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Fujiyoshi A, Kohsaka S, Hata J, Hara M, Kai H, Masuda D, Miyamatsu N, Nishio Y, Ogura M, Sata M, Sekiguchi K, Takeya Y, Tamura K, Wakatsuki A, Yoshida H, Fujioka Y, Fukazawa R, Hamada O, Higashiyama A, Kabayama M, Kanaoka K, Kawaguchi K, Kosaka S, Kunimura A, Miyazaki A, Nii M, Sawano M, Terauchi M, Yagi S, Akasaka T, Minamino T, Miura K, Node K. JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease. Circ J 2024; 88:763-842. [PMID: 38479862 DOI: 10.1253/circj.cj-23-0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Jun Hata
- Department of Epidemiology and Public Health, Graduate School of Medical Sciences, Kyushu University
| | - Mitsuhiko Hara
- Department of Health and Nutrition, Wayo Women's University
| | - Hisashi Kai
- Department of Cardiology, Kurume Univeristy Medical Center
| | | | - Naomi Miyamatsu
- Department of Clinical Nursing, Shiga University of Medical Science
| | - Yoshihiko Nishio
- Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Sciences
| | - Masatsune Ogura
- Department of General Medical Science, Chiba University School of Medicine
- Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Yasushi Takeya
- Division of Helath Science, Osaka University Gradiate School of Medicine
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine
| | | | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | - Yoshio Fujioka
- Division of Clinical Nutrition, Faculty of Nutrition, Kobe Gakuin University
| | | | - Osamu Hamada
- Department of General Internal Medicine, Takatsuki General Hospital
| | | | - Mai Kabayama
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
| | - Kenjiro Kawaguchi
- Division of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University
| | | | | | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Mitsuaki Sawano
- Department of Cardiology, Keio University School of Medicine
- Yale New Haven Hospital Center for Outcomes Research and Evaluation
| | | | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Nishinomiya Watanabe Cardiovascular Cerebral Center
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Meidicine
| | - Katsuyuki Miura
- Department of Preventive Medicine, NCD Epidemiology Research Center, Shiga University of Medical Science
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
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2
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Wekenborg MK, Künzel RG, Rothe N, Penz M, Walther A, Kirschbaum C, Thayer JF, Hill LK. Exhaustion and cardiovascular risk factors: the role of vagally-mediated heart rate variability. Ann Epidemiol 2023; 87:S1047-2797(23)00182-5. [PMID: 37748549 DOI: 10.1016/j.annepidem.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE Exhaustion symptoms are known to be associated with cardiovascular disease (CVD) risk; however, the underlying mechanisms remain unclear. Autonomic imbalance, as indicated by reductions in vagally-mediated heart rate variability (vmHRV), appears to be a valid candidate for such a biological link, as it has been associated with both exhaustion symptoms and CVD risk and mortality. METHODS The present study examined a potential mediation of vmHRV on the association between exhaustion symptoms and self-reported CVD risk factors as well as the age dependency of this mediation in a large, heterogeneous sample of the Dresden Burnout Study (N = 388; 72.9% females; Mage = 42.61, SD = 11.67). RESULTS Results indicate that exhaustion symptoms were indirectly associated with CVD risk factors through vmHRV even after adjusting for well-known confounders (i.e., sex, body mass index, depressive symptoms). Moreover, this pattern was significant only among middle-aged (i.e., 54.27 years) and older individuals. CONCLUSIONS Our findings add to growing evidence that autonomic imbalance may be a key biological link between exhaustion symptoms and CVD risk in middle-aged and older individuals. Implications for public health are discussed.
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Affiliation(s)
- Magdalena K Wekenborg
- Chair of Biological Psychology, Faculty of Psychology, TU Dresden, Dresden, Germany; Else Kröner Fresenius Center for Digital Health, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany.
| | - Richard G Künzel
- Chair of Biological Psychology, Faculty of Psychology, TU Dresden, Dresden, Germany.
| | - Nicole Rothe
- Chair of Biological Psychology, Faculty of Psychology, TU Dresden, Dresden, Germany.
| | - Marlene Penz
- Institute of Education and Psychology, Johannes Kepler University, Linz, Austria.
| | - Andreas Walther
- Clinical Psychology and Psychotherapy, University of Zurich, Zürich, Switzerland.
| | - Clemens Kirschbaum
- Chair of Biological Psychology, Faculty of Psychology, TU Dresden, Dresden, Germany.
| | - Julian F Thayer
- Department of Psychological Science, School of Social Ecology, University of California, Irvine.
| | - LaBarron K Hill
- Department of Psychology, North Carolina Agricultural & Technical State University, Greensboro.
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3
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Ezzati F, Jafarzadeh M, Darabi F. Assessing and predicting the trend of cardiovascular risk factors in 40-80-year population based on the Ira-PEN program as an integrated service in primary health care. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:374. [PMID: 38144037 PMCID: PMC10743925 DOI: 10.4103/jehp.jehp_124_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/30/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND In Iran, half of all mortalities and 79% of those induced by noncommunicable diseases are attributed to cardiovascular diseases. In Iran, due to the high rate of noncommunicable diseases, a modified program (PEN) called Ira-PEN was integrated into the primary care program in health centers. The Ira-PEN program is adapted from the comprehensive WHO-PEN program to estimate the 10-year risk of cardiovascular diseases to control the main risk factors of noncommunicable diseases nationally. This study was conducted to investigate the process of service provision to determine the information needs and the necessary interventions in the comprehensive health service centers of Ardabil Province. MATERIALS AND METHODS The present descriptive and analytical study was conducted in the Ardabil University of Medical Sciences. It used the data available in the registration system of the Health Network. The research population consisted of all people aged between 40 and 80 who visited the comprehensive health service centers to perform risk assessment of cardiovascular strokes in the province from 2018 to the end of 2021. The collected data were added to Excel. FORCAST function was used to predict the future through a linear regression analysis. To compare the final results, which is actually a reduction in mortality due to cardiovascular diseases, the difference test of two mortality rates due to cardiovascular diseases was used in 2018 and 2021. Test of two death proportions was performed through z test and Minitab21 Software. RESULTS The prevalence of cardiovascular disease risk factors was as follows: history of heart attack (0.59%), history of stroke (0.51%), history of diabetes (7.9%), history of high blood pressure (15.7%), and history of prediabetics (12.8%). The probability of suffering from lipid disorder was 26.4% and BMI > 30 was 32.4%. The risk factors of hypertension, abdominal obesity, and smoking showed a decrease in the measurement of disease risk factors during 4 years. CONCLUSIONS Identification of the common risk factors in the region helps to focus interventions on effective prevention and treatment measures and adopt evidence-based policies in order to reduce these risk factors. Since the investigated risk factors are rooted in inappropriate behaviors and lifestyles, by modifying these behaviors and changing lifestyles, their prevalence can be reduced and reducing these risk factors will lead to a reduction in the prevalence of cardiovascular diseases.
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Affiliation(s)
- Farahnaz Ezzati
- Department of Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohammad Jafarzadeh
- Department of Infectious Diseases School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Fatemeh Darabi
- Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran
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Hefner M, Baliga V, Amphay K, Ramos D, Hegde V. Cardiometabolic Modification of Amyloid Beta in Alzheimer's Disease Pathology. Front Aging Neurosci 2021; 13:721858. [PMID: 34497507 PMCID: PMC8419421 DOI: 10.3389/fnagi.2021.721858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 12/14/2022] Open
Abstract
In recent years, several studies have suggested that cardiometabolic disorders, such as diabetes, obesity, hypertension, and dyslipidemia, share strong connections with the onset of neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease (AD). However, establishing a definitive link between medical disorders with coincident pathophysiologies is difficult due to etiological heterogeneity and underlying comorbidities. For this reason, amyloid β (Aβ), a physiological peptide derived from the sequential proteolysis of amyloid precursor protein (APP), serves as a crucial link that bridges the gap between cardiometabolic and neurodegenerative disorders. Aβ normally regulates neuronal synaptic function and repair; however, the intracellular accumulation of Aβ within the brain has been observed to play a critical role in AD pathology. A portion of Aβ is believed to originate from the brain itself and can readily cross the blood-brain barrier, while the rest resides in peripheral tissues that express APP required for Aβ generation such as the liver, pancreas, kidney, spleen, skin, and lungs. Consequently, numerous organs contribute to the body pool of total circulating Aβ, which can accumulate in the brain and facilitate neurodegeneration. Although the accumulation of Aβ corresponds with the onset of neurodegenerative disorders, the direct function of periphery born Aβ in AD pathophysiology is currently unknown. This review will highlight the contributions of individual cardiometabolic diseases including cardiovascular disease (CVD), type 2 diabetes (T2D), obesity, and non-alcoholic fatty liver disease (NAFLD) in elevating concentrations of circulating Aβ within the brain, as well as discuss the comorbid association of Aβ with AD pathology.
