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Zhang Z, Shao B, Liu H, Huang B, Gao X, Qiu J, Wang C. Construction and Validation of a Predictive Model for Coronary Artery Disease Using Extreme Gradient Boosting. J Inflamm Res 2024; 17:4163-4174. [PMID: 38973999 PMCID: PMC11226989 DOI: 10.2147/jir.s464489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 06/25/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose Early recognition of coronary artery disease (CAD) could delay its progress and significantly reduce mortality. Sensitive, specific, cost-efficient and non-invasive indicators for assessing individual CAD risk in community population screening are urgently needed. Patients and Methods 3112 patients with CAD and 3182 controls were recruited from three clinical centers in China, and differences in baseline and clinical characteristics were compared. For the discovery cohort, the least absolute shrinkage and selection operator (LASSO) regression was used to identify significant features and four machine learning algorithms (logistic regression, support vector machine (SVM), random forest (RF) and extreme gradient boosting (XGBoost)) were applied to construct models for CAD risk assessment, the receiver operating characteristics (ROC) curve and precision-recall (PR) curve were conducted to evaluate their predictive accuracy. The optimal model was interpreted by Shapley additive explanations (SHAP) analysis and assessed by the ROC curve, calibration curve, and decision curve analysis (DCA) and validated by two external cohorts. Results Using LASSO filtration, all included variables were considered to be statistically significant. Four machine learning models were constructed based on these features and the results of ROC and PR curve implied that the XGBoost model exhibited the highest predictive performance, which yielded a high area of ROC curve (AUC) of 0.988 (95% CI: 0.986-0.991) to distinguish CAD patients from controls with a sensitivity of 94.6% and a specificity of 94.6%. The calibration curve showed that the predicted results were in good agreement with actual observations, and DCA exhibited a better net benefit across a wide range of threshold probabilities. External validation of the model also exhibited favorable discriminatory performance, with an AUC, sensitivity, and specificity of 0.953 (95% CI: 0.945-0.960), 89.9%, and 87.1% in the validation cohort, and 0.935 (95% CI: 0.915-0.955), 82.0%, and 90.3% in the replication cohort. Conclusion Our model is highly informative for clinical practice and will be conducive to primary prevention and tailoring the precise management for CAD patients.
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Affiliation(s)
- Zheng Zhang
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
- Center for Gene Diagnosis, Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
| | - Binbin Shao
- Department of Prenatal Diagnosis, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, Nanjing, Jiangsu Province, People’s Republic of China
| | - Hongzhou Liu
- Center for Gene Diagnosis, Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
- School of Clinical Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuang Province, People’s Republic of China
| | - Ben Huang
- Center for Gene Diagnosis, Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China
| | - Xuechen Gao
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Jun Qiu
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
| | - Chen Wang
- Center of Clinical Laboratory, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China
- Center for Gene Diagnosis, Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei Province, People’s Republic of China
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Kong M, Pei Z, Xie Y, Gao Y, Li J, He G. Prognostic factors of MINOCA and their possible mechanisms. Prev Med Rep 2024; 39:102643. [PMID: 38426041 PMCID: PMC10902145 DOI: 10.1016/j.pmedr.2024.102643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/24/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Objective Despite not showing substantial stenosis of coronary arteries, Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) presents with myocardial ischemia injury, thus having a grave prognosis and a high risk of long-term complications. This necessitates increased clinical attention and exploration of its root causes to prevent a similar crisis. Methods Research on MINOCA is limited, especially in terms of its clinical attributes, long-term outlook, risk stratification, and prognosis-linked cardiometabolic risk factors. This review aims to fill these gaps, providing an extensive overview of clinical trials and studies on MINOCA to separate the issue from the presence of non-obstructive coronary arteries in cardiac patients. Results It has been found that MINOCA patients still face a high risk of long-term adverse events. Due to social and physiological factors, the hospital mortality rate is higher among women, and they are also more susceptible to MINOCA. Cardiac metabolic risk factors, including disorder of glucose and lipid metabolism, as well as changes in serum CysC levels, have significant impacts on the occurrence and prognosis of MINOCA. Conclusions Further research is still needed to fully understand the complex biological mechanisms underlying the prognostic factors of MINOCA. A profound understanding of these factors could reveal potential targets for improving prognosis, thereby indicating new strategies for managing this cardiovascular condition.
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Affiliation(s)
- Mowei Kong
- Department of Cardiology, Guiqian International General Hospital, Guiyang, Guizhou 550018, PR China
| | - Zhenying Pei
- Department of Cardiology, Guiqian International General Hospital, Guiyang, Guizhou 550018, PR China
| | - Yuyu Xie
- Department of Dermatology, Chengdu Fifth People’s Hospital, Chengdu, Sichuan 610000, PR China
| | - Yu Gao
- Department of Endocrinology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei 067000, PR China
| | - Jun Li
- Department of Cardiology, Guiqian International General Hospital, Guiyang, Guizhou 550018, PR China
| | - Guoxiang He
- Department of Cardiology, Guiqian International General Hospital, Guiyang, Guizhou 550018, PR China
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Christensen JJ, Arnesen EK, Rundblad A, Telle-Hansen VH, Narverud I, Blomhoff R, Bogsrud MP, Retterstøl K, Ulven SM, Holven KB. Dietary fat quality, plasma atherogenic lipoproteins, and atherosclerotic cardiovascular disease: An overview of the rationale for dietary recommendations for fat intake. Atherosclerosis 2024; 389:117433. [PMID: 38219649 DOI: 10.1016/j.atherosclerosis.2023.117433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/29/2023] [Accepted: 12/20/2023] [Indexed: 01/16/2024]
Abstract
The scientific evidence supporting the current dietary recommendations for fat quality keeps accumulating; however, a paradoxical distrust has taken root among many researchers, clinicians, and in parts of the general public. One explanation for this distrust may relate to an incomplete overview of the totality of the evidence for the link between fat quality as a dietary exposure, and health outcomes such as atherosclerotic cardiovascular disease (ASCVD). Therefore, the main aim of the present narrative review was to provide a comprehensive overview of the rationale for dietary recommendations for fat intake, limiting our discussion to ASCVD as outcome. Herein, we provide a core framework - a causal model - that can help us understand the evidence that has accumulated to date, and that can help us understand new evidence that may become available in the future. The causal model for fat quality and ASCVD is comprised of three key research questions (RQs), each of which determine which scientific methods are most appropriate to use, and thereby which lines of evidence that should feed into the causal model. First, we discuss the link between low-density lipoprotein (LDL) particles and ASCVD (RQ1); we draw especially on evidence from genetic studies, randomized controlled trials (RCTs), epidemiology, and mechanistic studies. Second, we explain the link between dietary fat quality and LDL particles (RQ2); we draw especially on metabolic ward studies, controlled trials (randomized and non-randomized), and mechanistic studies. Third, we explain the link between dietary fat quality, LDL particles, and ASCVD (RQ3); we draw especially on RCTs in animals and humans, epidemiology, population-based changes, and experiments of nature. Additionally, the distrust over dietary recommendations for fat quality may partly relate to an unclear understanding of the scientific method, especially as applied in nutrition research, including the process of developing dietary guidelines. We therefore also aimed to clarify this process. We discuss how we assess causality in nutrition research, and how we progress from scientific evidence to providing dietary recommendations.
