on cardiovascular disease prevention. To facilitate the implementation of the ESC guidelines, a dedicated prevention implementation committee has been established within the European Association of Preventive Cardiology. The paper will first explore potential barriers to the guidelines’ implementation. It then develops a discussion that seeks to inform the future development of the committee’s work, including a new definition of the guidelines’ stakeholders (health policy-makers, healthcare professionals and health educators, patient organisations, entrepreneurs and the general public), future activities within four specific areas: strengthening awareness of the guidelines among stakeholders; supporting organisational changes to facilitate the guidelines’ implementation; motivating stakeholders to utilise the guidelines; and present ideas on new implementation strategies. Providing multifaceted cooperation between healthcare professionals, healthcare management executives and health policy-makers, the novel approach proposed in this paper should contribute to a wider use of the 2016 ESC guidelines and produce desired effects of less cardiovascular disease morbidity and mortality. Furthermore, the solutions presented within the paper may constitute a benchmark for the implementation of practice guidelines in other medical disciplines.
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Affiliation(s)
| | - Arno Hoes
- Department of General Practice, University Medical Center Utrecht, The Netherlands
| | - Joep Perk
- Faculty of Health and Life Sciences, Linnaeus University, Sweden
| | - Gabrielle McKee
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | | | | | - Arne Janssen
- Clinical Research Department Cardiology, Heartcentre Hasselt, Belgium
| | - Anna Oleksiak
- Department of Intensive Cardiac Therapy, Institute of Cardiology, Poland
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital and Hasselt University, Belgium
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Milà L, Barrabés JA, Lidón RM, Sambola A, Bañeras J, Oristrell G, Rafecas A, García-Dorado D. Cumplimiento previo de los objetivos recomendados de control lipídico para pacientes que ingresan por síndrome coronario agudo. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Annemans L, Azuri J, Al-Rasadi K, Al-Zakwani I, Daclin V, Mercier F, Danchin N. Healthcare resource utilization in patients on lipid-lowering therapies outside Western Europe and North America: findings of the cross-sectional observational International ChoLesterol management Practice Study (ICLPS). Lipids Health Dis 2020; 19:64. [PMID: 32264883 PMCID: PMC7140553 DOI: 10.1186/s12944-020-01235-5] [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: 11/05/2019] [Accepted: 03/12/2020] [Indexed: 11/30/2022] Open
Abstract
Background Few recent large-scale studies have examined healthcare consumption associated with dyslipidemia in countries outside Western Europe and North America. Methods This analysis, from a cross-sectional observational study conducted in 18 countries in Eastern Europe, Asia, Africa, the Middle East and Latin America, evaluated avoidable healthcare consumption (defined as ≥1 hospitalization for cardiovascular reasons or ≥1 visit to the emergency room for any reason in the previous 12 months) in patients receiving stable lipid-lowering therapy (LLT). A total of 9049 patients (aged ≥18 years) receiving LLT for ≥3 months and who had had their low-density lipoprotein cholesterol (LDL-C) value measured on stable LLT in the previous 12 months were enrolled between August 2015 and August 2016. Patients who had received a proprotein convertase subtilisin/kexin type 9 inhibitor in the previous 6 months were excluded. Patients were stratified by cardiovascular risk level using the Systematic Coronary Risk Estimation chart for high-risk countries. Results The proportion of patients at their LDL-C goal was 32.1% for very-high risk patients compared with 55.7 and 51.9% for patients at moderate and high cardiovascular risk, respectively. Overall, 20.1% of patients had ≥1 reported hospitalization in the previous 12 months (7.9% for cardiovascular reasons), 35.2% had ≥1 intensive care unit stay and 13.8% visited the emergency room. Avoidable healthcare resource consumption was reported for 18.7% patients overall, and in 27.8, 7.7, 7.7 and 13.2% of patients at very-high, high, moderate and low risk, respectively. Across all risk groups 22.4% of patients not at LDL-C goal and 16.6% of patients at LDL-C goal had avoidable healthcare resource consumption. Being at very-high cardiovascular risk, having cardiovascular risk factors (including hypertension and smoking), and having factors indicating that the patient may be difficult to treat (including statin intolerance, comorbidities and chronic medication), were independent risk factors for avoidable healthcare resource consumption (all p <0.05). Conclusions Healthcare resource consumption associated with adverse clinical outcomes was observed in patients on stable LLT in countries outside Western Europe and North America, particularly those at very-high cardiovascular risk and those who were difficult to treat.
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Affiliation(s)
- Lieven Annemans
- Department of Public Health, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Joseph Azuri
- Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Khalid Al-Rasadi
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ibrahim Al-Zakwani
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | | | | | - Nicolas Danchin
- Department of Cardiology, European Hospital Georges-Pompidou, Paris, France
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21
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Milà L, Barrabés JA, Lidón RM, Sambola A, Bañeras J, Oristrell G, Rafecas A, García-Dorado D. Prior adherence to recommended lipid control targets in patients admitted for acute coronary syndrome. ACTA ACUST UNITED AC 2019; 73:376-382. [PMID: 31706709 DOI: 10.1016/j.rec.2019.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/13/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND OBJECTIVES Optimal lipid control is difficult to attain. We assessed preadmission achievement of the European Society of Cardiology targets for low-density lipoprotein-cholesterol (LDL-C) control in patients admitted for acute coronary syndrome. METHODS Fasting LDL-C levels were measured in 3164 patients admitted between 2010 and 2017. We assessed the frequency of adequate LDL-C control, with targets defined according to individual cardiovascular risk, and the predictors of inadequate control. RESULTS The median LDL-C value was 104 (80-130) mg/dL. Most patients had high or very high cardiovascular risk and only 34.2% had LDL-C levels below the recommended target for their estimated risk. Achievement of LDL-C goals increased moderately throughout the study period. Adequate LDL-C control was inversely associated with patient risk. Dyslipidemia, active smoking, diabetes mellitus, and body mass index ≥ 25 were independent predictors of inadequate lipid control, while ongoing statin therapy was associated with adequate control. CONCLUSIONS Only slightly more than one third of patients admitted for acute coronary syndrome meet recommended LDL-C targets on admission. There is broad scope for improvement in primary and secondary prevention, especially among patients who are overweight or have other cardiovascular risk factors.
