Science.gov

Sample records for cardiovascular risk assessment

  1. Cardiovascular risk assessment: a global perspective.

    PubMed

    Zhao, Dong; Liu, Jing; Xie, Wuxiang; Qi, Yue

    2015-05-01

    An important strategy in primary prevention of cardiovascular diseases (CVD) is the early identification of high-risk individuals. Effective implementation of a strategy to identify these individuals in a clinical setting is reliant on the availability of appropriate CVD risk-assessment models and guideline recommendations. Several well-known models for CVD risk assessment have been developed and utilized in the USA and Europe, but might not be suitable for use in other regions or countries. Very few reports have discussed the development of risk-assessment models and recommendations from a global perspective. In this Review, we discuss why risk-assessment methods developed from studies in one geographical region or ethnic population might not be suitable for other regions or populations, and examine the availability and characteristics of predictive models in areas beyond the USA or Europe. In addition, we compare the differences in risk-assessment recommendations outlined in CVD clinical guidelines from developed and developing countries, and consider their potential effect on clinical practice. This overview of cardiovascular risk assessment from a global perspective can potentially guide low-to-middle-income countries in the development or validation of their own CVD risk-assessment models, and the formulation of recommendations in their own clinical guidelines according to local requirements.

  2. New approaches for improving cardiovascular risk assessment.

    PubMed

    Paredes, Simão; Rocha, Teresa; Mendes, Diana; Carvalho, Paulo; Henriques, Jorge; Morais, João; Ferreira, Jorge; Mendes, Miguel

    2016-01-01

    Clinical guidelines recommend the use of cardiovascular risk assessment tools (risk scores) to predict the risk of events such as cardiovascular death, since these scores can aid clinical decision-making and thereby reduce the social and economic costs of cardiovascular disease (CVD). However, despite their importance, risk scores present important weaknesses that can diminish their reliability in clinical contexts. This study presents a new framework, based on current risk assessment tools, that aims to minimize these limitations. Appropriate application and combination of existing knowledge is the main focus of this work. Two different methodologies are applied: (i) a combination scheme that enables data to be extracted and processed from various sources of information, including current risk assessment tools and the contributions of the physician; and (ii) a personalization scheme based on the creation of patient groups with the purpose of identifying the most suitable risk assessment tool to assess the risk of a specific patient. Validation was performed based on a real patient dataset of 460 patients at Santa Cruz Hospital, Lisbon, Portugal, diagnosed with non-ST-segment elevation acute coronary syndrome. Promising results were obtained with both approaches, which achieved sensitivity, specificity and geometric mean of 78.79%, 73.07% and 75.87%, and 75.69%, 69.79% and 72.71%, respectively. The proposed approaches present better performances than current CVD risk scores; however, additional datasets are required to back up these findings. Copyright © 2015 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  3. Assessment of cardiovascular risk in primary health care

    PubMed Central

    Korhonen, Päivi; Vesalainen, Risto; Aarnio, Pertti; Kautiainen, Hannu; Järvenpää, Salme; Kantola, Ilkka

    2012-01-01

    Objective This study aimed at investigating whether cardiovascular risk factors and their impact on total risk estimation differ between men and women. Design Cross-sectional cohort study. Subjects Finnish cardiovascular risk subjects (n = 904) without established cardiovascular disease, renal disease, or known diabetes. Main outcome measures Ankle-brachial index (ABI), estimated glomerular filtration rate (eGFR), oral glucose tolerance test, and total cardiovascular risk using SCORE risk charts. Results According to the SCORE risk charts, 27.0% (95% CI 23.1–31.2) of the women and 63.1% (95% CI 58.3–67.7) of the men (p < 0.001) were classified as high-risk subjects. Of the women classified as low-risk subjects according to SCORE, 25% had either subclinical peripheral arterial disease or renal insufficiency. Conclusions The SCORE system does not take into account cardiovascular risk factors typical in women, and thus underestimates their total cardiovascular risk. Measurement of ABI and eGFR in primary care might improve cardiovascular risk assessment. especially in women. PMID:22643155

  4. Method and apparatus for assessing cardiovascular risk

    NASA Technical Reports Server (NTRS)

    Albrecht, Paul (Inventor); Bigger, J. Thomas (Inventor); Cohen, Richard J. (Inventor)

    1998-01-01

    The method for assessing risk of an adverse clinical event includes detecting a physiologic signal in the subject and determining from the physiologic signal a sequence of intervals corresponding to time intervals between heart beats. The long-time structure of fluctuations in the intervals over a time period of more than fifteen minutes is analyzed to assess risk of an adverse clinical event. In a preferred embodiment, the physiologic signal is an electrocardiogram and the time period is at least fifteen minutes. A preferred method for analyzing the long-time structure variability in the intervals includes computing the power spectrum and fitting the power spectrum to a power law dependence on frequency over a selected frequency range such as 10.sup.-4 to 10.sup.-2 Hz. Characteristics of the long-time structure fluctuations in the intervals is used to assess risk of an adverse clinical event.

  5. Cardiovascular risk assessment and treatment in systemic lupus erythematosus.

    PubMed

    Elliott, Jennifer R; Manzi, Susan

    2009-08-01

    With improved treatment modalities and survival rates, patients with systemic lupus erythematosus live longer and their co-morbidities have become more apparent. Of great concern is cardiovascular disease, which has become a leading cause of death. Lupus patients prematurely develop atherosclerosis, which likely arises from an interaction among traditional cardiovascular risk factors, factors specific to lupus itself and inflammatory mediators. Despite these findings, lupus patients are not always adequately evaluated for traditional risk factors, many of which are treatable and reversible. We propose that lupus patients be assessed and managed regarding cardiovascular risk factors in the same manner as patients with known cardiovascular disease. As a result, preventive cardiology should be considered an essential component of the care for patients with lupus.

  6. Assessment of cardiovascular risk factors in menopausal Argentinian women.

    PubMed

    Etchegoyen, G S; Ortiz, D; Goya, R G; Sala, C; Panzica, E; Sevillano, A; Dron, N

    1995-01-01

    The cardiovascular risk factor profile was assessed in a population sample consisting of 60 nonmenopausal (control) and 100 menopausal women from different cities in Buenos Aires Province, Argentina. Each subject was individually interviewed and asked to complete a specially designed questionnaire aimed at identifying cardiovascular risk factors. A clinical general and gynecological examination including blood pressure and anthropometric measurements as well as a Papanicolaou smear were performed. The most prevalent risk factor in the menopausal group was low physical activity (87% of the subjects), followed by nervous complaints (67%), obesity (64%), familial antecedents of cardiovascular disease (CVD; 38%) and hypertension (33%). Other risk factors assessed showed a level of prevalence below 10%. In the control group, a tobacco smoking habit was the CVD risk factor with the highest prevalence (47%). Nervous complaints also showed a high prevalence (48%). Most menopausal patients (77%) had a cardiovascular risk index (RI) level between 1.5 and 4.0, whereas 17% of these subjects had an RI greater than 4.0 (high-risk patients). The present study reveals that, in the studied community, the menopause is associated with increased levels of both estrogen-dependent and psychosocial risk factors for CVD.

  7. Assessment of cardiovascular risk in hypertensive patients: a comparison of commonly used risk scoring programs.

    PubMed

    Ulusoy, Sükrü

    2013-12-01

    Several calculation modalities are used today for cardiovascular risk assessment. Cardiovascular risk assessment should be performed in all hypertensive patients. Risk assessment methods being based on the population in which the patient lives and the inclusion of factors such as ethnicity variations, socioeconomic status, and medication use will contribute to improvements in risk assessments. The results should be shared with the patient, and modifiable risk factors must be effectively treated.

  8. Assessment of Cardiovascular Risk in Collegiate Football Players and Nonathletes

    ERIC Educational Resources Information Center

    Dobrosielski, Devon A.; Rosenbaum, Daryl; Wooster, Benjamin M.; Merrill, Michael; Swanson, John; Moore, J. Brian; Brubaker, Peter H.

    2010-01-01

    Collegiate American football players may be at risk for cardiovascular disease. Objective: To compare cardiovascular disease risk factors and cardiovascular structure and function parameters of football players, stratified by position, to a group of sedentary, nonathletes. Participants: Twenty-six collegiate football players and 13 nonathletes…

  9. Assessment of Cardiovascular Risk in Collegiate Football Players and Nonathletes

    ERIC Educational Resources Information Center

    Dobrosielski, Devon A.; Rosenbaum, Daryl; Wooster, Benjamin M.; Merrill, Michael; Swanson, John; Moore, J. Brian; Brubaker, Peter H.

    2010-01-01

    Collegiate American football players may be at risk for cardiovascular disease. Objective: To compare cardiovascular disease risk factors and cardiovascular structure and function parameters of football players, stratified by position, to a group of sedentary, nonathletes. Participants: Twenty-six collegiate football players and 13 nonathletes…

  10. Cardiovascular Risk Factors among College Students: Knowledge, Perception, and Risk Assessment

    ERIC Educational Resources Information Center

    Tran, Dieu-My T.; Zimmerman, Lani M.; Kupzyk, Kevin A.; Shurmur, Scott W.; Pullen, Carol H.; Yates, Bernice C.

    2017-01-01

    Objective: To assess college students' knowledge and perception of cardiovascular risk factors and to screen for their cardiovascular risks. Participants: The final sample that responded to recruitment consisted of 158 college students from a midwestern university. Methods: A cross-sectional, descriptive study was performed using convenience…

  11. [Assessing the cardiovascular risk in patients with systemic lupus erythematosus].

    PubMed

    Arnaud, L; Mathian, A; Bruckert, E; Amoura, Z

    2014-11-01

    Multiple factors contribute to the increased cardiovascular risk observed in patients with systemic lupus erythematosus (SLE). Among these are the so-called classical cardiovascular risk factors, the disease itself through its activity, treatments, and complications, and the thrombotic risk due to antiphospholipid antibodies (aPL). Observational studies suggest that most classical cardiovascular risk factors are observed more frequently in SLE patients than in the general population, and that these are insufficient to explain the increased cardiovascular risk observed in most studies. Given this high risk, adequate management of cardiovascular risk factors should be recommended in SLE patients. Paradoxically, the benefit due to the anti-inflammatory properties of treatments such as corticosteroids may exceed, in certain cases, their pro-atherogenic effect. Importantly, the tools that were developed for the estimation of cardiovascular risk at the individual level among the general population cannot be used reliably in SLE patients, as these tools appear to underestimate the true cardiovascular risk. The adequate indications and targets of cardiovascular treatments are therefore not fully known in SLE. A better understanding of the determinants of the cardiovascular risk in SLE will allow the identification and more tailored management of these high-risk patients.

  12. Assessment of high cardiovascular risk profiles for the clinician.

    PubMed

    Whayne, Thomas F

    2013-07-01

    Diabetes mellitus (DM) is a major cardiovascular (CV) risk factor. General Framingham Risk Profile (GFRP) and World Health Organization/International Society of Hypertension (WHO/ISH) charts were used to assess CV risk in DM in Oman. The GFRP identified more patients with medium-risk DM; GFRP and WHO/ISH identified essentially equal numbers at very high risk. These were then used to evaluate statin usage in Oman, including economics. Google lists innumerable tools from organizations, hospitals, practitioners, magazines, societies, clinics, and medical associations. The GFRP and WHO/ISH calculations provided useful DM assessment of populations in Oman. Other major risk models are Adult Treatment Panel III, based on Framingham, and Reynolds Risk Score; the latter incorporates other factors such as family history, high-sensitivity C-reactive protein, and hemoglobin A(1c) (in DM). These models are useful in assessing specific populations. Individual practitioners with limited time may just evaluate patients as low, medium, and high CV risk based on general knowledge and then treat.

  13. Cardiovascular risk

    PubMed Central

    Payne, Rupert A

    2012-01-01

    Cardiovascular disease is a major, growing, worldwide problem. It is important that individuals at risk of developing cardiovascular disease can be effectively identified and appropriately stratified according to risk. This review examines what we understand by the term risk, traditional and novel risk factors, clinical scoring systems, and the use of risk for informing prescribing decisions. Many different cardiovascular risk factors have been identified. Established, traditional factors such as ageing are powerful predictors of adverse outcome, and in the case of hypertension and dyslipidaemia are the major targets for therapeutic intervention. Numerous novel biomarkers have also been described, such as inflammatory and genetic markers. These have yet to be shown to be of value in improving risk prediction, but may represent potential therapeutic targets and facilitate more targeted use of existing therapies. Risk factors have been incorporated into several cardiovascular disease prediction algorithms, such as the Framingham equation, SCORE and QRISK. These have relatively poor predictive power, and uncertainties remain with regards to aspects such as choice of equation, different risk thresholds and the roles of relative risk, lifetime risk and reversible factors in identifying and treating at-risk individuals. Nonetheless, such scores provide objective and transparent means of quantifying risk and their integration into therapeutic guidelines enables equitable and cost-effective distribution of health service resources and improves the consistency and quality of clinical decision making. PMID:22348281

  14. Biomarkers for cardiovascular risk assessment in autoimmune diseases.

    PubMed

    Teixeira, Priscila Camillo; Ferber, Philippe; Vuilleumier, Nicolas; Cutler, Paul

    2015-02-01

    Autoimmune diseases, such as antiphospholipid syndrome, systemic lupus erythematosus, and rheumatoid arthritis, are characterized by a high prevalence of cardiovascular (CV) disease (CVD), which constitutes the leading causes of morbidity and mortality among such patients. Although such effects are partly explained by a higher prevalence of traditional CV risk factors, many studies indicate that such factors do not fully explain the enhanced CV risk in these patients. In addition, risk stratification algorithms based upon traditional CV risk factors are not as predictive in autoimmune diseases as in the general population. For these reasons, the timely and accurate assessment of CV risk in these high-risk populations still remains an unmet clinical need. An enhanced contribution of different inflammatory components of the immune response, as well as autoimmune elements (e.g. autoantibodies, autoantigens, and cellular response), has been proposed to underlie the incremental CV risk observed in these populations. Recent advances in proteomic tools have contributed to the discovery of proteins involved in CVDs, including some that may be suitable to be used as biological markers. In this review we summarize the main markers in the field of CVDs associated with autoimmunity, as well as the recent advances in proteomic technology and their application for biomarker discovery in autoimmune disease.

  15. Cardiovascular Risk Assessment and Management in Prerenal Transplantation Candidates.

    PubMed

    Lindley, Eric M; Hall, Amanda K; Hess, Jordan; Abraham, Jo; Smith, Brigham; Hopkins, Paul N; Shihab, Fuad; Welt, Frederick; Owan, Theophilus; Fang, James C

    2016-01-01

    Cardiovascular (CV) assessment in prerenal transplant patients varies by center. Current guidelines recommend stress testing for candidates if ≥ 3 CV risk factors exist. We evaluated the CV assessment and management in 685 patients referred for kidney transplant over a 7-year period. All patients had CV risk factors, and the most common cause of end-stage renal disease was diabetes. Thirty-three percent (n = 229) underwent coronary angiography. The sensitivity of stress testing to detect obstructive coronary artery disease (CAD) was poor (0.26). Patients who had no CAD, nonobstructive CAD, or CAD with intervention had significantly higher event-free survival compared with patients with obstructive CAD without intervention. There were no adverse clinical events (death, myocardial infarction, stroke, revascularization, and graft failure) within 30 days post-transplant in patients who had preoperative angiography (n = 77). Of the transplanted patients who did not have an angiogram (n = 289), there were 8 clinical events (6 myocardial infarctions) in the first 30 days. In conclusion, our results indicate that stress testing and usual risk factors were poor predictors of obstructive CAD and that revascularization may prove beneficial in these patients. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Diabetes Mellitus, Arterial Wall, and Cardiovascular Risk Assessment

    PubMed Central

    Kozakova, Michaela; Palombo, Carlo

    2016-01-01

    Diabetes mellitus is an independent risk factor for atherothrombotic cardiovascular disease. Adults with diabetes are two to four times more likely to develop heart disease or stroke than adults without diabetes. The two major features of diabetes, i.e., hyperglycemia and insulin-resistance, trigger arterial stiffening and increase the susceptibility of the arterial wall to atherosclerosis at any given age. These pathological changes in the arterial wall may provide a functional and structural background for cardiovascular events. The present paper provides a critical overview of the clinical evidence linking diabetes-related metabolic abnormalities to cardiovascular risk, debates the pathophysiologic mechanisms through which insulin resistance and hyperglycemia may affect the arterial wall, and discusses the associations between vascular biomarkers, metabolic abnormalities and cardiovascular events. PMID:26861377

  17. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient

    PubMed Central

    Budoff, Matthew J.; Raggi, Paolo; Beller, George A.; Berman, Daniel S.; Druz, Regina S.; Malik, Shaista; Rigolin, Vera H.; Weigold, Wm. Guy; Soman, Prem

    2017-01-01

    Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a “coronary risk equivalent,” implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data. PMID:26846937

  18. Assessment of Cardiovascular Risk Factors in the Healthy Elderly.

    ERIC Educational Resources Information Center

    Waller, Kathy V.; And Others

    1992-01-01

    Cardiovascular risk factors in 57 healthy older individuals were measured (blood pressure, lipids and lipoproteins, and lifestyle behaviors) via a personal health questionnaire. Results indicated that, though the subjects were generally healthy, their lifestyle behaviors, particularly diet and physical activity, could be improved. (SM)

  19. Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators.

    PubMed

    Barber, Claire E H; Esdaile, John M; Martin, Liam O; Faris, Peter; Barnabe, Cheryl; Guo, Selynne; Lopatina, Elena; Marshall, Deborah A

    2016-11-01

    Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.

  20. ISPD Cardiovascular and Metabolic Guidelines in Adult Peritoneal Dialysis Patients Part I - Assessment and Management of Various Cardiovascular Risk Factors.

    PubMed

    Wang, Angela Yee Moon; Brimble, K Scott; Brunier, Gillian; Holt, Stephen G; Jha, Vivekanand; Johnson, David W; Kang, Shin-Wook; Kooman, Jeroen P; Lambie, Mark; McIntyre, Chris; Mehrotra, Rajnish; Pecoits-Filho, Roberto

    2015-01-01

    Cardiovascular disease contributes significantly to the adverse clinical outcomes of peritoneal dialysis (PD) patients. Numerous cardiovascular risk factors play important roles in the development of various cardiovascular complications. Of these, loss of residual renal function is regarded as one of the key cardiovascular risk factors and is associated with an increased mortality and cardiovascular death. It is also recognized that PD solutions may incur significant adverse metabolic effects in PD patients. The International Society for Peritoneal Dialysis (ISPD) commissioned a global workgroup in 2012 to formulate a series of recommendations regarding lifestyle modification, assessment and management of various cardiovascular risk factors, as well as management of the various cardiovascular complications including coronary artery disease, heart failure, arrhythmia (specifically atrial fibrillation), cerebrovascular disease, peripheral arterial disease and sudden cardiac death, to be published in 2 guideline documents. This publication forms the first part of the guideline documents and includes recommendations on assessment and management of various cardiovascular risk factors. The documents are intended to serve as a global clinical practice guideline for clinicians who look after PD patients. The ISPD workgroup also identifies areas where evidence is lacking and further research is needed.

  1. Recommendations from the EGAPP Working Group: genomic profiling to assess cardiovascular risk to improve cardiovascular health.

    PubMed

    2010-12-01

    The Evaluation of Genomic Applications in Practice and Prevention Working Group (EWG) found insufficient evidence to recommend testing for the 9p21 genetic variant or 57 other variants in 28 genes (listed in ) to assess risk for cardiovascular disease (CVD) in the general population, specifically heart disease and stroke. The EWG found that the magnitude of net health benefit from use of any of these tests alone or in combination is negligible. The EWG discourages clinical use unless further evidence supports improved clinical outcomes. Based on the available evidence, the overall certainty of net health benefit is deemed "Low." It has been suggested that an improvement in CVD risk classification (adjusting intermediate risk of CVD into high- or low-risk categories) might lead to management changes (e.g., earlier initiation or higher rates of medical interventions, or targeted recommendations for behavioral change) that improve CVD outcomes. In the absence of direct evidence to support this possibility, this review sought indirect evidence aimed at documenting the extent to which genomic profiling alters CVD risk estimation, alone and in combination with traditional risk factors, and the extent to which risk reclassification improves health outcomes. Assay-related evidence on available genomic profiling tests was deemed inadequate. However, based on existing technologies that have been or may be used and on data from two of the companies performing such testing, the analytic sensitivity and specificity of tests for individual gene variants might be at least satisfactory. Twenty-nine gene candidates were evaluated, with 58 different gene variant/disease associations. Evidence on clinical validity was rated inadequate for 34 of these associations (59%) and adequate for 23 (40%). Inadequate grades were based on limited evidence, poor replication, existence of possible biases, or combinations of these factors. For heart disease (25 combined associations) and stroke (13

  2. [Cardiovascular risk assessment and risk stratification- guided therapy: predict, prevent and individualize].

    PubMed

    Ural, Dilek

    2011-09-01

    Modern concept in primary prevention of cardiovascular diseases (CVD) entails assessing the person's global risk and making the right management in accordance with these results. Correspondingly, 3 steps recommended for the prevention of CVD under risk guidance are: (a) risk assessment via a proper system like Framingham Risk Score, SCORE, QRISK, PROCAM; (b) decision-making in the proper management in terms of informing the patient about lifestyle changes that he or she can cope and drug selection; and (c) evaluation of treatment decision in terms of cost effectiveness. Although, a significant decline is observed in CVD morbidity and mortality, particularly in the western countries, we still are trying to approach to competent quality measures about management under CV risk guidance. This review summarizes the main challenges regarding risk stratification-guided management strategy in primary prevention of CVD.

