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The Global Burden of Cardiovascular Disease
Abstract
Cardiovascular disease (CVD) today is responsible for approximately one-third of deaths worldwide, and that figure will surely increase in both developing and developed countries as risk factors for the disease--primarily dyslipidemia, hypertension, obesity, diabetes, physical inactivity, poor diet, and smoking--continue to increase. Although these risk factors are modifiable, to date there is a relative paucity of measures to prevent or control them, particularly in developing countries. A population strategy combined with a high-risk strategy for CVD prevention could greatly reduce the burden of disease in the coming decades. Many initiatives are working, but many more are needed. This chapter provides background on the global burden of CVD and provides the context for the subsequent chapters addressing nurses' roles in reversing the bleak predictions for the ravages of CVD if risk factors are left unchecked in the coming decades.
... These devices have also found considerable utility in sports applications. Cardiovascular diseases, including cardiac arrhythmia and coronary heart disease (CHD), remain a major global health concern, contributing significantly to human mortality (Deaton et al., 2011). In 2019, these diseases accounted for approximately 17.9 million deaths, comprising 32% of all global fatalities. ...
... Since these electrodes use conductive gel for signal transduction, they are known as wet electrodes . The conductive gel also behaves like an ECG electrode's electrolyte leading to high sensitivity (Deaton et al., 2011). The gel also establishes a stable contact between the skin and the electrodes, which reduces contact impedance and increases signal-to-noise ratio (Deaton et al., 2011). ...
... The conductive gel also behaves like an ECG electrode's electrolyte leading to high sensitivity (Deaton et al., 2011). The gel also establishes a stable contact between the skin and the electrodes, which reduces contact impedance and increases signal-to-noise ratio (Deaton et al., 2011). But there are a few disadvantages to using wet electrodes. ...
Electrocardiogram (ECG) is the most common and simple technique to diagnose cardiovascular diseases. Cardiovascular diseases can be detected effectively if ECG signals are monitored for a long time, producing innovative clinical outcomes to diagnose and treat cardiovascular diseases. Due to skin irritation and degradation of signal quality with time, traditional wet electrodes are unsuitable for long-term ECG monitoring. Researchers are trying to fabricate flexible, wearable, highly conductive and lightweight ECG sensors, which can be applied for long-term monitoring of ECG signals and the detection of several cardiovascular diseases. Graphene is used for fabricating dry ECG electrodes because it exhibits robust mechanical flexibility, good environmental stability and excellent carrier mobility. This review paper presents the progress of various fabrication methods to make graphene-based ECG electrodes and provides the researcher’s clarification on recent advancements and direction in this domain. This paper focuses on a systematic review and comparative study of various fabrication methods of graphene-based ECG electrodes, such as screen printing, dip coating, drop casting, wet transfer, electrospinning, wet transfer and dry patterning, spin coating, spray coating, ink-jet printing etc.
... Coronary artery disease is one of the primary health concerns worldwide [1]. Coronary heart disease is one of the three leading causes of death in the world [2] and it is predicted that by 2030, 7 out of 10 deaths worldwide will be due to chronic diseases related to cardiovascular disease [3]. Research has shown that one person dies every second due to cardiovascular disorders [4]. ...
... Coronary arteries disease (CAD) is the most common type of heart disease [1] resulting from accumulation of arteriosclerotic plaques in artery walls [2]. This would lead to artery wall thickening, heart failure, angina pectoris, and myocardial infarction [2]. ...
... Coronary arteries disease (CAD) is the most common type of heart disease [1] resulting from accumulation of arteriosclerotic plaques in artery walls [2]. This would lead to artery wall thickening, heart failure, angina pectoris, and myocardial infarction [2]. Coronary Arteries Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) are two common treatments for this condition [6]. ...
Background
Cost-effectiveness analysis plays a key role in evaluating health systems and services. Coronary artery disease is one of the primary health concerns worldwide. This study sought to compare the cost-effectiveness of Coronary Arteries Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) through drug stent using Quality-Adjusted Life Years (QALY) index.
Methods
This is a cohort study involving all patients undergoing CABG and PCI through drug stent in south of Iran. A total of 410 patients were randomly selected to be included in the study. Data were gathered using SF-36, SAQ and a form for cost data from the patients' perspective. The data were analyzed descriptively and inferentially. Considering the analysis of cost-effectiveness, Markov Model was initially developed using TreeAge Pro 2020. Both deterministic and probabilistic sensitivity analyses were performed.
Results
Compared with the group treated with PCI, the total cost of interventions was higher in the CABG group ($102,103.8 vs $71,401.22) and the cost of lost productivity ($20,228.68 vs $7632.11), while the cost of hospitalization was lower in CABG ($67,567.1 vs $49,660.97). The cost of hotel stay and travel ($6967.82 vs $2520.12) and the cost of medication ($7340.18 vs $11,588.01) was lower in CABG. From the patients' perspective and SAQ instrument, CABG was cost-saving, with a reduction of $16,581 for every increase in effectiveness. Based on patients’ perspective and SF-36 instrument, CABG was cost-saving, with a reduction of $34,543 for every increase in effectiveness.
Conclusion
In the same indications, CABG intervention leads to more resource savings.
... Cardiovascular disease (CVD) is the leading cause of mortality with an estimated 30% of deaths worldwide 1 . From an economic standpoint, CVD places a heavy burden which could potentially be limited by population-wide interventions, but should also be addressed in a patient-oriented approach, especially in patients who are at high or very-high cardiovascular risk 1,2 . ...
... Cardiovascular disease (CVD) is the leading cause of mortality with an estimated 30% of deaths worldwide 1 . From an economic standpoint, CVD places a heavy burden which could potentially be limited by population-wide interventions, but should also be addressed in a patient-oriented approach, especially in patients who are at high or very-high cardiovascular risk 1,2 . ...
... The prevalence of arterial hypertension and type 2 diabetes mellitus, keystone factors of CVD, is high and likely to increase further due to "globalization" of dietary habits and urbanization 1,3 . These conditions potentiate one another in producing atherosclerotic cardiovascular disease (ASCVD) which may lead to stroke, myocardial infarction, chronic kidney disease and ultimately death. ...
Objective – The purpose of our study was to evaluate LDL-cholesterol goal attainment in patients at very high-cardiovascular risk due to concurrent arterial hypertension, type 2 diabetes mellitus and ASCVD, in light of the recently updated dyslipidemia guidelines.
Methods – Data from patients enrolled between January 2016 and December 2017 was collected in order to assess LDL cholesterol target attainment (≤70 mg/dL and <55 mg/dL) corresponding to 2016 and 2019 European Dyslipidemia Guidelines.
Results – A total of 993 patients were included in the analysis. Only 31% of patients achieved LDL-c goals of ≤70 mg/dL, without gender differences, a percentage which further dropped to 15% after establishing the target below 55 mg/dL. Patients with concurrent atrial fibrillation (34.9% vs. 25.1%, p=0.006), heart failure (37.1% vs. 27.2%, p=0.047) and chronic kidney disease (36.3% vs. 28.2%, p=0.028) had better, though far from optimal lipid control per the 2016 guidelines. Two in three patients had controlled diabetes with HbA1c values below 7%.
Conclusion – Our study shows that LDL-c targets were not met by very-high risk patients even with the lower 2016 threshold, with the new recommendations making lipid goals look more daunting.
... Cardiovascular diseases (CVDs), primarily ischemic heart disease and stroke, are one of the leading causes of death worldwide [1,2]. Despite numerous efforts, the prevalence and incidence of CVDs are still rising, especially in low-and middle-income countries [1]. ...
... Individualized treatment and diagnostic approaches are essential elements of effective therapy [2,4]. It is especially important in CVD management, as CVDs affect all ages and social groups, and numerous diseases could be treated in outpatient circumstances [1,5]. ...
... The aims of this study were: (1) to assess patients' opinions about the recommendations they receive from their attending physicians, (2) to recognize the steps the patients are taking to obtain a diagnosis of their symptoms, and (3) to identify the main ways of knowledge that patients use for self-education about their CVDs, (4) to point out major areas that require improvement, and (5) provide the direction of potential changes in the healthcare sector. ...
Cardiovascular diseases (CVDs) are major concerns in the healthcare system. An individual diagnostic approach and personalized therapy are key areas of an effective therapeutic process. The major aims of this study were: (1) to assess leading patient problems related to symptoms, diagnosis, and treatment of CVDs, (2) to examine patients’ opinions about the healthcare system in Poland, and (3) to provide a proposal of practical solutions. The 27-point author’s questionnaire was distributed in the Cardiology Department of the Tertiary Care Centre between 2nd September–13th November 2021. A total of 132 patients were recruited, and 82 (62.12%; nmale = 37, 45.12%; nfemale = 45, 54.88%) was finally included. The most common CVDs were arrhythmias and hypertension (both n = 43, 52.44%). 23 (28.05%) patients had an online appointment. Of the patients, 66 (80.49%) positively assessed and obtained treatment, while 11 (13.41%) patients declared they received a missed therapy. The participants identified: (1) waiting time (n = 31; 37.80%), (2) diagnostic process (n = 18; 21.95%), and (3) high price with limited availability of drugs (n = 12; 14.63%) as the areas that needed the strongest improvement. Younger patients more often negatively assessed doctor visits (30–40 yr.; p = 0.02) and hospital interventions (40–50 yr.; p = 0.008). Older patients (50–60 years old) less often negatively assessed the therapeutic process (p = 0.01). The knowledge of the factors determining patient adherence to treatment and satisfaction by Medical Professionals is crucial in providing effective treatment. Areas that require the strongest improvement are: (1) waiting time for an appointment and diagnosis, (2) limited availability and price of drugs, and (3) prolonged, complicated diagnostic process. Providing practical solutions is a crucial aspect of improving CVDs therapy.
... Cardiovascular diseases (CVDs) cross geographic, socioeconomic, or gender boundaries [1]. Developed and lower-/middle-income countries have a higher prevalence of cardiovascular risk factors, incidences of CVD and stroke, and all-cause mortality [1,2]. ...
... Cardiovascular diseases (CVDs) cross geographic, socioeconomic, or gender boundaries [1]. Developed and lower-/middle-income countries have a higher prevalence of cardiovascular risk factors, incidences of CVD and stroke, and all-cause mortality [1,2]. Additionally, the 2015 Update on Heart Disease and Stroke Statistics by the American Heart Association (AHA) highlighted that both CVD and stroke are the leading causes of health and economic burden in the US and worldwide. ...
In the rapidly evolving landscape of continuous electrocardiogram (ECG) monitoring systems, there is a heightened demand for non-invasive sensors capable of measuring ECGs and detecting heart rate variability (HRV) in diverse populations, ranging from cardiovascular patients to sports enthusiasts. Challenges like device accuracy, patient privacy, signal noise, and long-term safety impede the use of wearable devices in clinical practice. This scoping review aims to assess the performance and safety of novel multi-channel, sensor-based biopotential wearable devices in adults. A comprehensive search strategy was employed on four databases, resulting in 143 records and the inclusion of 12 relevant studies. Most studies focused on healthy adult subjects (n = 6), with some examining controlled groups with atrial fibrillation (AF) (n = 3), long QT syndrome (n = 1), and sleep apnea (n = 1). The investigated bio-sensor devices included chest-worn belts (n = 2), wrist bands (n = 2), adhesive chest strips (n = 2), and wearable textile smart clothes (n = 4). The primary objective of the included studies was to evaluate device performance in terms of accuracy, signal quality, comparability, and visual assessment of ECGs. Safety findings, reported in five articles, indicated no major side effects for long-term/continuous monitoring, with only minor instances of skin irritation. Looking forward, there are ample opportunities to enhance and test these technologies across various physical activity intensities and clinical conditions.
... Cardiovascular diseases (CVDs) are now a global burden, accounting for one-third of all fatalities worldwide [1]. Knowing the early risk factors for CVDs is crucial because of this high burden. ...
... Numerous studies have found a direct correlation between cardiovascular illness and type A personalities [5]. Research has shown that intense psychosocial feelings, like violence or situational rage, together with competitive thinking, are associated with increased hemodynamic reactivity and increase the risk of 1 2 3 4 5 5 myocardial infarction in the near term [6]. ...
Background: A considerable link between personality types and cardiovascular diseases (CVDs) has been seen. Autonomic responses in both type A and type B personality individuals were found to be influenced by their personality traits. The study suggests further research on cardiac autonomic functions in larger sample sizes and the use of non-invasive screening techniques like cardiovascular reflex tests to stratify participants' risk of future illness.
Objective: This study aimed to assess autonomic stress reactivity tests in type A and type B personalities using cardiovascular reflex tests.
Methods: This study was conducted at the Department of Physiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. The Hunter-Wolf Personality Questionnaire Scale was used to identify 60 adults, 30 of whom were classified to have type A personality and 30 have type B personality, from the psychiatry department. Autonomic function tests, such as the handgrip tests, cold pressor test, deep breathing test (DBT), lying-to-standing test (LST), and Valsalva maneuver, were performed and recorded for each subject. IBM SPSS Statistics for Windows, version 21 (released 2012; IBM Corp., Armonk, New York, United States) was used for the compilation and analysis of data.
Results: The E:I (expiration-to-inspiration) ratio and delta heart rate of the type A personality patients both significantly decreased (p = 0.000*) as compared to the type B personality patients (1.18 ± 0.03 versus 1.25 ± 0.77 and 1.18 ± 0.03 versus 1.25 ± 0.77). The Valsalva ratio of the type A personality patients decreased (1.38 ± 0.10) as compared to the type B personality patients (1.48 ± 0.18), which was statistically significant (p = 0.001*). The 30:15 ratio in the type A personality patients was significantly decreased (p = 0.03*) compared to the type B personality patients (1.12 ± 0.05 versus 1.15 ± 0.10). The handgrip test and cold pressor test results were statistically insignificant.
Conclusion: Compared to the type B personality patients, which exhibited an increase in both parasympathetic and sympathetic reactivity, the type A personality patients exhibited a reduction in resting cardiovascular parameters and resting autonomic tone. Consequently, in order to stratify the participants' risk of future illness, we recommend employing non-invasive procedures, such as cardiovascular reflex tests, as a screening technique.
... If not identified and treated, these conditions-hereafter termed cardiometabolic conditions-can lead to a considerable health burden, societal costs, and premature mortality [22,23]. Systematic reviews, meta-analyses, and cohort studies [24][25][26] have demonstrated positive associations of cardiometabolic conditions with a range of psychiatric disorders, including mood, anxiety, and stress-related disorders. ...
... We assessed associations between ADHD and cardiometabolic conditions by calculating age-adjusted prevalence ratios (PR) and accompanying 95% confidence intervals (CI) separately for each measured cardiometabolic condition and overall, using modified Poisson regression models. We present estimates stratified by women's age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45), and 46-69 years) as additional files (Additional files 2, 3 and 4: Fig. S2-S4). Age was measured at the time when the women responded to the survey, not at the time of their diagnoses. ...
Background
Leveraging a large nationwide study of Icelandic women, we aimed to narrow the evidence gap around female attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic comorbidities by determining the prevalence of obesity, hypertension, type 2 diabetes, and cardiovascular diseases among women with ADHD and examine the association between cardiometabolic conditions and co-occurring ADHD with anxiety and mood disorders, alcoholism/substance use disorder (SUD), self-harm, and suicide attempts.