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Affiliation(s)
- Laia Milà
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - José A Barrabés
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain.
| | - Rosa-Maria Lidón
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Antonia Sambola
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Jordi Bañeras
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Gerard Oristrell
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Agnès Rafecas
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - David García-Dorado
- Unidad Coronaria, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
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22
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Janssen A, Wagenaar KP, Dendale P, Grobbee DE. Accreditation of clinical centres providing primary prevention, secondary prevention and rehabilitation, and sports cardiology: A step towards optimizing quality. Eur J Prev Cardiol 2019; 26:1775-1777. [DOI: 10.1177/2047487319867503] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Arne Janssen
- Clinical Research Department cardiology, Heartcentre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Kim P Wagenaar
- University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Paul Dendale
- Hasselt University, Heartcentre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
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23
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The Taiwan Heart Registries: Its Influence on Cardiovascular Patient Care. J Am Coll Cardiol 2019; 71:1273-1283. [PMID: 29544612 DOI: 10.1016/j.jacc.2018.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 02/01/2018] [Accepted: 02/02/2018] [Indexed: 02/07/2023]
Abstract
Taiwanese heart registries for the main cardiovascular diseases have been conducted in the past 10 years, with the goal of examining the quality of cardiovascular patient care, which cannot be guaranteed by the universal Taiwan National Health Insurance. The results show suboptimal adherence to guideline recommendations. Door-to-balloon time and dual antiplatelet therapy use in acute coronary syndrome, standard medications for management of heart failure, low-density lipoprotein cholesterol levels in dyslipidemia, anticoagulant agent use in atrial fibrillation, and the understanding of sudden arrhythmia death syndrome were all found to be inadequate. However, all were improved, either by changing National Health Insurance policy or through continuous education for physicians and patients. Thus, specific cardiovascular disease registries could help examine the status of real-world practice, find inadequacies in guideline implementation and understanding of rare diseases, facilitate lobbying to policy makers and education for physicians and patients, and influence and improve cardiovascular patient care.
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De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Z, Rydén L, Tokgözoğlu L, Wood D, De Bacquer D, Kotseva K, De Backer G, Abreu A, Aguiar C, Badariene J, Bruthans J, Castro Conde A, Cifkova R, Crowley J, Davletov K, Bacquer DD, De Smedt D, De Sutter J, Deckers J, Dilic M, Dolzhenko M, Druais H, Dzerve V, Erglis A, Fras Z, Gaita D, Gotcheva N, Grobbee D, Gyberg V, Hasan Ali H, Heuschmann P, Hoes A, Jankowski P, Lalic N, Lehto S, Lovic D, Maggioni A, Mancas S, Marques-Vidal P, Mellbin L, Miličić D, Mirrakhimov E, Oganov R, Pogosova N, Reiner Ž, Rydén L, Stagmo M, Störk S, Sundvall J, Tokgözoğlu L, Tsioufis K, Vulic D, Wood D, Wood D, Kotseva K, Jennings C, Adamska A, Adamska S, Rydén L, Mellbin L, Tuomilehto J, Schnell O, Druais H, Fiorucci E, Glemot M, Larras F, Missiamenou V, Maggioni A, Taylor C, Ferreira T, Lemaitre K, Bacquer DD, De Backer G, Raman L, Sundvall J, DeSmedt D, De Sutter J, Willems A, De Pauw M, Vervaet P, Bollen J, Dekimpe E, Mommen N, Van Genechten G, Dendale P, Bouvier C, Chenu P, Huyberechts D, Persu A, Dilic M, Begic A, Durak Nalbantic A, Dzubur A, Hadzibegic N, Iglica A, Kapidjic S, Osmanagic Bico A, Resic N, Sabanovic Bajramovic N, Zvizdic F, Vulic D, Kovacevic-Preradovic T, Popovic-Pejicic S, Djekic D, Gnjatic T, Knezevic T, Kovacevic-Preradovic T, Kos L, Popovic-Pejicic S, Stanetic B, Topic G, Gotcheva N, Georgiev B, Terziev A, Vladimirov G, Angelov A, Kanazirev B, Nikolaeva S, Tonkova D, Vetkova M, Milicic D, Reiner Ž, Bosnic A, Dubravcic M, Glavina M, Mance M, Pavasovic S, Samardzic J, Batinic T, Crljenko K, Delic-Brkljacic D, Dula K, Golubic K, Klobucar I, Kordic K, Kos N, Nedic M, Olujic D, Sedinic V, Blazevic T, Pasalic A, Percic M, Sikic J, Bruthans J, Cífková R, Hašplová K, Šulc P, Wohlfahrt P, Mayer O, Cvíčela M, Filipovský J, Gelžinský J, Hronová M, Hasan-Ali H, Bakery S, Mosad E, Hamed H, Ibrahim A, Elsharef M, Kholef E, Shehata A, Youssef M, Elhefny E, Farid H, Moustafa T, Sobieh M, Kabil H, Abdelmordy A, Lehto S, Kiljander E, Kiljander P, Koukkunen H, Mustonen J, Cremer C, Frantz S, Haupt A, Hofmann U, Ludwig K, Melnyk H, Noutsias M, Karmann W, Prondzinsky R, Herdeg C, Hövelborn T, Daaboul A, Geisler T, Keller T, Sauerbrunn D, Walz-Ayed M, Ertl G, Leyh R, Störk