  3. Assessment of cardiovascular risk in Tunisia: applying the Framingham risk score to national survey data

    PubMed Central

    Saidi, O; Malouche, D; O'Flaherty, M; Ben Mansour, N; A Skhiri, H; Ben Romdhane, H; Bezdah, L

    2016-01-01

    Objective This paper aims to assess the socioeconomic determinants of a high 10 year cardiovascular risk in Tunisia. Setting We used a national population based cross sectional survey conducted in 2005 in Tunisia comprising 7780 subjects. We applied the non-laboratory version of the Framingham equation to estimate the 10 year cardiovascular risk. Participants 8007 participants, aged 35–74 years, were included in the sample but effective exclusion of individuals with cardiovascular diseases and cancer resulted in 7780 subjects (3326 men and 4454 women) included in the analysis. Results Mean age was 48.7 years. Women accounted for 50.5% of participants. According to the Framingham equation, 18.1% (17.25–18.9%) of the study population had a high risk (≥20% within 10 years). The gender difference was striking and statistically significant: 27.2% (25.7–28.7%) of men had a high risk, threefold higher than women (9.7%; 8.8–10.5%). A higher 10 year global cardiovascular risk was associated with social disadvantage in men and women; thus illiterate and divorced individuals, and adults without a professional activity had a significantly higher risk of developing a cardiovascular event in 10 years. Illiterate men were at higher risk than those with secondary and higher education (OR=7.01; 5.49 to 9.14). The risk in illiterate women was more elevated (OR=13.57; 7.58 to 24.31). Those living in an urban area had a higher risk (OR=1.45 (1.19 to 1.76) in men and OR=1.71 (1.35 to 2.18) in women). Conclusions The 10 year global cardiovascular risk in the Tunisian population is already substantially high, affecting almost a third of men and 1 in 10 women, and concentrated in those more socially disadvantaged. PMID:27903556

  4. Ten-year cardiovascular risk assessment in university students.

    PubMed

    Uvacsek, Martina; Kneffel, Zs; Tóth, M; Johnson, A W; Vehrs, P; Myrer, J W; Hager, R

    2014-09-01

    Cardiovascular disease (CVD) is responsible for more than half of all deaths in the European region. The aim of the study was to compare body composition, blood pressure, total cholesterol (TC) and high density lipoprotein cholesterol (HDL-C), family history, activity behaviors, and the 10-year risk of having a heart attack between 166 university students (21.62 ± 2.59 yrs) from Utah (USA) and 198 students (22.11 ± 2.51 yrs) from Hungary. Ninety-two percent of the Hungarian students and 100% of the Utah students had an estimated 10-year Framingham risk score of 1% or less. The high prevalence of low risk was primarily due to the young age of study participants, healthy body composition and non-smoking behavior. Hungarians who had higher 10-year risk of heart attack had significantly higher waist hip ratio (WHR), TC, diastolic blood pressure (DBP) and were smokers compared to those Hungarians with lower risk. The self-reported physical activity levels between the two groups of students were not different. In conclusion the young men and women who participated in this study were, for the most part healthy; however the smoking habits and the lower physical activity of the Hungarian students likely elevated their risk of CVD.

  5. Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults

    MedlinePlus

    Understanding Task Force Recommendations Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with Ankle Brachial Index in Adults The U.S. Preventive Services Task Force (Task Force) has issued a ...

  6. Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps

    PubMed Central

    Zegkos, Thomas; Kitas, George; Dimitroulas, Theodoros

    2016-01-01

    Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality which cannot be fully explained by traditional CV risk factors; cumulative inflammatory burden and antirheumatic medication-related cardiotoxicity seem to be important contributors. Despite the acknowledgment and appreciation of CV disease burden in RA, optimal management of individuals with RA represents a challenging task which remains suboptimal. To address this need, the European League Against Rheumatism (EULAR) published recommendations suggesting the adaptation of traditional risk scores by using a multiplication factor of 1.5 if two of three specific criteria are fulfilled. Such guidance requires proper coordination of several medical specialties, including general practitioners, rheumatologists, cardiologists, exercise physiologists and psychologists to achieve a desirable result. Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients. Rather than enumerating studies and guidelines, this review attempts to critically appraise current literature, highlighting future perspectives of CV risk management in RA. PMID:27247635

  7. Assessment of cardiovascular risk in rheumatoid arthritis: impact of the new EULAR recommendations on the score cardiovascular risk index.

    PubMed

    Gómez-Vaquero, Carmen; Robustillo, Montserrat; Narváez, Javier; Rodríguez-Moreno, Jesús; González-Juanatey, Carlos; Llorca, Javier; Nolla, Joan Miquel; González-Gay, Miguel Angel

    2012-01-01

    To assess the impact of the application of the European League against Rheumatism (EULAR) task force recommendations in the cardiovascular (CV) risk of a series of Spanish patients diagnosed with rheumatoid arthritis (RA). Two hundred consecutive RA patients seen at the rheumatology outpatient clinics of Bellvitge Hospital, Barcelona, were studied. Information on clinical features of the disease, classic CV risk factors, and history of CV events was assessed. Both the systematic coronary risk evaluation (SCORE) CV risk index and the modified SCORE (mSCORE) according to the last EULAR recommendations were calculated. Based on the classic CV risk factors, the mean ± standard deviation SCORE was 2.1 ± 2.3% (median, 2; interquartile range [IQR], 1-3). Twenty-three (11%) patients were above the threshold of high CV risk for the Spanish population (≥5%). Following the EULAR recommendations, a change in the score was required in 119 (59%) patients. Therefore, the mean mSCORE was 2.7 ± 2.9% (median, 2; IQR, 1-3) and, due to this, 28 (14%) patients were above the threshold of high CV risk. Nine (5%) had at least one ischemic CV event. Patients with CV events were older and had more CV risk factors and higher SCORE and mSCORE than those without CV events. Although a large proportion of patients from this series fulfilled the criteria for the application of the EULAR recommendations, the final impact on the calculated CV risk was low and clinically significant in only a few patients. However, an association between the mSCORE and the presence of ischemic CV events was observed.

  8. Coronary Artery Calcium Assessment in CKD: Utility in Cardiovascular Disease Risk Assessment and Treatment?

    PubMed

    Bashir, Ahmed; Moody, William E; Edwards, Nicola C; Ferro, Charles J; Townend, Jonathan N; Steeds, Richard P

    2015-06-01

    Coronary artery calcification (CAC) is a strong predictor of cardiovascular event rates in the general population, and scoring with multislice computed tomography commonly is used to improve risk stratification beyond clinical variables. CAC is accelerated in chronic kidney disease, but this occurs as a result of 2 distinct pathologic processes that result in medial (arteriosclerosis) and intimal (atherosclerosis) deposition. Although there are data that indicate that very high CAC scores may be associated with increased risk of death in hemodialysis, average CAC scores in most patients are elevated at a level at which discriminatory power may be reduced. There is a lack of data to guide management strategies in these patients based on CAC scores. There are even fewer data available for nondialysis patients, and it is uncertain whether CAC score confers an elevated risk of premature cardiovascular morbidity and mortality in such patients. In this article, we review the evidence regarding the utility of CAC score for noninvasive cardiovascular risk assessment in individuals with chronic kidney disease, using a clinical vignette that highlights some of the limitations in using CAC score and considerations in risk stratification.

  9. Blood Pressure Variability: Can Nonlinear Dynamics Enhance Risk Assessment During Cardiovascular Surgery? A Feasibility Study

    PubMed Central

    Subramaniam, Balachundhar; Khabbaz, Kamal R.; Heldt, Thomas; Lerner, Adam B.; Mittleman, Murray A.; Davis, Roger B.; Goldberger, Ary L.; Costa, Madalena D.

    2014-01-01

    Brief Summary We propose that complex (nonlinear) fluctuations of hemodynamic variables (including systemic blood pressure parameters) during cardiovascular surgery contain information relevant to risk assessment and intraoperative management. Preliminary analysis of a pilot study supports the feasibility and potential merits of performing a larger, prospective study to assess the clinical utility of such new dynamical measures and to evaluate their potential role in enhancing contemporary approaches to risk assessment of major adverse events. PMID:24508020

  10. In vitro models for assessing the potential cardiovascular disease risk associated with cigarette smoking.

    PubMed

    Fearon, Ian M; Gaça, Marianna D; Nordskog, Brian K

    2013-02-01

    Atherosclerotic cardiovascular disease is a prevalent human disorder and a significant cause of human morbidity and mortality. A number of risk factors may predispose an individual to developing atherosclerosis, and of these factors, cigarette smoking is strongly associated with the development of cardiovascular disease. Current thinking suggests that exposure to toxicants found in cigarette smoke may be responsible for this elevated disease likelihood, and this gives rise to the idea that reductions in the levels of some smoke toxicants may reduce the harm associated with cigarette smoking. To assess the disease risk of individuals who smoke cigarettes with altered toxicant levels, a weight-of-evidence approach is required examining both exposure and disease-related endpoints. A key element of such an assessment framework are data derived from the use of in vitro models of cardiovascular disease, which when considered alongside other forms of data (e.g. from clinical studies) may support evidence of potential reduced risk. Importantly, such models may also be used to provide mechanistic insight into the effects of smoking and of smoke toxicant exposure in cardiovascular disease development. In this review the use of in vitro models of cardiovascular disease and one of the contributory factors, oxidative stress, is discussed in the context of assessing the risk potential of both conventional and modified cigarettes. Practical issues concerning the use of these models for cardiovascular disease understanding and risk assessment are highlighted and areas of development necessary to enhance the power and predictive capacity of in vitro disease models in risk assessment are discussed.

  11. Cardiovascular risk assessment in the treatment of nonalcoholic steatohepatitis: a secondary analysis of the MOZART trial.

    PubMed

    Lin, Steven C; Ang, Brandon; Hernandez, Carolyn; Bettencourt, Ricki; Jain, Rashmi; Salotti, Joanie; Richards, Lisa; Kono, Yuko; Bhatt, Archana; Aryafar, Hamed; Lin, Grace Y; Valasek, Mark A; Sirlin, Claude B; Brouha, Sharon; Loomba, Rohit

    2016-03-01

    Nonalcoholic steatohepatitis (NASH) is associated with increased cardiovascular risk and mortality. No US Food and Drug Administration (FDA) approved therapies for NASH are available; clinical trials to date have not yet systematically assessed for changes in cardiovascular risk. This study examines the prospective utility of cardiovascular risk assessments, the Framingham risk score (FRS) and coronary artery calcium (CAC) score, as endpoints in a NASH randomized clinical trial, and assesses whether histologic improvements lead to lower cardiovascular risk. Secondary analysis of a 24-week randomized, double-blind, placebo-controlled trial (MOZART) in which 50 biopsy-proven NASH patients received oral ezetimibe 10 mg daily (n = 25) versus placebo (n = 25). Biochemical profiling, FRS, CAC scores, liver biopsies were obtained at baseline and endpoint. Ezetimibe improved FRS whereas placebo did not (4.4 ± 6.2 to 2.9 ± 4.8, p = 0.038; 3.0 ± 4.4 to 2.9 ± 4.2, p = 0.794). CAC scores did not change with ezetimibe or placebo (180.4 ± 577.2 to 194.1 ± 623.9, p = 0.293; 151.4 ± 448.9 to 183.3 ± 555.7, p = 0.256). Ezetimibe improved FRS and CAC scores in more patients than placebo (48% versus 23%, p = 0.079, and 21% versus 0%, p = 0.090, respectively), though not significantly. No differences were noted in cardiovascular risk scores among histologic responders versus nonresponders. Ezetimibe improved FRS whereas placebo did not. FRS and CAC scores improved in a greater proportion of patients with ezetimibe; this trend did not reach significance. These findings indicate the utility and feasibility of monitoring cardiovascular risk in a NASH trial. The utility of CAC scores may be higher in trials of longer duration (⩾52 weeks) and with older patients (age ⩾45). ClinicalTrials.gov registration: NCT01766713.

  12. Evaluation of the performance of existing non-laboratory based cardiovascular risk assessment algorithms

    PubMed Central

    2013-01-01

    Background The high burden and rising incidence of cardiovascular disease (CVD) in resource constrained countries necessitates implementation of robust and pragmatic primary and secondary prevention strategies. Many current CVD management guidelines recommend absolute cardiovascular (CV) risk assessment as a clinically sound guide to preventive and treatment strategies. Development of non-laboratory based cardiovascular risk assessment algorithms enable absolute risk assessment in resource constrained countries. The objective of this review is to evaluate the performance of existing non-laboratory based CV risk assessment algorithms using the benchmarks for clinically useful CV risk assessment algorithms outlined by Cooney and colleagues. Methods A literature search to identify non-laboratory based risk prediction algorithms was performed in MEDLINE, CINAHL, Ovid Premier Nursing Journals Plus, and PubMed databases. The identified algorithms were evaluated using the benchmarks for clinically useful cardiovascular risk assessment algorithms outlined by Cooney and colleagues. Results Five non-laboratory based CV risk assessment algorithms were identified. The Gaziano and Framingham algorithms met the criteria for appropriateness of statistical methods used to derive the algorithms and endpoints. The Swedish Consultation, Framingham and Gaziano algorithms demonstrated good discrimination in derivation datasets. Only the Gaziano algorithm was externally validated where it had optimal discrimination. The Gaziano and WHO algorithms had chart formats which made them simple and user friendly for clinical application. Conclusion Both the Gaziano and Framingham non-laboratory based algorithms met most of the criteria outlined by Cooney and colleagues. External validation of the algorithms in diverse samples is needed to ascertain their performance and applicability to different populations and to enhance clinicians’ confidence in them. PMID:24373202

  13. Evaluation of the performance of existing non-laboratory based cardiovascular risk assessment algorithms.

    PubMed

    Kariuki, Jacob K; Stuart-Shor, Eileen M; Leveille, Suzanne G; Hayman, Laura L

    2013-12-28

    The high burden and rising incidence of cardiovascular disease (CVD) in resource constrained countries necessitates implementation of robust and pragmatic primary and secondary prevention strategies. Many current CVD management guidelines recommend absolute cardiovascular (CV) risk assessment as a clinically sound guide to preventive and treatment strategies. Development of non-laboratory based cardiovascular risk assessment algorithms enable absolute risk assessment in resource constrained countries.The objective of this review is to evaluate the performance of existing non-laboratory based CV risk assessment algorithms using the benchmarks for clinically useful CV risk assessment algorithms outlined by Cooney and colleagues. A literature search to identify non-laboratory based risk prediction algorithms was performed in MEDLINE, CINAHL, Ovid Premier Nursing Journals Plus, and PubMed databases. The identified algorithms were evaluated using the benchmarks for clinically useful cardiovascular risk assessment algorithms outlined by Cooney and colleagues. Five non-laboratory based CV risk assessment algorithms were identified. The Gaziano and Framingham algorithms met the criteria for appropriateness of statistical methods used to derive the algorithms and endpoints. The Swedish Consultation, Framingham and Gaziano algorithms demonstrated good discrimination in derivation datasets. Only the Gaziano algorithm was externally validated where it had optimal discrimination. The Gaziano and WHO algorithms had chart formats which made them simple and user friendly for clinical application. Both the Gaziano and Framingham non-laboratory based algorithms met most of the criteria outlined by Cooney and colleagues. External validation of the algorithms in diverse samples is needed to ascertain their performance and applicability to different populations and to enhance clinicians' confidence in them.

  14. [Risk factors analysis of cardiovascular diseases. Is the Life Style Assessment useful?].

    PubMed

    Bye, A

    1997-08-10

    The Norwegian Medical Association's Health Control Handbook (1993) has introduced a lifestyle risk analysis-a paper-based way of assessing risk factors for cardiovascular disease and transferring them into pedagogic risk scores. By using the lifestyle risk analysis in our data based risk profile system LIVDA, we compared and evaluated the two systems through 437 consultations at our Occupational Health Clinic. The lifestyle risk analysis is a pedagogic tool, as compared with the unsystematic clinical information recorded in journals. We found only small differences between the lifestyle risk analysis and LIVDA, except when assessing total cholesterol and physical exercise. Lifestyle risk analysis does not, however, allow categorisation of risk factor values without adjustments, and does not include all relevant risk factors. Further, there are no possibilities of measuring motivation, or for selecting patients for group intervention.

  15. Comparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations

    PubMed Central

    2013-01-01

    Background All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions We found a high level of

  16. Cardiovascular Disease in CKD in Children: Update on Risk Factors, Risk Assessment, and Management

    PubMed Central

    Wilson, Amy C; Mitsnefes, Mark M

    2009-01-01

    In young adults with onset of chronic kidney disease in childhood, cardiovascular disease is the most common cause of death. The likely reason for increased cardiovascular disease in these patients is high prevalence of traditional and uremia-related cardiovascular disease risk factors during childhood chronic kidney disease. Early markers of cardiomyopathy, such as left ventricular hypertrophy and left ventricular dysfunction and early markers of atherosclerosis, such as increased carotid artery intima-media thickness, carotid arterial wall stiffness and coronary artery calcification are frequently found in this patient population. The purpose of this review is to provide an update of recent advances in the understanding and management of cardiovascular disease risks in this population. PMID:19619845

  17. Cardiovascular Risk Assessment in the U.S. Coast Guard

    DTIC Science & Technology

    1985-03-01

    developing heart disease. For every 1 per cent of S change in cholesrol, the risk of heart disease changes by 2 or 3 per cent. This informa- " tion can...II BACKG•IUND 4 III DESIGN AND CONDUCT OP THE RESEARCH 6 A. DESIGN PROCEDURE 6 B. REVIEW OF DECEDENT DATA CARDS 8 C. DEVELOPMENT OP SURVEY...risk of developing heart disease. For every one percent of change in cholesterol, the risk of heart disease changes by two to three percent. This

  18. Cardiovascular risk assessment of South Asian populations in religious and community settings: a qualitative study.

    PubMed

    Eastwood, Sophie V; Rait, Greta; Bhattacharyya, Mimi; Nair, Devaki R; Walters, Kate

    2013-08-01

    Cardiovascular disease (CVD) is a leading cause of mortality, and South Asian groups experience worse outcomes than the general population in the UK. Regular screening for CVD risk factors is recommended, but we do not know the best settings in which to deliver this for ethnically diverse populations. Health promotion in religious and community settings may reduce inequalities in access to cardiovascular preventative health care. To use stakeholders' and attendees' experiences to explore the feasibility and potential impact of cardiovascular risk assessment targeting South Asian groups at religious and community venues and how health checks in these settings might compare with general practice assessments. Qualitative semi-structured interviews were used. The settings were two Hindu temples, one mosque and one Bangladeshi community centre in central and north-west London. Twenty-four participants (12 stakeholders and 12 attendees) were purposively selected for interview. Interviews were recorded and transcribed verbatim. Themes from the data were generated using thematic framework analysis. All attendees reported positive experiences of the assessments. All reported making lifestyle changes after the check, particularly to diet and exercise. Barriers to lifestyle change, e.g. resistance to change from family members, were identified. Advantages of implementing assessments in religious and community settings compared with general practice included accessibility and community encouragement. Disadvantages included reduced privacy, organizational difficulties and lack of follow-up care. Cardiovascular risk assessment in religious and community settings has the potential to trigger lifestyle change in younger participants. These venues should be considered for future health promotional activities.

  19. Assessment of cardiovascular risk in patients with rheumatoid arthritis using the SCORE risk index.

    PubMed

    de Campos, Otávio Augusto Martins; Nazário, Nazaré Otília; de Magalhães Souza Fialho, Sônia Cristina; Fialho, Guilherme Loureiro; de Oliveira, Fernando José Savóia; de Castro, Gláucio Ricardo Werner; Pereira, Ivânio Alves

    2016-01-01

    Rheumatoid arthritis is an autoimmune disease that causes systemic involvement and is associated with increased risk of cardiovascular disease. To analyze the prediction index of 10-year risk of a fatal cardiovascular disease event in female RA patients versus controls. Case-control study with analysis of 100 female patients matched for age and gender versus 100 patients in the control group. For the prediction of 10-year risk of a fatal cardiovascular disease event, the SCORE and modified SCORE (mSCORE) risk indexes were used, as suggested by EULAR, in the subgroup with two or more of the following: duration of disease ≥10 years, RF and/or anti-CCP positivity, and extra-articular manifestations. The prevalence of analyzed comorbidities was similar in RA patients compared with the control group (p>0.05). The means of the SCORE risk index in RA patients and in the control group were 1.99 (SD: 1.89) and 1.56 (SD: 1.87) (p=0.06), respectively. The means of mSCORE index in RA patients and in the control group were 2.84 (SD=2.86) and 1.56 (SD=1.87) (p=0.001), respectively. By using the SCORE risk index, 11% of RA patients were classified as of high risk, and with the use of mSCORE risk index, 36% were at high risk (p<0.001). The SCORE risk index is similar in both groups, but with the application of the mSCORE index, we recognized that RA patients have a higher 10-year risk of a fatal cardiovascular disease event, and this reinforces the importance of factors inherent to the disease not measured in the SCORE risk index, but considered in mSCORE risk index. Copyright © 2015 Elsevier Editora Ltda. All rights reserved.