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Affiliation(s)
- Jacob J Christensen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Erik Kristoffer Arnesen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Amanda Rundblad
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | | | - Ingunn Narverud
- Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Rune Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Martin P Bogsrud
- Unit for Cardiac and Cardiovascular Genetics, Oslo University Hospital, Oslo, Norway
| | - Kjetil Retterstøl
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; The Lipid Clinic, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
| | - Stine M Ulven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Kirsten B Holven
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway; Norwegian National Advisory Unit on Familial Hypercholesterolemia, Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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Xu F, Wang G, Ye N, Bian W, Yang L, Ma C, Zhao D, Liu J, Hao Y, Liu J, Yang N, Cheng H. Mild renal insufficiency and attributable risk of adverse In-hospital outcomes in patients with Acute Coronary Syndrome from the improving care for Cardiovascular Disease in China (CCC) project. BMC Nephrol 2022; 23:29. [PMID: 35027003 PMCID: PMC8759171 DOI: 10.1186/s12882-022-02663-4] [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: 05/07/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Renal insufficiency (RI) is a frequent comorbidity among patients with acute coronary syndrome (ACS). We aimed to evaluate the attributable risk associated with mild RI for the in-hospital outcomes in patients with ACS. Methods The Improving Care for Cardiovascular Disease in China-ACS (CCC-ACS) Project was a collaborative study of the American Heart Association and the Chinese Society of Cardiology. A total of 92,509 inpatients with a discharge diagnosis of ACS were included. The attributable risk was calculated to investigate the effect of mild RI (eGFR 60-89 ml / min · 1.73 m2) on major adverse cardiovascular events (MACEs) during hospitalization. Results The average age of these ACS patients was 63 years, and 73.9% were men. The proportion of patients with mild RI was 36.17%. After adjusting for other possible risk factors, mild RI was still an independent risk factor for MACEs in ACS patients. In the ACS patients, the attributable risk of eGFR 60-89ml/min·1.73m2 to MACEs was 7.78%, 4.69% of eGFR 45-59 ml/min·1.73m2, 4.46% of eGFR 30-44 ml/min·1.73m2, and 3.36% of eGFR<30 ml/min·1.73m2. Conclusion Compared with moderate to severe RI, mild RI has higher attributable risk to MACEs during hospitalization in Chinese ACS population. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02663-4.
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Bao J, Wang L, Hu P, Liu J, Tu J, Wang J, Li J, Ning X. Burden of Metabolic Syndrome Among a Low-Income Population in China: A Population-Based Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:2713-2723. [PMID: 36091482 PMCID: PMC9451033 DOI: 10.2147/dmso.s377490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/16/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Metabolic syndrome (MetS) is a chronic and complex disease associated with all-cause mortality, cardiovascular disease, and type 2 diabetes. The present study aimed to evaluate the prevalence of MetS and its risk factors among middle-aged and older adults in low-income, low-education rural areas with a high incidence of stroke. METHODS This cross-sectional study of the general population was performed from April 2019 to June 2019 in rural areas of Tianjin, China. All eligible residents aged ≥ 45 years and without active malignant tumors, hepatic failure, and severe renal disease underwent routine medical examinations, which included a questionnaire, physical examination, and routine blood and biochemical tests. The modified International Diabetes Federation criteria for the Asian population was used to identify patients with MetS. RESULTS A total of 3175 individuals (44.8% men, 55.2% women) were included in the final analysis. The prevalence of MetS was 52.8%, with higher prevalence in women than in men (62.4%and 40.9%, respectively). Of the five MetS components, high blood pressure and abdominal obesity were the two most prevalent in both women and men, accounting for 89.3% and 62.0%, respectively, followed by elevated fasting plasma glucose, low high-density lipoprotein cholesterol, and elevated triglycerides. Multivariate logistic regression analysis revealed the following traits to be risk factors for MetS: female sex, self-reported smoking, self-reported snoring, high body mass index, high waist-to-hip ratio, and high serum urate level. CONCLUSION The prevalence of MetS was quite high in rural areas with a low-income, low-education population. Implementing preventive and therapeutic interventions based on these risk factors is essential to prevent metabolic abnormalities.
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Affiliation(s)
- Jie Bao
- Department of Rehabilitation Medicine, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
| | - Lifeng Wang
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China
| | - Peng Hu
- Department of Acupuncture Encephalopathy, Binhai New Area Hospital of TCM, Tianjin, 300451, People’s Republic of China
| | - Jie Liu
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China
| | - Jun Tu
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China
| | - Jinghua Wang
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China
| | - Jidong Li
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China
- Department of Neurosurgery, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China
- Jidong Li, Department of Neurosurgery, Tianjin Jizhou People’s Hospital, Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, 18 Nanhuan Road, Jizhou District, Tianjin, 301900, People’s Republic of China, Tel/Fax +86-22- 60733586, Email
| | - Xianjia Ning
- Center of Clinical Epidemiology & Evidence-Based Medicine, Tianjin Jizhou People’s Hospital, Tianjin, 301900, People’s Republic of China
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People’s Republic of China
- Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People’s Republic of China
- Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China
- Correspondence: Xianjia Ning, Laboratory of Epidemiology, Tianjin Neurological Institute & Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People’s Republic of China, Tel +86-22-60817505, Fax +86-22-60817448, Email
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Dou L, Mao Z, Fu Q, Chen G, Li S. Health-Related Quality of Life and Its Influencing Factors in Patients with Coronary Heart Disease in China. Patient Prefer Adherence 2022; 16:781-795. [PMID: 35370403 PMCID: PMC8965016 DOI: 10.2147/ppa.s347681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/08/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study aimed to comprehensively evaluate Chinese coronary heart disease (CHD) patients' health-related quality of life (HRQoL) using various measures and explore influencing factors associated with HRQoL. METHODS A cross-sectional study was conducted from April to September 2019 in the General Hospital of Tianjin Medical University. A convenience sampling framework was used to successively recruit 316 inpatients with CHD. Two generic preference-based instruments (EQ-5D-5L and 15D), a disease-specific instrument (Seattle Angina Questionnaire, SAQ), and the WHO-5 well-being index (WHO-5) were administered. Tobit regression model and multiple linear regression were used for data analyses. RESULTS A total of 305 patients (mean age was 62.9) with CHD participated in this study. The mean health state utility (HSU) scores of EQ-5D-5L and 15D were 0.85 (SD=0.14) and 0.89 (SD=0.07), respectively. For EQ-5D-5L, pain/discomfort was the most frequently reported, followed by anxiety/depression. As for 15D, discomfort and symptoms was the most severely impaired dimension. For SAQ, more limitations were found in the domains of angina stability and disease perception. For WHO-5, the mean score was 16.93. Marital status, disease state and comorbidity were influencing factors associated with HRQoL, patient's subjective well-being had a positive impact on HRQoL. CONCLUSION To improve the HRQoL of CHD patients in China, more attention needs to be paid to unmarried and relapsed patients, especially those with comorbidity of hypertension. Additionally, more social support and psychological counseling should be provided to patients.
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Affiliation(s)
- Lei Dou
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, People’s Republic of China
- Center for Health Preference Research, Shandong University, Jinan, People’s Republic of China
| | - Zhuxin Mao
- School of Insurance, Southwestern University of Finance and Economics, Chengdu, People’s Republic of China
| | - Qiang Fu
- Department of Cardiovascular Surgery, General Hospital of Tianjin Medical University, Tianjin, People’s Republic of China
| | - Gang Chen
- Center for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Shunping Li
- Center for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of China
- NHC Key Laboratory of Health Economics and Policy Research (Shandong University), Jinan, People’s Republic of China
- Center for Health Preference Research, Shandong University, Jinan, People’s Republic of China
- Correspondence: Shunping Li, Center for Health Management and Policy Research, School of Public Health, Shandong University, Wenhua Xi Road 44, Jinan, Shandong Province, 250012, People’s Republic of China, Tel +86-131-8893-4998, Email
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Li R, Cheng X, Schwebel DC, Yang Y, Ning P, Cheng P, Hu G. Disability-adjusted life years associated with population ageing in China, 1990-2017. BMC Geriatr 2021; 21:369. [PMID: 34134664 PMCID: PMC8207592 DOI: 10.1186/s12877-021-02322-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The Chinese population has aged significantly in the last few decades. Comprehensive health losses including both fatal and non-fatal health outcomes associated with ageing in China have not been detailed. METHODS Based on freely accessible disability adjusted life years (DALYs) estimated by the Global Burden of Diseases (GBD) 2017, we adopted a robust decomposition method that ascribes changes in DALYs in any given country across two time points to changes resulting from three sources: population size, age structure, and age-specific DALYs rate per 100,000 population. Using the method, we calculated DALYs associated with population ageing in China from 1990 to 2017 and examined the counteraction between the effects of DALYs rate change and population ageing. This method extends previous work through attributing the change in DALYs to the three sources. RESULTS Population ageing was associated with 92.8 million DALYs between 1990 and 2017 in China, of which 65.8% (61.1 million) were years of life lost (YLLs). Males had comparatively more DALYs associated with population ageing than females in the study period. The five leading causes of DALYs associated with population ageing between 1990 and 2017 were stroke (23.6 million), chronic obstructive pulmonary disease (COPD) (18.3 million), ischemic heart disease (13.0 million), tracheal, bronchus, and lung cancer (6.1 million) and liver cancer (5.0 million). Between 1990 and 2017, changes in DALYs associated with age-specific DALY rate reductions far exceeded those related to population ageing (- 196.2 million versus 92.8 million); 57.5% (- 112.8 million) of DALYs were caused by decreases in rates attributed to 84 modifiable risk factors. CONCLUSION Population ageing was associated with growing health loss in China from 1990 to 2017. Despite the recent progress in alleviating health loss associated with population ageing, the government should encourage scientific research on effective and affordable prevention and control strategies and should consider investment in resources to implement strategies nationwide to address the future challenge of population ageing.