S, Heuschmann P, Ehlert T, Klocke B, Krapp J, Ludwig T, Käs J, Starke C, Ungethüm K, Wagner M, Wiedmann S, Tsioufis K, Tolis P, Vogiatzi G, Sanidas E, Tsakalis K, Kanakakis J, Koutsoukis A, Vasileiadis K, Zarifis J, Karvounis C, Crowley J, Gibson I, Houlihan A, Kelly C, O'Donnell M, Bennati M, Cosmi F, Mariottoni B, Morganti M, Cherubini A, Di Lenarda A, Radini D, Ramani F, Francese M, Gulizia M, Pericone D, Davletov K, Aigerim K, Zholdin B, Amirov B, Assembekov B, Chernokurova E, Ibragimova F, Kodasbayev A, Markova A, Mirrakhimov E, Asanbaev A, Toktomamatov U, Tursunbaev M, Zakirov U, Abilova S, Arapova R, Bektasheva E, Esenbekova J, Neronova K, Asanbaev A, Baigaziev K, Toktomamatov U, Zakirov U, Baitova G, Zheenbekov T, Erglis A, Andrejeva T, Bajare I, Kucika G, Labuce A, Putane L, Stabulniece M, Dzerve V, Klavins E, Sime I, Badariene J, Gedvilaite L, Pečiuraite D, Sileikienė V, Skiauteryte E, Solovjova S, Sidabraite R, Briedis K, Ceponiene I, Jurenas M, Kersulis J, Martinkute G, Vaitiekiene A, Vasiljevaite K, Veisaite R, Plisienė J, Šiurkaitė V, Vaičiulis Ž, Jankowski P, Czarnecka D, Kozieł P, Podolec P, Nessler J, Gomuła P, Mirek-Bryniarska E, Bogacki P, Wiśniewski A, Pająk A, Wolfshaut-Wolak R, Bućko J, Kamiński K, Łapińska M, Paniczko M, Raczkowski A, Sawicka E, Stachurska Z, Szpakowicz M, Musiał W, Dobrzycki S, Bychowski J, Kosior D, Krzykwa A, Setny M, Kosior D, Rak A, Gąsior Z, Haberka M, Gąsior Z, Haberka M, Szostak-Janiak K, Finik M, Liszka J, Botelho A, Cachulo M, Sousa J, Pais A, Aguiar C, Durazzo A, Matos D, Gouveia R, Rodrigues G, Strong C, Guerreiro R, Aguiar J, Abreu A, Cruz M, Daniel P, Morais L, Moreira R, Rosa S, Rodrigues I, Selas M, Gaita D, Mancas S, Apostu A, Cosor O, Gaita L, Giurgiu L, Hudrea C, Maximov D, Moldovan B, Mosteoru S, Pleava R, Ionescu M, Parepa I, Pogosova N, Arutyunov A, Ausheva A, Isakova S, Karpova A, Salbieva A, Sokolova O, Vasilevsky A, Pozdnyakov Y, Antropova O, Borisova L, Osipova I, Lovic D, Aleksic M, Crnokrak B, Djokic J, Hinic S, Vukasin T, Zdravkovic M, Lalic N, Jotic A, Lalic K, Lukic L, Milicic T, Macesic M, Stanarcic Gajovic J, Stoiljkovic M, Djordjevic D, Kostic S, Tasic I, Vukovic A, Fras Z, Jug B, Juhant A, Krt A, Kugonjič U, Chipayo Gonzales D, Gómez Barrado J, Kounka Z, Marcos Gómez G, Mogollón Jiménez M, Ortiz Cortés C, Perez Espejo P, Porras Ramos Y, Colman R, Delgado J, Otero E, Pérez A, Fernández-Olmo M, Torres-LLergo J, Vasco C, Barreñada E, Botas J, Campuzano R, González Y, Rodrigo M, de Pablo C, Velasco E, Hernández S, Lozano C, González P, Castro A, Dalmau R, Hernández D, Irazusta F, Vélez A, Vindel C, Gómez-Doblas J, García Ruíz V, Gómez L, Gómez García M, Jiménez-Navarro M, Molina Ramos A, Marzal D, Martínez G, Lavado R, Vidal A, Rydén L, Boström-Nilsson V, Kjellström B, Shahim B, Smetana S, Hansen O, Stensgaard-Nake E, Deckers J, Klijn A, Mangus T, Peters R, Scholte op Reimer W, Snaterse M, Aydoğdu S, Ç Erol, Otürk S, Tulunay Kaya C, Ahmetoğlu Y, Ergene O, Akdeniz B, Çırgamış D, Akkoyun H Kültürsay S, Kayıkçıoğlu M, Çatakoğlu A, Çengel A, Koçak A, Ağırbaşlı M, Açıksarı G, Çekin M, Tokgözoğlu L, Kaya E, Koçyiğit D, Öngen Z, Özmen E, Sansoy V, Kaya A, Oktay V, Temizhan A, Ünal S, İ Yakut, Kalkan A, Bozkurt E, Kasapkara H, Dolzhenko M, Faradzh C, Hrubyak L, Konoplianyk L, Kozhuharyova N, Lobach L, Nesukai V, Nudchenko O, Simagina T, Yakovenko L, Azarenko V, Potabashny V, Bazylevych A, Bazylevych M, Kaminska K, Panchenko L, Shershnyova O, Ovrakh T, Serik S, Kolesnik T, Kosova H, Wood D, Adamska A, Adamska S, Jennings C, Kotseva K, Hoye P Atkin A, Fellowes D, Lindsay S, Atkinson C, Kranilla C, Vinod M, Beerachee Y, Bennett C, Broome M, Bwalya A, Caygill L, Dinning L, Gillespie A, Goodfellow R, Guy J, Idress T, Mills C, Morgan C, Oustance N, Singh N, Yare M, Jagoda J, Bowyer H, Christenssen V, Groves A, Jan A, Riaz A, Gill M, Sewell T, Gorog D, Baker M, De Sousa P, Mazenenga T, Porter J, Haines F, Peachey T, Taaffe J, Wells K, Ripley D, Forward H, McKie H, Pick S, Thomas H, Batin P, Exley D, Rank T, Wright J, Kardos A, Sutherland SB, Wren L, Leeson P, Barker D, Moreby B, Sawyer J, Stirrup J, Brunton M, Brodison A, Craig J, Peters S, Kaprielian R, Bucaj A, Mahay K, Oblak M, Gale C, Pye M, McGill Y, Redfearn H, Fearnley M. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis 2019; 285:135-146. [DOI: 10.1016/j.atherosclerosis.2019.03.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
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Zhao M, Graham I, Cooney MT, Grobbee DE, Vaartjes I, Klipstein-Grobusch K. Determinants of coronary artery disease risk factor management across three world regions. HEART ASIA 2019; 11:e011112. [PMID: 31031827 PMCID: PMC6454324 DOI: 10.1136/heartasia-2018-011112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/14/2022]
Abstract