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Affiliation(s)
- Marleigh Hefner
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Vineet Baliga
- College of Arts and Sciences, University of North Carolina, Chapel Hill, Chapel Hill, NC, United States
| | - Kailinn Amphay
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Daniela Ramos
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
| | - Vijay Hegde
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, United States
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5
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Koohi F, Ahmadi N, Hadaegh F, Safiee S, Azizi F, Khalili D. Trajectories of cardiovascular disease risk and their association with the incidence of cardiovascular events over 18 years of follow-up: The Tehran Lipid and Glucose study. J Transl Med 2021; 19:309. [PMID: 34271961 PMCID: PMC8284005 DOI: 10.1186/s12967-021-02984-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding long-term patterns (trajectories) of cardiovascular diseases (CVD) risk and identifying different sub-groups with the same underlying risk patterns could help facilitate targeted cardiovascular prevention programs. METHODS A total of 3699 participants of the Tehran Lipid and Glucose Study (TLGS) (43% men, mean age = 53.2 years), free of CVD at baseline in 1999-2001 and attending at least one re-examination cycle between the second (2002-2005) and fourth cycles (2009-2011) were included. We examined trajectories of CVD risk, based on the ACC/AHA pooled cohort equation, over ten years and subsequent risks of incident CVD during eight years later. We estimated trajectories of CVD risk using group-based trajectory modeling. The prospective association of identified trajectories with CVD was examined using Cox proportional hazard model. RESULTS Three distinct trajectories were identified (low-low, medium-medium, and high-high risk). The high-high and medium-medium CVD risk trajectories had an increasing trend of risk during the time; still, this rising trend was disappeared after removing the effect of increasing age. Upon a median 8.4 years follow-up, 146 CVD events occurred. After adjusting for age, the medium-medium and high-high trajectories had a 2.4-fold (95% CI 1.46-3.97) and 3.46-fold (95% CI 1.56-7.70) risk of CVD compared with the low-low group, respectively. In all trajectory groups, unfavorable increasing in fasting glucose, but favorable raising in HDL and decreasing smoking and total cholesterol happened over time. CONCLUSIONS Although the risk trajectories were stable during the time, different risk factors varied differently in each trajectory. These findings emphasize the importance of attention to each risk factor separately and implementing preventive strategies that optimize CVD risk factors besides the CVD risk.
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Affiliation(s)
- Fatemeh Koohi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nooshin Ahmadi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Siavash Safiee
- Faculty of Medicin, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. .,Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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6
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Testelmans D, Spruit MA, Vrijsen B, Sastry M, Belge C, Kalkanis A, Gaffron S, Wouters EFM, Buyse B. Comorbidity clusters in patients with moderate-to-severe OSA. Sleep Breath 2021; 26:195-204. [PMID: 33942208 DOI: 10.1007/s11325-021-02390-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) is a prevalent and multifaceted disease. To date, the presence and severity of objectively identified comorbidities and their association with specific OSA phenotypes, CPAP adherence, and survival remain to be elucidated. The aim of this study is to cluster patients with OSA based on 10 clinically important objectively identified comorbidities, and to characterize the comorbidity clusters in terms of clinical and polysomnographic characteristics, CPAP adherence, and survival. STUDY DESIGN AND METHODS Seven hundred ten consecutive patients starting CPAP for moderate-to-severe OSA were included. Comorbidities were based on generally accepted cutoffs identified in the peer-reviewed literature. Self-organizing maps were used to order patients based on presence and severity of their comorbidities and to generate clusters. RESULTS The majority of patients were men (80%). They were generally middle-aged (52 years) and obese (BMI: 31.5 kg/m2). Mean apnea-hypopnea index (AHI) was 41 ± 20 per h of sleep. More than 94% of the patients had one or more comorbidities with arterial hypertension, dyslipidemia, and obesity being the most prevalent. Nine comorbidity clusters were identified. The clinical relevance of these comorbidity clusters was highlighted by the difference in symptoms, PSG parameters, and cardiovascular risk. Also, differences in CPAP adherence, improvements in ESS, and long-term survival were present between the clusters. CONCLUSION Comorbidity prevalence in patients with OSA is high, and different comorbidity clusters, demonstrating differences in cardiovascular risk, CPAP adherence, and survival, can be identified. These results further substantiate the need for a comprehensive assessment of patients with OSA beyond the AHI.
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Affiliation(s)
- Dries Testelmans
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. .,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium.
| | - M A Spruit
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - B Vrijsen
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - M Sastry
- Academic Sleep Centre, CIRO, Horn, The Netherlands
| | - C Belge
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - A Kalkanis
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - S Gaffron
- Analytics, Viscovery Software GmbH, Vienna, Austria
| | - E F M Wouters
- Department of Research and Education, CIRO, Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands.,Department of Respiratory Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.,Ludwig Boltzmann Institute for Lung Health, Vienna, Austria
| | - B Buyse
- Department of Pulmonology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
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7
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Clark CE, Warren FC, Boddy K, McDonagh STJ, Moore SF, Goddard J, Reed N, Turner M, Alzamora MT, Ramos Blanes R, Chuang SY, Criqui M, Dahl M, Engström G, Erbel R, Espeland M, Ferrucci L, Guerchet M, Hattersley A, Lahoz C, McClelland RL, McDermott MM, Price J, Stoffers HE, Wang JG, Westerink J, White J, Cloutier L, Taylor RS, Shore AC, McManus RJ, Aboyans V, Campbell JL. Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration. Hypertension 2020; 77:650-661. [PMID: 33342236 PMCID: PMC7803446 DOI: 10.1161/hypertensionaha.120.15997] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02-1.08) and 1.06 (95% CI, 1.02-1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01-1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00-1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01-1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06-1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227.
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Affiliation(s)
- Christopher E Clark
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Fiona C Warren
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Kate Boddy
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Sinead T J McDonagh
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Sarah F Moore
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - John Goddard
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Nigel Reed
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Malcolm Turner
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain (M.T.A.)
| | - Rafel Ramos Blanes
- Unitat de Suport a la Recerca Girona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Institut d'Investigació Biomèdica de Girona (IdIBGi), Department of Medical Sciences, School of Medicine, University of Girona, Spain (R.R.B.)
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes (NHRI), Taiwan, R.O.C (S.-Y.C.)
| | - Michael Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla (M.C.)
| | - Marie Dahl
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Allé 4, 8800 Viborg, Denmark (M.D.).,Department of Clinical Medicine, Aarhus University, Denmark (M.D.)
| | - Gunnar Engström
- Department of Clinical Science in Malmö, Lund University, Sweden (G.E.)
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany (R.E.)
| | | | | | - Maëlenn Guerchet
- INSERM U1094 & IRD, Tropical Neuroepidemiology, Institut d'Epidémiologie et de Neurologie Tropicale (IENT), Faculté de Médecine de l'Université de Limoges, Limoges Cedex, France (M.G., V.A.)
| | - Andrew Hattersley
- Institute of Biomedical and Clinical Science (A.H.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Carlos Lahoz
- Lípid and Vascular Risk Unit, Internal Medicine Service, Carlos III, La Paz Hospital, Madrid, Spain (C.L.)
| | | | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.)
| | - Jackie Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland (J.P.)
| | - Henri E Stoffers
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands (H.E.S.)
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands (J. Westerink)
| | - James White
- DECIPHer, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Wales (J. White)
| | - Lyne Cloutier
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Canada (L.C.)
| | - Rod S Taylor
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.,MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Scotland (R.S.T.)
| | - Angela C Shore
- NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter College of Medicine & Health, England (A.C.S.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, England (R.J.M.)
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and Inserm 1094, Tropical Neuroepidemiology, Limoges, France (V.A.)
| | - John L Campbell
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
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8
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Akyea RK, Leonardi-Bee J, Asselbergs FW, Patel RS, Durrington P, Wierzbicki AS, Ibiwoye OH, Kai J, Qureshi N, Weng SF. Predicting major adverse cardiovascular events for secondary prevention: protocol for a systematic review and meta-analysis of risk prediction models. BMJ Open 2020; 10:e034564. [PMID: 32718921 PMCID: PMC7389481 DOI: 10.1136/bmjopen-2019-034564] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) is the leading cause of morbidity and mortality globally. With advances in early diagnosis and treatment of CVD and increasing life expectancy, more people are surviving initial CVD events. However, models for stratifying disease severity risk in patients with established CVD for effective secondary prevention strategies are inadequate. Multivariable prognostic models to stratify CVD risk may allow personalised treatment interventions. This review aims to systematically review the existing multivariable prognostic models for the recurrence of CVD or major adverse cardiovascular events in adults with established CVD diagnosis. METHODS AND ANALYSIS Bibliographic databases (Ovid MEDLINE, EMBASE, PsycINFO and Web of Science) will be searched, from database inception to April 2020, using terms relating to the clinical area and prognosis. A hand search of the reference lists of included studies will also be done to identify additional published studies. No restrictions on language of publications will be applied. Eligible studies present multivariable models (derived or validated) of adults (aged 16 years and over) with an established diagnosis of CVD, reporting at least one of the components of the primary outcome of major adverse cardiovascular events (defined as either coronary heart disease, stroke, peripheral artery disease, heart failure or CVD-related mortality). Reviewing will be done by two reviewers independently using the pre-defined criteria. Data will be extracted for included full-text articles. Risk of bias will be assessed using the Prediction model study Risk Of Bias ASsessment Tool (PROBAST). Prognostic models will be summarised narratively. If a model is tested in multiple validation studies, the predictive performance will be summarised using a random-effects meta-analysis model to account for any between-study heterogeneity. ETHICS AND DISSEMINATION Ethics approval is not required. The results of this study will be submitted to relevant conferences for presentation and a peer-reviewed journal for publication. PROSPERO REGISTRATION NUMBER CRD42019149111.