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Affiliation(s)
- Ruotong Li
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - David C Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yang Yang
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.,Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Peixia Cheng
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, 410078, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Wang C, Zhao Y, Jin B, Gan X, Liang B, Xiang Y, Zhang X, Lu Z, Zheng F. Development and Validation of a Predictive Model for Coronary Artery Disease Using Machine Learning. Front Cardiovasc Med 2021; 8:614204. [PMID: 33634169 PMCID: PMC7902072 DOI: 10.3389/fcvm.2021.614204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/15/2021] [Indexed: 01/06/2023] Open
Abstract
Early identification of coronary artery disease (CAD) can prevent the progress of CAD and effectually lower the mortality rate, so we intended to construct and validate a machine learning model to predict the risk of CAD based on conventional risk factors and lab test data. There were 3,112 CAD patients and 3,182 controls enrolled from three centers in China. We compared the baseline and clinical characteristics between two groups. Then, Random Forest algorithm was used to construct a model to predict CAD and the model was assessed by receiver operating characteristic (ROC) curve. In the development cohort, the Random Forest model showed a good AUC 0.948 (95%CI: 0.941–0.954) to identify CAD patients from controls, with a sensitivity of 90%, a specificity of 85.4%, a positive predictive value of 0.863 and a negative predictive value of 0.894. Validation of the model also yielded a favorable discriminatory ability with the AUC, sensitivity, specificity, positive predictive value, and negative predictive value of 0.944 (95%CI: 0.934–0.955), 89.5%, 85.8%, 0.868, and 0.886 in the validation cohort 1, respectively, and 0.940 (95%CI: 0.922–0.960), 79.5%, 94.3%, 0.932, and 0.823 in the validation cohort 2, respectively. An easy-to-use tool that combined 15 indexes to assess the CAD risk was constructed and validated using Random Forest algorithm, which showed favorable predictive capability (http://45.32.120.149:3000/randomforest). Our model is extremely valuable for clinical practice, which will be helpful for the management and primary prevention of CAD patients.
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Affiliation(s)
- Chen Wang
- Department of Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yue Zhao
- Department of Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bingyu Jin
- Department of Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuedong Gan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Bin Liang
- Department of Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yang Xiang
- Department of Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaokang Zhang
- Department of Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Fang Zheng
- Department of Laboratory Medicine, Center for Gene Diagnosis, Zhongnan Hospital of Wuhan University, Wuhan, China
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Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: Findings from the EPICOR Asia study. Int J Cardiol 2020; 315:1-8. [DOI: 10.1016/j.ijcard.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/28/2020] [Accepted: 05/06/2020] [Indexed: 12/29/2022]
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Cheng X, Yang Y, Schwebel DC, Liu Z, Li L, Cheng P, Ning P, Hu G. Population ageing and mortality during 1990-2017: A global decomposition analysis. PLoS Med 2020; 17:e1003138. [PMID: 32511229 PMCID: PMC7279585 DOI: 10.1371/journal.pmed.1003138] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/13/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND As the number of older people globally increases, health systems need to be reformed to meet the growing need for medical resources. A few previous studies reported varying health impacts of population ageing, but they focused only on limited countries and diseases. We comprehensively quantify the impact of population ageing on mortality for 195 countries/territories and 169 causes of death. METHODS AND FINDINGS Using data from the Global Burden of Disease Study 2017 (GBD 2017), this study derived the total number of deaths and population size for each year from 1990 to 2017. A decomposition method was used to attribute changes in total deaths to population growth, population ageing, and mortality change between 1990 and each subsequent year from 1991 through 2017, for 195 countries/territories and for countries grouped by World Bank economic development level. For countries with increases in deaths related to population ageing, we calculated the ratio of deaths attributed to mortality change to those attributed to population ageing. The proportion of people aged 65 years and older increased globally from 6.1% to 8.8%, and the number of global deaths increased by 9 million, between 1990 and 2017. Compared to 1990, 12 million additional global deaths in 2017 were associated with population ageing, corresponding to 27.9% of total global deaths. Population ageing was associated with increases in deaths in high-, upper-middle-, and lower-middle-income countries but not in low-income countries. The proportions of deaths attributed to population ageing in 195 countries/territories ranged from -43.9% to 117.4% for males and -30.1% to 153.5% for females. The 2 largest contributions of population ageing to disease-specific deaths globally between 1990 and 2017 were for ischemic heart disease (3.2 million) and stroke (2.2 million). Population ageing was related to increases in deaths in 152 countries for males and 159 countries for females, and decreases in deaths in 43 countries for males and 36 countries for females, between 1990 and 2017. The decreases in deaths attributed to mortality change from 1990 to 2017 were more than the increases in deaths related to population ageing for the whole world, as well as in 55.3% (84/152) of countries for males and 47.8% (76/159) of countries for females where population ageing was associated with increased death burden. As the GBD 2017 does not provide variances in the estimated death numbers, we were not able to quantify uncertainty in our attribution estimates. CONCLUSIONS In this study, we found that population ageing was associated with substantial changes in numbers of deaths between 1990 and 2017, but the attributed proportion of deaths varied widely across country income levels, countries, and causes of death. Specific preventive and therapeutic techniques should be implemented in different countries and territories to address the growing health needs related to population ageing, especially targeting the diseases associated with the largest increase in number of deaths in the elderly.
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Affiliation(s)
- Xunjie Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yang Yang
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, United States of America
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - David C. Schwebel
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Zuyun Liu
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Li Li
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio, United States of America
| | - Peixia Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Peishan Ning
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Guoqing Hu
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- * E-mail:
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Coronary heart disease mortality is decreasing in Argentina, and Colombia, but keeps increasing in Mexico: a time trend study. BMC Public Health 2020; 20:162. [PMID: 32013918 PMCID: PMC6998818 DOI: 10.1186/s12889-020-8297-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background Mortality rates due to coronary heart disease (CHD) have decreased in most countries, but increased in low and middle-income countries. Few studies have analyzed the trends of coronary heart disease mortality in Latin America, specifically the trends in young-adults and the effect of correcting these comparisons for nonspecific causes of death (garbage codes). The objective of this study was to describe and compare standardized, age-specific, and garbage-code corrected mortality trends for coronary heart disease from 1985 to 2015 in Argentina, Colombia, and Mexico. Methods Deaths from coronary heart disease were grouped by country, year of registration, sex, and 10-year age bands to calculate age-adjusted and age and sex-specific rates for adults aged ≥25. We corrected for garbage-codes using the methodology proposed by the Global Burden of Disease. Finally, we fitted Joinpoint regression models. Results In 1985, age-standardized mortality rates per 100,000 population were 136.6 in Argentina, 160.6 in Colombia, and 87.51 in Mexico; by 2015 rates decreased 51% in Argentina and 6.5% in Colombia, yet increased by 61% in Mexico, where an upward trend in mortality was observed in young adults. Garbage-code corrections produced increases in mortality rates, particularly in Argentina with approximately 80 additional deaths per 100,000, 14 in Colombia and 13 in Mexico. Conclusions Latin American countries are at different stages of the cardiovascular disease epidemic. Garbage code correction produce large changes in the mortality rates in Argentina, yet smaller in Mexico and Colombia, suggesting garbage code corrections may be needed for specific countries. While coronary heart disease (CHD) mortality is falling in Argentina, modest falls in Colombia and substantial increases in Mexico highlight the need for the region to propose and implement population-wide prevention policies.