Background The SUrvey of Risk Factors (SURF) indicated poor control of risk factors in subjects with established coronary heart disease (CHD). The present study aimed to investigate determinants of risk factor management in patients with CHD. Methods and results SURF recruited 9987 consecutive patients with CHD from Europe, Asia and the Middle East between 2012 and 2013. Risk factor management was summarised as a Cardiovascular Health Index Score (CHIS) based on six risk factor targets (non-smoker/ex-smoker, body mass index <30, adequate exercise, controlled blood pressure, controlled low-density lipoprotein and controlled glucose). Logistic regression models assessed the associations between determinants (age, sex, family history, cardiac rehabilitation, previous hospital admission and diabetes) and achievement of moderate CHIS (≥3 risk factors controlled). The results are presented as OR with corresponding 95% CI. A moderate CHIS was less likely to be reached by women (OR 0.90, 95% CI 0.69 to 1.00), those aged <55 years old (OR 0.62, 95% CI 0.53 to 0.76) and those with diabetes (OR 0.41, 95% CI 0.37 to 0.46). Attendance in cardiac rehabilitation was associated with better CHIS achievements (OR 1.62, 95% CI 1.42 to 1.87). Younger Asian and European patients had poorer risk factor management, whereas for patients from the Middle East age was not significantly associated with risk factor management. The availability and applicability of cardiac rehabilitation varied by region. Conclusions Overall, risk factor management was poorer in women, those younger than 55 years old, those with diabetes and those who did not participate in a cardiac rehabilitation. Determinants of cardiovascular risk factor management differed by region.
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Affiliation(s)
- Min Zhao
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Marie Therese Cooney
- St Vincent's University Hospital, Dublin, Ireland.,University College Dublin, Dublin, Ireland
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Global Geo Health Data Center, Utrecht University, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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26
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Piepoli MF. Editor's presentation. Eur J Prev Cardiol 2018; 25:1907-1909. [PMID: 30466322 DOI: 10.1177/2047487318813775] [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: 11/16/2022]
Affiliation(s)
- Massimo F Piepoli
- Heart Failure Unit, Cardiology, G da Saliceto Hospital, Piacenza, Italy
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27
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Kotseva K. Attainment of low-density lipoprotein cholesterol target in patients with coronary heart disease: Still a long way to go. Eur J Prev Cardiol 2018; 25:1947-1949. [PMID: 30335509 DOI: 10.1177/2047487318806984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Kornelia Kotseva
- 1 National Heart and Lung Institute, Imperial College London, UK.,2 Department of Public Health, Ghent University, Belgium
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28
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Poh KK, Ambegaonkar B, Baxter CA, Brudi P, Buddhari W, Chiang FT, Horack M, Jang Y, Johnson B, Lautsch D, Sawhney J, Vyas A, Yan BP, Gitt AK. Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Asia-Pacific region: results from the Dyslipidemia International Study II. Eur J Prev Cardiol 2018; 25:1950-1963. [PMID: 30198749 DOI: 10.1177/2047487318798927] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND As mortality due to cardiovascular disease increases throughout the world, accurate data on risk factors such as hyperlipidemia are required. This is lacking in the Asia-Pacific region. DESIGN The observational Dyslipidemia International Study (DYSIS) II was established to quantify the extent of hyperlipidemia in adults with acute and stable coronary heart disease globally. METHODS Patients with stable coronary heart disease or hospitalised with an acute coronary syndrome were enrolled across nine Asia-Pacific countries from July 2013 to October 2014. Lipid-lowering therapy and low-density lipoprotein cholesterol target attainment (<70 mg/dL) were assessed. The acute coronary syndrome cohort was followed up 4 months post-discharge. RESULTS Of the 4592 patients enrolled, 2794 had stable coronary heart disease and 1798 were admitted with an acute coronary syndrome. In the coronary heart disease cohort, the mean low-density lipoprotein cholesterol level was 86.9 mg/dL, with 91.7% using lipid-lowering therapy and 31% achieving low-density lipoprotein cholesterol of less than 70 mg/dL. In the acute coronary syndrome cohort at admission, the corresponding values were 103.2 mg/dL, 63.4% and 23.0%, respectively. Target attainment was significantly higher in lipid-lowering therapy-treated than non-treated patients in each cohort (32.6% vs. 12.9% and 31.1% vs. 9.0%, respectively). Mean atorvastatin-equivalent dosages were low (20 ± 15 and 22 ± 18 mg/day, respectively), with little use of non-statin adjuvants (13.0% and 6.8%, respectively). Low-density lipoprotein cholesterol target attainment had improved by follow-up for the acute coronary syndrome patients, but remained low (41.7%). CONCLUSIONS Many patients in Asia at very high risk of recurrent cardiovascular events had a low-density lipoprotein cholesterol level above the recommended target. Although lipid-lowering therapy was common, it was not used to its full potential.