Methods
We conducted a cross-sectional analysis of the nationwide, all-female, population-based SAGA Cohort Study (n = 26,668). To ascertain diagnoses and symptoms, we used self-reported history of ADHD diagnoses, selected cardiometabolic conditions and psychiatric disorders, and measured current depressive, anxiety, and PTSD symptoms through appropriate questionnaires (PHQ-9, GAD-7, and PCL-5). We calculated age-adjusted prevalences of cardiometabolic conditions by women’s ADHD status and estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI), using modified Poisson regression models. Similarly, we assessed the association of cardiometabolic conditions and co-occurring ADHD with current psychiatric symptoms and psychiatric disorders, using adjusted PRs and 95% CIs.
Results
We identified 2299 (8.6%) women with a history of ADHD diagnosis. The age-adjusted prevalence of having at least one cardiometabolic condition was higher among women with ADHD (49.5%) than those without (41.7%), (PR = 1.19, 95% CI 1.14–1.25), with higher prevalence of all measured cardiometabolic conditions (myocardial infarctions (PR = 2.53, 95% CI 1.83-–3.49), type 2 diabetes (PR = 2.08, 95% CI 1.66–2.61), hypertension (PR = 1.23, 95% CI 1.12–1.34), and obesity (PR = 1.18, 95% CI 1.11–1.25)). Women with cardiometabolic conditions and co-occurring ADHD had, compared with those without ADHD, substantially increased prevalence of (a) all measured mood and anxiety disorders, e.g., depression (PR = 2.38, 95% CI 2.19–2.58), bipolar disorder (PR = 4.81, 95% CI 3.65–6.35), posttraumatic stress disorder (PR = 2.78, 95% CI 2.52–3.07), social phobia (PR = 2.96, 95% CI 2.64–3.32); (b) moderate/severe depressive, anxiety, and PTSD symptoms with PR = 1.76 (95% CI 1.67–1.85), PR = 1.97 (95% CI 1.82–2.12), and PR = 2.01 (95% CI 1.88–2.15), respectively; (c) alcoholism/SUD, PR = 4.79 (95% CI 3.90–5.89); and (d) self-harm, PR = 1.47 (95% CI 1.29–1.67) and suicide attempts, PR = 2.37 (95% CI 2.05–2.73).
Conclusions
ADHD is overrepresented among women with cardiometabolic conditions and contributes substantially to other psychiatric comorbidities among women with cardiometabolic conditions.
... For this reason, it is imperative to address it as soon as possible (Deaton C et al., 2011). 12 regularly monitored and controlled to stop these diseases from getting worse (Van Camp G et al., 2014). ...
Heart disease (CVD) is still a major worldwide health concern because of its extensive effects
on both people and society at large. It includes a wide range of disorders that impact the heart
and blood vessels and have different clinical manifestations and consequences. We consider
the many facets of CVD and its critical role in healthcare in this succinct conclusion,
highlighting important lessons ranging from risk factors to the critical requirement for all�encompassing preventive and management techniques (Huddart RA et al., 2003).
The intricate interaction of both controllable and non-modifiable risk factors leads to CVD.
Age, gender, genetics, and family history are examples of non-modifiable characteristics that
highlight how important it is to recognize one's innate susceptibility to this illness. Although
these criteria are unchangeable, they are extremely helpful in providing early identification and
customized prevention efforts (Huddart RA et al., 2003).
On the other hand, people may take charge of their cardiovascular health by modifying risk
factors including diet, exercise, smoking, obesity, diabetes, and hypertension. It is impossible
to overestimate the importance of these lifestyle variables since they provide a clear route for
lowering the risk of CVD. The essential pillars for supporting cardiovascular well-being
include a heart-healthy diet, frequent exercise, quitting smoking, controlling weight, blood
pressure, and managing diabetes (Berks D et al., 2013)
CVD affects more than just the person. Due to the high financial expenditures of medical
treatment, lost productivity, and decreased quality of life, it has a considerable negative impact
on society. In order to lessen this burden, public health programs that emphasize prevention,
early intervention, and awareness is essential (Berks D et al., 2013)
These include health-promoting policies, such as corporate wellness programs and school�based nutrition programs, as well as information campaigns and increased access to healthcare.
The advancement of knowledge about the complex mechanisms behind CVD is still being
fuelled by innovations and medical research. There is promise for better patient care and results
thanks to advancements in pharmacological treatments, therapy alternatives, and diagnostic
equipment. Customizing medications to individual CVD risks and profiles is a promising goal
of precision medicine, which is still being pursued and takes into account individual genetic
and lifestyle variables (Berks D et al., 2013
... Cardiometabolic diseases, including obesity, hypertension, hyperlipidemia, and type 2 diabetes, have reached epidemic proportions globally, representing a considerable healthcare burden [5]. Several studies have reported an increased risk of cardiometabolic disorders among adults born preterm compared to those born at full term [4,[6][7][8]. ...
... 1) ASCVD is the most prominent public health issue, accounting for one-third of deaths each year, and appears to progress due to the trends in the associated risk factors. 2) The most significant risk factors for ASCVD are modifiable and include smoking, being overweight, having hypertension, diabetes, dyslipidemia, lack of exercise, and a poor diet. 3,4) Clinicians frequently encounter patients with novel ASCVD events who are misclassified by models based on traditional cardiovascular risk factors. ...
It is unclear whether the atherogenic index of plasma (AIP) is associated with major adverse cardiovascular events (MACEs) in the general population. A total of 361,644 participants (aged 56.19 ± 8.09 years; 44.79% male) free of a history of MACEs at baseline from the UK Biobank data were included in the analysis. The AIP was calculated using log (triglyceride/high-density lipoprotein-cholesterol). Over a mean follow-up of 12.19 ± 1.60 years, 16,683 participants developed MACEs. After adjustment for traditional risk factors, each 1 unit increase in AIP was associated with a 45.3% higher risk of incident MACEs (hazard ratio (HR), 1.453 [95% confidence interval (CI) 1.371-1.540], P < 0.001). Results were similar when individuals were categorized by the AIP quartiles (HR, 1.283 [95% CI 1.217-1.351]; comparing extreme quartiles). The subgroup analyses showed that the association between AIP and risk of incident MACEs was more obvious in female participants who are < 60 years old and free of hypertension or diabetes. Sensitivity analysis included participants without any lipid-lowering medication or excluded incident MACEs in the first 2 years of follow-up confirming the robustness of the findings. Elevated AIP is a risk factor of incident MACEs in the general population, independent of traditional risk factors.
Dynamic monitoring of the AIP may help select the population at high risk of cardiovascular events and guide primary prevention.
... Cardiovascular disease (CVD) is a major public health problem that affects about 523 million people worldwide [1,2]. CVD is the leading cause of mortality on the globe, accounting for more than 17.9 million deaths per year, and it is projected to grow to more than 23.6 million by 2030 [3]. ...
Background
Optimal utilization of cardiovascular drugs is crucial in reducing morbidity and mortality associated with cardiovascular diseases. However, the effectiveness of these drugs can be compromised by drug therapy problems. Hospitalized patients with cardiovascular diseases, particularly those with multiple comorbidities, polypharmacy, and advanced age, are more susceptible to experiencing drug therapy problems. However, little is known about drug therapy problems and their contributing factors among patients with cardiovascular disease in our setting. Therefore, our study aimed to investigate drug therapy problems and their contributing factors in patients with cardiovascular diseases.
Method
A prospective observational study was conducted among hospitalized patients with cardiovascular disease at Ayder Comprehensive Specialized Hospital in the Tigray region of Northern Ethiopia from December 2020 to May 2021. We collected the data through patient interviews and review of patients’ medical records. We employed Cipolle’s method to identify and categorize drug therapy problems and sought consensus from a panel of experts through review. Data analysis was performed using the Statistical Software Package SPSS version 22. Binary logistic regression analysis was performed to determine the contributing factors of drug therapy problems in patients with cardiovascular disease. Statistical significance was set at p < 0.05.
Results
The study included a total of 222 patients, of whom 117 (52.7%) experienced one or more drug-related problems. We identified 177 drug therapy problems equating to 1.4 ± 0.7 drug therapy problems per patients. The most frequently identified DTP was the need for additional drug therapy (32.4%), followed by ineffective drug therapy (14%), and unnecessary drug therapy (13.1%). The predicting factors for drug therapy problems were old age (AOR: 3.97, 95%CI: 1.68–9.36) and number of medications ≥ 5 (AOR: 2.68, 95%CI: 1.47–5.11).
Conclusion
More than half of the patients experienced drug therapy problems in our study. Old age and number of medications were the predicting factors of drug therapy problems. Therefore, greater attention and focus should be given to patients who are at risk of developing drug therapy problems.
... Cardiovascular disease (CVD) affects millions of individuals worldwide and presents a significant public health challenge. The alarming increase in the prevalence of CVD, particularly in the context of social, environmental, and economic changes, calls for a comprehensive understanding of factors that increase CVD risk [1]. ...
Unlabelled:
This study sought to investigate the impact of exposure to metals and per- and polyfluoroalkyl substances (PFASs) on cardiovascular disease (CVD)-related risk. PFASs, including PFOA, PFOS, PFNA, and PFHxS, as well as metals such as lead (Pb), cadmium (Cd), and mercury (Hg), were analyzed to elucidate their combined effects on CVD risk.
Methods:
Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2014, this investigation explored the effects of PFASs and metals on CVD risk. A spectrum of individual CVD markers, encompassing systolic blood pressure (SBP), diastolic blood pressure (DBP), high-density lipoprotein (HDL), low-density lipoprotein (LDL), total cholesterol, and triglycerides, was examined. Additionally, comprehensive CVD risk indices were evaluated, namely the Overall Cardiovascular Biomarkers Index (OCBI), including the Framingham Risk Score and an Overall Cardiovascular Index. Linear regression analysis was employed to probe the relationships between these variables. Furthermore, to assess dose-response relationships between exposure mixtures and CVD while mitigating the influence of multicollinearity and potential interaction effects, Bayesian Kernel Machine Regression (BKMR) was employed.
Results:
Our findings indicated that exposure to PFAS and metals in combination increased CVD risk, with combinations occurring with lead bringing forth the largest impact among many CVD-related markers.
Conclusions:
This study finds that combined exposure to metals and PFASs significantly elevates the likelihood of CVD risk. These results highlight the importance of understanding the complex interplay between multipollutant exposures and their potential implications for cardiovascular health.
... Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels, representing the leading cause of mortality and disability worldwide [1][2][3]. Over the past 40 years, the prevalence of these diseases has doubled, and the number of deaths and disabilityadjusted life years (DALYs) has increased dramatically, making CVDs a major Public Health issue [4,5]. ...
Background
The role of the Mediterranean Diet (MD) in reducing cardiovascular (CV) risk is widely demonstrated and many studies have shown the effectiveness of educational interventions in primary prevention. This study aimed to evaluate the impact of a multidisciplinary educational intervention, that included nutritional, psychological and physical activity coaching, on adherence to MD and on CV risk.
Methods
In a Roman neighborhood, general practitioners enrolled 41 subjects to take part in the educational intervention from November 2018 (T0) to November 2019 (T1). Participants’ anthropometric measures, haematochemical parameters and CV risk score were assessed before and after the intervention. Furthermore, their adherence to MD was evaluated through the analysis of food frequency questionnaires using Medi-Lite.
Results
The study found a significant reduction of 2.5 points in individual CV risk score, and an increase of 2.5 point in adherence to the MD. The stratification by gender showed statistically significant decreases in weight of 1.16 kg, BMI of 0.47, LDL cholesterol of 14.00 mg/dL, and individual CV risk score of 1.16 points among female participants.
Conclusions
These results show that a multidisciplinary educational intervention model including the adoption of MD could be an effective strategy in Public Health for CV primary prevention and improvement of people’s lifestyles.
... The prevalence and incidence of cardio metabolic problems have also increased in tandem with the rise in obesity, diabetes, and hypertension (Springer et al., 2013;Kuklina et al., 2012). Inactivity, an unhealthy lifestyle, and an unhealthy food are the main risk factors for cardio metabolic illnesses, which are primarily brought on by smoking (James, 2008;Yusuf et al., 2001;Deaton et al., 2011;World population ageing, 2002). The American Diabetes Association (ADA) created a classification of diabetes in 1997 that includes type 1 (insulindependent diabetes mellitus), type 2 (non-insulin-dependent diabetes mellitus), other types, and gestational diabetes mellitus (GDM). ...
Diabetes mellitus is a group of cardiometabolic disorders defined by elevated blood sugar levels. The majority of people affected by this disease reside in rural areas of low- and middle-income countries. The PTP1B inhibitory enzyme is involved in the control of leptin and insulin signaling. The Cucumis sativus plant, which includes several phytochemical constituents, has been shown to have antidiabetic properties. This study examines the in silico inhibitory potential of bioactive compounds obtained from Cucumis sativus against a potentially diabetogenic enzyme, PTP1B. (Trodusquesmine). The analysis resulted in scores for the first five compounds (isoorientin, chlorogenic acid, isovitexin, caffeic acid, and ferullic acid) ranging from -8.60 to -6.44 kcal/mol. The MM-GBSA of each ligand is expressed as follows: -56.46, -51.13, -51.63, -53.06 and -52.65 ΔGbind. Researchers are looking for plants that can be used as stable treatments with few side effects, although many drugs are already used to treat diabetes. As a result, the molecular bond, generalized molecular mechanics surface area (MM-GBSA) and properties of the lead compound ADMETox were determined.
... Cardiovascular diseases(CVDs) are a group of disorders that damage the cardiovascular system such as heart, blood vessels, and circulatory system [1,2]. Due to increased urbanization and lifestyle changes that increase exposure to risk factors caused by changes in nutrition, physical activity, and environment, the disease remains the leading cause of death worldwide [3]. CVD caused 17.9 million deaths worldwide in 2019, accounting for 32% of all global deaths [4]. ...
Background
Cardiovascular disease is a cluster of illnesses that affect the heart and blood vessels. Dyslipidemia is the most common risk factor for cardiovascular disease, causing more than 4 million deaths each year worldwide. However, there is very little evidence concerning the prevalence and pattern of dyslipidemia among cardiac patients in Ethiopia.
Methods
Hospital-based cross-sectional study was conducted from June to September 2022 at Ambo University referral hospital. Data on socio-demographic, clinical and anthropometric features were collected from adults with cardiac diseases using a convenient sampling technique. Lipid profiles and uric acid were measured from overnight fasting blood. The national cholesterol education program adult treatment panel (NCEP-ATP) III criteria was used to define dyslipidemia.
Results
A total of 269 participants were enrolled and the overall 76.6% [95% confidence interval (CI):72.1–81] of patients had at least one dyslipidemia. The prevalence of total cholesterol (TC) ⩾200 mg/dl, triglyceride (TG), LDL-cholesterol and HDL-cholesterol < 40 mg/dl were 38.9%, 44.6%, 29.4%, and 53.5%, respectively. Age > 54 was associated with TC and TG dyslipidemia, adjusted odds ratio (aOR) and (95% CI) were 2.6(1.4–4.8) and 2.4(1.2–4.7), respectively. While, a family history of heart disease, sedentary lifestyle and obesity were associated with TC dyslipidemia, aOR (95%CI) were 1.9(1.1–3.5), 1.4 (1.4–14.6) and 6.7 (1.4–32.5), respectively. In addition, diabetetes mellitus and abdominal obesity were significantly associated with TG dyslipidemia, aOR (95%CI) were 1.9(1.0–3.6) and 2.6(1.16–5.8), respectively. Moreover, uric acid was positively correlated with TC and TG level.