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12
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Wou C, Unwin N, Huang Y, Roglic G. Implications of the growing burden of diabetes for premature cardiovascular disease mortality and the attainment of the Sustainable Development Goal target 3.4. Cardiovasc Diagn Ther 2019; 9:140-149. [PMID: 31143635 DOI: 10.21037/cdt.2018.09.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Non-communicable diseases (NCDs) are a major cause of deaths globally, and cardiovascular disease (CVD) is the leading cause of these deaths. 42% of NCD deaths are premature (occurring before the age of 70 years). As part of the United Nations 3rd Sustainable Development Goal (SDG) on health and wellbeing, target 3.4 is to reduce premature mortality from NCDs by one third between 2015 and 2030. This target adds to the World Health Organization (WHO) target of reducing premature deaths from NCDs by 25% between 2010 and 2025. As diabetes is a major risk factor for CVD, it is important to account for the trends in diabetes when considering premature CVD mortality. We aimed to describe the global trends in diabetes prevalence and mortality, critically review the literature on the estimated attainability of the WHO and SDG targets, and determine if and how these studies accounted for trends in diabetes. Worldwide, the prevalence of diabetes is rising, with an estimated 9.0% global prevalence in adults aged 20-69 by 2030, and low- and middle-income countries (LMICs) having the largest increase of the burden in absolute numbers and age-standardized prevalence. There is a lack of data from most LMICs on the excess CVD mortality associated with diabetes and therefore no consensus on the global risk of CVD mortality in people with diabetes. Where data do exist, there are discrepancies between studies on the direction of mortality trends from diabetes over time. We reviewed 12 studies that estimated the attainability of the WHO or SDG targets for premature NCD mortality. Seven of these considered the potential impacts of achieving the 2025 WHO risk factor targets. Six studies modelled the impact of current trends in risk factors, including diabetes, continuing toward the target dates. Four studies compared this 'business as usual' model with the attainment of the risk factor targets for the world as whole and individual regions, 2 studies for NCD mortality overall, and 2 specifically for CVD mortality. On the impact of diabetes with regards to attainment of the WHO or SDG targets for premature CVD mortality, the overall results were inconclusive. Some concluded that none of the countries or regions considered would meet the targets, and others predicted that in some areas, the targets would be met. Examining the potential impact of trends in diabetes on future CVD mortality rates in LMICs is limited by a relative lack of high quality studies, including on the age specific excess mortality associated with diabetes. Filling these data gaps will enable better estimates of the potential impacts on future CVD mortality of the rapidly increasing prevalence of diabetes in LMICs and help to better inform health policy and the attainment of SDG target 3.4.
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Affiliation(s)
- Constance Wou
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Yadi Huang
- International Diabetes Federation, Brussels, Belgium
| | - Gojka Roglic
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
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Chang J, Li B, Li J, Sun Y. The Effects of Age, Period, and Cohort on Mortality from Ischemic Heart Disease in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14010050. [PMID: 28067846 PMCID: PMC5295301 DOI: 10.3390/ijerph14010050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 12/10/2016] [Accepted: 12/22/2016] [Indexed: 12/12/2022]
Abstract
In contrast with most developed countries, mortality due to ischemic heart disease (IHD) continues to rise in China. We examined the effects of age, period, and cohort on IHD mortality in urban and rural populations from 1987 to 2013 to identify the drivers of this trend. Region-specific data on annual IHD mortality among adults aged 20 to 84 years and corresponding population statistics were collected. We then tested for age, period, and cohort effects using the Intrinsic Estimator approach. Our results indicated that IHD mortality in China increased significantly over the three decades studied. There was a log-linear increase in the age effect on IHD mortality as those aged 80–84 showed 277 and 161 times greater IHD mortality risk than those aged 20–24 in urban and rural populations, respectively. While there was an upward trend in the period effect in both populations, the influence of the cohort effect on mortality decreased over time for those born from 1904 to 1993. The age, period, and cohort effects on mortality in China were generally comparable between urban and rural populations. The results suggest that population aging is a major driver behind the rapid rise in IHD mortality. Increased exposure to air pollution may also have played a role in driving the period effect
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Affiliation(s)
- Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an 710061, China.
- Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an 710061, China.
| | - Boyang Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
| | - Jingjing Li
- Department of Behavior Science and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
- Department of Epidemiology, School of Public Health, Wuhan University, Wuhan 430071, China.
| | - Yang Sun
- Department of Public Affairs and Management, School of Political Science and Public Administration, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan 430072, China.
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Yang X, Li J, Hu D, Chen J, Li Y, Huang J, Liu X, Liu F, Cao J, Shen C, Yu L, Lu F, Wu X, Zhao L, Wu X, Gu D. Predicting the 10-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese Population: The China-PAR Project (Prediction for ASCVD Risk in China). Circulation 2016; 134:1430-1440. [PMID: 27682885 DOI: 10.1161/circulationaha.116.022367] [Citation(s) in RCA: 350] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND The accurate assessment of individual risk can be of great value to guiding and facilitating the prevention of atherosclerotic cardiovascular disease (ASCVD). However, prediction models in common use were formulated primarily in white populations. The China-PAR project (Prediction for ASCVD Risk in China) is aimed at developing and validating 10-year risk prediction equations for ASCVD from 4 contemporary Chinese cohorts. METHODS Two prospective studies followed up together with a unified protocol were used as the derivation cohort to develop 10-year ASCVD risk equations in 21 320 Chinese participants. The external validation was evaluated in 2 independent Chinese cohorts with 14 123 and 70 838 participants. Furthermore, model performance was compared with the Pooled Cohort Equations reported in the American College of Cardiology/American Heart Association guideline. RESULTS Over 12 years of follow-up in the derivation cohort with 21 320 Chinese participants, 1048 subjects developed a first ASCVD event. Sex-specific equations had C statistics of 0.794 (95% confidence interval, 0.775-0.814) for men and 0.811 (95% confidence interval, 0.787-0.835) for women. The predicted rates were similar to the observed rates, as indicated by a calibration χ2 of 13.1 for men (P=0.16) and 12.8 for women (P=0.17). Good internal and external validations of our equations were achieved in subsequent analyses. Compared with the Chinese equations, the Pooled Cohort Equations had lower C statistics and much higher calibration χ2 values in men. CONCLUSIONS Our project developed effective tools with good performance for 10-year ASCVD risk prediction among a Chinese population that will help to improve the primary prevention and management of cardiovascular disease.
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Affiliation(s)
- Xueli Yang
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Jianxin Li
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Dongsheng Hu
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Jichun Chen
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Ying Li
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Jianfeng Huang
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Xiaoqing Liu
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Fangchao Liu
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Jie Cao
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Chong Shen
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Ling Yu
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Fanghong Lu
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Xianping Wu
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Liancheng Zhao
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Xigui Wu
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Dongfeng Gu
- From Department of Epidemiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X.Y., J.L., J.C., Y.L., J.H., F. Liu, J.C., L.Z., X.W., D.G.); Department of Prevention Medicine, Shenzhen University School of Medicine, Shenzhen, China (D.H.); Division of Epidemiology, Guangdong Provincial People's Hospital and Cardiovascular Institute, Guangzhou, China (X.L.); Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China (C.S.); Department of Cardiology, Fujian Provincial People's Hospital, Fuzhou, China (L.Y.); Cardio-Cerebrovascular Control and Research Center, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, China (F. Lu); and Sichuan Center for Disease Control and Prevention, Chengdu, China.