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Affiliation(s)
- Kian-Keong Poh
- 1 Department of Cardiology, National University Heart Centre, Singapore.,2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Wacin Buddhari
- 5 Division of Cardiovascular Medicine, Chulalongkorn University, Thailand
| | - Fu-Tien Chiang
- 6 Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Martin Horack
- 7 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Yangsoo Jang
- 8 Division of Cardiology, Yonsei University College of Medicine, Korea
| | - Brett Johnson
- 9 Merck Sharp & Dohme (Australia) Pty Ltd., Australia
| | | | - Jps Sawhney
- 10 Department of Cardiology, Sri Ganga Ram Hospital, Rajinder Nagar, India
| | - Ami Vyas
- 11 Department of Epidemiology, Rutgers University, USA.,12 Department of Pharmacy Practice, University of Rhode Island, USA
| | - Bryan P Yan
- 13 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Anselm K Gitt
- 7 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.,14 Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Germany
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Selak V, Webster R, Stepien S, Bullen C, Patel A, Thom S, Arroll B, Bots ML, Brown A, Crengle S, Dorairaj P, Elley CR, Grobbee DE, Harwood M, Hillis GS, Laba TL, Neal B, Peiris D, Rafter N, Reid C, Stanton A, Tonkin A, Usherwood T, Wadham A, Rodgers A. Reaching cardiovascular prevention guideline targets with a polypill-based approach: a meta-analysis of randomised clinical trials. Heart 2018; 105:42-48. [DOI: 10.1136/heartjnl-2018-313108] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/17/2018] [Accepted: 05/24/2018] [Indexed: 01/11/2023] Open
Abstract
ObjectiveThe aim of this study was to determine the effect of polypill-based care on the achievement of 2016 European Society of Cardiology (ESC) guideline targets for blood pressure (BP), low-density lipoprotein (LDL) cholesterol and antiplatelet therapy.MethodsWe conducted an individual participant data meta-analysis of three randomised clinical trials that compared a strategy using a polypill containing aspirin, statin and antihypertensive therapy with usual care in patients with a prior cardiovascular disease (CVD) event or who were at high risk of their first event. Overall, the trials included 3140 patients from Australia, England, India, Ireland, the Netherlands and New Zealand (75% male, mean age 62 years and 76% with a prior CVD event). The primary outcome for this study was the proportion of people achieving ESC guideline targets for BP, LDL and antiplatelet therapy.ResultsThose randomised to polypill-based care were more likely than those receiving usual care to achieve recommended targets for BP (62% vs 58%, risk ratio (RR) 1.08, 95% CI 1.02 to 1.15), LDL (39% vs 34%, RR 1.13, 95% CI 1.02 to 1.25) and all three targets for BP, LDL and adherence to antiplatelet therapy (the latter only applicable to those with a prior CVD event) simultaneously (24% vs 19%, RR 1.27, 95% CI 1.10 to 1.47) at 12 months. There was no difference between groups in antiplatelet adherence (96% vs 96%, RR 1.00, 95% CI 0.98 to 1.01). There was heterogeneity by baseline treatment intensity such that treatment effects increased with the fewer the number of treatments being taken at baseline: for patients taking 3, 2 and 0–1 treatment modalities the RRs for reaching all three guideline goals simultaneously were 1.10 (95% CI 0.94 to 1.30, 22% vs 20%), 1.62 (95% CI 1.09 to 2.42, 27% vs 17%) and 3.07 (95% CI 1.77 to 5.33, 35% vs 11%), respectively.ConclusionsPolypill-based therapy significantly improved the achievement of all three ESC targets for BP, LDL and antiplatelet therapy compared with usual care, particularly among those undertreated at baseline.
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Dudina A, Lane S, Butler M, Cooney MT, Graham I. SURF-COPD: the recording of cardiovascular risk in patients with chronic lung disease. QJM 2018; 111:303-306. [PMID: 29432601 DOI: 10.1093/qjmed/hcy028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in patients with chronic obstructive pulmonary disease (COPD) and such patients tend to carry a heavy burden of risk factors for CVD. There is little information on the documentation and management of CVD risk factors in COPD patients. AIM To audit the recording and management of CVD risk factors in 200 COPD patients attending the respiratory out-patient clinics at two University teaching hospitals. DESIGN Retrospective analysis of hospital records. RESULTS While there was reasonable recording of a history of CVD risk factors such as hypertension and hyperlipidaemia, the actual recording of risk factor levels was poor-blood pressure and heart rate were recorded in less than half of subjects; lipids, waist circumference, HbA1c and height were essentially not recorded at all. CONCLUSIONS Best practice guidelines and standard operating procedures for CVD risk factor recording and control require to be developed if the major cause of death in COPD subjects, CVD, is to be addressed. An outline for a standard operating procedure is presented in the Appendix. Serial audits will be required to assess the efficacy of such measures.