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Affiliation(s)
- Ralph K Akyea
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Riyaz S Patel
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
| | - Paul Durrington
- Cardiovascular Research Group, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | | | - Oluwaseun H Ibiwoye
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Joe Kai
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Stephen F Weng
- Division of Primary Care, University of Nottingham, Nottingham, UK
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9
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Studziński K, Tomasik T, Krzysztoń J, Jóźwiak J, Windak A. Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: an overview of systematic reviews. BMC Cardiovasc Disord 2019; 19:11. [PMID: 30626326 PMCID: PMC6327540 DOI: 10.1186/s12872-018-0990-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 12/21/2018] [Indexed: 12/24/2022] Open
Abstract
Background Our objectives were to critically appraise and summarise the current evidence for the effectiveness of using cardiovascular disease (CVD) risk scoring (total risk assessment - TRA) in routine risk assessment in primary prevention of CVD compared with standard care with regards to patients outcomes, clinical risk factor levels, medication prescribing, and adverse effects. Methods We carried out an overview of existing systematic reviews (SRs). Presentation of the results aligned guidelines from the PRISMA statement. The data is presented as a narrative synthesis. We searched MEDLINE (Ovid), EMBASE, CENTRAL and SCOPUS databases from January 1990 to March 2017, reviewed the reference lists of all included SRs and searched for ongoing SRs in PROSPERO database. We encompassed SRs and meta-analyses which took into account RCTs, quasi-RCTs, and observational studies investigating the effect of using CVD risk scoring. Only studies performed in a primary care setting, with adult participants free of clinical CVD were eligible. Intervention was CVD risk assessment with use of the total CVD risk scoring compared with standard care with no use of TRA . Results We identified 2157 records, we then recognised and analysed 10 relevant SRs. One SR reported statistically insignificant reduction of CVD death, when using TRA, the second SR presented meta-analysis which reported no effect on fatal and non-fatal CV events compared with conventional care (5.4% vs 5.3%; RR 1.01, 95% CI 0.95 to 1.08; I2 = 25%). Three SRs have shown that using TRA causes no adverse events. The impact of TRA on global CVD risk as well as individual risk factors is ambiguous, but a tendency towards slight reduction of blood pressure, total cholesterol and smoking levels, especially in high risk patient groups was observed. TRA had no influence on lifestyle behaviour. Conclusions There is limited evidence, of low overall quality, suggesting a possible lack of effectiveness of TRA in reducing CVD events and mortality, as well as a clinically insignificant influence on individual risk factor levels. Using TRA does not cause harm to patients. Trial registration Systematic review protocol was registered with the International PROSPERO database - registration number CRD42016046898. Electronic supplementary material The online version of this article (10.1186/s12872-018-0990-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Krzysztof Studziński
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, 4 Bochenska Street, 31-061, Krakow, Poland.,College of Family Physicians in Poland, Warszawa, Poland
| | - Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, 4 Bochenska Street, 31-061, Krakow, Poland. .,College of Family Physicians in Poland, Warszawa, Poland.
| | - Janusz Krzysztoń
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, 4 Bochenska Street, 31-061, Krakow, Poland.,College of Family Physicians in Poland, Warszawa, Poland
| | - Jacek Jóźwiak
- Department of Family Medicine and Public Health, Institute of Medicine, University of Opole, Opole, Poland.,College of Family Physicians in Poland, Warszawa, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, 4 Bochenska Street, 31-061, Krakow, Poland.,College of Family Physicians in Poland, Warszawa, Poland
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10
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An evaluation of CardioPrevent: a technology-enabled, health-behavior change program for the global reduction of cardiovascular risk. Curr Opin Cardiol 2018. [PMID: 28639974 DOI: 10.1097/hco.0000000000000438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cardiovascular diseases (CVDs) are the leading cause of mortality globally. Primary CVD prevention programs have the potential to improve risk factor profiles and, ultimately, the risk of developing CVD. The present study presents an evaluation of CardioPrevent, a global cardiovascular risk reduction program. RECENT FINDINGS Of the 478 participants enrolled in the CardioPrevent program, 308 and 236 had complete 6-month and 12-month data, respectively at the time of evaluation. At 6 months, the average reduction in the Framingham risk score was -19.5% (median = -26.5%). Women experienced a greater reduction in risk than men (-23.1 vs. -11.4%, P = 0.013). Significant improvements were observed in body composition, blood pressure, low-density lipoproteins, triglycerides, total cholesterol-to-high-density lipoprotein ratio, HbA1c, perceived stress, anxiety, depression, quality of life, physical activity, sitting time, fruit and vegetable consumption, and medication adherence. Improvements seen at 6 months were maintained at 12 months. The majority (98%) of participants were very satisfied with the program and would recommend it to others. SUMMARY Results of this evaluation identified that CardioPrevent is an effective CVD risk reduction program with high satisfaction rates. CardioPrevent is an effective, scalable program with the capacity to reduce CVD risk among primary care patients.
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11
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Usher-Smith JA, Silarova B, Sharp SJ, Mills K, Griffin SJ. Effect of interventions incorporating personalised cancer risk information on intentions and behaviour: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2018; 8:e017717. [PMID: 29362249 PMCID: PMC5786113 DOI: 10.1136/bmjopen-2017-017717] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 11/20/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To provide a comprehensive review of the impact on intention to change health-related behaviours and health-related behaviours themselves, including screening uptake, of interventions incorporating information about cancer risk targeted at the general adult population. DESIGN A systematic review and random-effects meta-analysis. DATA SOURCES An electronic search of MEDLINE, EMBASE, CINAHL and PsycINFO from 1 January 2000 to 1 July 2017. INCLUSION CRITERIA Randomised controlled trials of interventions including provision of a personal estimate of future cancer risk based on two or more non-genetic variables to adults recruited from the general population that include at least one behavioural outcome. RESULTS We included 19 studies reporting 12 outcomes. There was significant heterogeneity in interventions and outcomes between studies. There is evidence that interventions incorporating personalised cancer risk information do not affect intention to attend or attendance at screening (relative risk 1.00 (0.97-1.03)). There is limited evidence that they increase smoking abstinence, sun protection, adult skin self-examination and breast examination, and decrease intention to tan. However, they do not increase smoking cessation, parental child skin examination or intention to protect skin. No studies assessed changes in diet, alcohol consumption or physical activity. CONCLUSIONS Interventions incorporating personalised cancer risk information do not affect uptake of screening, but there is limited evidence of effect on some health-related behaviours. Further research, ideally including objective measures of behaviour, is needed before cancer risk information is incorporated into routine practice for health promotion in the general population.
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Affiliation(s)
- Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Barbora Silarova
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
| | - Katie Mills
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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12
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Damegunta SR, Gundugurti PR. A Cross-sectional Study to Estimate Cardiovascular Risk Factors in Patients with Bipolar Disorder. Indian J Psychol Med 2017; 39:634-640. [PMID: 29200560 PMCID: PMC5688891 DOI: 10.4103/ijpsym.ijpsym_369_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is increasing recognition of cardiovascular mortality and comorbidity in bipolar disorder (BD) in the recent times. Framingham 10 years risk of coronary heart disease (CHD) has been a widely accepted as a reliable estimate of cardiovascular risk in the general population. A few studies have estimated the relative risk of developing CHD in BDs, in India. We attempt to present a cross-sectional data from a prospective study to estimate the 10 years cardiovascular risk in BD population. SUBJECTS AND METHODS A total of 50 patients with BD aged between 20 and 60 years fulfilling the inclusion and exclusion criteria were enrolled into this study. Demographic variables and clinical evaluations including smoking history, medical and pharmacologic treatment history, physical examination, anthropometric measurements, and clinical laboratories for metabolic profiles were assessed. Using the Framingham 10-year risk questionnaire, the risk for each patient was calculated and compared with that of normal healthy control group. RESULTS The risk of developing a future cardiovascular event was 3.26% in BD and 2.02% in controls. We identified that a higher age at onset of illness, waist-hip ratio, total cholesterol, and unemployment showed a strong positive correlation with future CHD risk whereas administration of valproate, lithium for management of BD, higher socioeconomic status and educational status, and nonsmokers was associated negatively with the future CHD risk. CONCLUSIONS It appears that there is a significant association between BD and metabolic factors, CHD, sociodemographic variables, and underscores the predictive ability of Framingham risk score in detecting cardiovascular diseases.