  20. Global cardiovascular risk assessment in the primary prevention of cardiovascular disease in adults: systematic review of systematic reviews

    PubMed Central

    Tompson, Alice C; Onakpoya, Igho J; Roberts, Nia; Ward, Alison M; Heneghan, Carl J

    2017-01-01

    Objective To identify, critically appraise and summarise existing systematic reviews on the impact of global cardiovascular risk assessment in the primary prevention of cardiovascular disease (CVD) in adults. Design Systematic review of systematic reviews published between January 2005 and October 2016 in The Cochrane Library, EMBASE, MEDLINE or CINAHL databases, and post hoc analysis of primary trials. Participants, interventions, outcomes Systematic reviews of interventions involving global cardiovascular risk assessment relative to no formal risk assessment in adults with no history of CVD. The primary outcomes of interest were CVD-related morbidity and mortality and all-cause mortality; secondary outcomes were systolic blood pressure (SBP), cholesterol and smoking. Results We identified six systematic reviews of variable but generally of low quality (mean Assessing the Methodological Quality of Systematic Reviews 4.2/11, range 0/11 to 7/11). No studies identified by the systematic reviews reported CVD-related morbidity or mortality or all-cause mortality. Meta-analysis of reported randomised controlled trials (RCTs) showed small reductions in SBP (mean difference (MD) −2.22 mm Hg (95% CI −3.49 to −0.95); I2=66%; n=9; GRADE: very low), total cholesterol (MD −0.11 mmol/L (95% CI −0.20 to −0.02); I2=72%; n=5; GRADE: very low), low-density lipoprotein cholesterol (MD −0.15 mmol/L (95% CI −0.26 to −0.05), I2=47%; n=4; GRADE: very low) and smoking cessation (RR 1.62 (95% CI 1.08 to 2.43); I2=17%; n=7; GRADE: low). The median follow-up time of reported RCTs was 12 months (range 2–36 months). Conclusions The quality of existing systematic reviews was generally poor and there is currently no evidence reported in these reviews that the prospective use of global cardiovascular risk assessment translates to reductions in CVD morbidity or mortality. There are reductions in SBP, cholesterol and smoking but they may not be clinically

  1. Cardiovascular risk assessment and management in mental health clients: whose role is it anyway?

    PubMed

    Wheeler, Amanda J; Harrison, Jeff; Mohini, Priya; Nardan, Jeshika; Tsai, Amy; Tsai, Eve

    2010-12-01

    People with serious mental illness have higher rates of morbidity and mortality from cardiovascular disease. This study describes health practitioners' views on their role and confidence assessing and managing cardiovascular risk. The key findings were of a widespread acknowledgement of the need to undertake systematic risk assessment and offer structured approaches to risk factor management. Barriers of client engagement, lack of good systems and poor information sharing between primary and secondary care providers were identified. Solutions discussed included a collaborative care model or the integration of physical health services, perhaps a general practitioner-led clinic, within the secondary care setting. Whilst there is a need to identify an optimal care model there is an even greater need to take some rather than no action.

  2. Assessment of cardiovascular risk of new drugs for the treatment of diabetes mellitus: risk assessment vs. risk aversion.

    PubMed

    Zannad, Faiez; Stough, Wendy Gattis; Lipicky, Raymond J; Tamargo, Juan; Bakris, George L; Borer, Jeffrey S; Alonso García, Maria de Los Angeles; Hadjadj, Samy; Koenig, Wolfgang; Kupfer, Stuart; McCullough, Peter A; Mosenzon, Ofri; Pocock, Stuart; Scheen, André J; Sourij, Harald; Van der Schueren, Bart; Stahre, Christina; White, William B; Calvo, Gonzalo

    2016-07-01

    The Food and Drug Administration issued guidance for evaluating the cardiovascular risk of new diabetes mellitus drugs in 2008. Accumulating evidence from several completed trials conducted within this framework raises questions as to whether requiring safety outcome studies for all new diabetes mellitus therapies remains justified. Given the burden of cardiovascular disease in patients with diabetes, the focus should shift towards cardiovascular outcome studies designed to evaluate efficacy (i.e. to determine the efficacy of a drug over placebo or standard care) rather than demonstrating that risk is not increased by a pre-specified safety margin. All stakeholders are responsible for ensuring that new drug approvals occur under conditions of appropriate safety and effectiveness. It is also a shared responsibility to avoid unnecessary hurdles that may compromise access to useful drugs and threaten the sustainability of health systems. It is critical to renew this debate so that stakeholders can collectively determine the optimal approach for developing new drugs to treat type 2 diabetes mellitus.

  3. [Computed tomographic measurement of coronary artery calcification in the assessment of cardiovascular risk: a descriptive study].

    PubMed

    Morcillo, César; Valderas, José M; Roca, Joan M; Oliveró, Ruperto; Núñez, Cristina; Sánchez, Mónica; Bechich, Siraj

    2007-03-01

    Measurement of coronary artery calcification (CAC) is used in the evaluation of cardiovascular risk. We investigated its usefulness by comparing CAC assessment with that of various risk charts. We determined cardiovascular risk in patients without known atherosclerosis using the 1998 European Task Force (ETF), REGICOR (Registre Gironí del Corazón) and SCORE (Systematic Coronary Risk Evaluation) charts. CAC was assessed by computerized tomography and measurements were classified as low risk (i.e., score <1), intermediate risk (i.e., score 1-100), or high risk (i.e., score >100). The study included 331 patients (mean age 54 [8.5] years, 89% male). In 44.1%, CAC was detected (mean score 96 [278]). The degree of agreement between the cardiovascular risk derived from the CAC score and that derived from the SCORE and ETF charts was acceptable: kappa=.33 (P<.05) and kappa=.28 (P<.05), respectively, but agreement was poor with the REGICOR chart: kappa=.02 (P=.32). The SCORE and ETF charts, respectively, classified 45.0% and 38.3% of patients with a CAC score >100 as high risk, whereas the REGICOR chart did not classify any of these patients as high risk. Male sex, older age, smoking history, and a family history of coronary heart disease were all associated with the detection of CAC. Measurement of CAC demonstrated calcification in 44.1% of patients without known atherosclerosis. By regarding those with a CAC score > 100 as high-risk, 10.4% of patients evaluated using the SCORE chart would be reclassified as high risk, as would 11.6% of those evaluated using the ETF chart, and 18.9% of those evaluated using the REGICOR chart. Consequently, more patients would be eligible for preventative treatment.

  4. Disseminating cardiovascular disease risk assessment with a PAHO mobile app: a public eHealth intervention.

    PubMed

    Ordúñez, Pedro; Tajer, Carlos

    2015-07-01

    Cardiovascular diseases are the leading cause of death in the Region of the Americas, making cardiovascular risk assessment a critical component of the clinical decision-making process. This process is facilitated by the use of appropriate tools. This article presents the technical characteristics of an application (app) developed by the Pan American Health Organization/World Health Organization (PAHO/WHO) for mobile devices and computers. Called the Cardiovascular Risk Calculator, it is based on WHO risk tables and applied to the countries of the Region. The article details the epidemiological basis of the diagram for predicting cardiovascular risk and describes the app and its four modules, its main audiences, its production process, and finally, the initial results and some of the challenges. Four months after its launch, the application was being used daily by more than 12 000 users and had been downloaded in virtually all the countries of the Region. The app can be used in by physicians, nurses, and other technical personnel in their daily practice, especially at the primary care level. Since it can also be used by the general public, special attention was paid to its design and tutorial and to ensuring that the clinical estimates and recommendations were easy to understand. This type of app facilitates communication between health care providers and users, and its systematic use in the health services, especially in primary care services, should be promoted.

  5. Renal volume and cardiovascular risk assessment in normotensive autosomal dominant polycystic kidney disease patients

    PubMed Central

    Sans, Laia; Pascual, Julio; Radosevic, Aleksandar; Quintian, Claudia; Ble, Mireia; Molina, Lluís; Mojal, Sergi; Ballarin, José A.; Torra, Roser; Fernández-Llama, Patricia

    2016-01-01

    Abstract Cardiovascular disease, closely related to an early appearance of hypertension, is the most common mortality cause among autosomal dominant polycystic kidney disease patients (ADPKD). The development of hypertension is related to an increase in renal volume. Whether the increasing in the renal volume before the onset of hypertension leads to a major cardiovascular risk in ADPKD patients remains unknown. Observational and cross-sectional study of 62 normotensive ADPKD patients with normal renal function and a group of 28 healthy controls. Renal volume, blood pressure, and renal (urinary albumin excretion), blood vessels (carotid intima media thickness and carotid-femoral pulse wave velocity), and cardiac (left ventricular mass index and diastolic dysfunction parameters) asymptomatic organ damage were determined and were considered as continuous variables. Correlations between renal volume and the other parameters were studied in the ADPKD population, and results were compared with the control group. Blood pressure values and asymptomatic organ damage were used to assess the cardiovascular risk according to renal volume tertiles. Even though in the normotensive range, ADPKD patients show higher blood pressure and major asymptomatic organ damage than healthy controls. Asymptomatic organ damage is not only related to blood pressure level but also to renal volume. Multivariate regression analysis shows that microalbuminuria is only associated with height adjusted renal volume (htTKV). An htTKV above 480 mL/m represents a 10 times higher prevalence of microalbuminuria (4.8% vs 50%, P < 0.001). Normotensive ADPKD patients from the 2nd tertile renal volume group (htTKV > 336 mL/m) show higher urinary albumin excretion, but the 3rd tertile htTKV (htTKV > 469 mL/m) group shows the worst cardiovascular risk profile. Normotensive ADPKD patients show in the early stages of the disease with slight increase in renal volume, higher cardiovascular risk

  6. Renal volume and cardiovascular risk assessment in normotensive autosomal dominant polycystic kidney disease patients.

    PubMed

    Sans, Laia; Pascual, Julio; Radosevic, Aleksandar; Quintian, Claudia; Ble, Mireia; Molina, Lluís; Mojal, Sergi; Ballarin, José A; Torra, Roser; Fernández-Llama, Patricia

    2016-12-01

    Cardiovascular disease, closely related to an early appearance of hypertension, is the most common mortality cause among autosomal dominant polycystic kidney disease patients (ADPKD). The development of hypertension is related to an increase in renal volume. Whether the increasing in the renal volume before the onset of hypertension leads to a major cardiovascular risk in ADPKD patients remains unknown.Observational and cross-sectional study of 62 normotensive ADPKD patients with normal renal function and a group of 28 healthy controls. Renal volume, blood pressure, and renal (urinary albumin excretion), blood vessels (carotid intima media thickness and carotid-femoral pulse wave velocity), and cardiac (left ventricular mass index and diastolic dysfunction parameters) asymptomatic organ damage were determined and were considered as continuous variables. Correlations between renal volume and the other parameters were studied in the ADPKD population, and results were compared with the control group. Blood pressure values and asymptomatic organ damage were used to assess the cardiovascular risk according to renal volume tertiles.Even though in the normotensive range, ADPKD patients show higher blood pressure and major asymptomatic organ damage than healthy controls. Asymptomatic organ damage is not only related to blood pressure level but also to renal volume. Multivariate regression analysis shows that microalbuminuria is only associated with height adjusted renal volume (htTKV). An htTKV above 480 mL/m represents a 10 times higher prevalence of microalbuminuria (4.8% vs 50%, P < 0.001). Normotensive ADPKD patients from the 2nd tertile renal volume group (htTKV > 336 mL/m) show higher urinary albumin excretion, but the 3rd tertile htTKV (htTKV > 469 mL/m) group shows the worst cardiovascular risk profile.Normotensive ADPKD patients show in the early stages of the disease with slight increase in renal volume, higher cardiovascular risk than healthy

  7. Cardiovascular risk assessment in the treatment of nonalcoholic steatohepatitis: a secondary analysis of the MOZART trial

    PubMed Central

    Lin, Steven C.; Ang, Brandon; Hernandez, Carolyn; Bettencourt, Ricki; Jain, Rashmi; Salotti, Joanie; Richards, Lisa; Kono, Yuko; Bhatt, Archana; Aryafar, Hamed; Lin, Grace Y.; Valasek, Mark A.; Sirlin, Claude B.; Brouha, Sharon; Loomba, Rohit

    2016-01-01

    Background: Nonalcoholic steatohepatitis (NASH) is associated with increased cardiovascular risk and mortality. No US Food and Drug Administration (FDA) approved therapies for NASH are available; clinical trials to date have not yet systematically assessed for changes in cardiovascular risk. This study examines the prospective utility of cardiovascular risk assessments, the Framingham risk score (FRS) and coronary artery calcium (CAC) score, as endpoints in a NASH randomized clinical trial, and assesses whether histologic improvements lead to lower cardiovascular risk. Methods: Secondary analysis of a 24-week randomized, double-blind, placebo-controlled trial (MOZART) in which 50 biopsy-proven NASH patients received oral ezetimibe 10 mg daily (n = 25) versus placebo (n = 25). Biochemical profiling, FRS, CAC scores, liver biopsies were obtained at baseline and endpoint. Results: Ezetimibe improved FRS whereas placebo did not (4.4 ± 6.2 to 2.9 ± 4.8, p = 0.038; 3.0 ± 4.4 to 2.9 ± 4.2, p = 0.794). CAC scores did not change with ezetimibe or placebo (180.4 ± 577.2 to 194.1 ± 623.9, p = 0.293; 151.4 ± 448.9 to 183.3 ± 555.7, p = 0.256). Ezetimibe improved FRS and CAC scores in more patients than placebo (48% versus 23%, p = 0.079, and 21% versus 0%, p = 0.090, respectively), though not significantly. No differences were noted in cardiovascular risk scores among histologic responders versus nonresponders. Conclusions: Ezetimibe improved FRS whereas placebo did not. FRS and CAC scores improved in a greater proportion of patients with ezetimibe; this trend did not reach significance. These findings indicate the utility and feasibility of monitoring cardiovascular risk in a NASH trial. The utility of CAC scores may be higher in trials of longer duration (⩾52 weeks) and with older patients (age ⩾45). ClinicalTrials.gov registration: NCT01766713. PMID:26929777

  8. Cardiovascular safety risk assessment for new candidate drugs from functional and pathological data: Conference report.

    PubMed

    Klein, Stephanie K; Redfern, Will S

    2015-01-01

    This is a report on a 2-day joint meeting between the British Society of Toxicological Pathology (BSTP) and the Safety Pharmacology Society (SPS) held in the UK in November 2013. Drug induced adverse effects on the cardiovascular system are associated with the attrition of more marketed and candidate drugs than any other safety issue. The objectives of this meeting were to foster inter-disciplinary approaches to address cardiovascular risk assessment, improve understanding of the respective disciplines, and increase awareness of new technologies. These aims were achieved. This well attended meeting covered both 'purely functional' cardiovascular adverse effects of drugs (e.g., electrophysiological and haemodynamic changes) as well as adverse effects encompassing both functional and pathological changes. Most of the presentations focused on nonclinical safety data, with information on translation to human where known. To reflect the content of the presentations we have cited key references and review articles.

  9. Cardiovascular health status and health risk assessment method of preference among worksite employees.

    PubMed

    Marschke, Lisa M; Allen, George J; Coble, Denis A; Zellner, Scott R; Klein, Randi; Aiudi, Barbara; Murphy, Donna; Pescatello, Linda S

    2006-01-01

    We investigated whether employees (n = 62) selecting a self-report Health Risk Assessment (HRA) would be at increased CVD risk compared to employees (n = 114) choosing an HRA with measurement of cardiovascular (CVD) health indicators. Participants were mostly middle-aged (44.1 +/- 0.8 yr) men (71.6%) displaying borderline features of the cardiometabolic syndrome. Although there were no significant differences between the groups regarding their measured CVD health status or self-reported lifestyle habits, employees in both groups consistently over-stated their level of cardiovascular health. Contrary to reports in the literature, cardiovascular health status did not appear to influence employee HRA method of preference.Editors' Strategic Implications: These findings await replication in other samples, both more diverse and less self-selected. Nonetheless, the authors' methods and their conclusions about workers' over-estimation of their health and the lack of differences across assessment methods will be useful to employers, health professionals, and all practitioners with an interest in health risk assessments.

  10. Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management

    PubMed Central

    Zolezzi, Monica; Abdallah, Oraib; Aden, Suad; Major, Stella; White, Diana; El-Awaisi, Alla

    2017-01-01

    Early assessment and management of risk factors is known to have significant impact in preventing cardiovascular disease (CVD) and its associated burden. Cardiovascular disease risk assessment and management (CVDRAM) is best approached by teamwork across health care professionals. This study aimed at assessing health care students’ (HCSs) knowledge about the parameters needed for estimating CVD risk, their self-assessed preparedness/confidence and perceived barriers for the provision of CVDRAM services through a survey administered to third and fourth year pharmacy, medical, and nursing students in Qatar. Although all student cohorts achieved similar knowledge scores, less than half (n = 38, 47%) were able to identify all of the six main risk factors necessary to estimate absolute CVD risk, and a third (32%) were unable to identify total cholesterol as an independent risk factor necessary to estimate CVD risk. Training on the use of CVD risk assessment tools differed among the three student cohorts. All student cohorts also perceived similar levels of preparedness in CVDRAM. However, pharmacy students reported the highest preparedness/confidence with the use of the latest CVDRAM guidelines. The majority of statements listed under the barriers scale were perceived by the students as being moderate (median score = 3). Poor public acceptance or unawareness of importance of estimating CVD risk was the only barrier perceived as a major by nursing students. Future integration of interprofessional educational (IPE) activities in the CVDRAM curricula of HCSs may be a suitable strategy to minimize barriers and foster collaborative practice for the provision of CVDRAM services in Qatar.

  11. Global cardiovascular disease risk assessment in United States adults with diabetes.

    PubMed

    Wong, Nathan D; Glovaci, Diana; Wong, Kalina; Malik, Shaista; Franklin, Stanley S; Wygant, Gail; Iloeje, Uchenna

    2012-04-01

    Diabetes mellitus (DM) is often considered a risk equivalent for cardiovascular disease (CVD); however, the variation in CVD risk in adults with DM has not been described. We studied 1114 US adults aged ≥18 years with DM from national survey data and the proportion at low (<10%), intermediate (10-20%) and high (>20%) risk, or with CVD, by age, gender, ethnicity and diabetes type and treatment, and glycaemic and risk factor control by risk group. Overall, 22.9% were low, 17.5% intermediate, 31.4% high risk and 28.2% had pre-existing CVD (total 59.6% high risk/CVD). More Hispanics (32.4%) and Blacks (30.6%) versus Whites (18.8%) were at lower risk (p<0.0001). Among type 1 versus 2 DM, 35% vs. 65% (p<0.0001) and among insulin users 68.1% were high risk or with CVD. However, among low-intermediate risk, >50% have metabolic syndrome and 7% chronic kidney disease, increasing the high risk/CVD group to 86.8%. Simultaneous achievement of HbA1c, blood pressure and low density lipoprotein-cholesterol goals was low (<15%) regardless of risk group. Many DM patients are not at high 10-year CVD risk, but metabolic factors may place them at greater long-term risk. Risk assessment could help target the intensity of treatment.

  12. Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: protocol for an overview of systematic reviews

    PubMed Central

    Studzin´ski, Krzysztof; Tomasik, Tomasz; Krzyszton´, Janusz; Józ´wiak, Jacek; Windak, Adam

    2017-01-01

    Introduction Major clinical practice guidelines recommend assessing risk of cardiovascular disease (CVD) using absolute/global/total CVD risk scores. However, the effectiveness of using them in clinical practice, despite publication of numerous randomised controlled trials (RCTs), is still poorly understood. To summarise and analyse current knowledge in this field, we will carry out an overview of existing systematic reviews (SRs). The objective of this overview will be to assess the effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of CVD compared with standard care. Methods and analysis We will include SRs and meta-analyses which take into account RCTs and quasi-RCTs investigating the effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of CVD. SRs will be retrieved from 4 bibliographical databases and reference lists of identified reviews. Additionally, the PROSPERO database will be searched for unpublished, ongoing or recently completed SRs. 2 reviewers will assess the SRs independently for eligibility and bias. The data will be extracted to a special form. Any disagreement will be resolved by discussion. In case of lack of consensus, a third author will arbitrate. The overview of SRs will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Ethics and dissemination Ethics approval is not required for overview of SRs. We will summarise evidence concerning whether use of the absolute/global/total CVD risk scoring tools in primary prevention of CVD is effective and supported with scientific data or not. If we face unsatisfactory confirmation, we will highlight a need for further research and advice on how to plan such a study. We will submit the results of our study for peer-review publication in a journal indexed in the international bibliographic database of biomedical information. PMID:28274967

  13. Effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of cardiovascular disease: protocol for an overview of systematic reviews.