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Hao Y, Liu J, Liu J, Smith SC, Huo Y, Fonarow GC, Ma C, Ge J, Taubert KA, Morgan L, Guo Y, Zhang Q, Wang W, Zhao D. Rationale and design of the Improving Care for Cardiovascular Disease in China (CCC) project: A national effort to prompt quality enhancement for acute coronary syndrome. Am Heart J 2016; 179:107-15. [PMID: 27595685 DOI: 10.1016/j.ahj.2016.06.005] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/01/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND A sizeable gap exists between guideline recommendations for treatment of acute coronary syndrome (ACS) and application of these recommendations in clinical practice. The CCC-ACS project is a novel national quality enhancement registry designed to help medical care providers bridge this gap, thereby improving clinical outcomes for ACS patients in China. METHODS AND RESULTS The CCC-ACS project uses data collection, analysis, feedback, rapid-cycle improvement, and performance recognition to extend the use of evidence-based guidelines throughout the health care system and improve cardiovascular health. The project was launched in 2014, with 150 centers recruited representing the diversity of care for ACS patients in tertiary hospitals across China. Clinical information for patients with ACS is collected via a Web-based data collecting platform, including patients' demographics, medical history, symptoms on arrival, in-hospital treatment and procedures, in-hospital outcomes, and discharge medications for secondary prevention. Improvement in adherence to guideline recommendations is facilitated through monthly benchmarked hospital quality reports, recognition of hospital quality achievement, and regular webinars. As of April 16, 2016, a total of 35,616 ACS cases have been enrolled. CONCLUSIONS The CCC-ACS is a national hospital-based quality improvement program, aiming to increase adherence to ACS guidelines in China and improve patient outcomes.
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Affiliation(s)
- Yongchen Hao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jing Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Jun Liu
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Sidney C Smith
- Division of Cardiology, University of North Carolina, Chapel Hill, NC
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Gregg C Fonarow
- Geffen School of Medicine at University of California, Los Angeles, CA
| | - Changsheng Ma
- Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University, Beijing, China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kathryn A Taubert
- Department of Global Strategies, American Heart Association, Dallas, TX
| | - Louise Morgan
- International Quality Improvement Department, American Heart Association, Dallas, TX
| | - Yang Guo
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Qian Zhang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Wei Wang
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
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Lawson KD, Lewsey JD, Ford I, Fox K, Ritchie LD, Tunstall-Pedoe H, Watt GCM, Woodward M, Kent S, Neilson M, Briggs AH. A cardiovascular disease policy model: part 2-preparing for economic evaluation and to assess health inequalities. Open Heart 2016; 3:e000140. [PMID: 27335653 PMCID: PMC4908904 DOI: 10.1136/openhrt-2014-000140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 02/17/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022] Open
Abstract
Objectives This is the second of the two papers introducing a cardiovascular disease (CVD) policy model. The first paper described the structure and statistical underpinning of the state-transition model, demonstrating how life expectancy estimates are generated for individuals defined by ASSIGN risk factors. This second paper describes how the model is prepared to undertake economic evaluation. Design To generate quality-adjusted life expectancy (QALE), the Scottish Health Survey was used to estimate background morbidity (health utilities) and the impact of CVD events (utility decrements). The SF-6D algorithm generated utilities and decrements were modelled using ordinary least squares (OLS). To generate lifetime hospital costs, the Scottish Heart Health Extended Cohort (SHHEC) was linked to the Scottish morbidity and death records (SMR) to cost each continuous inpatient stay (CIS). OLS and restricted cubic splines estimated annual costs before and after each of the first four events. A Kaplan-Meier sample average (KMSA) estimator was then used to weight expected health-related quality of life and costs by the probability of survival. Results The policy model predicts the change in QALE and lifetime hospital costs as a result of an intervention(s) modifying risk factors. Cost-effectiveness analysis and a full uncertainty analysis can be undertaken, including probabilistic sensitivity analysis. Notably, the impacts according to socioeconomic deprivation status can be made. Conclusions The policy model can conduct cost-effectiveness analysis and decision analysis to inform approaches to primary prevention, including individually targeted and population interventions, and to assess impacts on health inequalities.
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Affiliation(s)
- K D Lawson
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK; Centre for Health Research, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - J D Lewsey
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - I Ford
- Robertson Centre for Biostatistics, Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - K Fox
- BHF Centre for Research Excellence, University of Edinburgh , Edinburgh , UK
| | - L D Ritchie
- Centre of Academic Primary Care, University of Aberdeen , Aberdeen , UK
| | - H Tunstall-Pedoe
- Institute of Cardiovascular Research, Ninewells Hospital, University of Dundee , Dundee , UK
| | - G C M Watt
- General Practice & Primary Care , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - M Woodward
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia; Oxford Martin School, University of Oxford, Oxford, UK
| | - S Kent
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - M Neilson
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
| | - A H Briggs
- Health Economics and Health Technology Assessment , Institute of Health & Wellbeing, University of Glasgow , Glasgow , UK
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Maracy MR, Isfahani MT, Kelishadi R, Ghasemian A, Sharifi F, Shabani R, Djalalinia S, Majidi S, Ansari H, Asayesh H, Qorbani M. Burden of ischemic heart diseases in Iran, 1990-2010: Findings from the Global Burden of Disease study 2010. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2016; 20:1077-83. [PMID: 26941812 PMCID: PMC4755095 DOI: 10.4103/1735-1995.172832] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Cardiovascular diseases are viewed worldwide as one of the main causes of death. This study aims to report the burden of ischemic heart diseases (IHDs) in Iran by using data of the global burden of disease (GBD) study, 1990-2010. Materials and Methods: The GBD study 2010 was a systematic effort to provide comprehensive data to calculate disability-adjusted life years (DALYs) for diseases and injuries in the world. Years of life lost (YLLs) due to premature mortality were computed on the basis of cause-of-death estimates, using Cause of Death Ensemble model (CODEm). Years lived with disability (YLDs) were assessed by the multiplication of prevalence, the disability weight for a sequel, and the duration of symptoms. A systematic review of published and unpublished data was performed to evaluate the distribution of diseases, and consequently prevalence estimates were calculated with a Bayesian meta-regression method (DisMod-MR). Data from population-based surveys were used for producing disability weights. Uncertainty from all inputs into the calculations of DALYs was disseminated by Monte Carlo simulation techniques. Results: The age-standardized IHDs DALY specified rate decreased 31.25% over 20 years from 1990 to 2010 [from 4720 (95% uncertainty interval (UI): 4,341-5,099) to 3,245 (95% UI: 2,810-3,529) person-years per 100,000]. The decrease were 38.14% among women and 26.87% among men. The age-standardized IHDs death specefied rate decreased by 21.17% [from 222) 95% UI: 207-243 (to 175 (95% UI:152-190) person-years per 100,000] in both the sexes. The age-standardized YLL and YLD rates decreased 32.05% and 4.28%, respectively, in the above period. Conclusion: Despite decreasing age-standardized IHD of mortality, YLL, YLD, and DALY rates from 1990 to 2010, population growth and aging increased the global burden of IHD. YLL has decreased more than IHD deaths and YLD since 1990 but IHD mortality remains the greatest contributor to disease burden.