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13
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Usher-Smith JA, Harte E, MacLure C, Martin A, Saunders CL, Meads C, Walter FM, Griffin SJ, Mant J. Patient experience of NHS health checks: a systematic review and qualitative synthesis. BMJ Open 2017; 7:e017169. [PMID: 28801437 PMCID: PMC5724113 DOI: 10.1136/bmjopen-2017-017169] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/05/2017] [Accepted: 05/24/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To review the experiences of patients attending NHS Health Checks in England. DESIGN A systematic review of quantitative and qualitative studies with a thematic synthesis of qualitative studies. DATA SOURCES An electronic literature search of Medline, Embase, Health Management Information Consortium, Cumulative Index of Nursing and Allied Health Literature, Global Health, PsycInfo, Web of Science, OpenGrey, the Cochrane Library, National Health Service (NHS) Evidence, Google Scholar, Google, Clinical Trials.gov and the ISRCTN registry to 09/11/16 with no language restriction and manual screening of reference lists of all included papers. INCLUSION CRITERIA Primary research reporting experiences of patients who have attended NHS Health Checks. RESULTS 20 studies met the inclusion criteria, 9 reporting quantitative data and 15 qualitative data. There were consistently high levels of reported satisfaction in surveys, with over 80% feeling that they had benefited from an NHS Health Check. Data from qualitative studies showed that the NHS Health Check had been perceived to act as a wake-up call for many who reported having gone on to make substantial lifestyle changes which they attributed to the NHS Health Check. However, some had been left with a feeling of unmet expectations, were confused about or unable to remember their risk scores, found the lifestyle advice too simplistic and non-personalised or were confused about follow-up. CONCLUSIONS While participants were generally very supportive of the NHS Health Check programme and examples of behaviour change were reported, there are a number of areas where improvements could be made. These include greater clarity around the aims of the programme within the promotional material, more proactive support for lifestyle change and greater appreciation of the challenges of communicating risk and the limitations of relying on the risk score alone as a trigger for facilitating behaviour change.
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Affiliation(s)
- Juliet A Usher-Smith
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Emma Harte
- RAND Europe, Westbrook Centre, Cambridge, UK
| | | | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Catherine L Saunders
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Catherine Meads
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, UK
| | - Fiona M Walter
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
| | - Jonathan Mant
- The Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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14
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Tomasik T, Krzysztoń J, Dubas-Jakóbczyk K, Kijowska V, Windak A. The systematic coronary risk evaluation (SCORE) for the prevention of cardiovascular diseases. Does evidence exist for its effectiveness? A systematic review. Acta Cardiol 2017; 72:370-379. [PMID: 28705107 DOI: 10.1080/00015385.2017.1335052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The SCORE model predicts the ten-year risk of cardiovascular mortality but it is still unknown whether applying the SCORE in clinical practice subsequently improves cardiovascular disease (CVD) outcomes. The objective of this study is to assess the effect of total cardiovascular risk estimation using the SCORE in preventing serious cardiovascular events in European adults without prior CVD. METHODS AND RESULTS Data sources: eight bibliographical databases (2003 - August 2015), other internet sources and reference lists of articles were checked. This was supplemented by contact with the board members of the European Society of Cardiology (ESC) and the authors of the SCORE model. STUDY ELIGIBILITY CRITERIA all prospective studies in any language investigating the effect of using the SCORE on the clinical outcome (CVD death, major events and adverse outcomes) in an adult population were examined. Two reviewers assessed the studies independently (titles, abstracts, full texts). After removal of duplicates, 5,256 records were screened and 14 full text papers considered. No eligible studies were identified. An extensive literature search revealed no randomized control trial or other prospective study comparing significant clinical outcomes between groups that used the SCORE and those who did not. CONCLUSIONS The effect of using the SCORE (with or without subsequent intervention) on CVD death, all-cause mortality, major CVD events like myocardial infarction and stroke, as well as adverse outcomes, is still unknown. A cluster randomised controlled trial is warranted to evaluate the use of the SCORE on important outcomes.
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Affiliation(s)
- Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Janusz Krzysztoń
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Institute of Public Health, Chair of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Violetta Kijowska
- Unit for Research on Aging Society, Department of Sociology of Medicine at Chair of Epidemiology and Preventive Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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Kozakova M, Morizzo C, La Carrubba S, Fabiani I, Della Latta D, Jamagidze J, Chiappino D, Di Bello V, Palombo C. Associations between common carotid artery diameter, Framingham risk score and cardiovascular events. Nutr Metab Cardiovasc Dis 2017; 27:329-334. [PMID: 28242234 DOI: 10.1016/j.numecd.2017.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/30/2016] [Accepted: 01/03/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Vascular biomarkers are associated with risk burden and are capable to predict the development of future cardiovascular (CV) events; yet, their additive predictive value over and above established risk algorithms seems to be only modest. The present study evaluated the cross-sectional associations between vascular biomarkers, 10-year Framingham risk (FR) and prevalent CV events in a population with a high prevalence of hypertension and diabetes. METHODS AND RESULTS As many as 681 subjects (419 men, age = 60 ± 10 years, 282 diabetics, 335 hypertensives, mean FR score = 22.5 ± 16.5%) underwent an integrated vascular examination including: radiofrequency-based ultrasound of common carotid artery (cca) to measure intima-media thickness (IMT), inter-adventitial diameter (IAD) and local pulse wave velocity (PWV); applanation tonometry to assess carotid pulse pressure (PP) and augmentation index (AIx); carotid-femoral PWV (cfPWV) measurement. One hundred and thirty-five subjects (19.8%) had history of CV events, and CV events were independently associated with male sex, age, antihypertensive treatment, current smoking, HDL-cholesterol and ccaIAD. In logistic regression model, only ccaIAD was associated with prevalence of CV events after adjustment for FR score, with the OR of 1.71 [1.34-2.19] (P < 0.0001) that remained unchanged when ccaIMT was included into the model (OR = 1.76 [1.36-2.27]; P < 0.0001). The association between prevalent CV events and ccaIAD was significant (OR of 1.65 [1.24-2.20]; P = 0.0005) also in a subgroup of subjects being at a high 10-year risk of CV disease (N = 330). CONCLUSIONS In a population with a high prevalence of diabetes and hypertension, ccaIAD was the only vascular measure associated with prevalent CV events, independently of FR score.
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Affiliation(s)
- M Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy; Esaote SpA, Genova, Italy
| | - C Morizzo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - I Fabiani
- Department of Surgical, Medical Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - D Della Latta
- Imaging Department, Fondazione Toscana G. Monasterio, Massa-Pisa, Italy
| | - J Jamagidze
- Imaging Department, Fondazione Toscana G. Monasterio, Massa-Pisa, Italy
| | - D Chiappino
- Department of Surgical, Medical Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - V Di Bello
- Imaging Department, Fondazione Toscana G. Monasterio, Massa-Pisa, Italy
| | - C Palombo
- Imaging Department, Fondazione Toscana G. Monasterio, Massa-Pisa, Italy.