    PubMed

    Studziński, Krzysztof; Tomasik, Tomasz; Krzyszton, Janusz; Jóźwiak, Jacek; Windak, Adam

    2017-03-08

    Major clinical practice guidelines recommend assessing risk of cardiovascular disease (CVD) using absolute/global/total CVD risk scores. However, the effectiveness of using them in clinical practice, despite publication of numerous randomised controlled trials (RCTs), is still poorly understood. To summarise and analyse current knowledge in this field, we will carry out an overview of existing systematic reviews (SRs). The objective of this overview will be to assess the effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of CVD compared with standard care. We will include SRs and meta-analyses which take into account RCTs and quasi-RCTs investigating the effect of using cardiovascular risk scoring in routine risk assessment in primary prevention of CVD. SRs will be retrieved from 4 bibliographical databases and reference lists of identified reviews. Additionally, the PROSPERO database will be searched for unpublished, ongoing or recently completed SRs. 2 reviewers will assess the SRs independently for eligibility and bias. The data will be extracted to a special form. Any disagreement will be resolved by discussion. In case of lack of consensus, a third author will arbitrate. The overview of SRs will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Ethics approval is not required for overview of SRs. We will summarise evidence concerning whether use of the absolute/global/total CVD risk scoring tools in primary prevention of CVD is effective and supported with scientific data or not. If we face unsatisfactory confirmation, we will highlight a need for further research and advice on how to plan such a study. We will submit the results of our study for peer-review publication in a journal indexed in the international bibliographic database of biomedical information. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted

  14. Cardiovascular risk assessment in rheumatoid arthritis – controversies and the new approach

    PubMed Central

    Głuszko, Piotr

    2016-01-01

    The current methods of cardiovascular (CV) risk assessment in the course of inflammatory connective tissue diseases are a subject of considerable controversy. Comparing different methods of CV risk assessment in current rheumatoid arthritis (RA) guidelines, only a few of them recommend the use of formal risk calculators. These are the EULAR guidelines suggesting the use of SCORE and the British Society for Rheumatology guidelines performed in collaboration with NICE preferring the use of QRISK-2. Analyzing the latest American and British reports, two main concepts could be identified. The first one is to focus on risk calculators developed for the general population taking into account RA, and the calculator that might fulfill this role is the new QRISK-2 presented by NICE in 2014. The second concept is to create RA-specific risk calculators, such as the Expanded Cardiovascular Risk Prediction Score for RA. In this review we also discuss the efficiency of a new Pooled Cohort Equation and other calculators in the general and RA population. PMID:27504023

  15. Cardiovascular risk assessment in rheumatoid arthritis - controversies and the new approach.

    PubMed

    Bonek, Krzysztof; Głuszko, Piotr

    2016-01-01

    The current methods of cardiovascular (CV) risk assessment in the course of inflammatory connective tissue diseases are a subject of considerable controversy. Comparing different methods of CV risk assessment in current rheumatoid arthritis (RA) guidelines, only a few of them recommend the use of formal risk calculators. These are the EULAR guidelines suggesting the use of SCORE and the British Society for Rheumatology guidelines performed in collaboration with NICE preferring the use of QRISK-2. Analyzing the latest American and British reports, two main concepts could be identified. The first one is to focus on risk calculators developed for the general population taking into account RA, and the calculator that might fulfill this role is the new QRISK-2 presented by NICE in 2014. The second concept is to create RA-specific risk calculators, such as the Expanded Cardiovascular Risk Prediction Score for RA. In this review we also discuss the efficiency of a new Pooled Cohort Equation and other calculators in the general and RA population.

  16. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings

    PubMed Central

    Modesti, Pietro A.; Agostoni, Piergiuseppe; Agyemang, Charles; Basu, Sanjay; Benetos, Athanase; Cappuccio, Francesco P.; Ceriello, Antonio; Del Prato, Stefano; Kalyesubula, Robert; O’Brien, Eoin; Kilama, Michael O.; Perlini, Stefano; Picano, Eugenio; Reboldi, Gianpaolo; Remuzzi, Giuseppe; Stuckler, David; Twagirumukiza, Marc; Van Bortel, Luc M.; Watfa, Ghassan; Zhao, Dong; Parati, Gianfranco

    2014-01-01

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on ‘Hypertension and Cardiovascular risk in low resource settings’, which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs. PMID:24577410

  17. Cardiovascular risk assessment in low-resource settings: a consensus document of the European Society of Hypertension Working Group on Hypertension and Cardiovascular Risk in Low Resource Settings.

    PubMed

    Modesti, Pietro A; Agostoni, Piergiuseppe; Agyemang, Charles; Basu, Sanjay; Benetos, Athanase; Cappuccio, Francesco P; Ceriello, Antonio; Del Prato, Stefano; Kalyesubula, Robert; O'Brien, Eoin; Kilama, Michael O; Perlini, Stefano; Picano, Eugenio; Reboldi, Gianpaolo; Remuzzi, Giuseppe; Stuckler, David; Twagirumukiza, Marc; Van Bortel, Luc M; Watfa, Ghassan; Zhao, Dong; Parati, Gianfranco

    2014-05-01

    The Global Burden of Diseases, Injuries, and Risk Factors Study 2010 confirms ischemic heart disease and stroke as the leading cause of death and that hypertension is the main associated risk factor worldwide. How best to respond to the rising prevalence of hypertension in resource-deprived settings is a topic of ongoing public-health debate and discussion. In low-income and middle-income countries, socioeconomic inequality and cultural factors play a role both in the development of risk factors and in the access to care. In Europe, cultural barriers and poor communication between health systems and migrants may limit migrants from receiving appropriate prevention, diagnosis, and treatment. To use more efficiently resources available and to make treatment cost-effective at the patient level, cardiovascular risk approach is now recommended. In 2011, The European Society of Hypertension established a Working Group on 'Hypertension and Cardiovascular risk in low resource settings', which brought together cardiologists, diabetologists, nephrologists, clinical trialists, epidemiologists, economists, and other stakeholders to review current strategies for cardiovascular risk assessment in population studies in low-income and middle-income countries, their limitations, possible improvements, and future interests in screening programs. This report summarizes current evidence and presents highlights of unmet needs.

  18. Coverage of a national cardiovascular risk assessment and management programme (NHS Health Check): Retrospective database study.

    PubMed

    Chang, Kiara Chu-Mei; Soljak, Michael; Lee, John Tayu; Woringer, Maria; Johnston, Desmond; Khunti, Kamlesh; Majeed, Azeem; Millett, Christopher

    2015-09-01

    To determine coverage of NHS Health Check, a national cardiovascular risk assessment programme in England, in the first four years after implementation, and to examine prevalence of high cardiovascular disease (CVD) risk and uptake of statins in high risk patients. Study sample was 95,571 patients in England aged 40-74years continuously registered with 509 practices in the Clinical Practice Research Datalink between April 2009 and March 2013. Multilevel logistic regression models were used to assess predictors of Health Check attendance; elevated CVD risk factors and statin prescribing among attendees. Programme coverage was 21.4% over four years, with large variations between practices (0%-72.7%) and regions (9.4%-30.7%). Coverage was higher in older patients (adjusted odds ratio 2.88, 95% confidence interval 2.49-3.31 for patients 70-74years) and in patients with a family history of premature coronary heart disease (2.37, 2.22-2.53), but lower in Black Africans (0.75, 0.61-0.92) and Chinese (0.68, 0.47-0.96) compared with White British. Coverage was similar in patients living in deprived and affluent areas. Prevalence of high CVD risk (QRISK2≥20%) among attendees was 4.6%. One third (33.6%) of attendees at high risk were prescribed a statin after Health Checks. Coverage of the programme and statin prescribing in high risk individuals was low. Coverage was similar in deprived and affluent groups but lower in some ethnic minority groups, possibly widening inequalities. These findings raise a question about whether recommendations by WHO to develop CVD risk assessment programmes internationally will deliver anticipated health benefits. Copyright © 2015. Published by Elsevier Inc.

  19. Cost-effectiveness of the polypill versus risk assessment for prevention of cardiovascular disease.

    PubMed

    Ferket, Bart S; Hunink, M G Myriam; Khanji, Mohammed; Agarwal, Isha; Fleischmann, Kirsten E; Petersen, Steffen E

    2017-04-01

    There is an international trend towards recommending medication to prevent cardiovascular disease (CVD) in individuals at increasingly lower cardiovascular risk. We assessed the cost-effectiveness of a population approach with a polypill including a statin (simvastatin 20 mg) and three antihypertensive agents (amlodipine 2.5 mg, losartan 25 mg and hydrochlorothiazide 12.5 mg) and periodic risk assessment with different risk thresholds. We developed a microsimulation model for lifetime predictions of CVD events, diabetes, and death in 259 146 asymptomatic UK Biobank participants aged 40-69 years. We assessed incremental costs and quality-adjusted life-years (QALYs) for polypill scenarios with the same combination of agents and doses but differing for starting age, and periodic risk assessment with 10-year CVD risk thresholds of 10% and 20%. Restrictive risk assessment, in which statins and antihypertensives were prescribed when risk exceeded 20%, was the optimal strategy gaining 123 QALYs (95% credible interval (CI) -173 to 387) per 10 000 individuals at an extra cost of £1.45 million (95% CI 0.89 to 1.94) as compared with current practice. Although less restrictive risk assessment and polypill scenarios prevented more CVD events and attained larger survival gains, these benefits were offset by the additional costs and disutility of daily medication use. Lowering the risk threshold for prescription of statins to 10% was economically unattractive, costing £40 000 per QALY gained. Starting the polypill from age 60 onwards became the most cost-effective scenario when annual drug prices were reduced below £240. All polypill scenarios would save costs at prices below £50. Periodic risk assessment using lower risk thresholds is unlikely to be cost-effective. The polypill would become cost-effective if drug prices were reduced. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  20. The Legacy of MESA – Providing Evidence for Subclinical Cardiovascular Disease in Risk Assessment

    PubMed Central

    Blaha, Michael J.; Yeboah, Joseph; Al Rifai, Mahmoud; Liu, Kiang J.; Kronmal, Richard; Greenland, Philip

    2016-01-01

    Summary When the Multi-Ethnic Study of Atherosclerosis (MESA) began, the Framingham Risk Score (FRS) was the preferred tool for 10-year global coronary heart disease (CHD) risk assessment. The FRS had limitations including derivation in a homogenous population lacking racial and ethnic diversity and exclusive reliance on traditional risk factors without consideration of subclinical disease measures. MESA was designed to study the prognostic value of subclinical atherosclerosis and other risk markers in a multi-ethnic population. In a series of landmark publications, MESA demonstrated that measures of subclinical cardiovascular disease add significant prognostic value to the traditional Framingham risk variables. In head-to-head studies comparing these markers, MESA established that the coronary artery calcium (CAC) score may be the single best predictor of CHD risk. Results from MESA have directly influenced recent prevention guidelines including the recommendations on risk assessment and cholesterol-lowering therapy. The MESA study has published its own risk score, which allows for the calculation of 10-year risk of CHD before and after knowledge of a CAC score. PMID:27741975

  1. Step On It! Workplace Cardiovascular Risk Assessment of New York City Yellow Taxi Drivers.

    PubMed

    Gany, Francesca; Bari, Sehrish; Gill, Pavan; Ramirez, Julia; Ayash, Claudia; Loeb, Rebecca; Aragones, Abraham; Leng, Jennifer

    2016-02-01

    Multiple factors associated with taxi driving can increase the risk of cardiovascular disease (CVD) in taxi drivers. This paper describes the results of Step On It!, which assessed CVD risk factors among New York City taxi drivers at John F. Kennedy International Airport. Drivers completed an intake questionnaire and free screenings for blood pressure, glucose and body mass index (BMI). 466 drivers participated. 9 % had random plasma glucose values >200 mg/dl. 77 % had elevated BMIs. Immigrants who lived in the US for >10 years had 2.5 times the odds (CI 1.1-5.9) of having high blood pressure compared to newer immigrants. Abnormalities documented in this study were significant, especially for immigrants with greater duration of residence in the US, and underscore the potential for elevated CVD risk in this vulnerable population, and the need to address this risk through frameworks that utilize multiple levels of intervention.

  2. Assessment of Cardiovascular Risk Factors Among University Students: The Gender Factor

    PubMed Central

    Gharaibeh, Mohammad Y.; Alzoubi, Karem H; Khabour, Omar F.; Tinawi, Lubna; Hamad, Rawan; Keewan, Esraa F.; Matarneh, Sulaiman K.; Alomari, Mahmoud A.

    2012-01-01

    Background Evidence indicates that the pathophysiological process of cardiovascular (CV) disease begins at early age, though the manifestations of the disease do not appear until middle age adulthood. Risk factors for CV disease, particularly lipoprotein profiles, are affected by physiological abnormalities, and lifestyle related issues. To evaluate prevalence of CV diseases risk factors among university students and to investigate relation between number of risk factors and body anthropometric, hematological and biochemical indices parameters. Methods In this cross sectional study, 348 students were randomly recruited. Blood glucose, cholesterol profile (total, HDL, and LDL cholesterol), and triglyceride were measured using standard protocols. Physical activity (PA) level was assessed using the short-form Arabic version of the International Physical Activity Questionnaires (IPAQ). Results The most commonly encountered CV disease risk factor was low levels of HDL-C, followed by physical inactivity, high levels TG, and obese BMI. When stratified by gender, females were less likely to have low HDL-C, and high TG, whereas, males were more likely to have overweight or obese BMI (P < 0.001). About 49% of the participants had at least one CV disease risk factor, where as the prevalence of having one, two and three or more CV disease risk factors were 35.7%, 9.3% and 4%, respectively. Additionally, the number of CV disease risk factors showed strong positive correlation with increases in body fat and bone percentages, glucose, total cholesterol, TG, LDL-C, BMI, and WHR (range of R2: 0.17 to 0.603). On the other hand, physical activity, percentages of body water and muscle, HDL-C showed inverse strong correlation with cardiovascular risk factors (range of R2: -0.239 to -0.412). Conclusions Results indicate the high prevalence of CV disease risk factors among university students, and stress the need for early intervention programs to counteract these risks.

  3. Work-site cardiovascular risk reduction: a randomized trial of health risk assessment, education, counseling, and incentives.

    PubMed Central

    Gomel, M; Oldenburg, B; Simpson, J M; Owen, N

    1993-01-01

    OBJECTIVES. This study reports an efficacy trial of four work-site health promotion programs. It was predicted that strategies making use of behavioral counseling would produce a greater reduction in cardiovascular disease risk factors than screening and educational strategies. METHODS. Twenty-eight work sites were randomly allocated to a health risk assessment, risk factor education, behavioral counseling, or behavioral counseling plus incentives intervention. Participants were assessed before the intervention and at 3, 6, and 12 months. RESULTS. Compared with the average of the health risk assessment and risk factor education conditions, there were significantly higher validated continuous smoking cessation rates and smaller increases in body mass index and estimated percentage of body fat in the two behavioral counseling conditions. The behavioral counseling condition was associated with a greater reduction in mean blood pressure than was the behavioral counseling plus incentives condition. On average among all groups, there was a short-term increase in aerobic capacity followed by a return to baseline levels. CONCLUSIONS. Work-site interventions that use behavioral approaches can produce lasting changes in some cardiovascular risk factors and, if implemented routinely, can have a significant public health impact. PMID:8362997

  4. Assessment of gastrointestinal and cardiovascular risk in patients with osteoarthritis who require NSAIDs: the LOGICA study.

    PubMed

    Lanas, Angel; Tornero, Jesús; Zamorano, José Luis

    2010-08-01

    Medical management of adults with osteoarthritis (OA) who require non-steroidal anti-inflammatory drugs (NSAIDs) must be decided after assessing prevalent gastrointestinal (GI) and cardiovascular (CV) risks in the individual patient. To evaluate the GI and CV risk profile of patients with OA who require NSAIDs. A transversal, multicentre and observational study was conducted in consecutive patients with OA who were considered candidates for NSAID treatment and were visited by 374 unselected rheumatologists throughout the National Health System. Patients were classified into three risk groups (low, moderate and high) for their GI and CV characteristics. These were defined by considering the presence of a number of well-established GI risk factors or by application of the Systematic Coronary Risk Evaluation model for assessing the overall risk for CV disease, respectively. Of 3293 consecutive patients, most (86.6%) were at increased GI risk and a considerable number, 22.3%, were at high GI risk. The CV risk was high in 44.2% of patients, moderate in 28.5% and low in 27.3%. Overall, 15.5% of patients presented a very high-risk profile, having high GI and CV risks. The type of NSAID prescription was similar regardless of the associated GI and CV risk profile. Most patients with OA requiring NSAIDs for pain control showed a high prevalence of GI and CV risk factors. Over half of the patients were at either high GI or CV risk, or both, such that the prescription of OA treatments should be very carefully considered.

  5. Narrative review: Assessment of C-reactive protein in risk prediction for cardiovascular disease.

    PubMed

    Lloyd-Jones, Donald M; Liu, Kiang; Tian, Lu; Greenland, Philip

    2006-07-04

    Some experts propose C-reactive protein (CRP) as a screening tool for prediction of cardiovascular disease (CVD). Many epidemiologic studies show positive associations between elevated CRP levels and incident CVD. Assessment of the value of new prognostic tests, however, must rely on understanding of test characteristics rather than on associations measured by relative risks. In the case of CRP, test characteristics must be judged in the context of currently available CVD risk prediction algorithms. In this review of literature published before January 2006, the authors describe what is known about the additional utility of CRP in risk prediction. They find no definitive evidence that, for most individuals, CRP adds substantial predictive value above that provided by risk estimation using traditional risk factors for CVD. Use of CRP may add to risk estimation in a limited subset of individuals who are at intermediate predicted risk according to the Framingham risk score. The authors propose that many questions still must be addressed before CRP is incorporated into risk prediction algorithms and before universal screening with CRP can be recommended.

  6. Expert knowledge integration in the data mining process with application to cardiovascular risk assessment.

    PubMed

    Tavares, M; Paredes, S; Rocha, T; Carvalho, P; Ramos, J; Mendes, D; Henriques, J; Morais, J

    2015-01-01

    The data mining process, when applied to clinical databases, suffers from critical data problems, from noisy acquisitions to missing or incomplete data points. Expert knowledge, in the form of practitioners' experience and clinical guidelines, is already used to manually correct some of these problems, while enhancing expert's confidence in such systems. In this work, we propose the Knowledge-Biased Tree (KB3), a knowledge biased decision tree inducer that is able to exploit IF THEN rules to guide the tree inducing process. The KB3 approach was tested against its unbiased counterpart, the C5.0 algorithm in the cardiovascular risk assessment task. Using a clinical dataset provided by the hospital of Sta Cruz (Lisbon, Portugal) the performance of the proposed algorithm is compared against the unbiased C5.0 and the state of the art risk score used in clinical practice (GRACE risk score).

  7. Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease.

    PubMed

    Dyakova, Mariana; Shantikumar, Saran; Colquitt, Jill L; Drew, Christian M; Sime, Morag; MacIver, Joanna; Wright, Nicola; Clarke, Aileen; Rees, Karen

    2016-01-29

    Screening programmes can potentially identify people at high cardiovascular risk and reduce cardiovascular disease (CVD) morbidity and mortality. However, there is currently not enough evidence showing clear clinical or economic benefits of systematic screening-like programmes over the widely practised opportunistic risk assessment of CVD in primary care settings. The primary objective of this review was to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE, EMBASE on 30 January 2015, and Web of Science Core Collection and additional databases on the Cochrane Library on 4 December 2014. We also searched two clinical trial registers and checked reference lists of relevant articles. We applied no language restrictions. We selected randomised controlled trials (RCTs) that assessed the effects of systematic risk assessment, defined as a screening-like programme involving a predetermined selection process of people, compared with opportunistic risk assessment which ranged from no risk assessment at all to incentivised case finding of CVD and related risk factors. Participants included healthy adults from the general population, including those who are at risk of CVD. Two review authors independently selected studies. One review author extracted data and assessed them for risk of bias and a second checked them. We assessed evidence quality using the GRADE approach and present this in a 'Summary of findings' table. Nine completed RCTs met the inclusion criteria, of which four were cluster-randomised. We also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. The length of follow-up varied from one year in four studies, three years in one study, five or six years

  8. Using run charts for cardiovascular disease risk assessments in general practice.

    PubMed

    Wells, Susan; Rafter, Natasha; Eggleton, Kyle; Turner, Catherine; Huang, Ying; Bullen, Chris

    2016-06-01

    INTRODUCTION Run charts are quality improvement tools. AIM To investigate the feasibility and acceptability of run charts displaying weekly cardiovascular disease (CVD) risk assessments in general practice and assess their impact on CVD risk assessments. METHODS A controlled non-randomised observational study in nine practices using run charts and nine control practices. We measured the weekly proportion of eligible patients with completed CVD risk assessments for 19 weeks before and after run charts were introduced into intervention practices. A random coefficients model determined changes in CVD risk assessment rates (slope) from pre- to post- intervention by aggregating and comparing intervention and control practices' mean slopes. We interviewed staff in intervention practices about their use of run charts. RESULTS Seven intervention practices used their run chart; six consistently plotting weekly data for >12 weeks and positioning charts in a highly visible place. Staff reported that charts were easy to use, a visual reminder for ongoing team efforts, and useful for measuring progress. There were no significant differences between study groups: the mean difference in pre- to post-run chart slope in the intervention group was 0.03% more CVD risk assessments per week; for the control group the mean difference was 0.07%. The between group difference was 0.04% per week (95% CI: -0.26 to 0.35, P = 0.77). DISCUSSION Run charts are feasible in everyday general practice and support team processes. There were no differences in CVD risk assessment between the two groups, likely due to national targets driving performance at the time of the study.

  9. Cardiovascular risk factors underestimate atherosclerotic burden in chronic kidney disease: usefulness of non-invasive tests in cardiovascular assessment.

    PubMed

    Coll, Blai; Betriu, Angels; Martínez-Alonso, Montserrat; Borràs, Mercè; Craver, Lourdes; Amoedo, Maria Luisa; Marco, Ma Paz; Sarró, Felipe; Junyent, Mireia; Valdivielso, Jose Manuel; Fernández, Elvira

    2010-09-01

    Cardiovascular risk scoring (Score) does not specifically address chronic kidney disease (CKD) patients. The aim of our study is to quantify atherosclerosis using carotid ultrasound and ankle-brachial index (ABI) and to assess its additional value in risk scoring. In this cross-sectional, observational study, patients were studied according to a standardized protocol including carotid ultrasound and ABI to determine the atherosclerosis score (AS), ranging from absence of to severe atherosclerosis (AS 0 to AS 3). We included 409 CKD-affected patients (231 on dialysis, 99 in CKD Stages IV-V and 79 in CKD Stages I-III) and 851 subjects with normal renal function. The presence and severity of atherosclerosis was significantly higher in the CKD group than in the controls at every decade of age studied. Among the CKD-affected subjects, the prevalence of carotid plaques was significantly higher in the dialysis group (78.3%) than in the group in CKD Stages I-III (55.6%, P < 0.001). We identified 174 patients at low-intermediate risk. Among them, 110 (63.2%) presented either moderate (AS 2) or severe (AS 3) atherosclerosis. Variables significantly (P < 0.05) and positively related to atherosclerosis were being on dialysis [OR = 3.40, 95% CI (1.73, 6.78) vs CKD Stages I-III], age [OR = 1.08, 95% CI (1.06-1.11)] and C-reactive protein [OR = 1.04, 95% CI (1.01-1.08)]. Conversely, female sex was negatively related to atherosclerosis [OR = 0.40, 95% CI (0.23-0.71), P = 0.002]. The use of carotid ultrasound and ABI identifies atherosclerosis in a population of CKD patients in which risk scoring underestimates atherosclerosis burden.