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Affiliation(s)
- A Dudina
- Respiratory Department, Tallaght Hospital, Belgard Square North, Dublin 24, D24NR0A, Ireland
- Respiratory Department, St.Vincent's University Hospital, Elm Park, Dublin 4, D04Y8V0, Ireland
| | - S Lane
- Respiratory Department, Tallaght Hospital, Belgard Square North, Dublin 24, D24NR0A, Ireland
| | - M Butler
- Respiratory Department, St.Vincent's University Hospital, Elm Park, Dublin 4, D04Y8V0, Ireland
| | - M-T Cooney
- Respiratory Department, St.Vincent's University Hospital, Elm Park, Dublin 4, D04Y8V0, Ireland
| | - I Graham
- Respiratory Department, Tallaght Hospital, Belgard Square North, Dublin 24, D24NR0A, Ireland
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Zhao M, Vaartjes I, Klipstein-Grobusch K, Kotseva K, Jennings C, Grobbee DE, Graham I. Quality assurance and the need to evaluate interventions and audit programme outcomes. Eur J Prev Cardiol 2018; 24:123-128. [PMID: 28618906 DOI: 10.1177/2047487317703829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.
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Affiliation(s)
- Min Zhao
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Ilonca Vaartjes
- 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,3 Global Geo and Health Data Center, Utrecht University, The Netherlands
| | - Kerstin Klipstein-Grobusch
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,4 Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kornelia Kotseva
- 5 National Heart & Lung Institute, Imperial College London, United Kingdom.,6 Department of Public Health, University of Ghent, Belgium
| | - Catriona Jennings
- 5 National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Diederick E Grobbee
- 1 Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands.,3 Global Geo and Health Data Center, Utrecht University, The Netherlands
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Hwong WY, Abdul Aziz Z, Sidek NN, Bots ML, Selvarajah S, Kappelle LJ, Sivasampu S, Vaartjes I. Prescription of secondary preventive drugs after ischemic stroke: results from the Malaysian National Stroke Registry. BMC Neurol 2017; 17:203. [PMID: 29169331 PMCID: PMC5701494 DOI: 10.1186/s12883-017-0984-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/15/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Evaluation of secondary stroke prevention in low and middle-income countries remains limited. This study assessed the prescription of secondary preventive drugs among ischemic stroke patients upon hospital discharge in Malaysia and identified factors related to the prescribing decisions. METHODS From Malaysian National Stroke Registry, we included patients with non-fatal ischemic stroke. Prescriptions of antiplatelet, anticoagulants, antihypertensive drugs and lipid-lowering drugs were assessed. Multi-level logistic regressions were performed to determine the relation between potential factors and drug prescriptions. RESULTS Of 5292 patients, 48% received antihypertensive drugs, 88.9% antiplatelet and 88.7% lipid-lowering drugs upon discharge. Thirty-three percent of patients with an indication for anticoagulants (n = 391) received it. Compared to patients <=50 years, patients above 70 years were less likely to receive antiplatelet (OR: 0.72, 95% CI: 0.50-1.03), lipid-lowering drugs (OR: 0.66, 95% CI: 0.45-0.95) and anticoagulants (OR: 0.27, 95% CI: 0.09-0.83). Patients with moderate to severe disability upon discharge had less odds of receiving secondary preventive drugs; an odds ratio of 0.57 (95% CI: 0.45-0.71) for antiplatelet, 0.86 (95% CI: 0.75-0.98) for antihypertensive drugs and 0.78 (95% CI: 0.63-0.97) for lipid-lowering drugs in comparison to those with minor disability. Having prior specific comorbidities and drug prescriptions significantly increased the odds of receiving these drugs. No differences were found between sexes and ethnicities. CONCLUSIONS Prescription of antihypertensive drugs and anticoagulants among ischemic stroke patients in Malaysia were suboptimal. Efforts to initiate regular clinical audits to evaluate the uptake and effectiveness of secondary preventive strategies are timely in low and middle-income settings.
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Affiliation(s)
- Wen Yea Hwong
- National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia. .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Zariah Abdul Aziz
- Department of Neurology, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Norsima Nazifah Sidek
- Clinical Research Centre, Hospital Sultanah Nur Zahirah, Kuala Terengganu, Terengganu, Malaysia
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sharmini Selvarajah
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Sharmini Selvarajah Consulting, Selangor, Malaysia
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sheamini Sivasampu
- National Clinical Research Centre, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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AlBadri A, Wei J, Mehta PK, Shah R, Herscovici R, Gulati M, Shufelt C, Bairey Merz N. Sex differences in coronary heart disease risk factors: rename it ischaemic heart disease! Heart 2017; 103:1567-1568. [PMID: 28931566 PMCID: PMC6728076 DOI: 10.1136/heartjnl-2017-311921] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | | | - Romana Herscovici
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | | | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California, USA
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Zhao M, Vaartjes I, Graham I, Grobbee D, Spiering W, Klipstein-Grobusch K, Woodward M, Peters SA. Sex differences in risk factor management of coronary heart disease across three regions. Heart 2017; 103:1587-1594. [PMID: 28931567 PMCID: PMC5739833 DOI: 10.1136/heartjnl-2017-311429] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/22/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To investigate whether there are sex differences in risk factor management of patients with established coronary heart disease (CHD), and to assess demographic variations of any potential sex differences. Methods Patients with CHD were recruited from Europe, Asia, and the Middle East between 2012-2013. Adherence to guideline-recommended treatment and lifestyle targets was assessed and summarised as a Cardiovascular Health Index Score (CHIS). Age-adjusted regression models were used to estimate odds ratios for women versus men in risk factor management. Results 10 112 patients (29% women) were included. Compared with men, women were less likely to achieve targets for total cholesterol (OR 0.50, 95% CI 0.43 to 0.59), low-density lipoprotein cholesterol (OR 0.57, 95% CI 0.51 to 0.64), and glucose (OR 0.78, 95% CI 0.70 to 0.87), or to be physically active (OR 0.74, 95% CI 0.68 to 0.81) or non-obese (OR 0.82, 95% CI 0.74 to 0.90). In contrast, women had better control of blood pressure (OR 1.31, 95% CI 1.20 to 1.44) and were more likely to be a non-smoker (OR 1.93, 95% CI 1.67 to 2.22) than men. Overall, women were less likely than men to achieve all treatment targets (OR 0.75, 95% CI 0.60 to 0.93) or obtain an adequate CHIS (OR 0.81, 95% CI 0.73 to 0.91), but no significant differences were found for all lifestyle targets (OR 0.93, 95% CI 0.84 to 1.02). Sex disparities in reaching treatment targets were smaller in Europe than in Asia and the Middle East. Women in Asia were more likely than men to reach lifestyle targets, with opposing results in Europe and the Middle East. Conclusions Risk factor management for the secondary prevention of CHD was generally worse in women than in men. The magnitude and direction of the sex differences varied by region.