Conclusions
The results indicate that more than 75% of the cardiac patients had at least one dyslipidemia. This reflects the need for regular monitoring of lipid profiles and intensive counseling in this population to mitigate further cardio-metabolic complications.
... Cardiovascular diseases (CVDs) are significant contributors to worldwide fatalities, accounting for approximately 33% of all deaths across the world [1]. Because of its low cost, simplicity, and non-invasive nature, the electrocardiogram (ECG) is the most used technique for diagnosing and monitoring CVDs in both clinical and telemedicine settings [2]. ...
AI techniques have recently been put under the spotlight for analyzing electrocardiograms (ECGs). However, the performance of AI-based models relies on the accumulation of large-scale labeled datasets, which is challenging. To increase the performance of AI-based models, data augmentation (DA) strategies have been developed recently. The study presented a comprehensive systematic literature review of DA for ECG signals. We conducted a systematic search and categorized the selected documents by AI application, number of leads involved, DA method, classifier, performance improvements after DA, and datasets employed. With such information, this study provided a better understanding of the potential of ECG augmentation in enhancing the performance of AI-based ECG applications. This study adhered to the rigorous PRISMA guidelines for systematic reviews. To ensure comprehensive coverage, publications between 2013 and 2023 were searched across multiple databases, including IEEE Explore, PubMed, and Web of Science. The records were meticulously reviewed to determine their relevance to the study’s objective, and those that met the inclusion criteria were selected for further analysis. Consequently, 119 papers were deemed relevant for further review. Overall, this study shed light on the potential of DA to advance the field of ECG diagnosis and monitoring.
... These can be caused by illness, accidents, or birth defects. In this context stroke plays a major role, since it is one of the most common causes of neuromotor disorders and permanent disabilities in western civilization (Deaton et al., 2011). ...
In this work an upper limb active orthosis for assistive rehabilitation is presented. The design and torque control scheme of the orthosis that take into account important aspects of human rehabilitation, are described. Furthermore, first results of successful muscle activity detection and processing for the operation of the or-thosis in two movement directions are presented. The proposed system is the first step towards an adaptive support of patients with respect to the strength of their muscle activity. To allow an adaptive support, different methods for EMG analysis have to be applied which allow to correlate muscle activity strength with the recorded signal and thus enable to adapt the support of the orthosis to the needs of the patient and state of therapy.
... Coronary heart disease is a leading cause of morbidity and mortality in most industrialized countries and is a growing concern worldwide [1]. According to the World Health Organization (WHO), coronary artery disease is expected to be one of the four leading causes of death worldwide by 2030 [2]. ...
This study examines the effect of recirculation zones and flow pulsatility on the transfer of the active ingredient from drug-eluting stents to the arterial wall, which can be hindered by recirculation zones located upstream and downstream of stent struts, leading to restenosis and thrombosis. Numerical simulations were conducted using a left coronary artery model with steady or pulsatile flows, and mass transfer analysis was performed on a single-stent strut with a square cross section. The findings offer valuable insights into optimizing the geometric design of drug-eluting stents by controlling the size and dynamics of induced recirculation cells, thereby enhancing the efficacy of stent treatments.
... The conventional risk factors including poor and unhealthy diet, lack of physical activity, excessive alcohol intake, and cigarette smoking are responsible for the increase in the prevalence of CMDs [6,7]. These factors are known to cause metabolic derangements such as obesity, hypertension, dyslipidemia, oxidative stress, insulin resistance and/or pancreatic beta cell dysfunction, which progresses to the CMDs especially T2D. ...
Single nucleotide polymorphisms of the TCF7L2 , HHEX , SLC30A8 , MTNR1B , SLC2A2 and GLIS3 genes are well established candidate genes for cardiometabolic diseases (CMDs) across different ethnic populations. We investigated their association with CMDs in a mixed ancestry population of South Africa. rs10830963, rs1111875, rs11920090, rs13266634, rs7034200 and rs7903146 SNPs were genotyped by quantitative real time PCR in 1650 participants and Hardy-Weinberg equilibrium (HWE) analyses performed on the SNPs. Diabetes, obesity, hypertension and cardiometabolic traits were compared across genotypes of SNPs in HWE. Linear and logistic regressions adjusting for age, gender and body mass index were used to determine the risk of T2D, obesity and hypertension. rs7903146 (p = 0.055), rs1111875 (p = 0.465), rs13266634 (p = 0.828), and rs10830963 (p = 0.158) were in HWE. The rs10830963 recessive genotype was able to predict FPG, insulin and HOMA-IR, while the rs1111875 recessive genotype was able to predict total cholesterol, triglyceride, LDL cholesterol and FPG. The rs7903146 recessive genotype was able to predict SBP and LDL cholesterol. The recessive genotypes of MTNRIB and HHEX SNPs were associated with T2D traits in the study population and could partially explain the high prevalence of T2D. Further studies are required to confirm these findings and establish candidate genes in the African population.
... Medical experts, other physicians, and public health professionals might greatly benefit from these summary indicators of health when combined with information on CVD and risk factor prevalence. They offer vital population-level data that can improve preventive, treatment, and management efforts for CVD and risk factor management at the national, global, and subnational levels [1], [2]. ...
“Peripheral artery disease” or PAD, is considered as a most prevalent condition, and it commonly coexists with vascular diseases in other body parts. The epidemiology of PAD is well known and connected to age and, particularly, the predisposing factors of smoking and diabetes mellitus. Diagnosis on early basis is important for enhancing the quality of life (QOL) in addition to the reducing risk for the development of significant subsequent vascular events such as “acute myocardial infarction (AMI)” or “stroke”. There are a variety of treatments used to manage and treat the disease. However, there are negative effects and toxicities associated with that treatment in addition to higher costs. Hence, a surge in the hunt for natural compounds of botanical origin is gaining traction. The present study aims at exploring the targeting ability of phytocompound, and genistein against FABP4 which is an emerging target for PAD in diabetes patients. The study is conducted using a computation method employing Autodock4 and other accessory tools. The results of the docking process revealed a significant binding energy of -6.14 which demonstrated a stable complex formation between protein and selected compound. Thus, showing great potential for the treatment of PAD.
... Cardiovascular diseases (CVDs) remain the number one cause of death worldwide and are responsible for an estimated 17.9 million deaths each year (31% of all deaths globally) [5]. Cardiovascular diseases are the leading cause of mortality [6,7] and contributors to the global burden of disease [8]. Harper et al. [9] implied that population levels of CVDs depend on the prevalence of major risk factors, and levels of risk factors depend on macro-social forces and socioeconomic position. ...
Background
The main objective of this study was to construct and validate a composite socioeconomic status indicator containing material capital, human capital, and social capital (CAPSES scale) and also appropriate it for CVDs in a large population-based study.
Methods
This cross-sectional study, the Urban HEART-2 project, was conducted in Tehran, Iran, in 2011. A total of 34,116 households covering 118,542 individuals were assessed in this study. A 14-parts questionnaire was completed for all selected households. All the gathered data were based on the participants’ self-reports. Literacy, wealth index, expenditure, skill level, and Townsend index were used as SES indexes. CVDs, including Hypertension, Myocardial infarction, and stroke, were considered the main outcomes. A structural equation model (SEM) was used to construct a CAPSES scale and a composition index of SES. Criterion validity and Construct validity were used to assess this scale.
Results
A total of 91,830 subjects consisting of 33,884 (49%) men were included in this analysis. The mean age of the participants was 41.5 ± 11.37 years. Among the assessed participants, 5904(6.4%) reported hypertension, 1507(1.6%) myocardial infarction, and 407(0.4%) strokes. The overall weighted prevalence of self-reported cardiovascular events (hypertension, stroke, and MI) was 8.03% (95%CI: 7.8–8.2). Inverse associations were seen between the CAPSES scale and its domains with CVDs, adjusted for sex, age, BMI, smoking, and diabetes by a multiple logistic regression model.
Conclusion
The CAPSES scale was significantly associated with stroke and hypertension. Our findings showed that the CAPSES index could be useful for public health research.
... Las anormalidades lipídicas incluyen altos niveles de LDL (colesterol de lipoproteínas de baja densidad), triglicéridos elevados y HDL bajo (lipoproteínas de colesterol de alta densidad). El colesterol presente en la β-lipoproteína (LDL) y pre-B-lipoproteína se deposita en los vasos sanguíneos, mientras que α-lipoproteína (HDL) ayuda a reducir el colesterol sérico (Singh & Singh, 2008) (Mikaili et al., 2013) Los problemas del sobrepeso y de obesidad en la zona centro andino de Ecuador pueden presentarse desde edades tempranas (Jara et al., 2018a;Jara et al., 2018b ) y tienen una alta prevalencia en los adultos; ambos constituyen un grave problema de salud pública sobre todo por su asociación con los riesgos a desarrollar diversas enfermedades crónicas (Heredia et al., 2016); algunas de las cuales se encuentran dentro de las primeras causas de fallecimientos en países desarrollados y en vías de desarrollo (Deaton, 2011). ...
Resumen: la Dislipidemia Aterogénica es una alteración lipo proteica; constituye un factor asociado a enfermedades cardiovasculares. El objetivo del presente trabajo fue el de determinar variables asociadas a Dislipidemia Aterogénica y Obesidad Visceral en el personal que labora en una Empresa Pública de la ciudad de Riobamba. Se tomaron medidas antropométricas y valores bioquímicos. Los participantes fueron 105 adultos (73% hombres, 27 % mujeres). Al evaluar su estado nutricional: 35% presentó obesidad y 40% sobrepeso; el porcentaje de masa de grasa visceral observado fue un 18% muy alto, y 43% alto; circunferencia de cintura el 73 % la tiene elevada. Al valorar los exámenes bioquímicos, se estimó la existencia de un 16% con Dislipidemia y pre-diabetes un 24%. Al relacionar la Dislipidemia Aterogénica con la Obesidad Visceral se obtuvo una relación positiva significativa. Las variables analizadas evidencian en algunas personas la presencia de un síndrome metabólico y diabetes tipo 2. Se deben analizar y mejorar las rutinas alimenticias en la mayoría de personas analizadas, así como promover un estilo de vida más saludable. Palabras clave: Dislipidemia aterogénica, obesidad visceral, síndrome metabólico, Riobamba.
... Social determinants have been recognized to be a signi cant factor in the development of cardiovascular diseases (CVDs) and related risk factors (1,19). Cardiovascular diseases (CVDs) remains the number one cause of death worldwide and is responsible for an estimated 17.9 million deaths each year (31% of all deaths globally) (20) Cardiovascular diseases are the leading cause of mortality (21,22) and contributors to the global burden of disease(23). Harper, et al. (24) implied that population levels of CVDs are dependent on the prevalence of major risk factors and levels of risk factors are dependent on macro-social forces and socioeconomic position. ...
Background
The main objective of this study was to construct and validate a composite socio-economic status indicator, containing material capital, human capital, and social capital (CAPSES scale) and also appropriate it for CVDs in a large population-based study.
Methods
This cross-sectional study, the Urban HEART-2 project, was conducted in Tehran, Iran in 2011. A total of 34116 households covering 118542 individuals were assessed in this study. A 14-parts questionnaire was completed for all selected households. All the gathered data were based on the participants’ self-reports. Literacy, wealth index, expenditure, skill level, and Townsend index were used as SES indexes. CVDs including Hypertension, Myocardial infarction, and Stroke were considered as the main outcomes. A structural equation model (SEM) was used to construct CAPSES scale a composition index of SES. Criterion validity and Construct validity were used to assess this scale.
Results
A total of 91830 subjects consisting of 33884 (49%) men were included in this analysis. The mean age of the participants was 41.5 ± 11.37 years. Among the assessed participants, 5904(6.4%) reported Hypertension, 1507(1.6%) myocardial infarction, and 407(0.4%) strokes. The overall weighted prevalence of self-reported cardiovascular events (hypertension, stroke, and MI) was 8.03% (95%CI: 7.8–8.2). Inverse associations were seen between the CAPSES scale and its domains with CVDs, adjusted for sex, age, BMI, smoking, and diabetes by multiple logistic regression model.
Conclusion
The CAPSES scale was significantly associated with stroke and hypertension. Our findings showed that the CAPSES index can be useful for public health research.
... The main risk factors for CVD in the overall population include dyslipidemia, hypertension, obesity, lack of physical activity, poor nutrition, and smoking [37]. Disease activity scores and inflammation are important risk factors for CVD in RA patients as there is a significant association between them [38]. ...
Background and Objectives: The most frequent cause of mortality in rheumatoid arthritis (RA) patients is cardiovascular disease (CVD). Inflammation, dyslipidemia, and decreased physical activity are some of the main risk factors for CVD. Siwan sand therapy is a type of traditional therapy used in Egypt to treat RA. The approach of this therapy depends on the experience of the healers. The aim of the current study was to compare the effects of three sessions of Siwan traditional therapy to five sessions on common CVD risk factors and physical function in rheumatoid arthritis patients. Materials and Methods: Thirty patients (9 male and 21 female) were assigned into two groups of equal size: group (A) received three sessions of Siwan traditional therapy in the form of a sand bath. Group (B) received the same form of therapy for five days. Erythrocyte sedimentation rate (ESR), lipid profile, atherogenic index of plasma (AIP), and a health assessment questionnaire (HAQ) were measured before and after treatment. Results: There was a significant increase above normal within group (A) for ESR (p = 0.001), triglycerides (TG; p = 0.015), total cholesterol (Tot-Chol; p = 0.0001), and low-density lipoprotein (LDL; p = 0.0001). However, there were no considerable differences in high-density lipoprotein (HDL; p = 0.106), very low-density lipoprotein (VLDL; p = 0.213), AIP (p = 0.648), and HAQ (p = 0.875). For the second group, there were significant changes within group B only in Tot-Chol (p = 0.0001), HDL (p = 0.0001), VLDL (p = 0.0001), AIP (p = 0.008), and HAQ (p = 0.014). There was a significant difference between both groups regarding HDL (p = 0.027), LDL (p = 0.005), AIP (p = 0.029), ESR (p = 0.016), and HAQ (p = 0.036). Conclusions: For RA patients, five days of Siwan traditional therapy caused significant changes regarding inflammation, Tot-Chol, LDL, HDL, AIP, and functional activity when compared to three days of Siwan hot sand therapy.
... An estimated 17.5 million of the 58 million deaths that occurred from all causes in the world in 2005 were attributable to CVD, which is nearly three times the number of deaths brought on by contagious diseases like HIV/AIDS, TB, and malaria put together. More than three-fourths of deaths are predicted to be caused by non-communicable diseases by 2030, with 23.4 million deaths from cardiovascular disease (CVD), a 37% increase from 2004 rates [1], [2]. ...
Atherosclerosis is an inflammatory vascular disease defined by the increasing buildup of cholesterol in the walls of the arteries, and it is a primary contributor to cardiovascular diseases (CVDs). Issues concerning the adverse effects of synthetic treatments have recently resulted in a lack of patient consultations, drug misuse, and, as a result, a disturbance in meticulous disease control. As a result, a new understanding of traditional medicines has recently developed, and much research has been undertaken on such botanicals in an attempt to produce newer naturally based drugs. Santalum album, commonly known as sandalwood is one of the promising botanicals which is rich in α-Santalol. Therefore, the present study aims at exploring the targeting ability of α-Santalol against the protein CD36 which plays a significant part in the development and progression of atherosclerosis. In this research, a computation approach using Autodock4 is carried out which revealed negative binding energy of 9.10Kcal/mol highlighting the potential of α-Santalol for the effective management of cardiovascular diseases like atherosclerosis. However, there is still a need to validate the findings of this research with both, In Vivo and In Vitro studies.