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Karmali KN, Persell SD, Perel P, Lloyd-Jones DM, Berendsen MA, Huffman MD. Risk scoring for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2017; 3:CD006887. [PMID: 28290160 PMCID: PMC6464686 DOI: 10.1002/14651858.cd006887.pub4] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The current paradigm for cardiovascular disease (CVD) emphasises absolute risk assessment to guide treatment decisions in primary prevention. Although the derivation and validation of multivariable risk assessment tools, or CVD risk scores, have attracted considerable attention, their effect on clinical outcomes is uncertain. OBJECTIVES To assess the effects of evaluating and providing CVD risk scores in adults without prevalent CVD on cardiovascular outcomes, risk factor levels, preventive medication prescribing, and health behaviours. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (2016, Issue 2), MEDLINE Ovid (1946 to March week 1 2016), Embase (embase.com) (1974 to 15 March 2016), and Conference Proceedings Citation Index-Science (CPCI-S) (1990 to 15 March 2016). We imposed no language restrictions. We searched clinical trial registers in March 2016 and handsearched reference lists of primary studies to identify additional reports. SELECTION CRITERIA We included randomised and quasi-randomised trials comparing the systematic provision of CVD risk scores by a clinician, healthcare professional, or healthcare system compared with usual care (i.e. no systematic provision of CVD risk scores) in adults without CVD. DATA COLLECTION AND ANALYSIS Three review authors independently selected studies, extracted data, and evaluated study quality. We used the Cochrane 'Risk of bias' tool to assess study limitations. The primary outcomes were: CVD events, change in CVD risk factor levels (total cholesterol, systolic blood pressure, and multivariable CVD risk), and adverse events. Secondary outcomes included: lipid-lowering and antihypertensive medication prescribing in higher-risk people. We calculated risk ratios (RR) for dichotomous data and mean differences (MD) or standardised mean differences (SMD) for continuous data using 95% confidence intervals. We used a fixed-effects model when heterogeneity (I²) was at least 50% and a random-effects model for substantial heterogeneity (I² > 50%). We evaluated the quality of evidence using the GRADE framework. MAIN RESULTS We identified 41 randomised controlled trials (RCTs) involving 194,035 participants from 6422 reports. We assessed studies as having high or unclear risk of bias across multiple domains. Low-quality evidence evidence suggests that providing CVD risk scores may have little or no effect on CVD events compared with usual care (5.4% versus 5.3%; RR 1.01, 95% confidence interval (CI) 0.95 to 1.08; I² = 25%; 3 trials, N = 99,070). Providing CVD risk scores may reduce CVD risk factor levels by a small amount compared with usual care. Providing CVD risk scores reduced total cholesterol (MD -0.10 mmol/L, 95% CI -0.20 to 0.00; I² = 94%; 12 trials, N = 20,437, low-quality evidence), systolic blood pressure (MD -2.77 mmHg, 95% CI -4.16 to -1.38; I² = 93%; 16 trials, N = 32,954, low-quality evidence), and multivariable CVD risk (SMD -0.21, 95% CI -0.39 to -0.02; I² = 94%; 9 trials, N = 9549, low-quality evidence). Providing CVD risk scores may reduce adverse events compared with usual care, but results were imprecise (1.9% versus 2.7%; RR 0.72, 95% CI 0.49 to 1.04; I² = 0%; 4 trials, N = 4630, low-quality evidence). Compared with usual care, providing CVD risk scores may increase new or intensified lipid-lowering medications (15.7% versus 10.7%; RR 1.47, 95% CI 1.15 to 1.87; I² = 40%; 11 trials, N = 14,175, low-quality evidence) and increase new or increased antihypertensive medications (17.2% versus 11.4%; RR 1.51, 95% CI 1.08 to 2.11; I² = 53%; 8 trials, N = 13,255, low-quality evidence). AUTHORS' CONCLUSIONS There is uncertainty whether current strategies for providing CVD risk scores affect CVD events. Providing CVD risk scores may slightly reduce CVD risk factor levels and may increase preventive medication prescribing in higher-risk people without evidence of harm. There were multiple study limitations in the identified studies and substantial heterogeneity in the interventions, outcomes, and analyses, so readers should interpret results with caution. New models for implementing and evaluating CVD risk scores in adequately powered studies are needed to define the role of applying CVD risk scores in primary CVD prevention.
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Affiliation(s)
- Kunal N Karmali
- Departments of Medicine (Cardiology), Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, USA, 60611
| | - Stephen D Persell
- Department of Medicine-General Internal Medicine and Geriatrics, Northwestern University, 750 N Lake Shore Drive, Rubloff Building 10th Floo, Chicago, Illinois, USA, 60611
| | - Pablo Perel
- Department of Population Health, London School of Hygiene & Tropical Medicine, Room 134b Keppel Street, London, UK, WC1E 7HT
| | - Donald M Lloyd-Jones
- Departments of Preventive Medicine and Medicine (Cardiology), Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, USA, 60611
| | - Mark A Berendsen
- Galter Health Sciences Library, Northwestern University, 303 E. Chicago Avenue, Chicago, IL, USA, 60611
| | - Mark D Huffman
- Departments of Preventive Medicine and Medicine (Cardiology), Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, USA, 60611
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17
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Studziński K, Tomasik T, Krzyszton J, Jóźwiak J, Windak A. Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: protocol for an overview of systematic reviews. BMJ Open 2017; 7:e014206. [PMID: 28274967 PMCID: PMC5353260 DOI: 10.1136/bmjopen-2016-014206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/13/2017] [Accepted: 01/17/2017] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Major clinical practice guidelines recommend assessing risk of cardiovascular disease (CVD) using absolute/global/total CVD risk scores. However, the effectiveness of using them in clinical practice, despite publication of numerous randomised controlled trials (RCTs), is still poorly understood. To summarise and analyse current knowledge in this field, we will carry out an overview of existing systematic reviews (SRs). The objective of this overview will be to assess the effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of CVD compared with standard care. METHODS AND ANALYSIS We will include SRs and meta-analyses which take into account RCTs and quasi-RCTs investigating the effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of CVD. SRs will be retrieved from 4 bibliographical databases and reference lists of identified reviews. Additionally, the PROSPERO database will be searched for unpublished, ongoing or recently completed SRs. 2 reviewers will assess the SRs independently for eligibility and bias. The data will be extracted to a special form. Any disagreement will be resolved by discussion. In case of lack of consensus, a third author will arbitrate. The overview of SRs will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. ETHICS AND DISSEMINATION Ethics approval is not required for overview of SRs. We will summarise evidence concerning whether use of the absolute/global/total CVD risk scoring tools in primary prevention of CVD is effective and supported with scientific data or not. If we face unsatisfactory confirmation, we will highlight a need for further research and advice on how to plan such a study. We will submit the results of our study for peer-review publication in a journal indexed in the international bibliographic database of biomedical information.
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Affiliation(s)
- Krzysztof Studziński
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Tomasik
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Janusz Krzyszton
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Jóźwiak
- Institute of Health and Nutrition Sciences, Czestochowa University of Technology, Czestochowa, Poland
| | - Adam Windak
- Department of Family Medicine, Chair of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
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18
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Wade AT, Davis CR, Dyer KA, Hodgson JM, Woodman RJ, Keage HAD, Murphy KJ. A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study. Nutrients 2017; 9:E145. [PMID: 28212320 PMCID: PMC5331576 DOI: 10.3390/nu9020145] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 01/24/2017] [Accepted: 02/09/2017] [Indexed: 02/07/2023] Open
Abstract
The Mediterranean diet has demonstrated efficacy for improving cardiovascular and cognitive health. However, a traditional Mediterranean diet delivers fewer serves of dairy and less dietary calcium than is currently recommended in Australia, which may limit long-term sustainability. The present study aims to evaluate whether a Mediterranean diet with adequate dairy and calcium can improve cardiovascular and cognitive function in an at-risk population, and thereby reduce risk of cardiovascular disease (CVD) and cognitive decline. A randomised, controlled, parallel, crossover design trial will compare a Mediterranean diet supplemented with dairy foods against a low-fat control diet. Forty participants with systolic blood pressure above 120 mmHg and at least two other risk factors of CVD will undertake each dietary intervention for eight weeks, with an eight-week washout period between interventions. Systolic blood pressure will be the primary measure of interest. Secondary outcomes will include measures of cardiometabolic health, dietary compliance, cognitive function, assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), psychological well-being and dementia risk. This research will provide empirical evidence as to whether the Mediterranean diet can be modified to provide recommended dairy and calcium intakes while continuing to deliver positive effects for cardiovascular and cognitive health. The findings will hold relevance for the field of preventative healthcare and may contribute to revisions of national dietary guidelines.
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Affiliation(s)
- Alexandra T Wade
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia.
| | - Courtney R Davis
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia.
| | - Kathryn A Dyer
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia.
| | - Jonathan M Hodgson
- School of Medicine and Pharmacology, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia.
- School of Medical and Health Sciences, Edith Cowan University, Joondalup WA 6027, Australia.
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, GPO Box 2100, Adelaide SA 5001, Australia.
| | - Hannah A D Keage
- Cognitive Ageing and Impairment Neurosciences, School of Psychology, Social Work and Social Policy, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia.
| | - Karen J Murphy
- Alliance for Research in Exercise, Nutrition and Activity, School of Health Sciences, University of South Australia, GPO Box 2471, Adelaide SA 5001, Australia.