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Affiliation(s)
- Min Zhao
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Global Geo and Health Data Center, Utrecht University, Utrecht, The Netherlands
| | | | - Diederick Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Global Geo and Health Data Center, Utrecht University, Utrecht, The Netherlands
| | - Wilko Spiering
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Sanne Ae Peters
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
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Grobbee DE, Pellicia A. Secondary prevention of cardiovascular disease: Unmet medical need, implementation and innovation. Eur J Prev Cardiol 2017; 24:5-7. [DOI: 10.1177/2047487317709369] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Turner LR, Cicuttini F, Pearce C, Mazza D. Cardiovascular disease screening in general practice: General practitioner recording of common risk factors. Prev Med 2017; 99:282-285. [PMID: 28322884 DOI: 10.1016/j.ypmed.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/03/2017] [Accepted: 03/11/2017] [Indexed: 02/05/2023]
Abstract
The assessment and screening of individual risk factors for cardiovascular disease (CVD) is a critical component of CVD prevention strategies in general practice (GP). This study sought to examine current CVD risk factor recording as recommended by Australian guidelines for the management of absolute cardiovascular disease risk. A retrospective analysis of routine GP data from 149,306 GP patients aged 45years and above in eastern Melbourne was conducted. Data were collected from GP clinics located throughout inner east Melbourne from July 2011 to September 2014 through the Melbourne East Monash General Practice Database. Recording of primary risk factors necessary for CVD screening as recommended by the national guidelines was assessed, and logistic regression with generalised estimating equations was used to estimate associations between patient characteristics and risk factor recording. 137,976 (92.4%) patients were found to have had at least one risk factor recorded, 62,214 (41.7%) had the Framingham risk factors recorded (lipids, blood pressure, smoking status), while only 1957 (1.3%) had all risk factors recorded. Females (Odds Ratio [OR]: 0.72, 95% Confidence Interval [CI]: 0.65, 0.81), and those identified with diabetes (OR: 12.26, 95% CI: 9.58, 15.68) were less and more likely to have documented risk factors, respectively. Given the role of GPs in the prevention and management of CVD, it is important to improve the identification of high risk patients through screening and recording of CVD risk factors. Strategies are therefore needed to encourage ongoing CVD risk factor recording to support preventive care by GPs.
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Affiliation(s)
- Lyle R Turner
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Victoria 3168, Australia.
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Victoria 3004, Australia; Rheumatology Unit, Alfred Hospital, 55 Commercial Road, Victoria 3004, Australia.
| | - Christopher Pearce
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Victoria 3168, Australia; Melbourne East General Practice Network (trading as Outcome Health), 1/5 Lakeside Drive, Victoria 3151, Australia.
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Victoria 3168, Australia.
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Bis(4,4'-dimethyl-2,2'-bipyridine)oxidovanadium(IV) Sulfate Dehydrate: Potential Candidate for Controlling Lipid Metabolism? BIOMED RESEARCH INTERNATIONAL 2017; 2017:6950516. [PMID: 28529953 PMCID: PMC5424176 DOI: 10.1155/2017/6950516] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 04/10/2017] [Indexed: 01/16/2023]
Abstract
Vanadium is a trace element mainly connected with regulation of insulin metabolism which is particularly important in diabetes. In recent years, organic complexes of vanadium seem to be more interesting than inorganic salts. Nevertheless, the effect of vanadium on lipid metabolism is still a problematic issue; therefore, the main purpose of this study was to investigate the effect of 3 organic complexes of vanadium such as sodium (2,2′-bipyridine)oxidobisperoxovanadate(V) octahydrate, bis(2,2′-bipyridine)oxidovanadium(IV) sulfate dehydrate, and bis(4,4′-dimethyl-2,2′-bipyridine)oxidovanadium(IV) sulfate dihydrate in conjunction with high-fat as well as control diet in nondiabetes model on the following lipid parameters: total cholesterol, triglycerides, and high density lipoprotein as well as activity of paraoxonase 1. All of these parameters were determined in plasma of Wistar rats. The most significant effect was observed in case of bis(4,4′-dimethyl-2,2′ bipyridine)oxidovanadium(IV) sulfate dehydrate in rats fed with high-fat diet. Based on our research, bis(4,4′-dimethyl-2,2′-bipyridine)oxidovanadium(IV) sulfate dihydrate should be the aim of further research and perhaps it will be an important factor in the regulation of lipid metabolism.