... The worldwide obesity epidemic represents a major health burden, with obesity leading to a spectrum of comorbidities that are the basis for cardiometabolic diseases (CMD). CMD are multifactorial metabolic diseases that can include insulin resistance (IR), type 2 diabetes (T2D), and cardiovascular disease (CVD) [1,2], with other conditions like hyperlipidemia and hypertension also related to CMD. Circulating concentrations of the branched-chain amino acids (BCAAs), isoleucine, leucine, and valine have consistently been associated with CMD and CMD risk factors in various studies [3][4][5]. ...
Background
Branched-chain amino acids (BCAAs; valine, leucine, and isoleucine) are essential amino acids that are associated with an increased risk of cardiometabolic diseases (CMD). However, there are still only limited insights into potential direct associations between BCAAs and a wide range of CMD parameters, especially those remaining after correcting for covariates and underlying causal relationships.
Methods
To shed light on these relationships, we systematically characterized the associations between plasma BCAA concentrations and a large panel of 537 CMD parameters (including atherosclerosis-related parameters, fat distribution, plasma cytokine concentrations and cell counts, circulating concentrations of cardiovascular-related proteins and plasma metabolites) in 1400 individuals from the Dutch population cohort LifeLines DEEP and 294 overweight individuals from the 300OB cohort. After correcting for age, sex, and BMI, we assessed associations between individual BCAAs and CMD parameters. We further assessed the underlying causality using Mendelian randomization.
Results
A total of 838 significant associations were detected for 409 CMD parameters. BCAAs showed both common and specific associations, with the most specific associations being detected for isoleucine. Further, we found that obesity status substantially affected the strength and direction of associations for valine, which cannot be corrected for using BMI as a covariate. Subsequent univariable Mendelian randomization (UVMR), after removing BMI-associated SNPs, identified seven significant causal relationships from four CMD traits to BCAA levels, mostly for diabetes-related parameters. However, no causal effects of BCAAs on CMD parameters were supported.
Conclusions
Our cross-sectional association study reports a large number of associations between BCAAs and CMD parameters. Our results highlight some specific associations for isoleucine, as well as obesity-specific effects for valine. MR-based causality analysis suggests that altered BCAA levels can be a consequence of diabetes and alteration in lipid metabolism. We found no MR evidence to support a causal role for BCAAs in CMD. These findings provide evidence to (re)evaluate the clinical importance of individual BCAAs in CMD diagnosis, prevention, and treatment.
... For example, peripheral arterial disease (PAD) is the thirdmost common cardiovascular disease and is usually associated with other cardiovascular and cerebrovascular diseases and has a high disability and fatality rate. 1,2 More than 220 million patients worldwide experience PAD resulting in intermittent claudication, 3,4 resting pain, extremity ulcers, and limb gangrene, and this number is rapidly increasing due to the aging of the population. It is worth noting that the progress of the disease is hidden, while PAD monitoring is not included in general physical examinations. ...
Abstract Evaluation of the oxygen‐mediated effects of clinical and daily activities demands an on‐skin device that can track multi‐vital regional tissue hemodynamics simultaneously. For example, peripheral arterial disease (PAD) is the third most prevalent cardiovascular disease, but the means of diagnosing and monitoring this disease are limited because the affected area is usually in the non‐pulsatile area away from the heart. Herein, we report on an ultrathin and ultralight multi‐vital near‐infrared optoelectronic biosensor for the diagnosis and rehabilitation monitoring of regional tissue hemodynamics, which is suitable for mounting on the skin for long‐term measurement. The device can simultaneously detect tissue oxygen saturation, heart rate, arterial blood oxygen, and tissue perfusion and shows potential for various hypoxia monitoring applications. Moreover, the tissue hemodynamics detected by this device showed a highly accordance with the ankle‐brachial index and CT angiography obtained by traditional clinical methods. Therefore, our design was able to accurately diagnose and effectively evaluate PAD patients before and after surgery. The on‐skin optoelectronic biosensor shows potential in biological oxygen‐mediated behavior evaluation, injury‐state monitoring, PAD clinical diagnosis optimization, and after surgery care.
... The aging population is increasing in all 195 countries in the world, with the fastest rate of aging shifting away from Europe and North America and toward China and India [2]. These trends have important implications for public health, as the burden of diseases related to older age, ranging from cardiovascular disease [3], to cancer [4], to diabetes [5], to dementia [6], are expected to continue to increase. In addition to the impact of these public health challenges on population well-being, they are expected to cause substantial increases in public and private expenditures on health care [1]. ...
Objective: Population aging is an ongoing challenge for global health policy and is expected to have an increasing impact on developing economies in years to come. A variety of community health programs have been developed to deliver health services to older adults, and evaluating these programs is crucial to improving service delivery and avoiding barriers to implementation. This systematic review examines published evaluation research relating to public and community health programs aimed at older adults throughout the world.
Methods: A literature search using standardized criteria yielded 58 published articles evaluating 46 specific programs in 14 countries.
Results: Service models involving sponsorship of comprehensive facilities providing centralized access to multiple types of health services were generally evaluated the most positively, with care coordination programs appearing to have generally more modest success, and educational programs having limited effectiveness. Lack of sufficient funding was a commonly-cited barrier to successful program implementations.
Conclusion: It is important to include program evaluation as a component of future community and public health interventions aimed at aging populations to better understand how to improve these programs.
... Cardiovascular disease (CVD) is associated with an enormous burden, including a high mortality rate and healthcare cost, worldwide (Leal et al., 2006;Deaton et al., 2011;Fox et al., 2016). Elevated low-density lipoprotein cholesterol (LDL-C) levels are a major risk factor for CVD and are associated with an increased risk of cardiovascular (CV) events and CVD-associated mortality (Pekkanen et al., 1990;Wong et al., 1991;Wilson et al., 1998). ...
Aim: Patients with type 2 diabetes mellitus (T2DM) in South Korea can be reimbursed for statins if they have a low-density lipoprotein cholesterol (LDL-C) level of ≥100 mg/dL. We aimed to explore the clinical and economic benefit received by T2DM patients when easing the current criteria for statin treatment by lowering the LDL-C threshold from 100 mg/dL to 70 mg/dL.
Methods: We used a static course model with a 5-year period to compare the following two scenarios in T2DM patients with no history of cardiovascular (CV) events: the current criteria covering LDL-C ≥100 mg/dL and the revised criteria covering LDL-C ≥70 mg/dL. The number of target patients was estimated based on previous Korean studies on patients with T2DM. The current mix of treatments used for T2DM and costs involving CV events were estimated using the National Health Insurance Service–National Health Screening Cohort database. The baseline CV event rates and case fatality were estimated using NHIS Customized database, including 50% patients who were prescribed atorvastatin and 100% who were not prescribed statins between 2009 and 2012 among patients with T2DM in the entire Korean population. After propensity score matching, patients with T2DM not prescribed statins were followed up until 2018 to estimate the incidence rates of coronary heart disease (CHD) and stroke. The efficacy of atorvastatin for the primary prevention of CV events in patients with T2DM was derived from a pivotal clinical trial. The outcome measures were the number of CV events prevented after the change in criteria and the consequent cost savings.
Results: In South Korea, the current and revised criteria covered 2,434,379 and 3,446,149 patients with T2DM, respectively. The change in criteria resulted in the prevention of 726 CV events and cost savings of US dollars (USD) 5.5 million at the national level and USD 0.0089 per member per month in the fifth year.
Conclusion: Easing the reimbursement criteria for statin treatment among patients with T2DM was associated with a reduction in CV events and their related costs; therefore, changing the reimbursement criteria is worth further consideration to mitigate the burden of CV disease.
... Nowadays, the tendency of sedentary lifestyles also greatly contributes to the development of CVD risk factors, such as obesity, high blood pressure, and smoking [3]. Controlling modifiable risk factors is expected to lower the incidence of NCD, especially CVD. ...
Background. AIP (Atherogenic Index of Plasma) is one of the scores that might estimate the risk of cardiovascular disease. AIP, calculated as the log10 of the plasma concentration of triglyceride compared to high density lipoprotein-C, was shown to be strongly associated with the risk of cardiovascular disease. Aims. This study aims to determine the relationship between atherogenic index of plasma and risk factors for cardiovascular disease. Methods. This analytic observational study with a cross-sectional design was conducted on 3,018 members of the East Java City police force. Data were obtained using complete physical and laboratory examinations that include systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), low-density lipoprotein-C (LDL-C), high-density lipoprotein-C (HDL-C), triglyceride (TG), total cholesterol (TC), and fasting blood glucose (FBG) that were obtained during medical checkup at the State Police Hospital Surabaya. Statistics were performed on SPSS version 22 using the Spearman Rho test and multiple linear regression. Results. AIP correlates with SBP (r = 0.167), DBP (r = 0.108), BMI (r = 0.07), TG (r = 0.915), LDL-C (r = 0.393), TC (r = 0.36), FBG (r = 0.087), and HDL-C (r =-0.0542). Multiple regression shows that SBP (p = 0.01), BMI (p = 0.04), LDL-C (p < 0.05), TC (p < 0.05) and FBG (p < 0.05) affects the AIP value. Conclusion. AIP correlates with other risk factors for cardiovascular disease.
... Moreover, over 71% of deaths in developing and low-income communities are attributed to coronary artery diseases (CADs). [1,2] Atherogenesis, a lipid-driven chronic inflammatory disorder, is a critical principle in CAD pathogenesis. ...
Background:
Plaque instability is a leading cause of morbidity and mortality in coronary artery disease (CAD) patients. Numerous efforts have been made to figure out and manage unstable plaques prior to major cardiovascular events incidence. The current study aims to assess the values of the atherogenic index of plasma (AIP) to detect unstable plaques.
Materials and methods:
The current case-control study was conducted on 435 patients who underwent percutaneous coronary intervention due to chronic stable angina (stable plaques, n = 145) or acute coronary syndrome (unstable plaques, n = 290). The demographic, comorbidities, chronic medications, biochemical and hematological characteristics of the patients were entered into the study checklist. The baseline AIP was measured according to the formula of triglycerides/high-density lipoprotein logarithm. Binary logistic regression was applied to investigate the standalone association of AIP with plaque instability. Receiver operating curve (ROC) was depicted to determine a cut-off, specificity, and sensitivity of AIP in unstable plaques diagnosis.
Results:
AIP was an independent predictor for atherogenic plaque unstability in both crude (odds ratio [OR]: 3.677, 95% confidence interval [CI]: 1.521-8.890; P = 0.004) and full-adjusted models (OR: 15, 95% CI: 2.77-81.157; P = 0.002). According to ROC curve, at cut-point level of 0.62, AIP had sensitivity and specificity of 89.70% and 34% to detect unstable plaques, respectively (area under the curve: 0.648, 95% CI: 0.601-0.692, P < 0.001).
Conclusion:
According to this study, at the threshold of 0.62, AIP as an independent biomarker associated with plaque instability can be considered a screening tool for patients at increased risk for adverse events due to unstable atherosclerotic plaques.
... Stroke is the second most common cause of death worldwide after coronary heart disease. 1 In Korea, stroke accounts for a large proportion of the disease population, ranking fourth in mortality. Fortunately, a decline in stroke mortality over the last few decades has been observed in many countries. ...
Purpose:
To analyze trends in mortality rates from hemorrhagic stroke (HS) according to HS subtypes, using nationwide data from January 2012 to December 2020.
Materials and methods:
We used data from the National Health Claims Database provided by the National Health Insurance Service for 2012-2020 using the International Classification of Disease. The age-adjusted mortality rates of HS, which included subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), were calculated, and additional analyses were conducted according to age and sex.
Results:
The age-adjusted mortality rates for HS, SAH, and ICH decreased substantially in both sexes between 2012 and 2020. During the study period, mortality rates for HS decreased from 8.87 deaths per 100,000 inhabitants to 6.27 deaths per 100,000 inhabitants. Regarding SAH, mortality rates decreased from 3.72 deaths per 100,000 inhabitants to 2.57 deaths per 100,000 inhabitants. Concerning ICH, mortality rates decreased from 6.91 deaths per 100,000 inhabitants to 4.75 deaths per 100,000 inhabitants. The average annual percentage change for HS, SAH, and ICH was -0.04, -0.04, and -0.05, respectively. Mortality rates from HS, SAH, and ICH in both sexes decreased from 2012 to 2020 in all age groups.
Conclusion:
In Korea, the age-adjusted mortality rate of HS, SAH, and ICH demonstrated a declining trend in both sexes and across all age groups. These results may aid in the design and improvement of preventive strategies.
... Hypertension is still a major health issue that affects millions of people. It is a major significant risk factor for cardiovascular events which are the world's leading causes of death (1). The risk of diabetes and cardiovascular disease is increased in patients with uncontrolled hypertension (2). ...
Background:
Hypertension is a key risk factor for ischemic heart disease and atherosclerosis. Most patients require a combination of antihypertensive medications to accomplish their therapeutic goals. Antihypertensive medicines such as calcium channel blockers and angiotensin receptor blockers are indicated for patients whose high blood pressure cannot be controlled with monotherapy. The combination of Amlodipine besylate (AML) with Irbesartan (IRB) is an example of this synergistic activity in lowering blood pressure.
Objective:
In this regard, the goal of the research is to develop sensitive spectrophotometric methods for the simultaneous determination of Amlodipine besylate and Irbesartan.
Methods:
Three simple ratio spectra manipulating spectrophotometric methods namely, ratio difference, mean centering of ratio spectra and derivative ratio were developed for the simultaneous assay of the cited mixture.
Results:
Linear correlations were attained over the concentration range of 1-35 μg/mL and 2-35 μg/mL for Amlodipine besylate and Irbesartan, respectively. The methods were validated according to the ICH guidelines with good results.
Conclusion:
Eventually, the introduced methods were successfully applied for the assay of the cited drugs in their marketed formulation. They could be efficiently used for routine analysis of the mentioned drugs in quality control laboratories.
Highlights:
The proposed approaches do not require expensive solvents or complex instruments. They could be used in routine laboratory tests where the time and cost are crucial.
... One of the most common causes of death in the world is cardiovascular disease(1), so it is predicted that at least 30.5% of deaths will occur due to cardiovascular diseases in the next ten years (2). Mortality due to cardiovascular diseases in Iran is also significant, so that 26% of deaths in the middle-aged population were due to cardiovascular disease (3). ...