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19
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Meneton P, Lemogne C, Herquelot E, Bonenfant S, Larson MG, Vasan RS, Ménard J, Goldberg M, Zins M. A Global View of the Relationships between the Main Behavioural and Clinical Cardiovascular Risk Factors in the GAZEL Prospective Cohort. PLoS One 2016; 11:e0162386. [PMID: 27598908 PMCID: PMC5012694 DOI: 10.1371/journal.pone.0162386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 08/22/2016] [Indexed: 12/05/2022] Open
Abstract
Although it has been recognized for a long time that the predisposition to cardiovascular diseases (CVD) is determined by many risk factors and despite the common use of algorithms incorporating several of these factors to predict the overall risk, there has yet been no global description of the complex way in which CVD risk factors interact with each other. This is the aim of the present study which investigated all existing relationships between the main CVD risk factors in a well-characterized occupational cohort. Prospective associations between 12 behavioural and clinical risk factors (gender, age, parental history of CVD, non-moderate alcohol consumption, smoking, physical inactivity, obesity, hypertension, dyslipidemia, diabetes, sleep disorder, depression) were systematically tested using Cox regression in 10,736 middle-aged individuals free of CVD at baseline and followed over 20 years. In addition to independently predicting CVD risk (HRs from 1.18 to 1.97 in multivariable models), these factors form a vast network of associations where each factor predicts, and/or is predicted by, several other factors (n = 47 with p<0.05, n = 37 with p<0.01, n = 28 with p<0.001, n = 22 with p<0.0001). Both the number of factors associated with a given factor (1 to 9) and the strength of the associations (HRs from 1.10 to 6.12 in multivariable models) are very variable, suggesting that all the factors do not have the same influence within this network. These results show that there is a remarkably extensive network of relationships between the main CVD risk factors which may have not been sufficiently taken into account, notably in preventive strategies aiming to lower CVD risk.
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Affiliation(s)
- Pierre Meneton
- INSERM U1142 LIMICS, UMR_S 1142 Sorbonne Université, UPMC Université Paris 06, Université Paris 13, Paris, France
- * E-mail:
| | - Cédric Lemogne
- Centre Psychiatrie et Neurosciences, INSERM U894, Université Paris Descartes, AP-HP Hôpitaux Universitaires Paris Ouest, Paris, France
| | | | | | - Martin G. Larson
- Department of Biostatistics, Department of Mathematics and Statistics, Boston University, Boston, MA, United States of America
| | - Ramachandran S. Vasan
- Framingham Heart Study, Department of Medicine, Boston University, Boston, MA, United States of America
| | - Joël Ménard
- INSERM/AP-HP CIC1418, Université Paris Descartes, AP-HP Hôpitaux Universitaires Paris Ouest, Paris, France
| | | | - Marie Zins
- INSERM UVSQ UMS 011 and UMR-S 1168 VIMA, Villejuif, France
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20
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Fuster-Parra P, Tauler P, Bennasar-Veny M, Ligęza A, López-González AA, Aguiló A. Bayesian network modeling: A case study of an epidemiologic system analysis of cardiovascular risk. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 126:128-142. [PMID: 26777431 DOI: 10.1016/j.cmpb.2015.12.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/28/2015] [Accepted: 12/11/2015] [Indexed: 06/05/2023]
Abstract
An extensive, in-depth study of cardiovascular risk factors (CVRF) seems to be of crucial importance in the research of cardiovascular disease (CVD) in order to prevent (or reduce) the chance of developing or dying from CVD. The main focus of data analysis is on the use of models able to discover and understand the relationships between different CVRF. In this paper a report on applying Bayesian network (BN) modeling to discover the relationships among thirteen relevant epidemiological features of heart age domain in order to analyze cardiovascular lost years (CVLY), cardiovascular risk score (CVRS), and metabolic syndrome (MetS) is presented. Furthermore, the induced BN was used to make inference taking into account three reasoning patterns: causal reasoning, evidential reasoning, and intercausal reasoning. Application of BN tools has led to discovery of several direct and indirect relationships between different CVRF. The BN analysis showed several interesting results, among them: CVLY was highly influenced by smoking being the group of men the one with highest risk in CVLY; MetS was highly influence by physical activity (PA) being again the group of men the one with highest risk in MetS, and smoking did not show any influence. BNs produce an intuitive, transparent, graphical representation of the relationships between different CVRF. The ability of BNs to predict new scenarios when hypothetical information is introduced makes BN modeling an Artificial Intelligence (AI) tool of special interest in epidemiological studies. As CVD is multifactorial the use of BNs seems to be an adequate modeling tool.
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Affiliation(s)
- P Fuster-Parra
- Department of Mathematics and Computer Science, Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain; Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain.
| | - P Tauler
- Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain
| | - M Bennasar-Veny
- Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain
| | - A Ligęza
- Department of Applied Computer Science, AGH University of Science and Technology, Kraków PL-30-059, Poland
| | - A A López-González
- Prevention of Occupational Risks in Health Services, GESMA, Balearic Islands Health Service, Hospital de Manacor, Manacor, Baleares E-07500, Spain
| | - A Aguiló
- Research Group on Evidence, Lifestyles & Health, Research Institute on Health Sciences (IUNICS), Universitat Illes Balears, Palma de Mallorca, Baleares E-07122, Spain
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21
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Goyal S, Morita PP, Picton P, Seto E, Zbib A, Cafazzo JA. Uptake of a Consumer-Focused mHealth Application for the Assessment and Prevention of Heart Disease: The <30 Days Study. JMIR Mhealth Uhealth 2016; 4:e32. [PMID: 27012937 PMCID: PMC4824871 DOI: 10.2196/mhealth.4730] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/13/2015] [Accepted: 12/15/2015] [Indexed: 11/15/2022] Open
Abstract
Background Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also predicted that the uptake would be influenced by incentives offered for downloading the mobile app. Objective The primary objective of our study was to evaluate the engagement levels of participants using the novel risk management app. The secondary aim was to assess the effect of incentives on the overall uptake and usage behaviors. Methods We publicly launched the app through the iTunes App Store and collected usage data over 5 months. Aggregate information included population-level data on download rates, use, risk factors, and user demographics. We used descriptive statistics to identify usage patterns, t tests, and analysis of variance to compare group means. Correlation and regression analyses determined the relationship between usage and demographic variables. Results We captured detailed mobile usage data from 69,952 users over a 5-month period, of whom 23,727 (33.92%) were registered during a 1-month AIR MILES promotion. Of those who completed the risk assessment, 73.92% (42,380/57,330) were female, and 59.38% (34,042/57,330) were <30 years old. While the older demographic had significantly lower uptake than the younger demographic, with only 8.97% of users aged ≥51 years old downloading the app, the older demographic completed more challenges than their younger counterparts (F8, 52,422 = 55.10, P<.001). In terms of engagement levels, 84.94% (44,537/52,431) of users completed 1–14 challenges over a 30-day period, and 10.03% (5,259/52,431) of users completed >22 challenges. On average, users in the incentives group completed slightly more challenges during the first 30 days of the intervention (mean 7.9, SD 0.13) than those in the nonincentives group (mean 6.1, SD 0.06, t28870=–12.293, P<.001, d=0.12, 95% CI –2.02 to –1.47). The regression analysis suggested that sex, age group, ethnicity, having 5 of the risk factors (all but alcohol), incentives, and the number of family histories were predictors of the number of challenges completed by a user (F14, 56,538 = 86.644, P<.001, adjusted R2 = .021). Conclusion While the younger population downloaded the app the most, the older population demonstrated greater sustained engagement. Behavior change apps have the potential to reach a targeted population previously thought to be uninterested in or unable to use mobile apps. The development of such apps should assume that older adults will in fact engage if the behavior change elements are suitably designed, integrated into daily routines, and tailored. Incentives may be the stepping-stone that is needed to guide the general population toward preventative tools and promote sustained behavior change.
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Affiliation(s)
- Shivani Goyal
- Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.
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22
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Usher-Smith JA, Silarova B, Schuit E, Moons KGM, Griffin SJ. Impact of provision of cardiovascular disease risk estimates to healthcare professionals and patients: a systematic review. BMJ Open 2015; 5:e008717. [PMID: 26503388 PMCID: PMC4636662 DOI: 10.1136/bmjopen-2015-008717] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To systematically review whether the provision of information on cardiovascular disease (CVD) risk to healthcare professionals and patients impacts their decision-making, behaviour and ultimately patient health. DESIGN A systematic review. DATA SOURCES An electronic literature search of MEDLINE and PubMed from 01/01/2004 to 01/06/2013 with no language restriction and manual screening of reference lists of systematic reviews on similar topics and all included papers. ELIGIBILITY CRITERIA FOR SELECTING STUDIES (1) Primary research published in a peer-reviewed journal; (2) inclusion of participants with no history of CVD; (3) intervention strategy consisted of provision of a CVD risk model estimate to either professionals or patients; and (4) the only difference between the intervention group and control group (or the only intervention in the case of before-after studies) was the provision of a CVD risk model estimate. RESULTS After duplicates were removed, the initial electronic search identified 9671 papers. We screened 196 papers at title and abstract level and included 17 studies. The heterogeneity of the studies limited the analysis, but together they showed that provision of risk information to patients improved the accuracy of risk perception without decreasing quality of life or increasing anxiety, but had little effect on lifestyle. Providing risk information to physicians increased prescribing of lipid-lowering and blood pressure medication, with greatest effects in those with CVD risk >20% (relative risk for change in prescribing 2.13 (1.02 to 4.63) and 2.38 (1.11 to 5.10) respectively). Overall, there was a trend towards reductions in cholesterol and blood pressure and a statistically significant reduction in modelled CVD risk (-0.39% (-0.71 to -0.07)) after, on average, 12 months. CONCLUSIONS There seems evidence that providing CVD risk model estimates to professionals and patients improves perceived CVD risk and medical prescribing, with little evidence of harm on psychological well-being.