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Amor AJ, Serra-Mir M, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Estruch R, Serra-Majem L, Arós F, Babio N, Ros E, Ortega E. Prediction of Cardiovascular Disease by the Framingham-REGICOR Equation in the High-Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata. J Am Heart Assoc 2017; 6:e004803. [PMID: 28288977 PMCID: PMC5524014 DOI: 10.1161/jaha.116.004803] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND The usefulness of cardiovascular disease (CVD) predictive equations in different populations is debatable. We assessed the efficacy of the Framingham-REGICOR scale, validated for the Spanish population, to identify future CVD in participants, who were predefined as being at high-risk in the PREvención con DIeta MEDiterránea (PREDIMED) study-a nutrition-intervention primary prevention trial-and the impact of adherence to the Mediterranean diet on CVD across risk categories. METHODS AND RESULTS In a post hoc analysis, we assessed the CVD predictive value of baseline estimated risk in 5966 PREDIMED participants (aged 55-74 years, 57% women; 48% with type 2 diabetes mellitus). Major CVD events, the primary PREDIMED end point, were an aggregate of myocardial infarction, stroke, and cardiovascular death. Multivariate-adjusted Cox regression was used to calculate hazard ratios for major CVD events and effect modification from the Mediterranean diet intervention across risk strata (low, moderate, high, very high). The Framingham-REGICOR classification of PREDIMED participants was 25.1% low risk, 44.5% moderate risk, and 30.4% high or very high risk. During 6-year follow-up, 188 major CVD events occurred. Hazard ratios for major CVD events increased in parallel with estimated risk (2.68, 4.24, and 6.60 for moderate, high, and very high risk), particularly in men (7.60, 13.16, and 15.85, respectively, versus 2.16, 2.28, and 3.51, respectively, in women). Yet among those with low or moderate risk, 32.2% and 74.3% of major CVD events occurred in men and women, respectively. Mediterranean diet adherence was associated with CVD risk reduction regardless of risk strata (P>0.4 for interaction). CONCLUSIONS Incident CVD increased in parallel with estimated risk in the PREDIMED cohort, but most events occurred in non-high-risk categories, particularly in women. Until predictive tools are improved, promotion of the Mediterranean diet might be useful to reduce CVD independent of baseline risk. CLINICAL TRIAL REGISTRATION URL: http://www.Controlled-trials.com. Unique identifier: ISRCTN35739639.
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Affiliation(s)
- Antonio J Amor
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mercè Serra-Mir
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Miguel A Martínez-González
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Spain
| | - Dolores Corella
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Genetic and Molecular Epidemiology Unit, Department of Preventive Medicine and Public Health, School of Medicine, University of Valencia, Spain
| | - Jordi Salas-Salvadó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Montserrat Fitó
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Cardiovascular Risk and Nutrition Research (REGICOR Group), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Ramón Estruch
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Lluis Serra-Majem
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Fernando Arós
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Cardiology, University Hospital of Alava, Vitoria, Spain
| | - Nancy Babio
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - Emilio Ros
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Emilio Ortega
- Lipid Clinic, Department of Endocrinology and Nutrition, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
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Similarities and differences between coronary heart disease and stroke in the associations with cardiovascular risk factors: The Japan Collaborative Cohort Study. Atherosclerosis 2017; 261:124-130. [PMID: 28292514 DOI: 10.1016/j.atherosclerosis.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 02/20/2017] [Accepted: 03/01/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Coronary heart disease (CHD) and stroke have common risk factors, but some of these differ in the magnitude or direction of associations between CHD and stroke. We assessed whether the impact of each risk factor differed between CHD and stroke mortality in Asians. METHODS In total, 104 910 subjects aged 40-79 years without histories of cancer, CHD and stroke at baseline were followed between 1988 and 2009. Competing-risks analysis was used to test for differences in the associations of each risk factor with two endpoints (CHD and stroke). Population attributable fractions (PAFs) were also calculated for these endpoints to estimate the population impact of each risk factor. RESULTS During a median 19.1-year follow-up, 1554 died from CHD and 3163 from stroke. The association of hypertension with CHD was similar to that with stroke in terms of the magnitude and direction (multivariable-adjusted hazard ratio for CHD: 1.63 vs. stroke: 1.73 in men and 1.70 vs. 1.66 in women). Conversely, the magnitude of these associations differed for smoking (CHD: 1.95 vs. stroke: 1.23 in men and 2.45 vs. 1.35 in women) and diabetes (1.49 vs. 1.09 in men and 2.08 vs. 1.39 in women). The highest PAF for CHD was caused by smoking in men and by hypertension in women; that for stroke was caused by hypertension in both sexes. CONCLUSIONS Hypertension associations and PAFs were consistent between CHD and stroke, but not for other risk factors. These findings may be useful to optimize public health intervention strategies.
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The polypill approach - An innovative strategy to improve cardiovascular health in Europe. BMC Pharmacol Toxicol 2017; 18:10. [PMID: 28166827 PMCID: PMC5294740 DOI: 10.1186/s40360-016-0102-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/27/2016] [Indexed: 12/21/2022] Open
Abstract
Background Cardiovascular disease (CVD) is a major cause of disability and premature death. Despite European guidelines advocating the use of medical therapies in CVD, many patients still do not achieve the guideline-recommended treatment, which highlights the need for change and innovations in this field. This requirement has been widely recognised by the national ministries of health, several European cardiology societies, and the European Parliament, who support the initiation of strategies to improve and promote cardiovascular health. Discussion One of the key risk factors to recurrent cardiovascular events is the lack of adherence to medication and this has been added to the agenda of the European Commission. With the intention to improve treatment adherence in CVD, polypills have been investigated and numerous studies demonstrate that they significantly improve medication adherence, which contributes to the improvement of health outcomes. In Europe, the first cardiovascular polypill, developed by a public-private partnership (CNIC-Ferrer), recently became available for general prescription as a therapy for CVD prevention. This polypill significantly improves adherence, preventing fatal and non-fatal cardiovascular events, and appears to be a cost-effective strategy to improve sustainability of the health care systems in CVD. Conclusions Given the importance of urgent and simple solutions to restraining the pandemic nature of CVD, the polypill approach should therefore be considered by physicians and public health systems as an available and innovative option to improve cardiovascular health.
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