Background: The quality of life of patients after percutaneous coronary interventions (PCI) is definitely not clear. The aim of this study was to evaluate the health-related quality of life (HRQL) and related factors in patients undergoing angioplasty. Methods: This analytical cross-sectional study was performed on patients with coronary artery disease who underwent PCI and had a history of hospitalization in Zanjan, Iran in 2020. 920 patients based on specific inclusion and exclusion criteria were included by census method.The study tool was a 36-item Short Form Health Survey questionnaire)SF-36). Mann-Whitney U test and Kruskal-Wallis tests were used to data analysis in SPSS 19 with a significance level of 5%. Results: In total, 70%(644people) were female, 86% (791) angina, 34.2% (315) Myocardial infarction. median (IQR) of age, Physical Component Summary(PCS), and Mental component summary (MCS) were 60 (15), 65.78(9.48), 64.18 (7.68), respectively. Multivariate linear regression showed that PCI type (B=-2.52, p=0.013) and age (B= -0.21,p<0.001) had a negative effect and education level(B=3.15, p=0.002), income(B=1.34, p=0.002), angina(B=1.27, p=0.02) and number of drugs(B=0.609, p<0.001) had a positive effect on PCS. Also, PCI type (B=-3.024, p=0.001), age(B=-0.123, p<0.001), diabetes(B=-1.19, p=0.008), blood pressure(B=-0.728, p=0.05) and duration of disease(B=-0.309, p=0.022) had a negative effect and education, income(B=2.57, p=0.022), number of drugs(B=0.615, p<0.001) had a positive effect on MCS. Conclusion: Age, type of PCI, diabetes, blood pressure, level of education, income were the most important factors related to HRQL of cardiovascular patients undergoing coronary angioplasty. Therefore, to improve the HLQL, these factors must be considered.
... Around a third of all deaths worldwide are due to cardiovascular disease (CVD), which has now become a global burden. 1 Given this enormous burden, it remains imperative to find early risk factors related to the development of cardiovascular disease that can focus and inform preventive measures or facilitate the adoption of approaches that promote healthy behaviors and attitudes throughout life. 2 Friedman and Rosenman first identified and described a relationship between personality and cardiovascular diseases. 3 Type A behavior was described by two cardiologists in 1959 as an action-emotion complex that can be observed in any person who is aggressively involved in a chronic, relentless struggle for multiple goals to be achieved at the same time. ...
Objective: To assess the cardiac autonomic functions in healthy adults with type A and type B personalities using heart rate variability (HRV) analyses. Methods: Two personality groups [Type A (n = 30) and Type B (n = 30)] Subjects based on the Hunter-Wolf Personality Questionnaire Scale were recruited from the Psychiatry Department of VMMC and Safdarjung Hospital, New Delhi, India. HRV parameters (LF, HF, LF: HF ratio, SDNN, RMSSD, total power and pNN50) were recorded for each subject. Data was compiled and analyzed with the help of SPSS Version 21.0. Results: In type A, RMSSD (41.21 ± 19.50 ms vs 45.56 ± 30.21 ms, p=1.000) and pNN50 (19.14 ± 16.59 ms vs 22.80 ± 22.90 ms, p=0.865) were lower than in type B. SDNN (49.87 ± 18.15 vs 48.13 ± 23.06 ms, p=0.469) was higher in type A than in type B. Frequency domain parameters like LF (928.27 ± 1002.50 ms2 vs 759.97 ± 581.75 ms2, p=0.734) and HF (1320.35 ± 1671.37 ms2 vs 1015.68 ± 845 ms2) were higher for type B compared to type A. The total power for type B was higher compared to type A (3052.50 ± 3197.96 ms2 vs 2857.15 ± 1893.20 ms2, p=0.46).
... Cardiovascular disease (CVD) represents today's main cause of disability worldwide with repercussions on national health systems in terms of escalating costs and beyond. Unfortunately, such diseases are characterized by asymptomatic nature with sporadic clinical manifestations resulting in an arduous evaluation during routine followup [3]. Thus, the role of continuous cardiovascular monitoring recently received high attention to overcome these issues, leading to novel clinical outcomes for the CVD diagnosis and treatment [4]. ...
Novel dry electrodes are increasingly evolving for monitoring electrocardiograms compared to the widely used
Ag/AgCl
(wet) electrodes as there is no skin preparation or wet gel needed. Many fabricated dry electrodes are however opaque, and the problem of skin irritation and rashes continue to pose a concern. In this paper, an optically unobtrusive dry electrode based on the iono-electric properties of zeolite is developed and proposed for continuous electrocardiogram (ECG) monitoring. An easily moldable composite of the sodium form of nano-porous zeolite and polydimethylsiloxane (PDMS) is reported for the first time. The electrical and bio-electrical characterizations are evaluated for 24 pairs of electrodes which were fabricated with two filler materials (Zeolite 4A and 13X), two filler concentrations (4 wt% and 12 wt%), three diameters (30 mm, 20 mm, and 10 mm), and differing thicknesses. High input impedance and high conductivity of the electrodes have proven the suitability for biosignal acquisition. ECG signals are acquired using each pair of electrodes. Results related to impedance, conductivity, and SNR measurements over a frequency range up to 10 kHz are presented. Among the 24 pairs, the results indicate that signal-to-noise ratio (SNR) for Zeolite 13X/PDMS- based filler with a concentration of 4 wt% and diameter of 30 mm has the highest SNR of 42.9 dB and conductivity of
$0.58 \mu \text{S}$
/mm. These electrodes are optically unobtrusive and easy to fabricate. Hence this process yields promising results for the next generation of wearable cardiovascular heart monitoring systems.
... Type 'A' personalities are more prone to stress and cardiovascular diseases. Cardiovascular disease (CVD) is a global burden and cause about one-third of all death worldwide [12]. The state of cardiovascular health can be measured by heart rate variability (HRV). ...
... Despite recent developments, coronary artery disease (CAD) remains the leading cause of death across the world. Myocardial infarction (MI) is known as the most severe presentation of CAD and CAD accounts for 30% of all mortalities (3). Each year, three million people expe-rience ST-segment elevation MI (STEMI) and also non-STsegment elevation MI (NSTEMI) was estimated to occur in about four million (4). ...
Introduction:
TIMI (Thrombolysis in Myocardial Infarction) score is a model for predicting the severity of vascular diseases. This study aimed to evaluate the correlation between this score and the number of vessels involved in patients with Unstable Angina (UA) or Non-ST Elevation Myocardial Infarction (NSTEMI).
Methods:
This prospective cross-sectional study was designed to evaluate the correlation between TIMI score, and the number of vessels involved in the angiographic study of NSTEMI and UA patients presenting to emergency department.
Results:
297 patients with the mean age of 62.16±36.59 years were entered (58.2% male; 193 (65%) UA and 104 (35%) NSTEMI). The Mean TIMI score among patients was 3.21±1.55. Based on the TIMI score, patients were categorized into 3 groups. 105 (35.35%) patients had a TIMI score of 0 to 2, 120 (40.40%) had a score of 3 to 4, and 72 (24.24%) had a score of 5 to 7. Patients with a TIMI score of 5 to 7 had a greater likelihood of three-vessel coronary artery disease compared to patients with a TIMI score of 3 to 4 (OR: 5.34, 95% CI: 2.64 to 10.80; p < 0.0001) or those with a TIMI score of 0 to 2. (OR: 29.45, 95% CI: 12.87 to 67.37; p < 0.0001). Two-vessel coronary artery disease was more likely to be found in patients with a TIMI score of 3 to 4 or those with a score of 5 to 7 compared to patients with a TIMI score of 0 to 2 (OR: 3.69, 95% CI: 1.60 to 8.51; p <0.0001 and OR: 2.67, 95% CI: 1.04 to 6.82; p = 0.04, respectively).
Conclusion:
There is a direct and significant correlation between TIMI score and the number of coronary vessels involved in patients presenting to emergency department following UA or NSTEMI.
Cerebrovascular events are linked to ankylosing spondylitis. Accelerated atherosclerosis and endothelial dysfunction against a backdrop of inflammation have been widely blamed for the increased cerebrovascular risk in ankylosing spondylitis. The absence of a comprehensive review encouraged us to consider the link between ankylosing spondylitis and cerebrovascular diseases. Web of Science, PubMed, Medline, Scopus, and EMBASE were searched to identify studies published from 2000 to June 10, 2023. All observational and cohort studies reporting myocardial infarction or stroke and considering classic cerebrovascular risk in ankylosing spondylitis patients and healthy controls were included. Most of the included studies reported that the risk of cerebrovascular disorders was greater in ankylosing spondylitis than in the general population. Also, most studies showed that for both sexes, the prevalence of cardiovascular illnesses rose with age, and this trend was consistent across all subgroups of cardiovascular disorders. Also, most studies reported that the rate of cerebrovascular accidents in ankylosing spondylitis patients was higher than in control groups. Some studies reported that the risk of developing an ischemic stroke was higher in young patients with ankylosing spondylitis, while others did not. Our systematic analysis found that most studies agreed that ankylosing spondylitis patients had a higher risk of cerebrovascular diseases than the general population. Still, this increased risk was influenced by several factors that need further research exploration.
Cardiovascular diseases (CVDs) can be described as a global health emergency imploring possible prevention strategies. Although the pathogenesis of CVDs has been extensively studied, the role of mitochondrial dysfunction in CVD development has yet to be investigated. Diabetic cardiomyopathy, ischemic-reperfusion injury, and heart failure are some of the CVDs resulting from mitochondrial dysfunction Recent evidence from the research states that any dysfunction of mitochondria has an impact on metabolic alteration, eventually causes the death of a healthy cell and therefore, progressively directing to the predisposition of disease. Cardiovascular research investigating the targets that both protect and treat mitochondrial damage will help reduce the risk and increase the quality of life of patients suffering from various CVDs. One such target, i.e., nuclear sirtuin SIRT6 is strongly associated with cardiac function. However, the link between mitochondrial dysfunction and SIRT6 concerning cardiovascular pathologies remains poorly understood. Although the Role of SIRT6 in skeletal muscles and cardiomyocytes through mitochondrial regulation has been well understood, its specific role in mitochondrial maintenance in cardiomyocytes is poorly determined. The review aims to explore the domain-specific function of SIRT6 in cardiomyocytes and is an effort to know how SIRT6, mitochondria, and CVDs are related.
6‐benzylaminopurine (6‐BA), a multifunctional plant growth regulator, which is frequently used worldwide to improve qualities of various crops, is an important ingredient in production of “toxic bean sprouts.” Although there is no direct evidence of adverse effects, its hazardous effects, as well as joint toxicity with other chemicals, have received particular attention and aroused furious debate between proponents and environmental regulators. By use of human umbilical vein endothelial cells (HUVECs), adverse effects of 6‐BA to human‐derived cells were first demonstrated in this study. A total of 25–50 mg 6‐BA/L inhibited proliferation, migration, and formation of tubular‐like structures by 50% in vitro. Results of Western blot analyses revealed that exposure to 6‐BA differentially modulated the MAPK signal transduction pathway in HUVECs. Specifically, 6‐BA decreased phosphorylation of MEK and ERK, but increased phosphorylation of JNK and P38. In addition, 6‐BA exacerbated atorvastatin‐induced cerebral hemorrhage via increasing hemorrhagic occurrence by 60% and areas by 4 times in zebrafish larvae. In summary, 6‐BA elicited toxicity to the endothelial system of HUVECs and zebrafish. This was due, at least in part, to discoordination of MAPK signaling pathway, which should pose potential risks to the cerebral vascular system.
Single nucleotide polymorphisms of the TCF7L2, HHEX, SLC30A8, MTNR1B, SLC2A2 and GLIS3 genes are well established candidate genes for cardiometabolic diseases (CMDs) across different ethnic populations. We investigated their association with CMDs in a mixed ancestry population of South Africa. rs10830963, rs1111875, rs11920090, rs13266634, rs7034200 and rs7903146 SNPs were genotyped by quantitative real time PCR in 1650 participants and Hardy–Weinberg equilibrium (HWE) analyses performed on the SNPs. Diabetes, obesity, hypertension and cardiometabolic traits were compared across genotypes of SNPs in HWE. Linear and logistic regressions adjusting for age, gender and body mass index were used to determine the risk of T2DM, obesity and hypertension. rs7903146 (p = 0.055), rs1111875 (p = 0.465), rs13266634 (p = 0.828), and rs10830963 (p = 0.158) were in HWE. The rs10830963 recessive genotype was able to predict FPG, insulin and HOMA-IR, while the rs1111875 recessive genotype was able to predict total cholesterol, triglyceride, LDL cholesterol and FPG. The rs7903146 recessive genotype was able to predict SBP and LDL cholesterol. The recessive genotypes of MTNRIB and HHEX SNPs were associated with T2DM traits in the study population and could partially explain the high prevalence of T2DM. Further studies are required to confirm these findings and establish candidate genes in the African population.
Dyslipidemia is an important risk factor for cardiovascular morbidity and mortality. Although low-density lipoprotein (LDL) is primarily responsible, the importance of triglyceride (TG) and high-density lipoprotein (HDL) has also been recognized. The present study investigated the effect of the atherogenic index of plasma (AIP), in which atherogenic and protective lipoproteins were evaluated together, on the initial flow in patients with ST elevation myocardial infarction. AIP was calculated as log(TG/HDL-cholesterol). Patients included in the study (n = 1535) were divided into Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 and >0. AIP was found to be significantly different between 2 groups (.55 ± .23 vs .67 ± .21; P < .001). AIP was an independent predictor for pre-intervention TIMI flow (Odds Ratio: 2.778). A moderate correlation was found between TIMI frame count measurements, calculated in patients with TIMI 2-3, and AIP (Pearson correlation coefficient: .63, P < .001). In the receiver operating characteristic analysis, AIP showed the highest area under curve (AUC) compared with other lipid parameters for predicting vascular patency. The AUC of AIP was .634, the cut-off value was .59, and the sensitivity and specificity were 67.6% and 68.4%, respectively (P < .001). In conclusion, AIP was found to be an important marker affecting pre-percutaneous coronary intervention TIMI flow.
Background
Developing global evidence on the influence of health-related behaviors (e.g., sedentary behavior, diet) and mobility limitations on health requires global consortia from diverse sets of countries. Thus, the purpose was to translate and culturally adapt (i) the Sedentary Behavior Questionnaire (SBQ); (ii) the Dietary Habits Questionnaire adapted from the Survey of Health, Aging and Retirement in Europe (SHARE) study; (iii) the Preclinical Mobility Limitation questionnaire for use in the Saudi Arabian context.Method50 adult Saudi participants (mean age 41.7±9.6, 48% female) participated in this study. We followed a systematic cross-cultural adaptation process that involved forward translation, synthesis, back-translation, expert panel, and pre-testing (cognitive interviewing). Four rounds of cognitive interviews were held with 40 participants for the SBQ, SHARE questionnaire, and the Preclinical Mobility Limitation questionnaire, an additional round was needed for the Preclinical Mobility Limitation questionnaire. Descriptive data (means ± standard deviations and frequencies with percentages) were reported for characteristics.ResultWith some minor changes to the questionnaires, the SBQ, Dietary Habits, and Preclinical Mobility Limitation questionnaires were translated and cross-culturally adapted into Arabic. 100% of the participants confirmed that the resulting Arabic versions of the SBQ, Dietary Habits questionnaire, and Preclinical Mobility Limitation questionnaires were appropriate and fully understandable for Arabic speakers in communicating the intended meanings of the items in each. For example, item SBQ1, 'Watching television (including videos on VCR/DVD)' was changed to 'Sitting and watching television or videos (including smartphones, tablets)'.Conclusion
The SBQ, Dietary Habits questionnaire, and Preclinical Mobility Limitation questionnaire were successfully cross-culturally adapted into Arabic and are now ready for use in Saudi Arabian.