  10. CRP at early follicular phase of menstrual cycle can cause misinterpretation for cardiovascular risk assessment.

    PubMed

    Gursoy, Asli Yarci; Caglar, Gamze Sinem; Kiseli, Mine; Pabuccu, Emre; Candar, Tuba; Demirtas, Selda

    2015-12-01

    C-reactive protein (CRP) is a well-known marker of inflammation and infection in clinical practice. This study is designed to evaluate CRP levels in different phases of menstrual cycle, which might end up with misleading conclusions especially when used for cardiovascular risk assessment. Twenty-seven women were eligible for the cross-sectional study. Venous blood samples from each participant were collected twice during the menstrual cycle. The first sampling was held at 2nd to 5th days of the menstrual cycle for FSH, estradiol, CRP, and sedimentation, and the second was done at 21st to 24th days of the menstrual cycle for measurement of progesterone, CRP, and sedimentation values. CRP values were significantly higher in the early follicular phase compared to luteal phase (1.8 mg/L [0.3-7.67] vs. 0.7 mg/L [0.1-8.3], p < 0.001, respectively). In both phases of the menstrual cycle, sedimentation rate was similar (12.1 ± 6.7 vs. 12.3 ± 7.7; p = 0.717, respectively). CRP levels in early follicular phase of the menstrual cycle (menstruation) are significantly higher than CRP levels in luteal phase of the same cycle. In reproductive age women, detection of CRP for cardiovascular risk assessment during menstruation might not be appropriate.

  11. Integrated and translational nonclinical in vivo cardiovascular risk assessment: gaps and opportunities.

    PubMed

    Berridge, Brian R; Hoffmann, Peter; Turk, James R; Sellke, Frank; Gintant, Gary; Hirkaler, Gerald; Dreher, Kevin; Schultze, A Eric; Walker, Dana; Edmunds, Nick; Halpern, Wendy; Falls, James; Sanders, Marty; Pettit, Syril D

    2013-02-01

    Cardiovascular (CV) safety concerns are a significant source of drug development attrition in the pharmaceutical industry today. Though current nonclinical testing paradigms have largely prevented catastrophic CV events in Phase I studies, many challenges relating to the inability of current nonclinical safety testing strategies to model patient outcomes persist. Contemporary approaches include a spectrum of evaluations of CV structure and function in a variety of laboratory animal species. These approaches might be improved with a more holistic integration of these evaluations in repeat-dose studies, addition of novel endpoints with greater sensitivity and translational application, and use of more relevant animal models. Particular opportunities present with advances in imaging capabilities applicable to rodent and non-rodent species, technical capabilities for measuring CV function in repeat-dose animal studies, detection and quantitation of microRNAs and wider use of alternative animal models. Strategic application of these novel opportunities considering putative CV risk associated with the molecular drug target as well as inherent risks present in the target patient population could tailor or 'personalize' nonclinical safety assessment as a more translational evaluation. This paper is a call to action for the clinical and nonclinical drug safety communities to assess these opportunities to determine their utility in filling potential gaps in our current cardiovascular safety testing paradigms. Copyright © 2012 Elsevier Inc. All rights reserved.

  12. Assessing cardiovascular risk in regional areas: the Healthy Hearts – Beyond City Limits program

    PubMed Central

    2012-01-01

    Background Cardiovascular disease (CVD) is more prevalent in regional and remote Australia compared to metropolitan areas. The aim of Healthy Hearts was to determine age and sex specific CVD risk factor levels and the potential value of national risk clinics. Methods Healthy Hearts was an observational research study conducted in four purposefully selected higher risk communities in regional Victoria, Australia. The main outcome measures were the proportion of participants with CVD risk factors with group comparisons to determine the adjusted likelihood of elevated risk factor levels. Trained personnel used a standardized protocol over four weeks per community to measure CVD risk factor levels, estimate absolute CVD risk and provide feedback and advice. Results A total of 2125 self-selected participants were assessed (mean age 58 ± 15 years, 57% women). Overall, CVD risk factors were highly prevalent. More men than women had ≥ 2 modifiable CVD risk factors (76% vs. 68%, p < .001), pre-existing CVD (20 vs. 15%, p < .01) and a major ECG abnormality requiring follow-up (15% vs. 7%, p < .001) . Less men reported depressive symptoms compared to women (28% vs. 22%, p < .01). A higher proportion of women were obese (adjusted OR 1.36, 95% CI 1.13 to 1.63), and physically inactive (adjusted OR 1.32, 95% CI 1.07 to 1.63). Conclusions High CVD risk factor levels were confirmed for regional Victoria. Close engagement with individuals and communities provides scope for the application of regional risk management clinics to reduce the burden of CVD risk in regional Australia. PMID:22943553

  13. Cardiovascular risk assessment and treatment in chronic inflammatory disorders in primary care

    PubMed Central

    Emanuel, G; Charlton, J; Ashworth, M; Gulliford, M C; Dregan, A

    2016-01-01

    Objective To compare differences in cardiovascular (CV) risk factors assessment and management among patients with rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) with that of matched controls. Methods A matched cohort study was conducted using primary care electronic health records for one London borough. All patients diagnosed with RA or IBD, and matched controls registered with local general practices on 12th of January 2014 were identified. The study compared assessment and treatment of CV risk factors (blood pressure, body mass index, cholesterol and smoking) in the year before, the year after, and 5 years after RA and IBD diagnosis. Results A total of 1121 patients with RA and 1875 patients with IBD were identified and matched with 4282 and, respectively, 7803 controls. Patients with RA were 25% (incidence rate ratio, 1.25, 95% CI 1.12 to 1.35) more likely to have a CV risk factor measured compared with matched controls. The difference declined to 8% (1.08, 1.04 to 1.14) over 5 years of follow-up. The corresponding figures for IBD were 26% (1.26, 1.16 to 1.38) and 10% (1.10, 1.05 to 1.15). Patients with RA showed higher antihypertensive prescription rates during 5 years of follow-up (OR, 1.37, 95% CI 1.14 to 1.65) and patients with IBD showed higher statin prescription rates in the year preceding diagnosis (2.30, 1.20 to 4.42). Incomplete CV risk assessment meant that QRISK scores could be calculated for less than a fifth (17%) and clinical recording of CV disease (CVD) risk scores among patients with RA and IBD was 11% and 6%, respectively. Conclusions The assessment and treatment of vascular risk in patients with RA and IBD in primary care is suboptimal, particularly with reference to CVD risk score calculation. PMID:27534979

  14. Adiponectin Provides Additional Information to Conventional Cardiovascular Risk Factors for Assessing the Risk of Atherosclerosis in Both Genders

    PubMed Central

    Yoon, Jin-Ha; Kim, Sung-Kyung; Choi, Ho-June; Choi, Soo-In; Cha, So-Youn; Koh, Sang-Baek

    2013-01-01

    Background This study evaluated the relation between adiponectin and atherosclerosis in both genders, and investigated whether adiponectin provides useful additional information for assessing the risk of atherosclerosis. Methods We measured serum adiponectin levels and other cardiovascular risk factors in 1033 subjects (454 men, 579 women) from the Korean Genomic Rural Cohort study. Carotid intima–media-thickness (CIMT) was used as measure of atherosclerosis. Odds ratios (ORs) with 95% confidence intervals (95% CI) were calculated using multiple logistic regression, and receiver operating characteristic curves (ROC), the category-free net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated. Results After adjustment for conventional cardiovascular risk factors, such as age, waist circumference, smoking history, low-density and high-density lipoprotein cholesterol, triglycerides, systolic blood pressure and insulin resistance, the ORs (95%CI) of the third tertile adiponectin group were 0.42 (0.25–0.72) in men and 0.47 (0.29–0.75) in women. The area under the curve (AUC) on the ROC analysis increased significantly by 0.025 in men and 0.022 in women when adiponectin was added to the logistic model of conventional cardiovascular risk factors (AUC in men: 0.655 to 0.680, p = 0.038; AUC in women: 0.654 to 0.676, p = 0.041). The NRI was 0.32 (95%CI: 0.13–0.50, p<0.001), and the IDI was 0.03 (95%CI: 0.01–0.04, p<0.001) for men. For women, the category-free NRI was 0.18 (95%CI: 0.02–0.34, p = 0.031) and the IDI was 0.003 (95%CI: −0.002–0.008, p = 0.189). Conclusion Adiponectin and atherosclerosis were significantly related in both genders, and these relationships were independent of conventional cardiovascular risk factors. Furthermore, adiponectin provided additional information to conventional cardiovascular risk factors regarding the risk of atherosclerosis. PMID:24116054

  15. Cardiovascular risk of patients with gout seen at rheumatology clinics following a structured assessment.

    PubMed

    Andrés, Mariano; Bernal, José Antonio; Sivera, Francisca; Quilis, Neus; Carmona, Loreto; Vela, Paloma; Pascual, Eliseo

    2017-07-01

    Gout-associated cardiovascular (CV) risk relates to comorbidities and crystal-led inflammation. The aim was to estimate the CV risk by prediction tools in new patients with gout and to assess whether ultrasonographic carotid changes are present in patients without high CV risk. Cross-sectional study. Consecutive new patients with crystal-proven gout underwent a structured CV consultation, including CV events, risk factors and two risk prediction tools-the Systematic COronary Evaluation (SCORE) and the Framingham Heart Study (FHS). CV risk was stratified according to current European guidelines. Carotid ultrasound (cUS) was performed in patients with less than very high CV risk. The presence of carotid plaques was studied depending on the SCORE and FHS by the area under the curve (AUC) of receiver operating curves. 237 new patients with gout were recruited. CV stratification by scores showed a predominance of very high (95 patients, 40.1%) and moderate (72 patients, 30.5%) risk levels. cUS was performed in 142 patients, finding atheroma plaques in 66 (46.5%, 95% CI 37.8 to 54.2). Following cUS findings, patients classified as very high risk increased from 40.1% up to 67.9% (161/237 patients). SCORE and FHS predicted moderately (AUC 0.711 and 0.683, respectively) the presence of atheroma plaques at cUS. The majority of patients presenting with gout may be at very high CV risk, indicating the need for initiating optimal prevention strategies at this stage. Risk prediction tools appear to underestimate the presence of carotid plaque in patients with gout. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  16. Adverse outcome analyses of observational data: assessing cardiovascular risk in HIV disease.

    PubMed

    Triant, V A; Josephson, F; Rochester, C G; Althoff, K N; Marcus, K; Munk, R; Cooper, C; D'Agostino, R B; Costagliola, D; Sabin, C A; Williams, P L; Hughes, S; Post, W S; Chandra-Strobos, N; Guaraldi, G; Young, S S; Obenchain, R; Bedimo, R; Miller, V; Strobos, J

    2012-02-01

    Clinical decisions are ideally based on randomized trials but must often rely on observational data analyses, which are less straightforward and more influenced by methodology. The authors, from a series of expert roundtables convened by the Forum for Collaborative HIV Research on the use of observational studies to assess cardiovascular disease risk in human immunodeficiency virus infection, recommend that clinicians who review or interpret epidemiological publications consider 7 key statistical issues: (1) clear explanation of confounding and adjustment; (2) handling and impact of missing data; (3) consistency and clinical relevance of outcome measurements and covariate risk factors; (4) multivariate modeling techniques including time-dependent variables; (5) how multiple testing is addressed; (6) distinction between statistical and clinical significance; and (7) need for confirmation from independent databases. Recommendations to permit better understanding of potential methodological limitations include both responsible public access to de-identified source data, where permitted, and exploration of novel statistical methods.

  17. Adverse Outcome Analyses of Observational Data: Assessing Cardiovascular Risk in HIV Disease

    PubMed Central

    Triant, V. A.; Josephson, F.; Rochester, C. G.; Althoff, K. N.; Marcus, K.; Munk, R.; Cooper, C.; D’Agostino, R. B.; Costagliola, D.; Sabin, C. A.; Williams, P. L.; Hughes, S.; Post, W. S.; Chandra-Strobos, N.; Guaraldi, G.; Young, S. S.; Obenchain, R.; Bedimo, R.; Miller, V.

    2012-01-01

    Clinical decisions are ideally based on randomized trials but must often rely on observational data analyses, which are less straightforward and more influenced by methodology. The authors, from a series of expert roundtables convened by the Forum for Collaborative HIV Research on the use of observational studies to assess cardiovascular disease risk in human immunodeficiency virus infection, recommend that clinicians who review or interpret epidemiological publications consider 7 key statistical issues: (1) clear explanation of confounding and adjustment; (2) handling and impact of missing data; (3) consistency and clinical relevance of outcome measurements and covariate risk factors; (4) multivariate modeling techniques including time-dependent variables; (5) how multiple testing is addressed; (6) distinction between statistical and clinical significance; and (7) need for confirmation from independent databases. Recommendations to permit better understanding of potential methodological limitations include both responsible public access to de-identified source data, where permitted, and exploration of novel statistical methods. PMID:22095570

  18. Prospective validation and assessment of cardiovascular and offspring risk models for pregnant women with congenital heart disease.

    PubMed

    Balci, Ali; Sollie-Szarynska, Krystyna M; van der Bijl, Antoinette G L; Ruys, Titia P E; Mulder, Barbara J M; Roos-Hesselink, Jolien W; van Dijk, Arie P J; Wajon, Elly M C J; Vliegen, Hubert W; Drenthen, Willem; Hillege, Hans L; Aarnoudse, Jan G; van Veldhuisen, Dirk J; Pieper, Petronella G

    2014-09-01

    Adequate prepregnancy prediction of maternal cardiovascular and offspring risk is important for counselling and management of pregnancy in women with congenital heart disease (CHD). Therefore we performed a study to identify the optimal assessment strategy for estimating the risk of pregnancy in women with CHD. In this prospective study, we determined the outcomes of 213 pregnancies in 203 women with CHD. The ZAHARA I (Zwangerschap bij Aangeboren HARtAfwijkingen I) and CARPREG (CARdiac disease in PREGnancy) risk scores were calculated for each pregnancy, as was the total number of cardiovascular (TPc) or offspring risk predictors (TPo) from these and other studies combined. Pregnancies were also classified according to the modified WHO classification of maternal cardiovascular risk and according to disease complexity (DC). Maternal cardiovascular events occurred during 22 pregnancies (10.3%). Offspring events occurred during 77 pregnancies in 81 children (37.3%). Cardiovascular and offspring event rates increased with higher risk scores, higher TPc or TPo, higher WHO class and greater DC. The highest area under the curve (AUC) for maternal cardiovascular risk was achieved by the WHO class (AUC: 0.77, p<0.0001). AUC for the ZAHARA I risk score was 0.71 (p=0.001), and for the CARPREG risk score 0.57 (p=0.32). All models performed insufficiently in predicting offspring events (AUC≤0.6). The WHO classification is the best available risk assessment model for estimating cardiovascular risk in pregnant women with CHD. None of the offspring prediction models perform adequately in our cohort. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  19. Assessment of the frequency of cardiovascular risk factors in patients with Takayasu's arteritis.

    PubMed

    Alibaz-Oner, Fatma; Koster, Matthew J; Unal, Ali U; Yildirim, Hale G; Çikikçi, Ceylan; Schmidt, Jean; Crowson, Cynthia S; Makol, Ashima; Ytterberg, Steven R; Matteson, Eric L; Direskeneli, Haner; Warrington, Kenneth J

    2017-08-09

    The prevalence of atherosclerotic risk factors and disease in Takayasu's arteritis (TAK) has not been well defined. We aimed to assess the frequency of cardiovascular (CV) risk factors and the incidence of CV events (CVEs) in patients with TAK from two ethnically different populations. Patients with TAK followed at Mayo Clinic, Rochester, MN, USA and Marmara University, Istanbul, Turkey were included in this retrospective study. Patients with TAK were compared with age-, sex- and calendar year-matched controls from the same geographical region without TAK. The 2008 Framingham 10-year general CV risk score (FRS) was used for the evaluation of CV risk at the time of TAK incidence/index date. In total, 191 patients with TAK and 191 non-TAK controls were included. Hypertension and the prevalence of lipid-lowering treatments were significantly more frequent in TAK. Prior to the incidence/index date, occurrence of CVE was significantly higher in TAK. The FRS was significantly higher in TAK compared with non-TAK at incidence/index date. The cumulative incidence of CVE was 15.4% at 10 years in TAK vs 5.8% in non-TAK; the risk of CVE was increased among patients with TAK (hazard ratio = 4.36; 95% CI: 1.25, 15.13). CV risk factors are more common in patients with TAK, particularly hypertension. The FRS is higher in patients with TAK at the time of diagnosis. The cumulative incidence of CVE was also significantly higher during follow-up in TAK. Our results suggest that patients with TAK should undergo careful assessment of CV risk factors, and an aggressive risk modification approach is warranted.

  20. Assessing perinatal depression as an indicator of risk for pregnancy-associated cardiovascular disease.

    PubMed

    Nicholson, Lauren; Lecour, Sandrine; Wedegärtner, Sonja; Kindermann, Ingrid; Böhm, Michael; Sliwa, Karen

    2016-01-01

    Cardiovascular conditions associated with pregnancy are serious complications. In general, depression is a well-known risk indicator for cardiovascular disease (CVD). Mental distress and depression are associated with physiological responses such as inflammation and oxidative stress. Both inflammation and oxidative stress have been implicated in the pathophysiology of CVDs associated with pregnancy. This article discusses whether depression could represent a risk indicator for CVDs in pregnancy, in particular in pre-eclampsia and peripartum cardiomyopathy (PPCM).

  1. Getting to the Heart of Cardiovascular Risk Assessment in Astronauts for Exploration Class Missions

    NASA Technical Reports Server (NTRS)

    Elgart, S. R.; Shavers, M. R.; Chappell, L.; Milder, C. M.; Huff, J. L.; Semones, E. J.; Simonsen, L. C.; Patel, Z. S.

    2017-01-01

    Since the beginning of manned spaceflight, NASA has recognized the potential risk of cardiovascular decrements due to stressors in the space environment. Of particular concern is the effect of space radiation on cardiovascular disease since astronauts will be exposed to higher levels of galactic cosmic rays outside the Earth's protective magnetosphere. To date, only a few studies have examined the effects of heavy ion radiation on cardiovascular disease, and at lower, space-relevant doses, the association between radiation exposure and cardiovascular pathology is more varied and unclear. Furthermore, other spaceflight conditions such as microgravity, circadian shifts, and confinement stress pose unique challenges in estimating the health risks that can be attributed to exposure to ionizing radiations. In this work, we review age, cause of mortality, and radiation exposure amongst early NASA astronauts in selection groups and discuss the limitations of assessing such a cohort when attempting to characterize the risk of space flight, including stressors such as space radiation and microgravity exposure, on cardiovascular health. METHODS: NASA astronauts in selection groups 1-7 were chosen and the comparison population was white men of the same birth cohort as drawn from data from the CDC Wonder Database and CDC National Center for Health Statistics Life Tables. Cause of death information was obtained from the Lifetime Surveillance of Astronaut Health program and deceased astronauts were classified based on ICD-10 codes: ischemic heart disease (IHD), stroke, cancer, acute occupational events, non-NASA accidents, and other/unknown. Expected years of life left and expected age at death were calculated for the cohort. RESULTS AND CONCLUSIONS: There were 32 deaths in this early astronaut population, 12 of which were due to accidents or acute occupational events that impacted lifespan considerably. The average age at death from these causes is 30 years lower than the

  2. Cardiovascular risk assessment in patients with rheumatoid arthritis: a correlative study of noninvasive arterial health testing.

    PubMed

    Scanlon, Erin M; Mankad, Rekha; Crowson, Cynthia S; Kullo, Iftikhar J; Mulvagh, Sharon L; Matteson, Eric L; Kvrgic, Zoran; Davis, John M

    2017-04-01

    This study aimed to determine the relationship between noninvasive measures of arterial health and both estimated 10-year cardiovascular risk and measures of disease activity over time in established rheumatoid arthritis. Fifty rheumatoid arthritis patients underwent noninvasive arterial health testing (brachial artery reactivity, aortic augmentation index [AIx], pulse wave velocity, carotid artery intima-media thickness, and carotid artery plaque presence) and assessment of clinical disease activity (tender or swollen joint counts, Clinical Disease Activity Index [CDAI], and Health Assessment Questionnaire II [HAQ-II]). Clinical measures during 3 years before the study visit were averaged. Arterial health testing was compared with the American Heart Association/American College of Cardiology (AHA/ACC) Pooled Cohort Equation. Spearman methods identified correlations between disease activity measures, cardiac biomarkers, and arterial health parameters. Among the patients (mean age, 57.5 years), disease activity was moderate (mean [SD] CDAI, 16.9 [15.3]). At the study visit, corrected aortic augmentation index correlated with CDAI (r = 0.37, P = .009) and HAQ-II (r = 0.33, P = .02). AIx correlated with time-averaged tender joint count (r = 0.37, P = .008), CDAI (r = 0.36, P = .01), HAQ-II (r = 0.36, P = .01), swollen joint count (r = 0.36, P = .10), patient global assessment (r = 0.33, P = .02), physician global assessment (r = 0.35, P = .01), and pain score (r = 0.38, P = .007). The AHA/ACC low-risk group (<5% 10-year risk) had highest prevalence of carotid plaques. Arterial health testing may identify increased risk of cardiovascular disease compared with risk obtained through AHA/ACC Pooled Cohort Equation. Measures of arterial stiffness correlate with the burden of disease activity over time.