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Affiliation(s)
- Juliet A Usher-Smith
- The Primary Care Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Barbora Silarova
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
| | - Ewoud Schuit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands Stanford Prevention Research Center, Stanford University, Stanford, USA
| | - Karel G M Moons
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Simon J Griffin
- The Primary Care Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge, UK
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23
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Rodriguez-Poncelas A, Coll-de-Tuero G, Saez M, Garrido-Martín JM, Millaruelo-Trillo JM, Barrot de-la-Puente J, Franch-Nadal J. Comparison of different vascular risk engines in the identification of type 2 diabetes patients with high cardiovascular risk. BMC Cardiovasc Disord 2015; 15:121. [PMID: 26464076 PMCID: PMC4605091 DOI: 10.1186/s12872-015-0120-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 10/01/2015] [Indexed: 12/27/2022] Open
Abstract
Background Some authors consider that secondary prevention should be conducted for all DM2 patients, while others suggest that the drug preventive treatment should start or be increased depending on each patient’s individual CVR, estimated using cardiovascular or coronary risk functions to identify the patients with a higher CVR. The principal objective of this study was to assess three different cardiovascular risk prediction models in type 2 diabetes patients. Methods Multicentre, cross-sectional descriptive study of 3,041 patients with type 2 diabetes and no history of cardiovascular disease. The demographic, clinical, analytical, and cardiovascular risk factor variables associated with type 2 diabetes were analysed. The risk function and probability that a cardiovascular disease could occur were estimated using three risk engines: REGICOR, UKPDS and ADVANCE. A patient was considered to have a high cardiovascular risk when REGICOR ≥ 10 % or UKPDS ≥ 15 % in 10 years or when ADVANCE ≥ 8 % in 4 years. Results The ADVANCE and UKPDS risk engines identified a higher number of diabetic patients with a high cardiovascular risk (24.2 % and 22.7 %, respectively) compared to the REGICOR risk engine (10.2 %). The correlation using the REGICOR risk engine was low compared to UKPDS and ADVANCE (r = 0.288 and r = 0.153, respectively; p < 0.0001). The agreement values in the allocation of a particular patient to the high risk group was low between the REGICOR engine and the UKPDS and ADVANCE engines (k = 0.205 and k = 0.123, respectively; p < 0.0001) and acceptable between the ADVANCE and UKPDS risk engines (k = 0.608). Conclusions There are discrepancies between the general population and the type 2 diabetic patient-specific risk engines. The results of this study indicate the need for a prospective study which validates specific equations for diabetic patients in the Spanish population, as well as research on new models for cardiovascular risk prediction in these patients.
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Affiliation(s)
- Antonio Rodriguez-Poncelas
- Primary Healtcare Center (PHC) Anglès, Girona, Spain. .,Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Gabriel Coll-de-Tuero
- Primary Healtcare Center (PHC) Anglès, Girona, Spain. .,Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,Department of Medical Sciences, University of Girona, Girona, Spain. .,Research Unit, IdIAP, Maluquer Salvador,11, 17002, Girona, Spain.
| | - Marc Saez
- Research Group in Statistic,Applied economy and Health. (GRECS), University of Girona, Girona, Spain.
| | - José M Garrido-Martín
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | | | - Joan Barrot de-la-Puente
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,PHC Salt, ICS, Salt, Girona, Spain.
| | - Josep Franch-Nadal
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. .,PHC Raval Sud, ICS, Barcelona, Spain.
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24
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Kesse-Guyot E, Lassale C, Assmann KE, Andreeva VA, Julia C, Blacher J, Fezeu L, Hercberg S, Galan P. Are different vascular risk scores calculated at midlife uniformly associated with subsequent poor cognitive performance? Atherosclerosis 2015; 243:286-92. [PMID: 26409628 DOI: 10.1016/j.atherosclerosis.2015.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/25/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Research concerning the link between individual vascular risk factors and cognition is plentiful but few studies have investigated the role of global vascular risk. We examined the cross-time associations of several vascular risk scores with cognitive performance during aging. METHODS Using data from the French SU.VI.MAX cohort, we studied a sample of 3061 participants. Framingham coronary heart disease, cardiovascular and stroke risk profiles were computed using baseline data (1994-1996). Cognitive performance was assessed after a mean of 13 years via a battery of six validated instruments. Principal component analysis identified scores for verbal memory and working memory. Associations between risk profiles (as continuous variables and in quartiles (Q)) and subsequent poor performance (defined as cognitive score ≤10th percentile) were examined via logistic regression (odds ratios, 95% CI) and analysis of covariance. RESULTS All continuous-scale Framingham risk scores assessed at midlife were inversely and uniformly associated with subsequent poor global cognitive performance, and especially in terms of verbal memory. Considering risk score Q, higher Q were associated with poorer performance in verbal memory: The fully-adjusted odds ratios (95% CI), comparing Q4 versus Q1, were 2.84 (1.70, 4.75), 2.31 (1.43, 3.73) and 1.77 (1.13, 2.76) for Framingham coronary heart disease, cardiovascular and stroke risk profiles, respectively. Similar findings were observed when modeling cognitive outcomes as continuous variables using covariance analyses. CONCLUSION This study supports the existence of an inverse cross-time association between midlife vascular risk profiles and subsequent poor cognitive performance, especially in the verbal memory domain. Beyond their importance as regards vascular risk, such risk scores may help primary prevention efforts in identifying and targeting middle-aged individuals at high risk of cognitive aging.
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Affiliation(s)
- Emmanuelle Kesse-Guyot
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France.
| | - Camille Lassale
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Karen E Assmann
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Valentina A Andreeva
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Chantal Julia
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France; Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - Jacques Blacher
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France; Université Paris-Descartes, Faculté de médecine, Hôpital Hôtel-Dieu, AP-HP, Centre de diagnostic et de thérapeutique, Paris, France
| | - Léopold Fezeu
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
| | - Serge Hercberg
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France; Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - Pilar Galan
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, F-93017, Bobigny, France
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25
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Álvarez-Bueno C, Cavero-Redondo I, Martínez-Andrés M, Arias-Palencia N, Ramos-Blanes R, Salcedo-Aguilar F. Effectiveness of multifactorial interventions in primary health care settings for primary prevention of cardiovascular disease: A systematic review of systematic reviews. Prev Med 2015; 76 Suppl:S68-75. [PMID: 25511466 DOI: 10.1016/j.ypmed.2014.11.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/14/2014] [Accepted: 11/29/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of multifactorial interventions carried out in the community setting to decrease cardiovascular risk in healthy patients. METHODS Systematic review of the MEDLINE (via PubMed), Web of Science and Cochrane Library databases from January 1980 to January 2014. Identified for inclusion were systematic reviews of clinical trials that included multifactorial interventions carried out in primary care or community settings, targeting more than one cardiovascular risk factor, and implementing more than one type of intervention. The methodological quality of the included articles was evaluated using the AMSTAR tool. RESULTS Eight systematic reviews were selected, including 219 studies. All of these reviews provided information about the effectiveness of multifactorial interventions in reducing mortality and morbidity due to cardiovascular diseases. Four reviews reported moderate effectiveness and four showed limited effectiveness. CONCLUSION Multifactorial community interventions improve cardiovascular risk factors and have a small but potentially important effect on mortality. These interventions seem to be more effective in the at-risk population and when they are carried out at a high level of intensity.
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Affiliation(s)
- Celia Álvarez-Bueno
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain.
| | - Iván Cavero-Redondo
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain.
| | - María Martínez-Andrés
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain.
| | - Natalia Arias-Palencia
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain.
| | - Rafael Ramos-Blanes
- Research Unit, Family Medicine, Girona, Jordi Gol Institute for Primary Care Research (IDIAP Jordi Gol) and Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain.
| | - Fernando Salcedo-Aguilar
- Social and Health Care Research Centre, University of Castilla-La Mancha, Cuenca, Spain; Health Centre Cuenca I, Health Service of Castilla-La Mancha (SESCAM), Cuenca, Spain.