Although continuous treatment leads to better patient outcomes, evidence regarding the effect of the continuity of care (COC) on preventable hospitalisation and medical expenses in Korea for patients with dyslipidaemia is insufficient. We evaluated the effect of COC on preventable hospitalisation and medical expenses for patients with dyslipidaemia. This study used National Health Insurance Sampling cohort data (2008–2015). We measured COC with the Bice–Boxerman index based on the outpatient visits of patients diagnosed with dyslipidaemia for the first time. Preventable hospitalisation included admission for cardiovascular disease (CVD) and all costs for outpatient visits. We evaluated the association of COC with preventable hospitalisation and medical expenses using a generalised estimating equation model. Patients (N = 53,372) with newly diagnosed dyslipidaemia participated. Compared to non‐hospitalised patients, hospitalised patients had higher fragmentation scores for CVD, met more healthcare providers, had higher total outpatient visits and had a lower proportion of primary healthcare providers served. A higher fragmentation score was associated with an increased risk of hospitalisation (rate ratio [RR]: 1.873, 95% confidence interval [CI]: 1.520–2.309) and healthcare expenditure (RR: 1.381, 95% CI: 1.322–1.442). The magnitude of the effect of COC on hospitalisation differed according to patients' drug intake and residence location. Fragmentation of care was associated with preventable hospitalisation and increased healthcare costs, especially for patients taking medications/living in rural areas. It is necessary to promote a more effective COC.
Purpose of review:
Enabled by widespread technological advancements, electronic health (eHealth) strategies have expanded rapidly over the last decade, presenting opportunities to support self-management including medication adherence for cardiometabolic disease control. eHealth can minimize access barriers to medications, enable timely assessment and shared decision-making, and provide medication reminders and health data feedback. This review summarizes current evidence for effectiveness of eHealth strategies for improving medication adherence in patients with hypertension, type 2 diabetes, and/or hyperlipidemia, and identifies priorities for future research.
Recent findings:
Current research supports the effectiveness of eHealth strategies to improve medication adherence and clinical outcomes for cardiometabolic disease. Although patient acceptability of eHealth strategies is generally high, engagement may decline over time. In addition, differences in effectiveness across intervention characteristics and sociodemographic groups are understudied, limiting generalizability and tailoring of interventions to local health system resources, culture, and patient needs or preferences.
Summary:
eHealth is a promising tool for addressing low medication adherence. Further work incorporating rigorous evaluation, assessment of patient engagement over time and effectiveness of intervention characteristics and components, and a health equity lens addressing eHealth use in vulnerable groups will increase understanding of the full potential of eHealth for improving medication adherence in diverse patients with cardiometabolic disease.
he initial Guide to the Primary Prevention of Cardiovas- cular Diseases was published in 1997 as an aid to healthcare professionals and their patients without established coronary artery disease or other atherosclerotic diseases. 1 It was intended to complement the American Heart Association (AHA)/American College of Cardiology (ACC) Guidelines for Preventing Heart Attack and Death in Patients with Atherosclerotic Cardiovascular Disease (updated2) and to provide the healthcare professional with a comprehensive approach to patients across a wide spectrum of risk. The imperative to prevent the first episode of coronary disease or stroke or the development of aortic aneurysm and peripheral arterial disease remains as strong as ever because of the still-high rate of first events that are fatal or disabling or require expensive intensive medical care. The evidence that most cardiovascular disease is preventable continues to grow. Results of long-term prospective studies consistently identify persons with low levels of risk factors as having lifelong low levels of heart disease and stroke. 3,4 Moreover, these low levels of risk factors are related to healthy lifestyles. Data from the Nurses Health Study,5 for example, suggest that in women, maintaining a desirable body weight, eating a healthy diet, exercising regularly, not smoking, and consuming a moderate amount of alcohol could account for an 84% reduction in risk, yet only 3% of the women studied were in that category. Clearly, the majority of the causes of cardio- vascular disease are known and modifiable.
To determine the effect of education and other measures of socioeconomic status (SES) on risk of acute myocardial infarction (AMI) in patients and controls from countries with diverse economic circumstances (high, middle, and low income countries).
Case-control study.
52 countries from all inhabited regions of the world.
12242 cases and 14622 controls.
First non-fatal AMI.
SES was measured using education, family income, possessions in the household and occupation. Low levels of education (< or =8 years) were more common in cases compared to controls (45.0% and 38.1%; p<0.0001). The odds ratio (OR) for low education adjusted for age, sex and region was 1.56 (95% confidence interval 1.47 to 1.66). After further adjustment for psychosocial, lifestyle, other factors and mutually for other socioeconomic factors, the OR associated with education < or =8 years was 1.31 (1.20 to 1.44) (p<0.0001). Modifiable lifestyle factors (smoking, exercise, consumption of vegetables and fruits, alcohol and abdominal obesity) explained about half of the socioeconomic gradient. Family income, numbers of possessions and non-professional occupation were only weakly or not at all independently related to AMI. In high-income countries (World Bank Classification), the risk factor adjusted OR associated with low education was 1.61 (1.33 to 1.94), whereas it was substantially lower in low-income and middle-income countries: 1.25 (1.14 to 1.37) (p for interaction 0.045).
Of the SES measures we studied, low education was the marker most consistently associated with increased risk for AMI globally, most markedly in high-income countries.
To assess life expectancy in relation to cardiovascular risk factors recorded in middle age.
Prospective cohort study.
Men employed in the civil service in London, England.
18 863 men examined at entry in 1967-70 and followed for 38 years, of whom 13,501 died and 4811 were re-examined in 1997.
Life expectancy estimated in relation to fifths and dichotomous categories of risk factors (smoking, "low" or "high" blood pressure (>or=140 mm Hg), and "low" or "high" cholesterol (>or=5 mmol/l)), and a risk score from these risk factors.
At entry, 42% of the men were current smokers, 39% had high blood pressure, and 51% had high cholesterol. At the re-examination, about two thirds of the previously "current" smokers had quit smoking shortly after entry and the mean differences in levels of those with high and low levels of blood pressure and cholesterol were attenuated by two thirds. Compared with men without any baseline risk factors, the presence of all three risk factors at entry was associated with a 10 year shorter life expectancy from age 50 (23.7 v 33.3 years). Compared with men in the lowest 5% of a risk score based on smoking, diabetes, employment grade, and continuous levels of blood pressure, cholesterol concentration, and body mass index (BMI), men in the highest 5% had a 15 year shorter life expectancy from age 50 (20.2 v 35.4 years).
Despite substantial changes in these risk factors over time, baseline differences in risk factors were associated with 10 to 15 year shorter life expectancy from age 50.
Abstract Background Cardiovascular risk factors start early, track through the young age and manifest in middle age in most societies. We conducted epidemiological studies to determine prevalence and age-specific trends in cardiovascular risk factors among adolescent and young urban Asian Indians. Methods Population based epidemiological studies to identify cardiovascular risk factors were performed in North India in 1999–2002. We evaluated major risk factors-smoking or tobacco use, obesity, truncal obesity, hypertension, dysglycemia and dyslipidemia using pre-specified definitions in 2051 subjects (male 1009, female 1042) aged 15–39 years of age. Age-stratified analyses were performed and significance of trends determined using regression analyses for numerical variables and Χ2 test for trend for categorical variables. Logistic regression was used to identify univariate and multivariate odds ratios (OR) for correlation of age and risk factors. Results In males and females respectively, smoking or tobacco use was observed in 200 (11.8%) and 18 (1.4%), overweight or obesity (body mass index, BMI ≥ 25 kg/m2) in 12.4% and 14.3%, high waist-hip ratio, WHR (males > 0.9, females > 0.8) in 15% and 32.3%, hypertension in 5.6% and 3.1%, high LDL cholesterol (≥ 130 mg/dl) in 9.4% and 8.9%, low HDL cholesterol (
The scarce amount of data available in Brazil on the economic burden of cardiovascular diseases (CVD) does not justify the growing concern in regard to the economic burden involved.
The present study aims at estimating the costs of severe CVD cases in Brazil.
Cases of severe CVD were estimated based on hospitalized cases lethality and total CVD mortality rates. National data bases and sample studies were used to estimate costs of hospitalization, outpatient care, and social security benefits. Loss of income was estimated from the Burden of Disease in Brazil data.
Approximately two million cases of severe CVD were reported in 2004 in Brazil. That accounts for 5.2% of the population over 35 years of age. The resulting annual cost was at least R$ 30.8 billion (36.4% for health care, 8.4% for social security and employers' reimbursements, and 55.2% due to loss in productivity). That corresponded to R$ 500.00 per capita (considering 35 year-old and older population) and R$ 9,400.00 per patient. Direct costs with health care from severe CVD cases accounted for 8% of total national expenditure on health and 0.52% of 2004 GNP (R$ 1,767 billion = US$ 602 billion). That corresponded to an yearly average direct cost of R$182.00 per capita (R$ 87.00 from public resources) and of R$ 3,514.00 per case.
Total annual costs per severe CVD case were estimated to be significant. Costs per capita and total costs corresponding to this sub-group of CVD patients are expected to escalate as the population ages and the prevalence of severe cases increases.
To clarify the determinants of contemporary trends in mortality from coronary heart disease (CHD), we conducted surveillance of hospital admissions for myocardial infarction and of in-hospital and out-of-hospital deaths due to CHD among 35-to-74-year-old residents of four communities of varying size in the United States (a total of 352,481 persons in 1994). Between 1987 and 1994, we estimate that there were 11,869 hospitalizations for myocardial infarction (on the basis of 8572 hospitalizations sampled) and 3407 fatal coronary events (3023 sampled).
The largest average annual decrease in mortality due to CHD occurred among white men (change in mortality, -4.7 percent; 95 percent confidence interval, -2.2 to -7.1 percent), followed by white women (-4.5 percent; 95 percent confidence interval, -0.7 to -8.2 percent), black women (-4.1 percent; 95 percent confidence interval, -10.3 to +2.5 percent), and black men (-2.5 percent; 95 percent confidence interval, -6.9 to +2.2 percent). Overall, in-hospital mortality from CHD fell by 5.1 percent per year, whereas out-of-hospital mortality declined by 3.6 percent per year. There was no evidence of a decline in the incidence of hospitalization for a first myocardial infarction among either men or women; in fact, such hospital admissions increased by 7.4 percent per year (95 percent confidence interval for the change, +0.5 to +14.8 percent) among black women and 2.9 percent per year (95 percent confidence interval, -3.6 to +9.9 percent) among black men. Rates of recurrent myocardial infarction decreased, and survival after myocardial infarction improved.
From 1987 to 1994, we observed a stable or slightly increasing incidence of hospitalization for myocardial infarction. Nevertheless, there were significant annual decreases in mortality from CHD. The decline in mortality in the four communities we studied may be due largely to improvements in the treatment and secondary prevention of myocardial infarction.
To estimate the fall in coronary heart disease (CHD) mortality in Scotland attributable to medical and surgical treatments, and risk factor changes, between 1975 and 1994.
A cohort model combining effectiveness data from meta-analyses with information on treatment uptake in all patient categories in Scotland.
The whole Scottish population of 5.1 million, including all patients with recognised CHD.
All cardiological, medical, and surgical treatments, and all risk factor changes between 1975 and 1994. Data were obtained from epidemiological surveys, routine National Health Service sources, and local audits.
Deaths from CHD in 1975 and 1994.
There were 15 234 deaths from CHD in 1994, 6205 fewer deaths than expected if there had been no decline from 1975 mortality rates. In 1994, the total number of deaths prevented or postponed by all treatments and risk factor reductions was estimated at 6747 (minimum 4790, maximum 10 695). Forty per cent of this benefit was attributed to treatments (initial treatments for acute myocardial infarction 10%, treatments for hypertension 9%, for secondary prevention 8%, for heart failure 8%, aspirin for angina 2%, coronary artery bypass grafting surgery 2%, and angioplasty 0.1%). Fifty one per cent of the reduction in deaths was attributed to measurable risk factor reductions (smoking 36%, cholesterol 6%, secular fall in blood pressure 6%, and changes in deprivation 3%). Other, unquantified factors apparently accounted for the remaining 9%. These proportions remained relatively consistent across a wide range of assumptions and estimates in a sensitivity analysis.
Medical treatments and risk factor changes apparently prevented or postponed about 6750 coronary deaths in Scotland in 1994. Modest gains from individual treatments produced a large cumulative survival benefit. Reductions in major risk factors explained about half the fall in coronary mortality, emphasising the importance and future potential of prevention strategies.
Cardiovascular diseases caused 2.3 million deaths in India in the year 1990; this is projected to double by the year 2020. Hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. Indian urban population studies in the mid-1950s used older WHO guidelines for diagnosis (BP > or =160 and/or 95 mmHg) and reported hypertension prevalence of 1.2-4.0%. Subsequent studies report steadily increasing prevalence from 5% in 1960s to 12-15% in 1990s. Hypertension prevalence is lower in the rural Indian population, although there has been a steady increase over time here as well. Recent studies using revised criteria (BP > or =140 and/or 90 mmHg) have shown a high prevalence of hypertension among urban adults: men 30%, women 33% in Jaipur (1995), men 44%, women 45% in Mumbai (1999), men 31%, women 36% in Thiruvananthapuram (2000), 14% in Chennai (2001), and men 36%, women 37% in Jaipur (2002). Among the rural populations, hypertension prevalence is men 24%, women 17% in Rajasthan (1994). Hypertension diagnosed by multiple examinations has been reported in 27% male and 28% female executives in Mumbai (2000) and 4.5% rural subjects in Haryana (1999). There is a strong correlation between changing lifestyle factors and increase in hypertension in India. The nature of genetic contribution and gene-environment interaction in accelerating the hypertension epidemic in India needs more studies. Pooling of epidemiological studies shows that hypertension is present in 25% urban and 10% rural subjects in India. At an underestimate, there are 31.5 million hypertensives in rural and 34 million in urban populations. A total of 70% of these would be Stage I hypertension (systolic BP 140-159 and/or diastolic BP 90-99 mmHg). Recent reports show that borderline hypertension (systolic BP 130-139 and/or diastolic BP 85-89 mmHg) and Stage I hypertension carry a significant cardiovascular risk and there is a need to reduce this blood pressure. Population-based cost-effective hypertension control strategies should be developed.
Coronary artery disease (CAD) is the leading cause of cardiovascular mortality worldwide, with >4.5 million deaths occurring in the developing world. Despite a recent decline in developed countries, both CAD mortality and the prevalence of CAD risk factors continue to rise rapidly in developing countries. The objectives of the current article are to review (1) the literature regarding CAD mortality and the prevalence of CAD risk factors in the developing world, and (2) prevention and control measures.
We conducted a MEDLINE search of the English language literature for the years 1990 to 2002 to identify articles pertaining to the prevalence of CAD in developing countries. The search was performed using the following key terms: coronary artery disease, developing countries, ischemic heart disease, incidence, prevalence, prevention and risk factors. We also obtained relevant statistical information from The World Health Organization's Internet database.
There is a paucity of data regarding CAD and its prevalence in the developing world. However, it is projected that CAD mortality rates will double from 1990 to 2020, with approximately 82% of the increase attributable to the developing world. Existing data suggest that rapid socioeconomic growth in developing countries is increasing exposure to risk factors for CAD, such as diabetes, genetic factors, hypercholesterolemia, hypertension, and smoking. There is a relative lack of prevention and control measures to decrease exposure to these risk factors in developing countries.
Documented information on the prevalence of CAD in developing countries is sparse, but there is sufficient data to suggest an impending epidemic. Prevention and targeted control of risk factors for CAD could potentially reduce the impact of CAD in the developing world as it has in industrialized nations.