  3. Lipid and Some Other Cardiovascular Risk Factors Assessment in a Rural Community in Eastern Nigeria

    PubMed Central

    Ahaneku, GI; Ahaneku, JE; Osuji, CU; Oguejiofor, CO; Anisiuba, BC; Opara, PC

    2015-01-01

    Background: Continuous re-evaluation of modifiable cardiovascular risk factors (cardiovascular diseases [CVDs]) in developing nations is imperative as it lays foundation for early preventive/intervention measures at grass root level to improve/prevent CVD morbidity and mortality in those nations where health indices still score below the standard. Aim: The aim was to assess CVD risk factors as a continuous re-evaluation of these may underscore the need for early intervention measures at grass root level. Subjects and Methods: A total of 257 apparently healthy inhabitants aged 18–85 years were recruited in a rural community in South Eastern Nigeria by convenient sampling. Blood pressure, waist circumference and blood lipid analysis were done procedurally and data analyzed using SPSS 16.0 statistical software. Results: The males were older (59.41 [5.22]) than the females (53.31 [16.90]). 69.2% (133/192) were low level farmers, retirees and dependents. Total cholesterol (TC), low density lipoprotein (LDL), and risk predictive index were higher in females while triglyceride (TG), high density lipoprotein and very LDL (VLDL) were higher in males. The middle aged and elderly respectively had higher TG and VLDL compared to the young. Aside hypertriglyceridemia, all lipid abnormalities were higher in females than males both singly (high TC: 28.9% [35/121] vs. 16.9% [12/71]; high LDL cholesterol: 52.0% [63/121] vs. 31.0% [22/71]) and in combination hypercholesterolemia with hypertriglyceridemia (42.9% [52/121] vs. 36.6% [26/71]). “Multiple risk factors” also occurred more in females with seeming further increase in older age. Conclusion: The chances of a female having CVD after menopause seemed to outweigh that of the male. CVD preventive measures should be focused at the primary/community level as a means to curtailing the increasing morbidity and eventual mortality from CVDs. PMID:26229718

  4. Transitioning to routine breast cancer risk assessment and management in primary care: what can we learn from cardiovascular disease?

    PubMed

    Phillips, Kelly-Anne; Steel, Emma J; Collins, Ian; Emery, Jon; Pirotta, Marie; Mann, G Bruce; Butow, Phyllis; Hopper, John L; Trainer, Alison; Moreton, Jane; Antoniou, Antonis C; Cuzick, Jack; Keogh, Louise

    2016-01-01

    To capitalise on advances in breast cancer prevention, all women would need to have their breast cancer risk formally assessed. With ~85% of Australians attending primary care clinics at least once a year, primary care is an opportune location for formal breast cancer risk assessment and management. This study assessed the current practice and needs of primary care clinicians regarding assessment and management of breast cancer risk. Two facilitated focus group discussions were held with 17 primary care clinicians (12 GPs and 5 practice nurses (PNs)) as part of a larger needs assessment. Primary care clinicians viewed assessment and management of cardiovascular risk as an intrinsic, expected part of their role, often triggered by practice software prompts and facilitated by use of an online tool. Conversely, assessment of breast cancer risk was not routine and was generally patient- (not clinician-) initiated, and risk management (apart from routine screening) was considered outside the primary care domain. Clinicians suggested that routine assessment and management of breast cancer risk might be achieved if it were widely endorsed as within the remit of primary care and supported by an online risk-assessment and decision aid tool that was integrated into primary care software. This study identified several key issues that would need to be addressed to facilitate the transition to routine assessment and management of breast cancer risk in primary care, based largely on the model used for cardiovascular disease.

  5. Cardiovascular risk assessment in rheumatoid arthritis: impact of the EULAR recommendations on a national calibrated score risk index.

    PubMed

    Rosales-Alexander, J L; Salvatierra, J; Llorca, J; Magro-Checa, C; González-Gay, M A; Cantero-Hinojosa, J; Raya-Álvarez, E

    2014-01-01

    To evaluate the impact of the application of the EULAR task force recommendations in the cardiovascular (CV) risk assessment of rheumatoid arthritis (RA) patients according to a national calibrated SCORE. Two hundred and one consecutive RA patients seen at the rheumatology outpatient clinics of the University Hospital 'San Cecilio', Granada, Southern Spain, were studied. Information on demographic, classic CV risk factors, history of CV events and disease clinical features were obtained. Both the systematic coronary risk evaluation (SCORE) risk index and the modified SCORE (mSCORE) following the EULAR recommendations were performed. Based on the classic CV risk factors the mean ± standard deviation SCORE was 2.2 ± 2.6 (median 2). Twenty-two (11%) patients were above the threshold of high risk for the Spanish population. Following the EULAR recommendations 52 of the 124 patients (41.93%) initially classified as having intermediate risk were reclassified as having high CV risk. Therefore, the mean mSCORE was 3.3 ± 4 (median 3) and, due to this, 74 (36.8%) patients were above the threshold of high CV risk for the Spanish population. As expected, patients who had experienced CV events were older, had more CV risk factors and higher mSCORE than those without CV events. These observations support the claim that the mSCORE should be specifically adapted to the population to be assessed. However, the use of additional tools should be considered in an attempt to fully identify high-risk RA patients.

  6. Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence.

    PubMed

    Lee, John Tayu; Lawson, Kenny D; Wan, Yizhou; Majeed, Azeem; Morris, Stephen; Soljak, Michael; Millett, Christopher

    2017-06-01

    The World Health Organization recommends that countries implement population-wide cardiovascular disease (CVD) risk assessment and management programmes. The aim of this study was to conduct a systematic review to evaluate whether this recommendation is supported by cost-effectiveness evidence. Published economic evaluations were identified via electronic medical and social science databases (including Medline, Web of Science, and the NHS Economic Evaluation Database) from inception to March 2016. Study quality was evaluated using a modified version of the Consolidated Health Economic Evaluation Reporting Standards. Fourteen economic evaluations were included: five studies based on randomised controlled trials, seven studies based on observational studies and two studies using hypothetical modelling synthesizing secondary data. Trial based studies measured CVD risk factor changes over 1 to 3years, with modelled projections of longer term events. Programmes were either not, or only, cost-effective under non-verified assumptions such as sustained risk factor changes. Most observational and hypothetical studies suggested programmes were likely to be cost-effective; however, study deigns are subject to bias and subsequent empirical evidence has contradicted key assumptions. No studies assessed impacts on inequalities. In conclusion, recommendations for population-wide risk assessment and management programmes lack a robust, real world, evidence basis. Given implementation is resource intensive there is a need for robust economic evaluation, ideally conducted alongside trials, to assess cost effectiveness. Further, the efficiency and equity impact of different delivery models should be investigated, and also the combination of targeted screening with whole population interventions recognising that there multiple approaches to prevention. Copyright © 2017. Published by Elsevier Inc.

  7. Engaging community pharmacists in the primary prevention of cardiovascular disease: protocol for the Pharmacist Assessment of Adherence, Risk and Treatment in Cardiovascular Disease (PAART CVD) pilot study.

    PubMed

    Mc Namara, Kevin P; George, Johnson; O'Reilly, Sharleen L; Jackson, Shane L; Peterson, Gregory M; Howarth, Helen; Bailey, Michael J; Duncan, Gregory; Trinder, Peta; Morabito, Elizabeth; Finch, Jill; Bunker, Stephen; Janus, Edward; Emery, Jon; Dunbar, James A

    2010-09-07

    Cardiovascular disease (CVD) is the leading cause of death globally. Community pharmacist intervention studies have demonstrated clinical effectiveness for improving several leading individual CVD risk factors. Primary prevention strategies increasingly emphasise the need for consideration of overall cardiovascular risk and concurrent management of multiple risk factors. It is therefore important to demonstrate the feasibility of multiple risk factor management by community pharmacists to ensure continued currency of their role. This study will be a longitudinal pre- and post-test pilot study with a single cohort of up to 100 patients in ten pharmacies. Patients aged 50-74 years with no history of heart disease or diabetes, and taking antihypertensive or lipid-lowering medicines, will be approached for participation. Assessment of cardiovascular risk, medicines use and health behaviours will be undertaken by a research assistant at baseline and following the intervention (6 months). Validated interview scales will be used where available. Baseline data will be used by accredited medicines management pharmacists to generate a report for the treating community pharmacist. This report will highlight individual patients' overall CVD risk and individual risk factors, as well as identifying modifiable health behaviours for risk improvement and suggesting treatment and behavioural goals. The treating community pharmacist will use this information to finalise and implement a treatment plan in conjunction with the patient and their doctor. Community pharmacists will facilitate patient improvements in lifestyle, medicines adherence, and medicines management over the course of five counselling sessions with monthly intervals. The primary outcome will be the change to average overall cardiovascular risk, assessed using the Framingham risk equation. This study will assess the feasibility of implementing holistic primary CVD prevention programs into community pharmacy, one of

  8. Engaging community pharmacists in the primary prevention of cardiovascular disease: protocol for the Pharmacist Assessment of Adherence, Risk and Treatment in Cardiovascular Disease (PAART CVD) pilot study

    PubMed Central

    2010-01-01

    Background Cardiovascular disease (CVD) is the leading cause of death globally. Community pharmacist intervention studies have demonstrated clinical effectiveness for improving several leading individual CVD risk factors. Primary prevention strategies increasingly emphasise the need for consideration of overall cardiovascular risk and concurrent management of multiple risk factors. It is therefore important to demonstrate the feasibility of multiple risk factor management by community pharmacists to ensure continued currency of their role. Methods/Design This study will be a longitudinal pre- and post-test pilot study with a single cohort of up to 100 patients in ten pharmacies. Patients aged 50-74 years with no history of heart disease or diabetes, and taking antihypertensive or lipid-lowering medicines, will be approached for participation. Assessment of cardiovascular risk, medicines use and health behaviours will be undertaken by a research assistant at baseline and following the intervention (6 months). Validated interview scales will be used where available. Baseline data will be used by accredited medicines management pharmacists to generate a report for the treating community pharmacist. This report will highlight individual patients' overall CVD risk and individual risk factors, as well as identifying modifiable health behaviours for risk improvement and suggesting treatment and behavioural goals. The treating community pharmacist will use this information to finalise and implement a treatment plan in conjunction with the patient and their doctor. Community pharmacists will facilitate patient improvements in lifestyle, medicines adherence, and medicines management over the course of five counselling sessions with monthly intervals. The primary outcome will be the change to average overall cardiovascular risk, assessed using the Framingham risk equation. Discussion This study will assess the feasibility of implementing holistic primary CVD prevention

  9. Step On It! - Workplace cardiovascular risk assessment of New York City yellow taxi drivers

    PubMed Central

    Gany, Francesca; Bari, Sehrish; Gill, Pavan; Ramirez, Julia; Ayash, Claudia; Loeb, Rebecca; Aragones, Abraham; Leng, Jennifer

    2015-01-01

    Background Multiple factors associated with taxi driving can increase the risk of cardiovascular disease (CVD) in taxi drivers. Methods This paper describes the results of Step On It!, which assessed CVD risk factors among New York City taxi drivers at John F. Kennedy International Airport. Drivers completed an intake questionnaire and free screenings for blood pressure, glucose and body mass index (BMI). Results 466 drivers participated. 9% had random plasma glucose values >200 mg/dl. 77% had elevated BMIs. Immigrants who lived in the U.S. for >10 years had 2.5 times the odds (CI: 1.1–5.9) of having high blood pressure compared to newer immigrants. Discussion Abnormalities documented in this study were significant, especially for immigrants with greater duration of residence in the U.S., and underscore the potential for elevated CVD risk in this vulnerable population, and the need to address this risk through frameworks that utilize multiple levels of intervention. PMID:25680879

  10. A pediatric approach to family history of cardiovascular disease: diagnosis, risk assessment, and management.

    PubMed

    Miller, Erin M; Hinton, Robert B

    2014-02-01

    The medical family history is a comprehensive and dynamic record of illnesses and other pertinent health information among family members. Family history is used to facilitate diagnosis, to identify family members at risk for developing a particular disease, and increasingly to manage disease. This article reviews the application of family history to pediatric cardiovascular disease. As more is learned about the genetic basis of cardiovascular disease, the family history will play an increasingly central role in management. Improved understanding of the causes of pediatric cardiovascular disease promises the opportunity to develop new diagnostic and therapeutic strategies. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. [Cardiovascular risk stratification].

    PubMed

    Martínez Réding, Jesús

    2006-01-01

    In often cited statistic cardiovascular disease is the number 1 cause of death in the worldwide and not only in the developed world. This represents an aggressive identification and management of risk factors. With the many advances in our understanding and practices of risk factor management we hope to change this tendency predicted to be in 2020 the same. Now we know that exists major factor risk and others who predispose. The presence of major risk factors was associated with development of cardiovascular disease. The process of risk factor management is a multidisciplinary one, directly involving both the patient his doctor as well as many others, including nurses, other healthcare and family. The goal is preventing future cardiac events.

  12. Can general cardiovascular risk evaluation facilitate the assessment of fitness for work and contribute to the reduction of cardiovascular incidents among seamen and fishermen? Article for discussion.

    PubMed

    Rosik, Elzbieta; Jaremin, Bogdan; Szymańska, Kinga

    2006-01-01

    Apart from accidents and work related injuries caused by external factors, being the primary cause of death at sea and repatriation of seamen and fishermen from ship to hospital on shore, acute cardiovascular incidents are the main internal causes of their death, both at sea and on land, as well as of long lasting sick leave and disability. In the regulations on health requirements for persons working on sea-going ships and in inland navigation (orders of the Ministry of Health 1993, 1996, 2003, guidelines (39), EU directives and other national regulations) and in the register of diseases and conditions disqualifying from such an employment (EU directive, annex to the order of the Ministry of Health 1993, European Commission (32,33), ILO/WHO guidelines, cardiovascular diseases are only generally mentioned. The minimal scope of examinations is recommended for seafarers in age up to 50 years, and for older seafarers, but without the assessment of their occupational risk. This gives rise to ambiguities in interpretation at the time of issuing their health certificates, and also in judicature when analyzing cause-and-effect relationship between the occurrence of an acute cardiovascular incident during the ship's voyage and conditions of the work at sea. Principles, possibilities and benefits are discussed in this paper, which may be expected from the general assessment of cardiovascular diseases risk at the time of the health assessment for the work at sea. The risk forecasting, health certification and the question of choosing primary preventive methods are included in this presentation.

  13. A new Web-based medical tool for assessment and prevention of comprehensive cardiovascular risk.

    PubMed

    Franchi, Daniele; Cini, Davide; Iervasi, Giorgio

    2011-01-01

    Multifactor cardiovascular disease is the leading cause of death; besides well-known cardiovascular risk factors, several emerging factors such as mental stress, diet type, and physical inactivity, have been associated to cardiovascular disease. To date, preventive strategies are based on the concept of absolute risk calculated by different algorithms and scoring systems. However, in general practice the patient's data collection represents a critical issue. A new multipurpose computer-based program has been developed in order to:1) easily calculate and compare the absolute cardiovascular risk by the Framingham, Procam, and Progetto Cuore algorithms; 2) to design a web-based computerized tool for prospective collection of structured data; 3) to support the doctor in the decision-making process for patients at risk according to recent international guidelines. During a medical consultation the doctor utilizes a common computer connected by Internet to a medical server where all the patient's data and software reside. The program evaluates absolute and relative cardiovascular risk factors, personalized patient's goals, and multiparametric trends, monitors critical parameter values, and generates an automated medical report. In a pilot study on 294 patients (47% males; mean age 60 ± 12 years [±SD]) the global time to collect data at first consultation was 13 ± 11 minutes which declined to 8 ± 7 minutes at the subsequent consultation. In 48.2% of cases the program revealed 2 or more primary risk factor parameters outside guideline indications and gave specific clinical suggestions to return altered parameters to target values. The web-based system proposed here may represent a feasible and flexible tool for clinical management of patients at risk of cardiovascular disease and for epidemiological research.

  14. [Vitamin D and cardiovascular risk].

    PubMed

    Mayer, Otto

    2012-05-01

    The pathogenesis of cardiovascular disease is without any doubt multifactorial, and it is generally accepted, that conventional risk factors determined only about 80% of cardiovascular risk. There is accumulating evidence that vitamin D exerts important pathophysiological effects on cardiovascular system. Low vitamin D was associated with increased cardiovascular risk in several reports. This review summarizes recent epidemiological evidence and possible pathophysiological mechanism for a role of low vitamin D in cardiovascular diseases. Moreover, available data concerning vitamin D supplementation are depicted.

  15. Supplemental studies for cardiovascular risk assessment in safety pharmacology: a critical overview.

    PubMed

    Picard, Sandra; Goineau, Sonia; Guillaume, Philippe; Henry, Joël; Hanouz, Jean-Luc; Rouet, René

    2011-12-01

    Safety Pharmacology studies for the cardiovascular risk assessment, as described in the ICH S7A and S7B guidelines, appear as being far from sufficient. The fact that almost all medicines withdrawn from the market because of life-threatening tachyarrhythmias (torsades-de-pointes) were shown as hERG blockers and QT interval delayers led the authorities to focus mainly on these markers. However, other surrogate biomarkers, e.g., TRIaD (triangulation, reverse-use-dependence, instability and dispersion of ventricular repolarization), have been identified to more accurately estimate the drug-related torsadogenic risk. In addition, more attention should be paid to other arrhythmias, not related to long QT and nevertheless severe and/or not self-extinguishing, e.g., atrial or ventricular fibrillation, resulting from altered electrical conduction or heterogeneous shortening of cardiac repolarization. Moreover, despite numerous clinical cases of drug-induced pulmonary hypertension, orthostatic hypotension, or heart valvular failure, few safety investigations are still conducted on drug interaction with cardiac and regional hemodynamics other than changes in aortic blood pressure evaluated in conscious large animals during the core battery mandatory studies. This critical review aims at discussing the usefulness, relevance, advantages, and limitations of some preclinical in vivo, in vitro, and in silico models, with high predictive values and currently used in supplemental safety studies.

  16. Dynamic prediction model and risk assessment chart for cardiovascular disease based on on-treatment blood pressure and baseline risk factors.

    PubMed

    Teramukai, Satoshi; Okuda, Yasuyuki; Miyazaki, Shigeru; Kawamori, Ryuzo; Shirayama, Masayuki; Teramoto, Tamio

    2016-02-01

    For patients with hypertension, an individual risk prediction tool for cardiovascular disease based on on-treatment blood pressure is needed and would be useful. The objective of this study was to establish a 3-year risk prediction model for cardiovascular disease based on data from 13 052 patients with no history of cardiovascular disease in the Olmesartan Mega study to determine the relationship between Cardiovascular Endpoints and Blood Pressure Goal Achievement study. To develop dynamic prediction models including on-treatment blood pressure, a Cox proportional hazard model using the sliding landmarking method with three landmark points (6, 12 and 18 months from baseline) was used. The prediction model included blood pressure (<130/85 mm Hg, ⩾130/85  to <140/90 mm Hg, ⩾140/90 to <160/100 mm Hg and ⩾160/100 mm Hg) as a time-dependent covariate and well-known baseline risk factors (sex, age, smoking, family history of coronary artery disease and diabetes) as covariates. The 3-year risk assessment chart was constructed using the combination of all risk factors in the prediction model, and six different colors were displayed on each chart corresponding to the predicted probability of cardiovascular disease. Judging from the chart, if an elderly man with diabetes and other risk factors had a blood pressure of <130/85 mm Hg at 6 months, the risk of cardiovascular disease would be 8.0%, whereas the risk would be 8.6% if he had a blood pressure of ⩾130/85 to <140/90 mm Hg. The risk assessment chart developed from the large-scale observational study data would help physicians to more easily assess the cardiovascular disease risk for hypertensive patients on antihypertensive treatments.

  17. Obesity as Assessed by Body Adiposity Index and Multivariable Cardiovascular Disease Risk

    PubMed Central

    Dhaliwal, Satvinder S.; Welborn, Timothy A.; Goh, Louise G. H.; Howat, Peter A.