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Affiliation(s)
- Mohammad Reza Maracy
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Motahareh Tabar Isfahani
- Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Department of Pediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Anoosheh Ghasemian
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reihaneh Shabani
- Department of Cardiology, Shahid Rajaei Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shirin Djalalinia
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Development of Research and Technology Center, Deputy of Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Somayye Majidi
- Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ansari
- Department of Epidemiology and Biostatistics, Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamid Asayesh
- Department of Medical Emergencies, Qom University of Medical Sciences, Qom, Iran
| | - Mostafa Qorbani
- Department of Community Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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18
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Morris RW, Taylor AE, Fluharty ME, Bjørngaard JH, Åsvold BO, Elvestad Gabrielsen M, Campbell A, Marioni R, Kumari M, Korhonen T, Männistö S, Marques-Vidal P, Kaakinen M, Cavadino A, Postmus I, Husemoen LLN, Skaaby T, Ahluwalia TVS, Treur JL, Willemsen G, Dale C, Wannamethee SG, Lahti J, Palotie A, Räikkönen K, McConnachie A, Padmanabhan S, Wong A, Dalgård C, Paternoster L, Ben-Shlomo Y, Tyrrell J, Horwood J, Fergusson DM, Kennedy MA, Nohr EA, Christiansen L, Kyvik KO, Kuh D, Watt G, Eriksson JG, Whincup PH, Vink JM, Boomsma DI, Davey Smith G, Lawlor D, Linneberg A, Ford I, Jukema JW, Power C, Hyppönen E, Jarvelin MR, Preisig M, Borodulin K, Kaprio J, Kivimaki M, Smith BH, Hayward C, Romundstad PR, Sørensen TIA, Munafò MR, Sattar N. Heavier smoking may lead to a relative increase in waist circumference: evidence for a causal relationship from a Mendelian randomisation meta-analysis. The CARTA consortium. BMJ Open 2015; 5:e008808. [PMID: 26264275 PMCID: PMC4538266 DOI: 10.1136/bmjopen-2015-008808] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To investigate, using a Mendelian randomisation approach, whether heavier smoking is associated with a range of regional adiposity phenotypes, in particular those related to abdominal adiposity. DESIGN Mendelian randomisation meta-analyses using a genetic variant (rs16969968/rs1051730 in the CHRNA5-CHRNA3-CHRNB4 gene region) as a proxy for smoking heaviness, of the associations of smoking heaviness with a range of adiposity phenotypes. PARTICIPANTS 148,731 current, former and never-smokers of European ancestry aged ≥ 16 years from 29 studies in the consortium for Causal Analysis Research in Tobacco and Alcohol (CARTA). PRIMARY OUTCOME MEASURES Waist and hip circumferences, and waist-hip ratio. RESULTS The data included up to 66,809 never-smokers, 43,009 former smokers and 38,913 current daily cigarette smokers. Among current smokers, for each extra minor allele, the geometric mean was lower for waist circumference by -0.40% (95% CI -0.57% to -0.22%), with effects on hip circumference, waist-hip ratio and body mass index (BMI) being -0.31% (95% CI -0.42% to -0.19), -0.08% (-0.19% to 0.03%) and -0.74% (-0.96% to -0.51%), respectively. In contrast, among never-smokers, these effects were higher by 0.23% (0.09% to 0.36%), 0.17% (0.08% to 0.26%), 0.07% (-0.01% to 0.15%) and 0.35% (0.18% to 0.52%), respectively. When adjusting the three central adiposity measures for BMI, the effects among current smokers changed direction and were higher by 0.14% (0.05% to 0.22%) for waist circumference, 0.02% (-0.05% to 0.08%) for hip circumference and 0.10% (0.02% to 0.19%) for waist-hip ratio, for each extra minor allele. CONCLUSIONS For a given BMI, a gene variant associated with increased cigarette consumption was associated with increased waist circumference. Smoking in an effort to control weight may lead to accumulation of central adiposity.
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Affiliation(s)
- Richard W Morris
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Department of Primary Care and Population Health, UCL, London, UK
| | - Amy E Taylor
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Meg E Fluharty
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Johan H Bjørngaard
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Forensic Department, Research Centre Bröset, St Olav's University Hospital Trondheim, Trondheim, Norway
| | - Bjørn Olav Åsvold
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Maiken Elvestad Gabrielsen
- Department of Laboratory Medicine, Children's and Women's Health, The Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Archie Campbell
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Riccardo Marioni
- Medical Genetics Section, Centre for Genomic and Experimental Medicine, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
- Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Meena Kumari
- Institute for Social and Economic Research, University of Essex, Colchester, UK
| | - Tellervo Korhonen
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- National Institute for Health and Welfare, Helsinki, Finland
| | - Satu Männistö
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Pedro Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Marika Kaakinen
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Alana Cavadino
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Population, Policy and Practice, UCL Institute of Child Health, University College London, UK
| | - Iris Postmus
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Consortium of Healthy Ageing, Leiden, The Netherlands
| | | | - Tea Skaaby
- Research Centre for Prevention and Health, the Capital Region of Denmark, Denmark
| | - Tarun Veer Singh Ahluwalia
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center, Gentofte, Denmark
- COPSAC, Copenhagen Prospective Studies on Asthma in Childhood, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jorien L Treur
- Department of Biological Psychology, Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - Gonneke Willemsen
- Department of Biological Psychology, Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - Caroline Dale
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jari Lahti
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Aarno Palotie
- Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Finland
- The Medical and Population Genomics Program, The Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Katri Räikkönen
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - Sandosh Padmanabhan
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Christine Dalgård
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lavinia Paternoster
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, UK
| | - Yoav Ben-Shlomo
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Jessica Tyrrell
- European Centre for Environment and Human Health, University of Exeter Medical School, Truro, UK
- Genetics of Complex Traits, University of Exeter Medical School, Exeter, UK
| | - John Horwood
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - David M Fergusson
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Martin A Kennedy
- Department of Pathology, University of Otago, Christchurch, New Zealand
| | - Ellen A Nohr
- Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Christiansen
- Department of Epidemiology, Biostatistics and Biodemography, Institute of Public Health, University of Southern Denmark, Denmark
| | - Kirsten Ohm Kyvik
- Department of Environmental Medicine, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | | | - Johan G Eriksson
- National Institute for Health and Welfare, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
- Vasa Central Hospital, Vasa, Finland
| | - Peter H Whincup
- Population Health Research Institute, St George's University of London, London, UK
| | - Jacqueline M Vink
- Department of Biological Psychology, Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - Dorret I Boomsma
- Department of Biological Psychology, Netherlands Twin Register, VU University, Amsterdam, The Netherlands
| | - George Davey Smith
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, UK
| | - Debbie Lawlor
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, UK
| | - Allan Linneberg
- Research Centre for Prevention and Health, the Capital Region of Denmark, Denmark
- Department of Clinical Experimental Research, Glostrup University Hospital, Glostrup, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Durrer Center for Cardiogenetic Research, Amsterdam, The Netherlands
- Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
| | - Chris Power
- Population, Policy and Practice, UCL Institute of Child Health, University College London, UK
| | - Elina Hyppönen
- Population, Policy and Practice, UCL Institute of Child Health, University College London, UK
- Centre for Population Health Research, School of Health Sciences and Sansom Institute of Health Research, University of South Australia, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Marjo-Riitta Jarvelin
- Institute of Health Sciences, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
- Unit of Primary Care, Oulu University Hospital, Oulu, Finland
- Department of Children and Young People and Families, National Institute for Health and Welfare, Oulu, Finland
- Department of Epidemiology and Biostatistics, MRC Health Protection Agency (HPA) Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Katja Borodulin
- National Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
- National Institute for Health and Welfare, Helsinki, Finland
- Institute for Molecular Medicine Finland FIMM, University of Helsinki, Helsinki, Finland
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Blair H Smith
- Division of Population Health Sciences, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Caroline Hayward
- Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - Pål R Romundstad
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Thorkild I A Sørensen
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, UK
- Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute of Preventive Medicine, Bispebjerg and Frederikberg Hospitals, The Capital Region, Copenhagen, Denmark
| | - Marcus R Munafò
- MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, University of Bristol, Bristol, UK
- UK Centre for Tobacco and Alcohol Studies and School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Naveed Sattar
- Faculty of Medicine, BHF Glasgow Cardiovascular Research Centre, Glasgow, UK
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Wong MCS, Zhang DX, Wang HHX. Rapid emergence of atherosclerosis in Asia: a systematic review of coronary atherosclerotic heart disease epidemiology and implications for prevention and control strategies. Curr Opin Lipidol 2015; 26:257-69. [PMID: 26103609 DOI: 10.1097/mol.0000000000000191] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is a global epidemic of coronary heart disease (CHD) caused by atherosclerosis. We discussed its emergence, underlying reasons, and implications for prevention and control strategies in Asia. RECENT FINDINGS Most countries in Asia are experiencing the challenges from CHD, with the mortality rate varying from 103 to 366 per 100 000 adult populations, reported by recently published studies. Raised population cholesterol levels played a pivotal role. Men, older adults, and those with dyslipidemia, hypertension, and diabetes were high-risk individuals. During the past decade, there was a marked rising trend of atherosclerosis-related burden particularly in Eastern Asia where an alarming increase of 117.2 and 115.3% of total deaths and disability adjusted life-years, respectively, were observed. The rise of CHD could be attributed to unhealthy lifestyles, clinical-risk factors, psychosocial factors, and public health transitions. Ageing, urbanization, and increase in prosperity may serve as underlying key drivers. SUMMARY The burden of CHD is substantial, whereas contributors are multifactorial. This grand challenge should be a top priority for injecting healthcare resources. The formulation of public health measures will need to adopt an integrated and life-course approach, based on the need and risks of different population subgroups in Asia.