Narghile (waterpipe) smoking is increasing in all Arab societies, but little is known about its pattern of use.
In 2003, a cross-sectional survey was conducted among students at Aleppo University using an interviewer-administered questionnaire. A representative sample of 587 students participated (278 males, 309 females; mean age 21.8 +/- 2.1 years; response rate 98.8%).
Ever narghile smoking was seen among 62.6% of men and 29.8% of women, while current smoking was seen among 25.5% of men and 4.9% of women. Only 7.0% of the men used narghile daily. Age of initiation was 19.2 +/- 2.2 and 21.7 +/- 3.2 years for men and women, respectively (P < 0.001). The salient feature of narghile smoking was its social pattern, where most users initiated and currently smoked narghile with friends. Narghile and cigarette smoking were related among students, with narghile smoking most prevalent among daily cigarette smokers. Multivariate correlates of narghile smoking were being older, male, originating from the city, smoking cigarettes, having friends who smoke narghile, and coming from a household where a greater number of narghiles were smoked daily.
Narghile smoking is prevalent among university students in Syria, where it is mainly practiced by men, intermittently, and in the context of social activities with friends.
The global tobacco epidemic may kill 10 million people annually in the next 20-30 years, with 70% of these deaths occurring in developing countries. Current research, treatment, and policy efforts focus on cigarettes, while many people in developing regions (Asia, Indian subcontinent, Eastern Mediterranean) smoke tobacco using waterpipes. Waterpipes are increasing in popularity, and more must be learned about them so that we can understand their effects on public health, curtail their spread, and help their users quit.
To conduct a comprehensive review regarding global waterpipe use, in order to identify current knowledge, guide scientific research, and promote public policy.
A Medline search using as keywords "waterpipe", "narghile", "arghile", "shisha", "hookah", "goza", "hubble bubble" and variant spellings (for example, "hooka"; "hukka") was conducted. Resources compiled recently by members of GLOBALink were used.
Every identified published study related to waterpipe use was included.
Research regarding waterpipe epidemiology and health effects is limited; no published studies address treatment efforts. Waterpipe use is increasing globally, particularly in the Eastern Mediterranean Region, where perceptions regarding health effects and traditional values may facilitate use among women and children. Waterpipe smoke contains harmful constituents and there is preliminary evidence linking waterpipe smoking to a variety of life threatening conditions, including pulmonary disease, coronary heart disease, and pregnancy related complications.
More scientific documentation and careful analysis is required before the spread of waterpipe use and its health effects can be understood, and empirically guided treatment and public policy strategies can be implemented.
We estimated life-years gained from cardiological treatments and cardiovascular risk factor changes in England and Wales between 1981 and 2000.
We used the IMPACT model to integrate data on the number of coronary heart disease patients, treatment uptake and effectiveness, risk factor trends, and median survival in coronary heart disease patients.
Compared with 1981, there were 68230 fewer coronary deaths in 2000. Approximately 925415 life-years were gained among people aged 25-84 years (range: 745 195-1 138 655). Cardiological treatments for patients accounted for approximately 194145 life-years gained (range: 142505-259225), and population risk factor changes accounted for approximately 731270 life-years gained (range; 602695-879430).
Modest reductions in major risk factors led to gains in life-years 4 times higher than did cardiological treatments. Effective policies to promote healthy diets and physical activity might achieve even greater gains.
There is no doubt that smoking is damaging global health on an unprecedented scale. However, there is continuing debate on the economics of tobacco control, including the costs and consequences of tobacco control policies. This book aims to fill the analytic gap around this debate This book brings together a set of critical reviews of the current status of knowledge on tobacco control. While the focus is on the needs of low-income and middle- income countries, the analyses are relevant globally. The book examines tobacco use and its consequences including new analyses of welfare issues in tobacco consumption, poverty and tobacco, and the rationale for government involvement. It provides an evidence-based review of policies to reduce demand including taxation, information, and regulation. It critically reviews supply-side issues such as trade and industry and farming issues, including new analyses on smuggling. It also discusses the impact of tobacco control programs on economies, including issues such as employment, tax revenue and welfare losses. It provides new evidence on the effectiveness and cost-effectiveness of control interventions. Finally, it outlines broad areas for national and international action, including future research directions. A statistical annex will contain information on where the reader can find data on tobacco consumption, prices, trade, employment and other items. The book is directed at academic economists and epidemiologists as well as technical staff within governments and international agencies. Students of economics, epidemiology and public policy will find this an excellent comprehensive introduction to economics of tobacco control.
Cardiovascular disease, mainly through coronary artery disease (CAD), is the number one killer in men and women in Europe even though most deaths and disabilities from CAD could be avoided by adopting healthy lifestyles. Because most CAD risk factors usually have no warning signs, continuous and intensive education on a healthy lifestyle at a population level is of enormous importance. The European Society of Cardiology (ESC), together with its National Cardiac Societies and the support of the European Union and other professional organizations, initiated the pan-European EuroHeart prevention project, with the aim of reducing the burden of CAD in Europe. The first year of the project clearly established the undisputable role of National Cardiac Societies in CAD prevention.
The World Health Organization (WHO) report on Prevention of Cardiovascular Disease (CVD) describes three strategies for prevention: a population strategy, a high-risk strategy, and a secondary prevention strategy. The population strategy is paramount because it addresses the whole population the economic, social, and cultural determinants of CVD, whereas the high-risk and secondary prevention strategies only address a minority of the population, namely, high-risk and sick individuals. The 61st World Health Assembly of the WHO on May 24th, 2008, stated its implementation strategy for prevention and control of noncommunicable diseases, of which CVD is the most common. The foundation for this action plan is the global strategy for the prevention and control of noncommunicable diseases reaffirmed by the Health Assembly in 2000, the WHO Framework Convention on Tobacco Control in 2003, and the Global Strategy on Diet, Physical Activity, and Health in 2004. The plan is intended to support coordinated, comprehensive, and integrated implementation of strategies and evidence-based interventions across individual diseases and risk factors, especially at the national level. A societal approach - health in all policies - by policymakers and politicians is paramount to preventing CVD.
The initial Guide to the Primary Prevention of Cardiovascular Diseases was published in 1997 as an aid to healthcare professionals and their patients without established coronary artery disease or other atherosclerotic diseases.1 It was intended to complement the American Heart Association (AHA)/American College of Cardiology (ACC) Guidelines for Preventing Heart Attack and Death in Patients with Atherosclerotic Cardiovascular Disease (updated2) and to provide the healthcare professional with a comprehensive approach to patients across a wide spectrum of risk. The imperative to prevent the first episode of coronary disease or stroke or the development of aortic aneurysm and peripheral arterial disease remains as strong as ever because of the still-high rate of first events that are fatal or disabling or require expensive intensive medical care. The evidence that most cardiovascular disease is preventable continues to grow. Results of long-term prospective studies consistently identify persons with low levels of risk factors as having lifelong low levels of heart disease and stroke.3,4⇓ Moreover, these low levels of risk factors are related to healthy lifestyles. Data from the Nurses Health Study,5 for example, suggest that in women, maintaining a desirable body weight, eating a healthy diet, exercising regularly, not smoking, and consuming a moderate amount of alcohol could account for an 84% reduction in risk, yet only 3% of the women studied were in that category. Clearly, the majority of the causes of cardiovascular disease are known and modifiable.
This 2002 update of the Guide acknowledges a number of advances in the field of primary prevention since 1997. Research continues to refine the recommendations on detection and management of established risk factors, including evidence against the safety and efficacy of interventions once thought promising (eg, antioxidant vitamins).6 This, in turn, has …
Background The WHO MONICA (monitoring trends and determinants in cardiovascular disease) Project monitored, from the early 1980s, trend over 10 years in coronary heart disease (CHD) across 37 populations in 21 countries. We aimed to validate trends in mortality, partitioning responsibility between changing coronary-event rates and changing survival. Methods Registers identified non-fatal definite myocardial infarction and definite, possible, or unclassifiable coronary deaths in men and women aged 35-64 years, followed up for 28 days in or out of hospital. We calculated rates from population denominators to estimate trends in age-standardised rates and case fatality (percentage of 28-day fatalities=[100-survival percentage]). Findings During 371 population-years, 166 000 events were registered. Official CHD mortality rates, based on death certification, fell (annual changes: men -4.0% [range -10.8 to 3.2]; women -4.0% [-12.7 to 3.0]). By MONICA criteria, CHD mortality rates were higher, but felt less (-2.7% [-8.0 to 4.2] and -2.1% [-8.5 to 4.1]). Changes in non-fatal rates were smaller (-2.1%, [-6.9 to 2.8] and -0.8% [-9.8 to 6.8]). MONICA coronary-event rates (fatal and non-fatal combined) fell more (-2.1% [-6.5 to 2.8] and -1.4% [-6.7 to 2.8]) than case fatality (-0.6% [-4.2 to 3.1] and -0.8% [-4.8 to 2.9]). Contribution to changing CHD mortality varied, but in populations in which mortality decreased, coronary-event rates contributed two thirds and case fatality one third. Interpretation Over the decade studied, the 37 populations in the WHO MONICA Project showed substantial contributions from changes in survival, but the major determinant of decline in CHD mortality is whatever drives changing coronary-event rates.
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Background
The worldwide epidemic of childhood obesity is progressing at an alarming rate. Risk factors for coronary heart disease (CHD) are already identifiable in overweight children. The severity of the long-term effects of excess childhood weight on CHD, however, remains unknown.
Methods
We investigated the association between body-mass index (BMI) in childhood (7 through 13 years of age) and CHD in adulthood (25 years of age or older), with and without adjustment for birth weight. The subjects were a cohort of 276,835 Danish schoolchildren for whom measurements of height and weight were available. CHD events were ascertained by linkage to national registers. Cox regression analyses were performed.
Results
In 5,063,622 person-years of follow-up, 10,235 men and 4318 women for whom childhood BMI data were available received a diagnosis of CHD or died of CHD as adults. The risk of any CHD event, a nonfatal event, and a fatal event among adults was positively associated with BMI at 7 to 13 years of age for boys and 10 to 13 years of age for girls. The associations were linear for each age, and the risk increased across the entire BMI distribution. Furthermore, the risk increased as the age of the child increased. Adjustment for birth weight strengthened the results.
Conclusions
Higher BMI during childhood is associated with an increased risk of CHD in adulthood. The associations are stronger in boys than in girls and increase with the age of the child in both sexes. Our findings suggest that as children are becoming heavier worldwide, greater numbers of them are at risk of having CHD in adulthood.
In an attempt to tackle climate change and obesity, health secretary, Alan Johnson, thinks the UK should follow the French lead and develop healthy towns. Hannah Westley describes the first 10 towns taking part in France
High dietary salt consumption is considered a risk factor for hypertension.
In order to determine the relationship between dietary sodium and blood pressure in the Chinese population, several nationwide epidemiological surveys have been conducted to investigate salt intake and the incidence of high blood pressure.
These surveys found that the residents living in the cold northern and northwestern areas of mainland China consume significantly more sodium than people from the south, that the average blood pressure and prevalence of hypertension are higher in the high-salt-consuming population, and that salt consumption correlates with blood pressure. It was also found that the nationwide prevalence of hypertension increased threefold over the past 30 years, but there was no parallel increase in salt consumption. In the same period, due to improved living standards, the occurrence of overweight or obesity in adults has increased significantly, which might contribute to the elevated prevalence of hypertension.
Thus, approaches to preventing hypertension should entail both dietary salt restriction and weight control.
The aim of this study was to determine the prevalence of key cardiovascular risk factors in the Middle East region. We conducted a systematic review of the literature through searches in the MEDLINE/PubMed and PARLINE databases between January 1980 and April 2005. Cohort studies published from 1980, in English, which included at least 1000 participants that reported the prevalence of at least one of the following; diabetes mellitus, obesity (body mass index > or =30 kg/m(2)), hypertension, hyperlipidemia, and smoking in the Middle East region. Data were abstracted using standardized data abstraction forms. Studies were combined using random-effect models. In total, 51 studies (267 537 participants) were included. On the basis of a random-effect model, the overall prevalence of obesity was 24.5% [95% confidence interval (CI): 21.8-27.5; I(2): 99.3%; 24 studies], diabetes mellitus was 10.5% (95% CI: 8.6-12.7%; I(2): 99.4%; 24 studies), hypertension was 21.7% (95% CI: 18.7-24.9; I(2): 99.5%; 24 studies), smoking was 15.6% (95% CI: 12.3-19.6%; I(2): 99.7%; 21 studies). Smoking was more common in men than women, whereas obesity and hypertension were more common in women. The overall prevalence was not calculated because of marked variations in the definition of dyslipidemia among studies. There is a high prevalence of diabetes mellitus, obesity, hypertension, and smoking in the Middle East. The prevalence of obesity and hypertension was higher in women, whereas prevalence of smoking was higher in men. These data suggest that cardiovascular disease will be a major health problem in the Middle East.
The first and second EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease. The third EUROASPIRE survey was done in 2006-07 in 22 countries to see whether preventive cardiology had improved and if the joint European Societies' recommendations on cardiovascular disease prevention are being followed in clinical practice.
Methods EUROASPIRE I, II, and III were designed as cross-sectional studies and included the same selected geographical areas and hospitals in the Czech Republic, Finland, France, Germany, Hungary, Italy, the Netherlands, and Slovenia. Consecutive patients (men and women = 30 kg/m(2)) increased from 25.0% in EUROASPIRE I, to 32.6% in 11, and 38.0% in III (p=0.0006). The proportion of patients with raised blood pressure (>= 140/90 mm Hg in patients without diabetes or >= 130/80 mm Hg in patients with diabetes) was similar (58.1% in EUROASPIRE 1, 58.3% in II, and 60.9% in III; p=0.49), whereas the proportion with raised total cholesterol (>= 4.5 mmol/L) decreased, from 94.5% in EUROASPIRE I to 76.7% in II, and 46.2% in III (p
The severity of the long term consequences of the current childhood obesity epidemic on coronary heart disease is unknown. Therefore we investigated the association between body mass index (BMI) at ages 7-13 years and heart disease in adulthood among 276,835 Danish schoolchildren. We found that higher BMI during this period of childhood is associated with an increased risk of any, non-fatal and fatal heart disease in adulthood. Worldwide, as children are becoming heavier, our findings suggest that greater numbers of children are at risk of having coronary heart disease in adulthood.
lthough d emography c ontinues t o b e t he most prominent discipline concerned with population dynam- ics, involvement of other disciplines is highly desirable. The case for a multidisciplinary approach to population theory has been aptly stated by Kurt Mayer: "Any meaningful interpretation of the cause and effects of population changes must ... extend beyond formal statistical measurement of the components of change, i.e. fertility, mortality and migration, and draw on the theoretical framework of several other dis- ciplines for assistance (Mayer 1962)." In noting that the "analysis of the causal determinants and consequences of population change forms the subject matter of population theory," Mayer inferentially acknowledges the epidemiologic character of population phenomena, for as its ety- mology indicates, (epi, upon; demos, people; logos, study), epidemiology is the study of what "comes upon" groups of people. More specifically, epidemiology is concerned with the distribution of disease and death, and with their determinants and consequences in population groups. Inasmuch as patterns of health and disease are integral components of population change, epidemiology's reservoir of knowledge about these patterns and their determinants in population groups serves not only as a basis for prediction of population change but also as a source of hy- potheses that can be further tested to correct, refine and build population theory. Furthermore, many epidemiologic techniques that have hereto- fore been limited to the examination of health and disease patterns can be profitably applied as well to the exploration of other mass phenomena, such as fertility control.