    2014-01-01

    To assess the role of body adiposity index (BAI) in predicting cardiovascular disease (CVD) and coronary heart disease (CHD) mortality, in comparison with body mass index (BMI), waist circumference (WC), and the waist circumference to hip circumference ratio (WHR). This study was a prospective 15 year mortality follow-up of 4175 Australian males, free of heart disease, diabetes and stroke. The Framingham Risk Scores (FRS) for CHD and CVD death were calculated at baseline for all subjects. Multivariable logistic regression was used to assess the effects of the measures of obesity on CVD and CHD mortality, before adjustment and after adjustment for FRS. The predictive ability of BAI, though present in the unadjusted analyses, was generally not significant after adjustment for age and FRS for both CVD and CHD mortality. BMI behaved similarly to BAI in that its predictive ability was generally not significant after adjustments. Both WC and WHR were significant predictors of CVD and CHD mortality and remained significant after adjustment for covariates. BAI appeared to be of potential interest as a measure of % body fat and of obesity, but was ineffective in predicting CVD and CHD. PMID:24714547

  18. Implications of Cardiovascular Disease Risk Assessment Using the WHO/ISH Risk Prediction Charts in Rural India

    PubMed Central

    Raghu, Arvind; Praveen, Devarsetty; Peiris, David; Tarassenko, Lionel; Clifford, Gari

    2015-01-01

    Cardiovascular disease (CVD) risk in India is currently assessed using the World Health Organization/International Society for Hypertension (WHO/ISH) risk prediction charts since no population-specific models exist. The WHO/ISH risk prediction charts have two versions—one with total cholesterol as a predictor (the high information (HI) model) and the other without (the low information (LI) model). However, information on the WHO/ISH risk prediction charts including guidance on which version to use and when, as well as relative performance of the LI and HI models, is limited. This article aims to, firstly, quantify the relative performance of the LI and HI WHO/ISH risk prediction (for WHO-South East Asian Region D) using data from rural India. Secondly, we propose a pre-screening (simplified) point-of-care (POC) test to identify patients who are likely to benefit from a total cholesterol (TC) test, and subsequently when the LI model is preferential to HI model. Analysis was performed using cross-sectional data from rural Andhra Pradesh collected in 2005 with recorded blood cholesterol measurements (N = 1066). CVD risk was computed using both LI and HI models, and high risk individuals who needed treatment(THR) were subsequently identified based on clinical guidelines. Model development for the POC assessment of a TC test was performed through three machine learning techniques: Support Vector Machine (SVM), Regularised Logistic Regression (RLR), and Random Forests (RF) along with a feature selection process. Disagreement in CVD risk predicted by LI and HI WHO/ISH models was 14.5% (n = 155; p<0.01) overall and comprised 36 clinically relevant THR patients (31% of patients identified as THR by using either model). Using two patient-specific parameters (age, systolic blood pressure), our POC assessment can pre-determine the benefit of TC testing and choose the appropriate risk model (out-of-sample AUCs:RF-0.85,SVM-0.84,RLR:0.82 and maximum sensitivity-98%). The

  19. Implications of Cardiovascular Disease Risk Assessment Using the WHO/ISH Risk Prediction Charts in Rural India.

    PubMed

    Raghu, Arvind; Praveen, Devarsetty; Peiris, David; Tarassenko, Lionel; Clifford, Gari

    2015-01-01

    Cardiovascular disease (CVD) risk in India is currently assessed using the World Health Organization/International Society for Hypertension (WHO/ISH) risk prediction charts since no population-specific models exist. The WHO/ISH risk prediction charts have two versions-one with total cholesterol as a predictor (the high information (HI) model) and the other without (the low information (LI) model). However, information on the WHO/ISH risk prediction charts including guidance on which version to use and when, as well as relative performance of the LI and HI models, is limited. This article aims to, firstly, quantify the relative performance of the LI and HI WHO/ISH risk prediction (for WHO-South East Asian Region D) using data from rural India. Secondly, we propose a pre-screening (simplified) point-of-care (POC) test to identify patients who are likely to benefit from a total cholesterol (TC) test, and subsequently when the LI model is preferential to HI model. Analysis was performed using cross-sectional data from rural Andhra Pradesh collected in 2005 with recorded blood cholesterol measurements (N = 1066). CVD risk was computed using both LI and HI models, and high risk individuals who needed treatment(THR) were subsequently identified based on clinical guidelines. Model development for the POC assessment of a TC test was performed through three machine learning techniques: Support Vector Machine (SVM), Regularised Logistic Regression (RLR), and Random Forests (RF) along with a feature selection process. Disagreement in CVD risk predicted by LI and HI WHO/ISH models was 14.5% (n = 155; p<0.01) overall and comprised 36 clinically relevant THR patients (31% of patients identified as THR by using either model). Using two patient-specific parameters (age, systolic blood pressure), our POC assessment can pre-determine the benefit of TC testing and choose the appropriate risk model (out-of-sample AUCs:RF-0.85,SVM-0.84,RLR:0.82 and maximum sensitivity-98%). The

  20. How artificial intelligence tools can be used to assess individual patient risk in cardiovascular disease: problems with the current methods

    PubMed Central

    Grossi, Enzo

    2006-01-01

    Background In recent years a number of algorithms for cardiovascular risk assessment has been proposed to the medical community. These algorithms consider a number of variables and express their results as the percentage risk of developing a major fatal or non-fatal cardiovascular event in the following 10 to 20 years Discussion The author has identified three major pitfalls of these algorithms, linked to the limitation of the classical statistical approach in dealing with this kind of non linear and complex information. The pitfalls are the inability to capture the disease complexity, the inability to capture process dynamics, and the wide confidence interval of individual risk assessment. Artificial Intelligence tools can provide potential advantage in trying to overcome these limitations. The theoretical background and some application examples related to artificial neural networks and fuzzy logic have been reviewed and discussed. Summary The use of predictive algorithms to assess individual absolute risk of cardiovascular future events is currently hampered by methodological and mathematical flaws. The use of newer approaches, such as fuzzy logic and artificial neural networks, linked to artificial intelligence, seems to better address both the challenge of increasing complexity resulting from a correlation between predisposing factors, data on the occurrence of cardiovascular events, and the prediction of future events on an individual level. PMID:16672045

  1. How artificial intelligence tools can be used to assess individual patient risk in cardiovascular disease: problems with the current methods.

    PubMed

    Grossi, Enzo

    2006-05-03

    In recent years a number of algorithms for cardiovascular risk assessment has been proposed to the medical community. These algorithms consider a number of variables and express their results as the percentage risk of developing a major fatal or non-fatal cardiovascular event in the following 10 to 20 years The author has identified three major pitfalls of these algorithms, linked to the limitation of the classical statistical approach in dealing with this kind of non linear and complex information. The pitfalls are the inability to capture the disease complexity, the inability to capture process dynamics, and the wide confidence interval of individual risk assessment. Artificial Intelligence tools can provide potential advantage in trying to overcome these limitations. The theoretical background and some application examples related to artificial neural networks and fuzzy logic have been reviewed and discussed. The use of predictive algorithms to assess individual absolute risk of cardiovascular future events is currently hampered by methodological and mathematical flaws. The use of newer approaches, such as fuzzy logic and artificial neural networks, linked to artificial intelligence, seems to better address both the challenge of increasing complexity resulting from a correlation between predisposing factors, data on the occurrence of cardiovascular events, and the prediction of future events on an individual level.

  2. The Addition of Vascular Calcification Scores to Traditional Risk Factors Improves Cardiovascular Risk Assessment in Patients with Chronic Kidney Disease

    PubMed Central

    Diouf, Momar; Temmar, Mohamed; Renard, Cédric; Choukroun, Gabriel; Massy, Ziad A.

    2015-01-01

    Background Although a variety of non-invasive methods for measuring cardiovascular (CV) risk (such as carotid intima media thickness, pulse wave velocity (PWV), coronary artery and aortic calcification scores (measured either by CT scan or X-ray) and the ankle brachial index (ABI)) have been evaluated separately in chronic kidney disease (CKD) cohorts, few studies have evaluated these methods simultaneously. Here, we looked at whether the addition of non-invasive methods to traditional risk factors (TRFs) improves prediction of the CV risk in patients at different CKD stages. Methods We performed a prospective, observational study of the relationship between the outputs of non-invasive measurement methods on one hand and mortality and CV outcomes in 143 patients at different CKD stages on the other. During the follow-up period, 44 patients died and 30 CV events were recorded. We used Cox models to calculate the relative risk for outcomes. To assess the putative clinical value of each method, we also determined the categorical net reclassification improvement (NRI) and the integrated discrimination improvement. Results Vascular calcification, PWV and ABI predicted all-cause mortality and CV events in univariate analyses. However, after adjustment for TRFs, only aortic and coronary artery calcification scores were found to be significant, independent variables. Moreover, the addition of coronary artery calcification scores to TRFs improved the specificity of prediction by 20%. Conclusion The addition of vascular calcification scores (especially the coronary artery calcification score) to TRFs appears to improve CV risk assessment in a CKD population. PMID:26181592

  3. Sharing risk management: an implementation model for cardiovascular absolute risk assessment and management in Australian general practice

    PubMed Central

    Wan, Q; Harris, M F; Zwar, N; Vagholkar, S

    2008-01-01

    Purpose Despite considerable work in developing and validating cardiovascular absolute risk (CVAR) algorithms, there has been less work on models for their implementation in assessment and management. The aim of our study was to develop a model for a joint approach to its implementation based on an exploration of views of patients, general practitioners (GPs) and key informants (KIs). Methods We conducted six focus group (three with GPs and three with patients) and nine KI interviews in Sydney. Thematic analysis was used with comparison to highlight the similarities and differences in perspectives of participants. Results Conducting CVAR was seen as more acceptable for regular patients rather than new patients for whom GPs had to attract their interest and build rapport before doing so at the next visit. GPs’ interest and patients’ positive attitude in managing risk were important in implementing CVAR. Long consultations, good communication skills and having a trusting relationship helped overcome the barriers during the process. All the participants supported engaging patients to self-assess their risk before the consultation and sharing decision making with GPs during consultation. Involving practice staff to help with the patient self-assessment, follow-up and referral would be helpful in implementing CVAR assessment and management, but GPs, patients and practices may need more support for this to occur. Conclusions Multiple strategies are required to promote the better use of CVAR in the extremely busy working environment of Australian general practice. An implementation model has been developed based on our findings and the Chronic Care Model. Further research needs to investigate the effectiveness of the proposed model. PMID:18479283

  4. A Survey of GPs Awareness and Use of Risk Assessment Tools and Cardiovascular Disease Prevention Guidelines.

    PubMed

    Byrne, D; O'Connor, L; Jennings, S; Bennett, K; Murphy, A W

    2015-01-01

    Cardiovascular disease (CVD) is the leading cause of death worldwide. This study aimed to benchmark awareness and use of CVD risk assessment (RA) tools and prevention guidelines in Irish general practice. 493 (18%) Irish general practitioners (GPs) were invited to participate in a cross-sectional study in 2011. 213 (43%) GPs responded with most being male (n = 128, 58.2%) and aged ≥ 45 years (n = 124, 56.8%). While 197 (92.5%) GPs were aware of at least one RA tool, only 69 (32.4%) GPs reported frequent use. 187 (87.8%) GPs were aware of one or more CVD prevention guidelines with 115 (54.0%) GPs reporting frequent use of at least one guideline. No age or gender difference observed. Barriers to implementation of CVD prevention guidelines were lack of remuneration, too many CVD guidelines and time constraints. Most Irish GPs were aware of RA tools and CVD prevention guidelines with half reporting frequent use of guidelines.

  5. Cardiovascular risk assessment and management in mental health clients: perceptions of mental health and general practitioners in New Zealand.

    PubMed

    Wheeler, Amanda; Harrison, Jeff; Homes, Zara

    2009-03-01

    People with mental illness have higher rates of morbidity and mortality, largely due to increased rates of cardiovascular disease (CVD). Metabolic syndrome is well recognised but rarely expressed as a need to assess and manage cardiovascular risk factors; furthermore there is confusion about whose role this is. This study explores health practitioners' knowledge, attitudes, barriers/solutions towards cardiovascular risk assessment and management in mental health patients. A survey of mental health practitioners (MHPs n = 421) and general practitioners (GPs n = 232) Three-quarters of respondents agreed mental illness predisposes to CVD. Fifty-five percent of MH doctors agreed they could effectively assess CVD risk compared to 67% of GPs. Only 21% of MH doctors agreed they could effectively manage CVD risk compared to 57% of GPs. Seventy-nine percent of MHPs believed that assessing CVD risk was a joint responsibility between GP and MHP, compared to 33% of GPs; 62% of GPs believed it was their sole responsibility. Forty-six percent of MHPs believed managing CVD risk was a joint responsibility compared with 29% of GPs; 58% of GPs saw this as their role. Only 13% of MHPs and fewer than 4% of GPs agreed that MH services were effectively assessing and managing CVD risk. MHPs identified lack of knowledge and skills (58%) and poor communication between primary-secondary care (53%) as the main barriers. GPs identified barriers of poor communication (64%) and patient compliance with health care management (71%). The top two solutions proposed by MHPs were provision of GP subsidies (47%) and training (43%). GPs also identified provision of a subsidy (66%) and collaborative management between GPs and MH (44%) as solutions. There is widespread recognition of increased risk of CVD in MH patients. MHPs do not believe they have the knowledge and skills to manage this risk. GPs believe this is their responsibility. Both groups recognise communication with, and access to, primary

  6. The 2013 American College of Cardiology/American Heart Association guidelines on treating blood cholesterol and assessing cardiovascular risk: a busy practitioner's guide.

    PubMed

    Gupta, Arpeta; Smith, Donald A

    2014-12-01

    The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults and Guideline on the Assessment of Cardiovascular Risk were released in mid-November 2013. This article explains the guidelines, the risk equations, and their derivations, and addresses criticisms so that practicing physicians may be more comfortable in using the guidelines and the risk equations to inform patients of their atherosclerotic cardiovascular risk and choices to reduce that risk. The article also addresses patient concerns about statin safety if lifestyle changes have been insufficient to reduce their risk.

  7. Assessing cardiovascular risks versus clinical benefits of atypical antipsychotic drug treatment.

    PubMed

    Meltzer, Herbert Y; Davidson, Michael; Glassman, Alexander H; Vieweg, W Victor R

    2002-01-01

    The atypical antipsychotic drugs are a major advance in the treatment of psychosis in spite of concerns about metabolic and cardiovascular side effects that affect morbidity and mortality. Concerns about weight gain, hypoglycemia, diabetes, and increases in lipids as well as sudden death due to torsades de pointes and other cardiovascular events can temper enthusiasm about the atypical antipsychotics. The challenge for the clinician is to weigh the benefits and risks for each drug for each patient and develop a treatment plan with the individual patient in mind. This article discusses both risks and benefits of antipsychotic treatment and presents a treatment algorithm to aid the clinician in choosing medications for the psychotic patient.

  8. Development and Psychometric Evaluation of a Cardiovascular Risk and Disease Management Knowledge Assessment Tool

    PubMed Central

    Rosneck, James S; Hughes, Joel; Gunstad, John; Josephson, Richard; Noe, Donald A; Waechter, Donna

    2013-01-01

    PURPOSE This paper describes the systematic construction and psychometric analysis of a knowledge assessment instrument for phase II cardiac rehabilitation (CR) patients measuring risk modification disease management knowledge and behavioral outcomes derived from national standards relevant to secondary prevention and management of cardiovascular disease. METHODS First, using adult curriculum based on disease specific learning outcomes and competencies, a systematic test item development process was completed by clinical staff. Second, a panel of educational and clinical experts used an iterative process to identify test content domain and arrive at consensus in selecting items meeting criteria. Third, the resulting 31 question instrument the Cardiac Knowledge Assessment Tool (CKAT) was piloted in CR patients to insure utility of application. Validity and reliability analysis were performed on 3,638 adult pre test administrations with additional focused analyses on 1,999 individuals completing both pre and post treatment administrations within 6 months. RESULTS Evidence of CKAT content validity was substantiated with 85% agreement among content experts. Evidence of construct validity was demonstrated via factor analysis identifying key underlying factors. Estimates of internal consistency, e.g. Cronbach’s Alpha = .852 and a Spearman-Brown split-half reliability = .817 on pre testing, supports test reliability. Item analysis, using point biserial correlation, measured relationships between performance on single items and total score (p<.01). Analyses utilizing item difficulty and item discrimination indices further verified item stability and validity of the CKAT. CONCLUSIONS A knowledge instrument specifically designed for an adult CR population was systematically developed and tested in a large representative patient population, satisfying psychometric parameters including validity and reliability. PMID:23612037

  9. Development and psychometric evaluation of a cardiovascular risk and disease management knowledge assessment tool.

    PubMed

    Rosneck, James S; Hughes, Joel; Gunstad, John; Josephson, Richard; Noe, Donald A; Waechter, Donna

    2014-01-01

    This article describes the systematic construction and psychometric analysis of a knowledge assessment instrument for phase II cardiac rehabilitation (CR) patients measuring risk modification disease management knowledge and behavioral outcomes derived from national standards relevant to secondary prevention and management of cardiovascular disease. First, using adult curriculum based on disease-specific learning outcomes and competencies, a systematic test item development process was completed by clinical staff. Second, a panel of educational and clinical experts used an iterative process to identify test content domain and arrive at consensus in selecting items meeting criteria. Third, the resulting 31-question instrument, the Cardiac Knowledge Assessment Tool (CKAT), was piloted in CR patients to ensure use of application. Validity and reliability analyses were performed on 3638 adults before test administrations with additional focused analyses on 1999 individuals completing both pretreatment and posttreatment administrations within 6 months. Evidence of CKAT content validity was substantiated, with 85% agreement among content experts. Evidence of construct validity was demonstrated via factor analysis identifying key underlying factors. Estimates of internal consistency, for example, Cronbach's α = .852 and Spearman-Brown split-half reliability = 0.817 on pretesting, support test reliability. Item analysis, using point biserial correlation, measured relationships between performance on single items and total score (P < .01). Analyses using item difficulty and item discrimination indices further verified item stability and validity of the CKAT. A knowledge instrument specifically designed for an adult CR population was systematically developed and tested in a large representative patient population, satisfying psychometric parameters, including validity and reliability.

  10. Cardiovascular risk assessment in patients with rheumatoid arthritis: The relevance of clinical, genetic and serological markers.

    PubMed

    López-Mejías, Raquel; Castañeda, Santos; González-Juanatey, Carlos; Corrales, Alfonso; Ferraz-Amaro, Iván; Genre, Fernanda; Remuzgo-Martínez, Sara; Rodriguez-Rodriguez, Luis; Blanco, Ricardo; Llorca, Javier; Martín, Javier; González-Gay, Miguel A

    2016-11-01

    Cardiovascular disease (CV) is the most common cause of premature mortality in patients with rheumatoid arthritis (RA). This is the result of an accelerated atherosclerotic process. Adequate CV risk stratification has special relevance in RA to identify patients at risk of CV disease. However, current CV risk screening and management strategies underestimate the actual CV risk in RA. Consequently, the search for additional tools that may help to identify those patients at high CV risk has become a key objective in the last years. In this regard, non-invasive surrogates, such as carotid ultrasonography, have been found to be excellent predictors of future CV events. In addition, several studies have revealed the relevance of a genetic component in the development of CV disease in RA patients. Besides an association with HLA-DRB1* shared epitope alleles other gene polymorphisms located inside and outside the HLA seem to influence the risk of cardiovascular disease in RA. Moreover, serum levels of some metabolic syndrome-related biomarkers, adipokines such as adiponectin and biomarkers of endothelial cell activation and inflammation such as Osteoprotegerin and Asymmetric dimethylarginine have recently been found useful for the prediction of CV disease in these patients. An update of the current knowledge on these potential markers, especially focused on new genetic and serological biomarkers is shown in this review.

  11. Lipoprotein(a): A Promising Marker for Residual Cardiovascular Risk Assessment

    PubMed Central

    Cai, Anping; Li, Liwen; Zhang, Ying; Mo, Yujin; Mai, Weiyi; Zhou, Yingling

    2013-01-01

    Atherosclerotic cardiovascular diseases (CVD) are still the leading cause of morbidity and mortality worldwide, although optimal medical therapy has been prescribed for primary and secondary preventions. Residual cardiovascular risk for some population groups is still considerably high although target low density lipoprotein-cholesterol (LDL-C) level has been achieved. During the past few decades, compelling pieces of evidence from clinical trials and meta-analyses consistently illustrate that lipoprotein(a) (Lp(a)) is a significant risk factor for atherosclerosis and CVD due to its proatherogenic and prothrombotic features. However, the lack of effective medication for Lp(a) reduction significantly hampers randomized, prospective, and controlled trials conducting. Based on previous findings, for patients with LDL-C in normal range, Lp(a) may be a useful marker for identifying and evaluating the residual cardiovascular risk, and aggressively lowering LDL-C level than current guidelines' recommendation may be reasonable for patients with particularly high Lp(a) level. PMID:24249942

  12. Impact of adipose tissue composition on cardiovascular risk assessment in patients with stable coronary artery disease.

    PubMed

    Kunimura, Ayako; Ishii, Hideki; Uetani, Tadayuki; Harada, Kazuhiro; Hirayama, Kenshi; Harata, Shingo; Shibata, Yohei; Kawashima, Kazuhiro; Shimbo, Yusaku; Takayama, Yohei; Tatami, Yosuke; Kawamiya, Toshiki; Osugi, Naohiro; Ota, Tomoyuki; Yamamoto, Dai; Okumura, Naoki; Suzuki, Susumu; Amano, Tetsuya; Murohara, Toyoaki

    2016-08-01

    Visceral adipose tissue (VAT), unlike subcutaneous adipose tissue (SAT), is highly correlated with cardiovascular risk factors. This study aimed to evaluate the predictive value of adipose tissue composition, as measured by computed tomography, for cardiovascular events in patients with stable coronary artery disease. 357 consecutive patients who underwent 64-slice computed tomography and elective percutaneous coronary intervention (PCI) were recruited. The ratio of visceral to subcutaneous adipose tissue (VAT/SAT) was calculated. Patients were divided into three groups in accordance with VAT/SAT (low VAT/SAT, <0.55 [<25th percentile]; moderate VAT/SAT, 0.55-1.03 [25th-75th percentile]; high VAT/SAT, ≥1.03 [≥75th percentile]). The investigated risk factors were hypertension, hyperglycaemia, and dyslipidaemia. We analysed the incidence of major adverse cardiovascular events (MACE), defined as the composite of cardiac death, myocardial infarction, and any revascularization. The rate of patients with two or more concomitant risk factors was significantly higher in the high VAT/SAT group (p = 0.006). During 1480 person-years, 109 events were documented. There was a significant association between the incidence of MACE and VAT/SAT, with the worst event-free survival rate in the high VAT/SAT group (log-rank, p = 0.01). In Cox analysis, the hazard ratio of high VAT/SAT for MACE was 2.72 (95% confidence interval 1.04-7.09, p = 0.04) compared with the low VAT/SAT after adjustment for confounding factors. Increased VAT/SAT is independently associated with the incidence of MACE, indicating that adipose tissue composition is a useful predictor of cardiovascular outcome, after elective PCI. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  13. Cardiovascular Risk Assessment: A Comparison of the Framingham, PROCAM, and DAD Equations in HIV-Infected Persons

    PubMed Central

    Nery, Max Weyler; Martelli, Celina Maria Turchi; Aparecida Silveira, Erika; de Sousa, Clarissa Alencar; Falco, Marianne de Oliveira; de Castro, Aline de Cássia Oliveira; Esper, Jorge Tannus; Souza, Luis Carlos Silva e; Turchi, Marília Dalva

    2013-01-01

    This study aims to estimate the risk of cardiovascular disease (CVD) and to assess the agreement between the Framingham, Framingham with aggravating factors, PROCAM, and DAD equations in HIV-infected patients. A cross-sectional study was conducted in an outpatient centre in Brazil. 294 patients older than 19 years were enrolled. Estimates of 10-year cardiovascular risk were calculated. The agreement between the CVD risk equations was assessed using Cohen's kappa coefficient. The participants' mean age was 36.8 years (SD = 10.3), 76.9% were men, and 66.3% were on antiretroviral therapy. 47.8% of the participants had abdominal obesity, 23.1% were current smokers, 20.0% had hypertension, and 2.0% had diabetes. At least one lipid abnormality was detected in 72.8%, and a low HDL-C level was the most common. The majority were classified as having low risk for CV events. The percentage of patients at high risk ranged from 0.4 to 5.7. The PROCAM score placed the lowest proportion of the patients into a high-risk group, and the Framingham equation with aggravating factors placed the highest proportion of patients into the high-risk group. Data concerning the comparability of different tools are informative for estimating the risk of CVD, but accuracy of the outcome predictions should also be considered. PMID:24228022

  14. Assessment of total cardiovascular risk using WHO/ISH risk prediction charts in three low and middle income countries in Asia.