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Affiliation(s)
- Martin C S Wong
- aJC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong bSchool of Public Health, Sun Yat-Sen University, Guangzhou, P.R. China cGeneral Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK *Martin C.S. Wong and De Xing Zhang contributed equally to the writing of this article
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20
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Mensah GA, Sampson UK. Coronary Mortality in China. Circ Cardiovasc Qual Outcomes 2014; 7:8-10. [DOI: 10.1161/circoutcomes.113.000761] [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)
- George A. Mensah
- From the National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (U.K.A.S.)
| | - Uchechukwu K.A. Sampson
- From the National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and Department of Medicine, Vanderbilt University Medical Center, Nashville, TN (U.K.A.S.)
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Shadmani FK, Karami M. Joint effect of modifying selected risk factors on attributable burden of cardiovascular diseases. Int J Prev Med 2013; 4:1461-7. [PMID: 24498503 PMCID: PMC3898453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 05/01/2013] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND There are few published studies that consider the joint effect of multiple risk factors on avoidable burden of cardiovascular diseases (CVDs). This study aimed to estimate the joint effect of avoidable burden of multiple risk factors to CVDs. METHODS Estimates of avoidable burden to CVDs were made using potential impact fraction (PIF). In order to calculate PIF, data on the Prevalence of the risk factors include diabetes, hypertension, central obesity, and hypercholesterolemia were obtained from 3(rd) national Surveillance of Risk Factors of Non-Communicable Diseases-2007 in Iran and data on corresponding measures of effect were derived from a cohort study with multivariate adjusted hazard ratios. Then, joint effect of risk factors was calculated. RESULTS About 37% (95% uncertainty interval: 21.7-50.2) of attributable disability adjusted life years (DALYs) to CVDs in adult males and 59.4% (95% uncertainty interval: 30-76) in adult females due to selected risk factors are avoidable in theoretical minimum risk levels. After changing the current prevalence of these risk factors to the plausible minimum risk levels, 17.8% (95% uncertainty interval: 10.1-25.1) of CVDs' attributable DALYs among adult males and 34% (95% uncertainty interval: 20-46.7) in adult females can be avoided. CONCLUSIONS To better priority setting as well as reporting the magnitude of avoidable DALYs rather than the percentage of avoidable burden, PIF should be applied to updated and revised burden of CVDs.
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Affiliation(s)
- Fatemeh Khosravi Shadmani
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Manoochehr Karami
- Research Center for Health Sciences and Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran,Correspondence to: Dr. Manoochehr Karami, Research Center for Health Sciences and Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. E-mail:
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22
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Jones DS, Greene JA. The decline and rise of coronary heart disease: understanding public health catastrophism. Am J Public Health 2013; 103:1207-18. [PMID: 23678895 PMCID: PMC3682614 DOI: 10.2105/ajph.2013.301226] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2012] [Indexed: 11/04/2022]
Abstract
The decline of coronary heart disease mortality in the United States and Western Europe is one of the great accomplishments of modern public health and medicine. Cardiologists and cardiovascular epidemiologists have devoted significant effort to disease surveillance and epidemiological modeling to understand its causes. One unanticipated outcome of these efforts has been the detection of early warnings that the decline had slowed, plateaued, or even reversed. These subtle signs have been interpreted as evidence of an impending public health catastrophe. This article traces the history of research on coronary heart disease decline and resurgence and situates it in broader narratives of public health catastrophism. Juxtaposing the coronary heart disease literature alongside the narratives of emerging and reemerging infectious disease helps to identify patterns in how public health researchers create data and craft them into powerful narratives of progress or pessimism. These narratives, in turn, shape public health policy.
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Affiliation(s)
- David S Jones
- Department of History of Science, Harvard University, Cambridge, MA, USA.
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Bowman S, Unwin N, Critchley J, Capewell S, Husseini A, Maziak W, Zaman S, Ben Romdhane H, Fouad F, Phillimore P, Unal B, Khatib R, Shoaibi A, Ahmad B. Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop. Bull World Health Organ 2012; 90:847-53. [PMID: 23226897 DOI: 10.2471/blt.12.104968] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Revised: 08/12/2012] [Accepted: 08/20/2012] [Indexed: 12/22/2022] Open
Abstract
Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases. However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a "policy effectiveness-feasibility loop" (PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach.
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Affiliation(s)
- Sarah Bowman
- Institute of Health and Society, Newcastle University, Newcastle, England
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24
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Albana D, Sun MC. Screening Biochemical Markers for the Prevention of Coronary Heart Disease. CHEMISTRY FOR SUSTAINABLE DEVELOPMENT 2012. [DOI: 10.1007/978-90-481-8650-1_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Shalnova SA, Deev AD. Russian mortality trends in the early XXI century: official statistics data. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2011. [DOI: 10.15829/1728-8800-2011-6-5-10] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
From the second half of the XX century, cardiovascular disease (CVD) remains one of the main problems of the modern medicine. Over the last two decades, developed countries demonstrated a marked decrease in all-cause mortality and CVD mortality, in particular. InRussia, since the mid-1960s, all-cause mortality gradually increased, with the proportion of CVD deaths being over 50 %, which led to unparalleled high levels of national mortality. In 2009, the absolute number of CVD deaths was 1136661, or 1 case out of 1,8. In other words, 3114 Russian people die from CVD every day. From 2004, all-cause mortality, including CVD mortality, started to decline, and this tendency has continued until at least 2009, as demonstrated by the mortality rate of 801 per 100,000. However, the mortality levels are still higher than in the late 1980s. The authors analysed the CVD dynamics between 2003 (the highest levels) and 2009 inclusive, using the official national statistics data. The last few years demonstrated a positive tendency of declining mortality. In particular, the all-cause mortality (deaths per 100,000) decreased from1644,2 in2003 to1416,8 in2009 (by 13,8 %). CVD mortality decreased by 13,6 %, and more markedly mostly in working-age people (by 18,9 %). Therefore, in 2009, the number of lives saved due to the decreasing CVD mortality was 260741. Further studies will explain the recent mortality trends inRussia.