Epidemiologic studies suggest an inverse relationship between physical activity or fitness and blood pressure. In a meta-analysis of 36 controlled intervention studies, the weighted net blood pressure response to dynamic aerobic training averaged -5.3 mm Hg for systolic and -4.8 mm Hg for diastolic pressure. The variation of the change of blood pressure among studies was mainly dependent on the initial blood pressure level and the gain in exercise capacity. The weighted net change of blood pressure with endurance training averaged -3/-3 mm Hg in normotensive patients, -6/-7 mm Hg in borderline hypertensive patients, and -10/-8 mm Hg in hypertensive patients. Reductions of blood pressure have also been observed for measurements during exercise and during ambulatory monitoring. Exercise programs can contribute to the management of hypertension. Care is needed in the choice of antihypertensive drugs for the exercising patient because some drugs may impair exercise capacity.
Scientists have long recognized the importance of the demographics and epidemiologic transitions in higher income countries. Only recently has it become understood that similar sets of broadly based changes are occurring in lower income countries. What has not been recognized is that concurrent changes in nutrition are also occurring, with equally important implications for resource allocation in many low-income countries. Several major changes seem to be emerging, leading to a marked shift in the structure of diet and the distribution of body composition in many regions of the world: a rapid reduction in fertility and aging of the population, rapid urbanization, the epidemiologic transition, and economic changes affecting populations in different and uneven ways. These changes vary significantly over time. In general, we find that problems of under- and overnutrition often coexist, reflecting the trend in which an increasing proportion of people consume the types of diets associated with a number of chronic diseases. This is occurring more rapidly than previously seen in higher income countries, or even in Japan and Korea. Examples from Thailand, China, and Brazil provide evidence of the changes and trends in dietary intake, physical activity, and body composition patterns.
Rapid socioeconomic development, urbanization and improved survival have given rise to a progressive increase in the occurrence of noncommunicable diseases in the Eastern Mediterranean Region. Cardiovascular diseases have emerged as a leading cause of morbidity and mortality in many countries. The prevalence of hypertension is already high in many countries of the Region and the number of hypertensives is likely to increase further in the coming years. Although the influence of geographical, ethnic and socioeconomic factors has not been studied adequately, it seems that the epidemiological and clinical patterns of hypertension do not differ markedly from those in developed countries. The growing impact of cardiovascular disease is already understood in most countries. The human and economic costs are enormous, there is a growing demand for medical services, and the need to take action is increasingly acknowledged. Most countries have either initiated or indicated the need to establish programmes in collaboration with WHO on the prevention and control of cardiovascular disease during 1992 and 1993. In view of the scarcity of precise epidemiological information, data collection and the assessment of risk factors for coronary heart disease are expected to form the basis of preliminary activities.
The availability of basic and reliable data on cardiovascular problems in Africans is limited and this hinders the presentation of a comprehensive review of the subject. Nevertheless, there is a strong suggestion that the spectrum and pattern of cardiovascular disorders in Africa is rapidly becoming indistinguishable from that observed in developed countries. The classic risk factors appear to be on the rise and smoking may attain levels equal to or exceeding those in many developed countries. Infectious and inflammatory cardiovascular conditions may still be the most common, although limitations in the technology available for accurate diagnosis make this difficult to verify. Rheumatic fever and rheumatic heart disease remain common, and the potential for educational and other preventive strategies is being realized in many countries. Hypertension at frequencies exceeding 5-10% in most rural areas and 12% in most urban areas, together with complications such as stroke, heart failure and renal failure, are leading causes of morbidity and mortality. Hypertension is the major public health problem in most African countries. The cardiomyopathies are a common problem, and the limited availability of specific diagnostic procedures is matched by limited therapeutic options for most Africans. The prevalence of atherosclerosis and coronary artery disease and its complications, such as myocardial infarction and other degenerative disorders, remains low, but the situation is rapidly changing, especially in urban areas where appropriate diagnostic capabilities exist. It is thought that changes or modifications in lifestyle, risk-prone behaviour, diet, cultural attitudes and certain other consequences of rapid urbanization and demographic tendencies largely explain the observed trends.(ABSTRACT TRUNCATED AT 250 WORDS)
India is undergoing an epidemiological transition and is on the threshold of an epidemic of cardiovascular disease. Cause-specific mortality data indicate that cardiovascular disease is already an important contributor to mortality. Demographic projections suggest a major increase in cardiovascular disease mortality as life expectancy increases and the age structure of the growing population changes. Surveys in urban areas suggest that coronary risk factors are already widespread and that urgent action is needed to prevent a further rise as socioeconomic development proceeds. It is vital to obtain epidemiological data from several regions in order to plan, initiate and monitor public health action.
Cardiovascular morbidity and mortality result from the chronic processes involved in hypertension. However, long-term sustained (LTS) hypertension has received little attention.
Trends in the prevalence of LTS hypertension and its treatment were assessed in 1950, 1960, and 1970 among three cohorts of men and women in the Framingham Heart Study (Mantel-Haenszel test). Cardiovascular disease (CVD) incidence and mortality were compared between patients with LTS hypertension with and without long-term treatment by use of the chi 2 test. Cox proportional hazards regression analysis was used to estimate 10-year risk of death as a function of risk factor levels and treatment. Prevalence of LTS hypertension rose from 138 to 208 per 1000 between the 1950 and 1970 male cohorts (P < .01), while prevalence fell from 253 to 198 per 1000 between the female cohorts (P < .02). Long-term treatment increased 51% between the male cohorts and 45% between the female cohorts (both P < .001). While CVD incidence was similar (26% versus 25%), all-cause mortality was significantly lower among men with long-term treatment (31% versus 43%; P < .05), and CVD mortality was less than half (13% versus 28%; P < .01). Among treated women, all-cause mortality was 21% (versus 34%; P < .01), and CVD mortality was 9% (versus 19%; P < .01). Ten-year risk of CVD death for patients with LTS hypertension with long-term treatment compared with those without was 0.40 (95% CI, 0.27 to 0.60).
This investigation of LTS hypertension, its treatment, and its sequelae in a free-living general population confirms the reduction in CVD mortality demonstrated in more short-term clinical trials of hypertension therapy in select patient groups.
Analyses of economic and food availability data for 1962-1994 reveal a major shift in the structure of the global diet marked by an uncoupling of the classic relationship between incomes and fat intakes. Global availability of cheap vegetable oils and fats has resulted in greatly increased fat consumption among low-income nations. Consequently, the nutrition transition now occurs at lower levels of the gross national product than previously, and is accelerated further by high urbanization rates. Data from Asian nations, where diet structure is rapidly changing, suggest that diets higher in fats and sweeteners are also more diverse and more varied. Given that preferences for palatable diets are a universal human trait, fat consumption may be governed not by physiological mechanisms but by the amount of fat available in the food supply. Whereas economic development has led to improved food security and better health, adverse health effects of the nutrition transition include growing rates of childhood obesity. The implications of these trends are explored.
As the twentieth century draws to a close, it is clear that cardiovascular disease (CVD) has become a ubiquitous cause of morbidity and a leading contributor to mortality in most countries.1 2 The rise and recent decline of the CVD epidemic in the developed countries have been well documented.3 4 The identification of major risk factors through population-based studies and effective control strategies combining community education and targeted management of high risk individuals have contributed to the fall in CVD mortality rates (inclusive of coronary and stroke deaths) that has been observed in almost all industrialized countries. It has been estimated that during the period 1965 to 1990, CVD related mortality fell by ≈50% in Australia, Canada, France, and the United States and by 60% in Japan.1 Other parts of Western Europe reported more modest declines (20% to 25%). The decline in stroke mortality has been more marked compared with the decline in coronary mortality. In the United States, the decline in stroke mortality commenced nearly two decades earlier than the decline in coronary mortality and maintained a sharper rate of decline. During the period 1979 to 1989, the age-adjusted mortality from stroke declined, in that country, by about one third, whereas the corresponding decline in coronary mortality was 22%.4 5 In Japan, where stroke mortality outweighs coronary mortality, the impressive overall decline in CVD mortality is principally contributed by the former. The discordant trend of rising CVD mortality rates in Eastern Europe, however, is in sharp contrast to the decline in Western Europe.1
The emergence of the CVD epidemic in the developing countries during the past two to three decades has attracted less comment and little public health response, even within these countries. It is not widely realized that at present, the developing countries …
The WHO MONICA (monitoring trends and determinants in cardiovascular disease) Project monitored, from the early 1980s, trends over 10 years in coronary heart disease (CHD) across 37 populations in 21 countries. We aimed to validate trends in mortality, partitioning responsibility between changing coronary-event rates and changing survival.
Registers identified non-fatal definite myocardial infarction and definite, possible, or unclassifiable coronary deaths in men and women aged 35-64 years, followed up for 28 days in or out of hospital. We calculated rates from population denominators to estimate trends in age-standardised rates and case fatality (percentage of 28-day fatalities=[100-survival percentage]).
During 371 population-years, 166,000 events were registered. Official CHD mortality rates, based on death certification, fell (annual changes: men -4.0% [range -10.8 to 3.2]; women -4.0% [-12.7 to 3.0]). By MONICA criteria, CHD mortality rates were higher, but fell less (-2.7% [-8.0 to 4.2] and -2.1% [-8.5 to 4.1]). Changes in non-fatal rates were smaller (-2.1%, [-6.9 to 2.8] and -0.8% [-9.8 to 6.8]). MONICA coronary-event rates (fatal and non-fatal combined) fell more (-2.1% [-6.5 to 2.8] and -1.4% [-6.7 to 2.8]) than case fatality (-0.6% [-4.2 to 3.1] and -0.8% [-4.8 to 2.9]). Contribution to changing CHD mortality varied, but in populations in which mortality decreased, coronary-event rates contributed two thirds and case fatality one third.
Over the decade studied, the 37 populations in the WHO MONICA Project showed substantial contributions from changes in survival, but the major determinant of decline in CHD mortality is whatever drives changing coronary-event rates.
This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiologic transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.
This two-part article provides an overview of the global burden of atherothrombotic cardiovascular disease. Part I initially discusses the epidemiological transition which has resulted in a decrease in deaths in childhood due to infections, with a concomitant increase in cardiovascular and other chronic diseases; and then provides estimates of the burden of cardiovascular (CV) diseases with specific focus on the developing countries. Next, we summarize key information on risk factors for cardiovascular disease (CVD) and indicate that their importance may have been underestimated. Then, we describe overarching factors influencing variations in CVD by ethnicity and region and the influence of urbanization. Part II of this article describes the burden of CV disease by specific region or ethnic group, the risk factors of importance, and possible strategies for prevention.
An important barrier to the delivery of health behavior change interventions in primary care settings is the lack of an integrated screening and intervention approach that can cut across multiple risk factors and help clinicians and patients to address these risks in an efficient and productive manner.
We review the evidence for interventions that separately address lack of physical activity, an unhealthy diet, obesity, cigarette smoking, and risky/harmful alcohol use, and evidence for interventions that address multiple behavioral risks drawn primarily from the cardiovascular and diabetes literature.
There is evidence for the efficacy of interventions to reduce smoking and risky/harmful alcohol use in unselected patients, and evidence for the efficacy of medium- to high-intensity dietary counseling by specially trained clinicians in high-risk patients. There is fair to good evidence for moderate, sustained weight loss in obese patients receiving high-intensity counseling, but insufficient evidence regarding weight loss interventions in nonobese adults. Evidence for the efficacy of physical activity interventions is limited. Large gaps remain in our knowledge about the efficacy of interventions to address multiple behavioral risk factors in primary care.
We derive several principles and strategies for delivering behavioral risk factor interventions in primary care from the research literature. These principles can be linked to the "5A's" construct (assess, advise, agree, assist, and arrange-follow up) to provide a unifying conceptual framework for describing, delivering, and evaluating health behavioral counseling interventions in primary healthcare settings. We also provide recommendations for future research.
Coronary heart disease (CHD) mortality is rising in many developing countries. We examined how much of the increase in CHD mortality in Beijing, China, between 1984 and 1999 could be attributed to changes in major cardiovascular risk factors and assessed the impact of medical and surgical treatments.
A validated, cell-based mortality model synthesized data on (1) patient numbers, (2) uptake of specific medical and surgical treatments, (3) treatment effectiveness, and (4) population trends in major cardiovascular risk factors (smoking, total cholesterol, blood pressure, obesity, and diabetes). Main data sources were the WHO MONICA and Sino-MONICA studies, the Chinese Multi-provincial Cohort Study, routine hospital statistics, and published meta-analyses. Age-adjusted CHD mortality rates increased by approximately 50% in men and 27% in women (1608 more deaths in 1999 than expected by application of 1984 rates). Most of this increase ( approximately 77%, or 1397 additional deaths) was attributable to substantial rises in total cholesterol levels (more than 1 mmol/L), plus increases in diabetes and obesity. Blood pressure decreased slightly, whereas smoking prevalence increased in men but decreased substantially in women. In 1999, medical and surgical treatments in patients together prevented or postponed approximately 642 deaths, mainly from initial treatments for acute myocardial infarction ( approximately 41%), hypertension (24%), angina (15%), secondary prevention (11%), and heart failure (10%). Multiway sensitivity analyses did not greatly influence the results.
Much of the dramatic CHD mortality increases in Beijing can be explained by rises in total cholesterol, reflecting an increasingly "Western" diet. Without cardiological treatments, increases would have been even greater.
Although more than 80% of the global burden of cardiovascular disease occurs in low-income and middle-income countries, knowledge of the importance of risk factors is largely derived from developed countries. Therefore, the effect of such factors on risk of coronary heart disease in most regions of the world is unknown.
We established a standardised case-control study of acute myocardial infarction in 52 countries, representing every inhabited continent. 15152 cases and 14820 controls were enrolled. The relation of smoking, history of hypertension or diabetes, waist/hip ratio, dietary patterns, physical activity, consumption of alcohol, blood apolipoproteins (Apo), and psychosocial factors to myocardial infarction are reported here. Odds ratios and their 99% CIs for the association of risk factors to myocardial infarction and their population attributable risks (PAR) were calculated.
Smoking (odds ratio 2.87 for current vs never, PAR 35.7% for current and former vs never), raised ApoB/ApoA1 ratio (3.25 for top vs lowest quintile, PAR 49.2% for top four quintiles vs lowest quintile), history of hypertension (1.91, PAR 17.9%), diabetes (2.37, PAR 9.9%), abdominal obesity (1.12 for top vs lowest tertile and 1.62 for middle vs lowest tertile, PAR 20.1% for top two tertiles vs lowest tertile), psychosocial factors (2.67, PAR 32.5%), daily consumption of fruits and vegetables (0.70, PAR 13.7% for lack of daily consumption), regular alcohol consumption (0.91, PAR 6.7%), and regular physical activity (0.86, PAR 12.2%), were all significantly related to acute myocardial infarction (p<0.0001 for all risk factors and p=0.03 for alcohol). These associations were noted in men and women, old and young, and in all regions of the world. Collectively, these nine risk factors accounted for 90% of the PAR in men and 94% in women.
Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical activity account for most of the risk of myocardial infarction worldwide in both sexes and at all ages in all regions. This finding suggests that approaches to prevention can be based on similar principles worldwide and have the potential to prevent most premature cases of myocardial infarction.