The effect of medicamentous and non-medicamentous therapy on lowering risk factors for cardiovascular and cerebrovascular episodes in an interventional study

[Integrated approach to prevention and control of cardiovascular diseases]

INTRODUCTION

From 1984 to 2004, the city of Novi Sad participated in the international MONICA (Multinational MONItoring of trends and determinants in CArdiovascular disease) project, as one of the 38 research centres form 21 countries around the world and in CINDI (Countrywide Integrated Noncommunicable Disease Intervention Programme) programme.

OBJECTIVE

Objective was to indicate the advantages of the integrated approach to prevention and control of the cardiovascular disease (CVD) over mono-programmes and still present curative approach. Additional objective was the assessment of the vulnerability from the leading risk factors of the population of Novi Sad, based on the results and experience gained in realization of international projects.

METHODS

We analysed the results obtained in the countries where MONICA project and CINDI programme have been applied. The results of their application in Novi Sad are analysed (the trend of the prevalence of risk factors, the incidence of coronary and cerebrovascular events).

RESULTS

The prevalence of risk factors (except smoking), the incidence of coronary and cerebrovascular events are significantly increasing and are in positive correlation with the values of the linear trend.The decrease was only recorded in 1987 (the implementation of the intervention programme).

CONCLUSION

The review of results and experiences in international projects and programs, clearly indicate the advantage of an integrated approach to prevention and control of CVD in relation to monoprograme. The great vulnerability of the population of Novi Sad of the risk factors of CVD points out the necessity of their reductions by the principles of integrated programmes of prevention and control.

[Family health and family physician's influence on prevention psychoactive substances abuse]

The family, as the basic social unit, has a decisive role in the health and disease of its members. It is the primary unit where health needs are formed and solved. By its own resources the family independently resolves about 75% of the total health requirements. In the paper the authors study family characteristics which influence family health and diseases, indicators of family health and the scale of life values. Also, the study evaluates social factors, communication and the influence of the usage of psychoactive substances on family health and the quality of family life. To form the personality of a child three factors are most significant: love, the feeling of safety and the presence of harmonious relationship between the parents. Life harmony in a family also depends on the quality of structural components of the personality and the interaction of motivation of its members. Early childhood determines the future personality of the adult person. At that period, habits and partially attitudes are formed. In harmonious family relationships the parents are the role model to children. Verbal and non-verbal communication enrich the relationship among people and enable efforts in supporting understanding, compassion and care for others by mutual agreement. On the scale of life values of Serbian citizens health holds the first position. Immediately following the health issue is good relationship in the family. As healthcare is not only the task of healthcare services, but also of each individual, family and the society as a whole, it is on healthcare personnel to educate the citizens how to preserve and improve their own health and the health of their family by a continual healthcare and education. Above all, this concerns avoidance of bad habits, such as smoking, immoderate alcohol consumption, narcotic abuse, physical inactivity, hypercaloric nutrition, etc. Also, it is significant to make an early recognition of disease symptoms and to turn for help to the chosen doctor on time. Family medicine and family doctors can in the best way, entirely and continually, prevent and treat numerous diseases occurring as the result of family dysfunction, with active participation of each individual, family, healthcare services and the community.

Do we reach target lipid levels in diabetic and non-diabetic patients with previous myocardial infarction?

Introduction. Considering that dyslipidaemia is an important factor for cardiovascular diseases, target lipid levels are rarely reached in everyday clinical practice. Objective. The objective of this study was to evaluate how often we achieve the treatment goals for the lipid parameters in the diabetic and non-diabetic patients after the previous myocardial infarction (MI). Methods. The survey included 118 patients (84 males and 34 females), mean age 59.38?9.86 years, 34 (28.8%) of them diabetics, with the history of MI in the previous 3 years. The patients were selected from the database of multicentre prospective interventional study ?Secondary prevention of coronary heart disease and cerebrovascular diseases?, conducted in 2005 on 1,189 patients in Serbia. The patients were further followed in the period from 18 (5th visit) and 36 months (6th visit) after inclusion into the study from 2005-2008. Their lipid status, the use of lipid-lowering drugs, and the independent prognostic factors for major adverse coronary events were identified. In the beginning of the study, all patients were informed about the importance of lifestyle change and active approach to treatment. The accomplishment of secondary preventive measures was estimated on the basis of the European guidelines on secondary prevention of the coronary heart disease. Results. Three years after introduction of the preventive measures, diabetics had a higher prevalence of the target levels of the total cholesterol (21.2% vs. 7.6%) and HDL-cholesterol than non-diabetics (100% vs. 87.3%) (p<0.05). Non-diabetics had significantly higher prevalence of the target levels of LDL-cholesterol than diabetics (19% vs. 3%) (p<0.05). No significant differences were found in the prevalence of the treatment goals of triglycerides in diabetic (42.4%) and non-diabetic patients (60.8%) (p>0.05). At the end of the study, after applying secondary prevention measures, 27.3% of diabetics did not use lipid-lowering drugs. The percentage of non-diabetics using no lipid-lowering drugs was lower (20.3%), but the difference was not statistically significant (p>0.05). By using the method Enter Cox regression multivariant analysis, the change in the level of triglycerides, total and LDL-cholesterol were singled out as independent prognostic factors for major adverse coronary events. Conclusion. Our study has shown high prevalence of increased plasma concentrations in the total, LDL-cholesterol and triglycerides and low plasma concentrations of HDL-cholesterol, as well as the insufficient use of lipid-lowering drugs in diabetic and non-diabetic patients with previous MI. Decreasing the total cholesterol and increasing the HDL-cholesterol are significant, decreasing of triglycerides and LDL-cholesterol does not suffice. Therefore, secondary prevention measures of cardiovascular events should be intensified, especially in patients with diabetes.

Optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke

Stroke is the most common cause of disability and a major cause of mortality. Each year, more than 500,000 Americans sustain a stroke. Reperfusion and antithrombotic therapies are still of limited benefit, hence increasing interest has been focused on therapeutic approaches that prevent and/or modulate infarct evolution. Hyperglycemia in acute stroke has a poor prognosis and is associated with significant morbidity and mortality. However, it remains unclear whether intensive lowering of blood glucose levels in the hyperacute and acute phases of stroke improves clinical outcomes. Experimental data suggest that elevated blood glucose may contribute to infarct expansion directly through a number of maladaptive metabolic pathways and that treatment with insulin may attenuate these adverse effects. Despite some controversy surrounding the optimal level of blood glucose control, much of the evidence to date supports rigorous blood glucose control and comprehensive cardiovascular risk factor management to prevent stroke in patients with diabetes. The current recommendation is to aim for strict control of blood pressure, glucose, and lipids along with lifestyle modification to improve cardiovascular health. However, there remains a distinct paucity of information concerning secondary stroke prevention. To date, the overwhelming evidence suggests that aggressive glucose management should be the standard of care in all patients with stroke and hyperglycemia. This article presents an overview of the recommendations for the optimum control of blood glucose for prevention and treatment of ischemic and hemorrhagic stroke.