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Affiliation(s)
| | - A. D. Deev
- State Research Centre for Preventive Medicine
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26
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Xu W, Hang J, Gao W, Zhao Y, Cao T, Guo L. Association between Job Stress and Newly Detected Combined Dyslipidemia among Chinese Workers: Findings from the SHISO Study. J Occup Health 2011; 53:334-42. [DOI: 10.1539/joh.11-0023-oa] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Weixian Xu
- Department of CardiologyPeking University Third HospitalChina
- Key Laboratory of Molecular Cardiovascular ScienceMinistry of EducationChina
| | - Juan Hang
- Department of CardiologyPeking University Third HospitalChina
- Department of PriorityPeking University Shenzhen HospitalChina
| | - Wei Gao
- Department of CardiologyPeking University Third HospitalChina
- Key Laboratory of Molecular Cardiovascular ScienceMinistry of EducationChina
| | - Yiming Zhao
- Research Center of Occupational Medicine, Peking University Third HospitalChina
| | - Tingting Cao
- Department of PriorityPeking University Shenzhen HospitalChina
| | - Lijun Guo
- Department of CardiologyPeking University Third HospitalChina
- Key Laboratory of Molecular Cardiovascular ScienceMinistry of EducationChina
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28
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Abstract
Cardiovascular disease prevention is a continuum that encompasses the life-course. This article discusses preventive strategies focusing on policy and clinical initiatives including primordial prevention (lifestyle changes involving smoking, diet and exercise), primary prevention (risk factor control), and secondary prevention (acute and chronic disease management). Combined use of all the three strategies can have an immediate and large impact on reducing CVD morbidity and mortality.
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29
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Gupta R, Guptha S, Joshi R, Xavier D. Translating evidence into policy for cardiovascular disease control in India. Health Res Policy Syst 2011; 9:8. [PMID: 21306620 PMCID: PMC3045991 DOI: 10.1186/1478-4505-9-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 02/09/2011] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVD) are leading causes of premature mortality in India. Evidence from developed countries shows that mortality from these can be substantially prevented using population-wide and individual-based strategies. Policy initiatives for control of CVD in India have been suggested but evidence of efficacy has emerged only recently. These initiatives can have immediate impact in reducing morbidity and mortality. Of the prevention strategies, primordial involve improvement in socioeconomic status and literacy, adequate healthcare financing and public health insurance, effective national CVD control programme, smoking control policies, legislative control of saturated fats, trans fats, salt and alcohol, and development of facilities for increasing physical activity through better urban planning and school-based and worksite interventions. Primary prevention entails change in medical educational curriculum and improved healthcare delivery for control of CVD risk factors-smoking, hypertension, dyslipidemia and diabetes. Secondary prevention involves creation of facilities and human resources for optimum acute CVD care and secondary prevention. There is need to integrate various policy makers, develop effective policies and modify healthcare systems for effective delivery of CVD preventive care.
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Affiliation(s)
| | | | - Rajnish Joshi
- Mahatma Gandhi Institute of Medical Sciences, Wardha 442102, India
| | - Denis Xavier
- St John's Medical College, Bangalore 560038, India
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30
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Nijjar APK, Wang H, Quan H, Khan NA. Ethnic and sex differences in the incidence of hospitalized acute myocardial infarction: British Columbia, Canada 1995-2002. BMC Cardiovasc Disord 2010; 10:38. [PMID: 20723259 PMCID: PMC2933615 DOI: 10.1186/1471-2261-10-38] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 08/19/2010] [Indexed: 01/24/2023] Open
Abstract
Background As populations in Western countries continue to change in their ethnic composition, there is a need for regular surveillance of diseases that have previously shown some health disparities. Earlier data have already demonstrated high rates of cardiovascular mortality among South Asians and relatively lower rates among people of Chinese descent. The aim of this study was to describe the differences in the incidence of hospitalized acute myocardial infarction (AMI) among the three largest ethnic groups in British Columbia (BC), Canada. Methods Using hospital administrative data, we identified all patients with incident AMI in BC between April 1, 1995, and March 31, 2002. Census data from 2001 provided the denominator for the entire BC population. Ethnicity was determined using validated surname analysis and applied to the census and hospital administrative datasets. Direct age standardization was used to compare incidence rates. Results A total of 34,848 AMI cases were identified. Among men, South Asians had the highest age standardized rate of AMI hospitalization at 4.97/1000 population/year, followed by Whites at 3.29, and then Chinese at 0.98. Young South Asian men, in particular, showed incidence rates that were double that of young Whites and ten times that of young Chinese men. South Asian women also had the highest age-standardized rate of AMI hospitalization at 2.35/1000 population/year, followed by White women (1.53) and Chinese women (0.49). Conclusions South Asians continue to have a higher incidence of hospitalized AMI while incidence rates among Chinese remain low. Ethnic differences are most notable among younger men.
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Affiliation(s)
- Aman P K Nijjar
- Division of General Internal Medicine, University of British Columbia, BC, Canada.
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31
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Moran A, Gu D, Zhao D, Coxson P, Wang YC, Chen CS, Liu J, Cheng J, Bibbins-Domingo K, Shen YM, He J, Goldman L. Future cardiovascular disease in china: markov model and risk factor scenario projections from the coronary heart disease policy model-china. Circ Cardiovasc Qual Outcomes 2010; 3:243-52. [PMID: 20442213 DOI: 10.1161/circoutcomes.109.910711] [Citation(s) in RCA: 251] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relative effects of individual and combined risk factor trends on future cardiovascular disease in China have not been quantified in detail. METHODS AND RESULTS Future risk factor trends in China were projected based on prior trends. Cardiovascular disease (coronary heart disease and stroke) in adults ages 35 to 84 years was projected from 2010 to 2030 using the Coronary Heart Disease Policy Model-China, a Markov computer simulation model. With risk factor levels held constant, projected annual cardiovascular events increased by >50% between 2010 and 2030 based on population aging and growth alone. Projected trends in blood pressure, total cholesterol, diabetes (increases), and active smoking (decline) would increase annual cardiovascular disease events by an additional 23%, an increase of approximately 21.3 million cardiovascular events and 7.7 million cardiovascular deaths over 2010 to 2030. Aggressively reducing active smoking in Chinese men to 20% prevalence in 2020 and 10% prevalence in 2030 or reducing mean systolic blood pressure by 3.8 mm Hg in men and women would counteract adverse trends in other risk factors by preventing cardiovascular events and 2.9 to 5.7 million total deaths over 2 decades. CONCLUSIONS Aging and population growth will increase cardiovascular disease by more than a half over the coming 20 years, and projected unfavorable trends in blood pressure, total cholesterol, diabetes, and body mass index may accelerate the epidemic. National policy aimed at controlling blood pressure, smoking, and other risk factors would counteract the expected future cardiovascular disease epidemic in China.
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Affiliation(s)
- Andrew Moran
- Columbia University Medical Center, New York, NY, USA
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Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, Greenlund K, Daniels S, Nichol G, Tomaselli GF, Arnett DK, Fonarow GC, Ho PM, Lauer MS, Masoudi FA, Robertson RM, Roger V, Schwamm LH, Sorlie P, Yancy CW, Rosamond WD. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010; 121:586-613. [PMID: 20089546 DOI: 10.1161/circulationaha.109.192703] [Citation(s) in RCA: 3208] [Impact Index Per Article: 229.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This document details the procedures and recommendations of the Goals and Metrics Committee of the Strategic Planning Task Force of the American Heart Association, which developed the 2020 Impact Goals for the organization. The committee was charged with defining a new concept, cardiovascular health, and determining the metrics needed to monitor it over time. Ideal cardiovascular health, a concept well supported in the literature, is defined by the presence of both ideal health behaviors (nonsmoking, body mass index <25 kg/m(2), physical activity at goal levels, and pursuit of a diet consistent with current guideline recommendations) and ideal health factors (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, and fasting blood glucose <100 mg/dL). Appropriate levels for children are also provided. With the use of levels that span the entire range of the same metrics, cardiovascular health status for the whole population is defined as poor, intermediate, or ideal. These metrics will be monitored to determine the changing prevalence of cardiovascular health status and define achievement of the Impact Goal. In addition, the committee recommends goals for further reductions in cardiovascular disease and stroke mortality. Thus, the committee recommends the following Impact Goals: "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." These goals will require new strategic directions for the American Heart Association in its research, clinical, public health, and advocacy programs for cardiovascular health promotion and disease prevention in the next decade and beyond.
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