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26
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Beswick AD, Wylde V, Gooberman-Hill R. Interventions for the prediction and management of chronic postsurgical pain after total knee replacement: systematic review of randomised controlled trials. BMJ Open 2015; 5:e007387. [PMID: 25967998 PMCID: PMC4431062 DOI: 10.1136/bmjopen-2014-007387] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Total knee replacement can be a successful operation for pain relief. However, 10-34% of patients experience chronic postsurgical pain. Our aim was to synthesise evidence on the effectiveness of applying predictive models to guide preventive treatment, and for interventions in the management of chronic pain after total knee replacement. SETTING We conducted a systematic review of randomised controlled trials using appropriate search strategies in the Cochrane Library, MEDLINE and EMBASE from inception to October 2014. No language restrictions were applied. PARTICIPANTS Adult patients receiving total knee replacement. INTERVENTIONS Predictive models to guide treatment for prevention of chronic pain. Interventions for management of chronic pain. PRIMARY AND SECONDARY OUTCOME MEASURES Reporting of specific outcomes was not an eligibility criterion but we sought outcomes relating to pain severity. RESULTS No studies evaluated the effectiveness of predictive models in guiding treatment and improving outcomes after total knee replacement. One study evaluated an intervention for the management of chronic pain. The trial evaluated the use of a botulinum toxin A injection with antinociceptive and anticholinergic activity in 49 patients with chronic postsurgical pain after knee replacement. A single injection provided meaningful pain relief for about 40 days and the authors acknowledged the need for a large trial with repeated injections. No trials of multidisciplinary interventions or individualised treatments were identified. CONCLUSIONS Our systematic review highlights a lack of evidence about the effectiveness of prediction and management strategies for chronic postsurgical pain after total knee replacement. As a large number of people are affected by chronic pain after total knee replacement, development of an evidence base about care for these patients should be a research priority.
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Affiliation(s)
- Andrew D Beswick
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK
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Wellens HJJ, Schwartz PJ, Lindemans FW, Buxton AE, Goldberger JJ, Hohnloser SH, Huikuri HV, Kääb S, La Rovere MT, Malik M, Myerburg RJ, Simoons ML, Swedberg K, Tijssen J, Voors AA, Wilde AA. Risk stratification for sudden cardiac death: current status and challenges for the future. Eur Heart J 2014; 35:1642-51. [PMID: 24801071 PMCID: PMC4076664 DOI: 10.1093/eurheartj/ehu176] [Citation(s) in RCA: 267] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/17/2013] [Accepted: 01/27/2014] [Indexed: 01/09/2023] Open
Abstract
Sudden cardiac death (SCD) remains a daunting problem. It is a major public health issue for several reasons: from its prevalence (20% of total mortality in the industrialized world) to the devastating psycho-social impact on society and on the families of victims often still in their prime, and it represents a challenge for medicine, and especially for cardiology. This text summarizes the discussions and opinions of a group of investigators with a long-standing interest in this field. We addressed the occurrence of SCD in individuals apparently healthy, in patients with heart disease and mild or severe cardiac dysfunction, and in those with genetically based arrhythmic diseases. Recognizing the need for more accurate registries of the global and regional distribution of SCD in these different categories, we focused on the assessment of risk for SCD in these four groups, looking at the significance of alterations in cardiac function, of signs of electrical instability identified by ECG abnormalities or by autonomic tests, and of the progressive impact of genetic screening. Special attention was given to the identification of areas of research more or less likely to provide useful information, and thereby more or less suitable for the investment of time and of research funds.
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Affiliation(s)
| | - Peter J Schwartz
- IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | | | - Alfred E Buxton
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeffrey J Goldberger
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stefan H Hohnloser
- Division of Clinical Electrophysiology, Department of Cardiology, J. W. Goethe University, Frankfurt, Germany
| | - Heikki V Huikuri
- Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland
| | - Stefan Kääb
- Department of Medicine I, University Hospital, Ludwig-Maximilians-University, Münich, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Münich Heart Alliance, Münich, Germany
| | - Maria Teresa La Rovere
- Department of Cardiology, Fondazione 'Salvatore Maugeri', IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia, Italy
| | - Marek Malik
- St Paul's Cardiac Electrophysiology, University of London and Imperial College, London, UK
| | - Robert J Myerburg
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Jan Tijssen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Adriaan A Voors
- University Medical Center Groningen, Groningen, The Netherlands
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands Princess Al Jawhara Albrahim Centre of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
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Cheserek MJ, Wu GR, Shen LY, Shi YH, Le GW. Disparities in the Prevalence of Metabolic Syndrome (MS) and its Components Among University Employees by Age, Gender and Occupation. J Clin Diagn Res 2014; 8:65-9. [PMID: 24701485 DOI: 10.7860/jcdr/2014/6515.4010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 12/09/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Metabolic Syndrome (MS), a known risk factor for Cardiovascular Disease (CVD) and type II diabetes is an emerging epidemic in China. Studies carried out on the general population indicate a varied clustering of cardiovascular risks in many parts of the country. However, there is limited data on its prevalence in the working population. Workplace can serve as an important place for prevention, control and management of CVD risks. The aim of this study was to investigate the prevalence of MS and its components among University workers, and determine how the prevalence varied according to sex and occupation. METHODS This was a cross-sectional study of 2,428 University employees (22-60 years) who received an annual clinical examination at the University hospital. Anthropometric measurements, blood pressure, Fasting Plasma Glucose (FPG), and lipid profiles were measured. MS was defined according to the National Cholesterol Education Program Adult Treatment panel III modified criteria. RESULTS Overall prevalence of MS was 6.1%, higher in males (5.1%) than females (1.1%), and increased with age. The most prevalent MS components in all workers were hypertension (37.9%) and hypertryglyceridemia (20.8%), corresponding rates in males were 28.3% and 16.1% while females had a prevalence of 9.6% and 4.7%. After adjustment for age, administrative work was associated (p<0.05) with increased hypertension (odds ratio (OR) =1.474; 95% confidence interval (CI), 1.146-1.896) and hyperglycemia (OR=1.469; 95% CI, 1.082-1.993) in male workers, and with hypertension (OR=1.492; 95% CI, 1.071-2.080) in females. However, prevalence of hypertryglyceridemia was lower (OR=0.390; 95% CI, 0.204-0.746) in female administrators compared to those in academics. Obesity, MS and reduced High Density Lipoprotein (HDL) cholesterol prevalence was not different (p>0.05) between the two occupations in both sexes. CONCLUSIONS Prevalence of MS and its components was higher in male workers than in females, increased with age, and were more common in administrative workers. The findings support the need for gender and occupation specific health interventions to prevent CVDs and type II diabetes in the workplace.
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Affiliation(s)
- Maureen Jepkorir Cheserek
- Faculty, Molecular and Applied Nutrition Laboratory, School of Food Science and Technology, Jiangnan University , Wuxi, Jiangsu, China and Lecturer, Department of Human Nutrition, Faculty of Health Science, Egerton University, Njoro, Kenya
| | - Gui-Rong Wu
- PG Student, Molecular and Applied Nutrition Laboratory, School of Food Science and Technology, Jiangnan University , Wuxi, Jiangsu, China
| | - Li-Ye Shen
- Faculty, Jiangnan University Hospital , Wuxi, Jiangsu, China
| | - Yong-Hui Shi
- Professor, Molecular and Applied Nutrition Laboratory, School of Food Science and Technology , Jiangnan University, Wuxi, Jiangsu, China
| | - Guo-Wei Le
- Professor, Molecular and Applied Nutrition Laboratory, School of Food Science and Technology , Jiangnan University, Wuxi, Jiangsu, China
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Kengne AP, Masconi K, Mbanya VN, Lekoubou A, Echouffo-Tcheugui JB, Matsha TE. Risk predictive modelling for diabetes and cardiovascular disease. Crit Rev Clin Lab Sci 2013; 51:1-12. [PMID: 24304342 DOI: 10.3109/10408363.2013.853025] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Absolute risk models or clinical prediction models have been incorporated in guidelines, and are increasingly advocated as tools to assist risk stratification and guide prevention and treatments decisions relating to common health conditions such as cardiovascular disease (CVD) and diabetes mellitus. We have reviewed the historical development and principles of prediction research, including their statistical underpinning, as well as implications for routine practice, with a focus on predictive modelling for CVD and diabetes. Predictive modelling for CVD risk, which has developed over the last five decades, has been largely influenced by the Framingham Heart Study investigators, while it is only ∼20 years ago that similar efforts were started in the field of diabetes. Identification of predictive factors is an important preliminary step which provides the knowledge base on potential predictors to be tested for inclusion during the statistical derivation of the final model. The derived models must then be tested both on the development sample (internal validation) and on other populations in different settings (external validation). Updating procedures (e.g. recalibration) should be used to improve the performance of models that fail the tests of external validation. Ultimately, the effect of introducing validated models in routine practice on the process and outcomes of care as well as its cost-effectiveness should be tested in impact studies before wide dissemination of models beyond the research context. Several predictions models have been developed for CVD or diabetes, but very few have been externally validated or tested in impact studies, and their comparative performance has yet to be fully assessed. A shift of focus from developing new CVD or diabetes prediction models to validating the existing ones will improve their adoption in routine practice.
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Affiliation(s)
- Andre Pascal Kengne
- Non-Communicable Disease Research Unit, South African Medical Research Council and University of Cape Town , Cape Town , South Africa
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