    PubMed

    Otgontuya, Dugee; Oum, Sophal; Buckley, Brian S; Bonita, Ruth

    2013-06-05

    Recent research has used cardiovascular risk scores intended to estimate "total cardiovascular disease (CVD) risk" in individuals to assess the distribution of risk within populations. The research suggested that the adoption of the total risk approach, in comparison to treatment decisions being based on the level of a single risk factor, could lead to reductions in expenditure on preventive cardiovascular drug treatment in low- and middle-income countries. So that the patient benefit associated with savings is highlighted. This study used data from national STEPS surveys (STEPwise Approach to Surveillance) conducted between 2005 and 2010 in Cambodia, Malaysia and Mongolia of men and women aged 40-64 years. The study compared the differences and implications of various approaches to risk estimation at a population level using the World Health Organization/International Society of Hypertension (WHO/ISH) risk score charts. To aid interpretation and adjustment of scores and inform treatment in individuals, the charts are accompanied by practice notes about risk factors not included in the risk score calculations. Total risk was calculated amongst the populations using the charts alone and also adjusted according to these notes. Prevalence of traditional single risk factors was also calculated. The prevalence of WHO/ISH "high CVD risk" (≥20% chance of developing a cardiovascular event over 10 years) of 6%, 2.3% and 1.3% in Mongolia, Malaysia and Cambodia, respectively, is in line with recent research when charts alone are used. However, these proportions rise to 33.3%, 20.8% and 10.4%, respectively when individuals with blood pressure > = 160/100 mm/Hg and/or hypertension medication are attributed to "high risk". Of those at "moderate risk" (10- < 20% chance of developing a cardio vascular event over 10 years), 100%, 94.3% and 30.1%, respectively are affected by at least one risk-increasing factor. Of all individuals, 44.6%, 29.0% and 15.0% are affected by

  15. Quantitative assessment of the gastrointestinal and cardiovascular risk-benefit of celecoxib compared to individual NSAIDs at the population level.

    PubMed

    Varas-Lorenzo, Cristina; Maguire, Andrew; Castellsague, Jordi; Perez-Gutthann, Susana

    2007-04-01

    To estimate the net cardiovascular (CV) (coronary heart disease, stroke, congestive heart failure), and gastrointestinal (GI) (peptic ulcer complications) risk-benefit public health impact of the use of celecoxib compared to non-selective NSAIDs in the arthritis population. We applied discrete event simulation models to data from the US National Health Surveys, CV risk-prediction models from the Framingham Heart Study, and population-based studies. Models took into account the multifactorial effect of risk factors, comorbidity, and competing risk of mortality. We simulated the natural history of CV and GI disease in the U.S. arthritis population over 1 year, through the individual baseline cardiovascular and gastrointestinal risk profile. This model was modified with relative risks associated with the use of each treatment. The mean number of events was estimated for each end-point in each model: natural history, celecoxib, diclofenac, ibuprofen, naproxen. The number of events for celecoxib was compared with each NSAID. The evaluation included 1% of the U.S. population with arthritis. Celecoxib, when applied to 100 000 patients over 1 year, resulted in 570 (range from sensitivity analysis: 440-691), 226 (124-313), and 746 (612-868) fewer ulcer complications than diclofenac, ibuprofen, and naproxen, respectively. There were 20 (16-25), 8 (4-12), and 27 (22-32) fewer deaths from ulcer complications, respectively. No increase in cardiovascular events or all cause mortality was observed for celecoxib versus the other individual NSAIDs. Results from these simulations suggest a gastrointestinal benefit for celecoxib not offset by increased cardiovascular events or mortality. The methodology used here provides a risk-benefit assessment framework for evaluating the public heath impact of drugs.

  16. Lipoprotein-associated phospholipase A2 (Lp-PLA(2)): a novel and promising biomarker for cardiovascular risks assessment.

    PubMed

    Cai, Anping; Zheng, Dongdan; Qiu, Ruofeng; Mai, Weiyi; Zhou, Yingling

    2013-01-01

    Atherosclerosis and its manifestations namely cardiovascular diseases (CVD) are still the leading cause of morbidity and mortality worldwide. Although intensified interventions have been applied, the residual cardiovascular (CV) risks are still very high. Lipoprotein-associated phospholipase A2 (Lp-PLA(2)) is a novel and unique biomarker highly specific for vascular inflammation and atherosclerosis. Both pro-atherogenic property of Lp-PLA(2) and positive correlation with CV events have already been demonstrated by a large number of scientific and clinical studies. Currently, in the Adult Treatment Panel III (ATP III) guideline, Lp-PLA(2) has been recommended as an adjunct to traditional risk factors in assessing future CV risks. Encouragingly, darapladib, an orally Lp-PLA(2) specific inhibitor, has been tested in basic research and preclinical trials and the outcomes are quite striking. Additionally, there are two phase III ongoing clinical trials in evaluating the efficacy and safety of darapladib on cardiovascular outcomes. With regard to the potential values of Lp-PLA(2) in risk stratification, therapeutic regimen establishment and prognosis evaluation in patients with moderate or high risk, our present review is going to summarize the relevant data about the bio-chemical characteristics of Lp-PLA(2), the actions of Lp-PLA(2) on atherosclerosis and the results of Lp-PLA(2) in scientific research and clinical studies.

  17. Assessment of six cardiovascular risk calculators in Mexican mestizo patients with rheumatoid arthritis according to the EULAR 2015/2016 recommendations for cardiovascular risk management.

    PubMed

    Galarza-Delgado, Dionicio A; Azpiri-Lopez, Jose R; Colunga-Pedraza, Iris J; Cardenas-de la Garza, Jesus A; Vera-Pineda, Raymundo; Serna-Peña, Griselda; Arvizu-Rivera, Rosa I; Martinez-Moreno, Adrian; Wah-Suarez, Martin; Garza Elizondo, Mario A

    2017-02-01

    Variability of the 10-year cardiovascular (CV) risk predicted by the Framingham Risk Score (FRS) using lipids, FRS using body mass index (BMI), Reynolds Risk Score (RRS), QRISK2, Extended Risk Score-Rheumatoid Arthritis (ERS-RA), and algorithm developed by the American College of Cardiology and the American Heart Association in 2013 (ACC/AHA 2013) according to the European League Against Rheumatism (EULAR) 2015/2016 update of its evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis (RA) has not been evaluated in Mexican mestizo patients. CV risk was predicted using six different risk calculators in 116 patients, aged 40-75, who fulfilled the ACR/EULAR 2010 classification criteria. Results were multiplied by 1.5 according to the EULAR 2015/2016 update. Global comparison of the risk predicted by all scales was done using the Friedman test, considering a P value of ≤0.05 as statistically significant. Individual comparison between the algorithms was made using the Wilcoxon signed-rank test, and a P value of ≤0.003 was considered statistically significant. All calculators showed to be different in the Friedman test (p ≤ 0.001). Median values of predicted 10-year CV risk were 11.02% (6.18-17.55) for FRS BMI; 8.47% (4.6-13.16) for FRS lipids; 5.55% (2.5-11.85) for QRISK2; 5% (3.1-8.65) for ERS-RA; 3.6% (1.5-9.3) for ACC/AHA 2013; and 1.5% (1.5-4.5) for RRS. ERS-RA showed no difference when compared against QRISK2 (p = 0.269). CV risk calculators showed variability among them and cannot be used indistinctly in RA-patients.

  18. Correlation of global risk assessment with cardiovascular complications in patients with diabetes mellitus living in Puerto Rico

    PubMed Central

    Rodríguez-Vigil, Efraín; Rodríguez-Chacón, Migdalia; Ruiz Valcarcel, José J

    2016-01-01

    Objective The objective of this study was to assess the current relationship between certain demographics and chemical factors, and the risk of cardiovascular complications, within a Puerto Rican population with diabetes mellitus. Research design and methods A total of 2075 patients with diabetes mellitus were retrospectively evaluated to determine the influence of certain demographics and chemical variables on the appearance of cardiovascular complications. A group of demographic and laboratory variables were analyzed. Our sample was obtained, based on convenience, from an endocrinologist's office in an area of about 250 000 people. All the patients met the American Diabetes Association (ADA) definitions for diabetes mellitus. The study covered a time period of 8 years. The patients signed an informed consent document at their first office visit. Data were obtained by the endocrinologist in charge. Results We considered the demographic variables of sex, age, time with diabetes, lipid profile, metabolic control (measured with glycated hemoglobin levels), and microalbumin renal excretion. Cardiovascular complications were more prevalent in patients with poor metabolic control, those with prolonged disease duration, men, and patients who were more than 50 years of age. We found no relationship between cardiovascular disease, systolic blood pressure over 130 mm Hg, body mass index and low-density lipoprotein cholesterol levels over 100 mg/dL. Conclusions In Puerto Rican patients with diabetes mellitus, there is a statistically significant relationship between patient's gender, age, disease duration, glycemic control and increased kidney microalbumin excretion with cardiovascular complications. PMID:27752328

  19. Cardiovascular risk assessment of South Asians in a religious setting: a feasibility study.

    PubMed

    Rao, N; Eastwood, S V; Jain, A; Shah, M; Leurent, B; Harvey, D; Robertson, L; Walters, K; Persaud, J W; Mikhailidis, D P; Nair, D R

    2012-03-01

    South Asians in the UK have high cardiovascular disease (CVD) mortality. Therefore, this population is likely to benefit from screening programmes. To address this issue, an initiative was set up between the Royal Free Hampstead NHS Trust, H.E.A.R.T. UK and two Hindu temples in North London to provide screening for CVD risk factors in the community. A total of 434 individuals of Gujarati Indian origin were screened. Measurements included anthropometry, blood pressure and lipid profiles. Three different scoring systems: Framingham, Joint British Societies' 2 and QRISK2 were used to estimate CVD risk. At least one modifiable CVD risk factor was present in 92% of the individuals screened; 52% were hypertensive, 40% were obese, 75% had central adiposity and 10% had total cholesterol/high density lipoprotein cholesterol ratio > 6. In addition, 37% of a subset of 104 individuals with a fasting sample fulfilled the diagnostic criteria for metabolic syndrome. Overall, 15% of participants screened had a 10-year CV risk score > 20% using QRISK2. The three risk score calculators showed moderate agreement: QRISK2 and JBS2 (kappa 0.61, 95% CI 0.54-0.67), QRISK2 and Framingham (kappa 0.63, 95% CI 0.57-0.70) and JBS2 and Framingham (kappa 0.70, 95% CI 0.64-0.75). A high prevalence of modifiable risk factors for CVD was detected in the population screened. © 2011 Blackwell Publishing Ltd.

  20. [Preeclampsia as cardiovascular risk factor].

    PubMed

    Heida, Karst Y; Franx, Arie; Bots, Michiel L

    2013-01-01

    Cardiovascular diseases (CVD) are the primary cause of death in women. Guidelines for identifying high-risk individuals have been developed, e.g. the Dutch Guideline on Cardiovascular Risk Management. In the most recent version of this guideline, diabetes mellitus (DM) and rheumatoid arthritis (RA) are cited as cardiovascular risk factors; therefore, individuals with these conditions are identified as being at high risk. As with DM and RA, there is strong evidence that the experience of having a hypertensive disorder during pregnancy is a cardiovascular risk factor. This is particularly the case for early preeclampsia, which constitutes a 7-fold increased risk of ischemic heart disease. However, in the Netherlands, there are no guidelines and there is no consensus on how to screen or treat these women. Trial evidence is therefore urgently needed to substantiate the value of cardiovascular risk management for those women with a history of hypertension during pregnancy.

  1. Cardiovascular risk in rheumatoid arthritis.

    PubMed

    Soubrier, Martin; Barber Chamoux, Nicolas; Tatar, Zuzana; Couderc, Marion; Dubost, Jean-Jacques; Mathieu, Sylvain

    2014-07-01

    The objectives of this review are to discuss data on the cardiovascular risk increase associated with rheumatoid arthritis (RA), the effects of RA treatments on the cardiovascular risk level, and the management of cardiovascular risk factors in patients with RA. Overall, the risk of cardiovascular disease is increased 2-fold in RA patients compared to the general population, due to the combined effects of RA and conventional risk factors. There is some evidence that the cardiovascular risk increase associated with nonsteroidal anti-inflammatory drug therapy may be smaller in RA patients than in the general population. Glucocorticoid therapy increases the cardiovascular risk in proportion to both the current dose and the cumulative dose. Methotrexate and TNFα antagonists diminish cardiovascular morbidity and mortality rates. The management of dyslipidemia remains suboptimal. Risk equations may perform poorly in RA patients even when corrected using the multiplication factors suggested by the EUropean League Against Rheumatism (EULAR) (multiply the score by 1.5 when two of the following three criteria are met: disease duration longer than 10 years, presence of rheumatoid factor or anti-cyclic citrullinated peptide (CCP) antibodies, and extraarticular manifestations). Doppler ultrasonography of the carotid arteries in patients at moderate cardiovascular risk may allow a more aggressive approach to dyslipidemia management via reclassification into the high-risk category of patients with an intima-media thickness greater than 0.9 mm or atheroma plaque.

  2. Assessment of Knowledge of Critical Cardiovascular Risk Indicators among College Students: Does Stage of Education Matter?

    PubMed

    Sarpong, Daniel F; Curry, India Y; Williams, Melinda

    2017-03-02

    The health risk of college students in the United States (US) is on the rise, with a significant increase in the prevalence of cardiovascular risk factors. Cardiovascular disease is the leading cause of death in the US, costing approximately $475.3 billion yearly. The goals of this "Know Your Numbers" study were to: (1) estimate the awareness of college students of their critical health numbers (CHN); and (2) compare a college of pharmacy entry class (IP1) with second semester non-commuter freshman college students (FCS) in knowing their numbers. A cross-sectional 15-item pre-test survey was conducted among a convenience sample of IP1 and FCS. All statistical tests were performed at α = 0.05. Awareness of their: cholesterol (7%), blood pressure (BP) (35%), glucose (8%), and body mass index (BMI) (42%) were low. The IP1, compared to FCS, were more knowledgeable of: (1) their BP (46% vs. 28%, p = 0.01); (2) BP normal range (74% vs. 63%, p = 0.02); and (3) BMI normal range (39% vs. 23%, p = 0.04). The IP1s maintained a healthier diet than the FCS (64% vs. 36%, p < 0.0001). Awareness of knowing CHN was very low. Knowledge of one's CHN was significantly associated with knowledge of normal reference values for BP, glucose, and BMI.

  3. Assessment of Knowledge of Critical Cardiovascular Risk Indicators among College Students: Does Stage of Education Matter?

    PubMed Central

    Sarpong, Daniel F.; Curry, India Y.; Williams, Melinda

    2017-01-01

    The health risk of college students in the United States (US) is on the rise, with a significant increase in the prevalence of cardiovascular risk factors. Cardiovascular disease is the leading cause of death in the US, costing approximately $475.3 billion yearly. The goals of this “Know Your Numbers” study were to: (1) estimate the awareness of college students of their critical health numbers (CHN); and (2) compare a college of pharmacy entry class (IP1) with second semester non-commuter freshman college students (FCS) in knowing their numbers. A cross-sectional 15-item pre-test survey was conducted among a convenience sample of IP1 and FCS. All statistical tests were performed at α = 0.05. Awareness of their: cholesterol (7%), blood pressure (BP) (35%), glucose (8%), and body mass index (BMI) (42%) were low. The IP1, compared to FCS, were more knowledgeable of: (1) their BP (46% vs. 28%, p = 0.01); (2) BP normal range (74% vs. 63%, p = 0.02); and (3) BMI normal range (39% vs. 23%, p = 0.04). The IP1s maintained a healthier diet than the FCS (64% vs. 36%, p < 0.0001). Awareness of knowing CHN was very low. Knowledge of one’s CHN was significantly associated with knowledge of normal reference values for BP, glucose, and BMI. PMID:28257080

  4. [Assessment of an intervention on cardiovascular risk factors in patients with rheumatoid arthritis].

    PubMed

    Zacarías, Andrea; Narváez, Javier; Rodríguez Moreno, Jesús; Jordana, Montserrat; Nolla, Joan M; Gómez Vaquero, Carmen

    2016-08-05

    To evaluate the effectiveness of an intervention on cardiovascular risk factors (CVRF) in patients with rheumatoid arthritis. After determining their CVRF and cardiovascular risk (CVR) by modified SCORE, we gave the patients a letter for their general practitioners in which they were requested for their cooperation in controlling CVRF and where the therapeutic goal for LDL cholesterol was specified. Three months later, any therapeutic intervention was recorded as well as the results. We included 211 patients, 29% with a high CVR. There were new diagnoses of CVRF in 100 patients (47%). The general practitioner changed the treatment in 2/12 diabetes, 30/84 HBP, 74/167 with elevation of LDL cholesterol and 21/51 with hypertriglyceridemia. The percentage of patients with good control over CVRF was: a) in HBP, 25 to 73%; b) elevation of LDL cholesterol from 10 to 17%; and c) in hypertriglyceridemia, 25 to 38%. Through this intervention, a new CVRF was diagnosed in nearly half of the patients. The effectiveness of the intervention on CVRF was low. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  5. Anabolic steroids and cardiovascular risk.

    PubMed

    Angell, Peter; Chester, Neil; Green, Danny; Somauroo, John; Whyte, Greg; George, Keith

    2012-02-01

    Recent reports from needle exchange programmes and other public health initiatives have suggested growing use of anabolic steroids (AS) in the UK and other countries. Data indicate that AS use is not confined to body-builders or high-level sportsmen. Use has spread to professionals working in emergency services, casual fitness enthusiasts and subelite sportsmen and women. Although the precise health consequences of AS use is largely undefined, AS use represents a growing public health concern. Data regarding the consequences of AS use on cardiovascular health are limited to case studies and a modest number of small cohort studies. Numerous case studies have linked AS use with a variety of cardiovascular disease (CVD) events or endpoints, including myocardial infarction, stroke and death. Large-scale epidemiological studies to support these links are absent. Consequently, the impact of AS use upon known CVD risk factors has been studied in relatively small, case-series studies. Data relating AS use to elevated blood pressure, altered lipid profiles and ECG abnormalities have been reported, but are often limited in scope, and other studies have often produced equivocal outcomes. The use of AS has been linked to the appearance of concentric left ventricular hypertrophy as well as endothelial dysfunction but the data again remains controversial. The mechanisms responsible for the negative effect of AS on cardiovascular health are poorly understood, especially in humans. Possibilities include direct effects on myocytes and endothelial cells, reduced intracellular Ca2+ levels, increased release of apoptogenic factors, as well as increased collagen crosslinks between myocytes. New data relating AS use to cardiovascular health risks are emerging, as novel technologies are developed (especially in non-invasive imaging) that can assess physiological structure and function. Continued efforts to fully document the cardiovascular health consequences of AS use is important to

  6. Predictive value of quantitative dipyridamole-thallium scintigraphy in assessing cardiovascular risk after vascular surgery in diabetes mellitus

    SciTech Connect

    Lane, S.E.; Lewis, S.M.; Pippin, J.J.; Kosinski, E.J.; Campbell, D.; Nesto, R.W.; Hill, T. )

    1989-12-01

    Cardiac complications represent a major risk to patients undergoing vascular surgery. Diabetic patients may be particularly prone to such complications due to the high incidence of concomitant coronary artery disease, the severity of which may be clinically unrecognized. Attempts to stratify groups by clinical criteria have been useful but lack the predictive value of currently used noninvasive techniques such as dipyridamole-thallium scintigraphy. One hundred one diabetic patients were evaluated with dipyridamole-thallium scintigraphy before undergoing vascular surgery. The incidence of thallium abnormalities was high (80%) and did not correlate with clinical markers of coronary disease. Even in a subgroup of patients with no overt clinical evidence of underlying heart disease, thallium abnormalities were present in 59%. Cardiovascular complications, however, occurred in only 11% of all patients. Statistically significant prediction of risk was not achieved with simple assessment of thallium results as normal or abnormal. Quantification of total number of reversible defects, as well as assessment of ischemia in the distribution of the left anterior descending coronary artery was required for optimum predictive accuracy. The prevalence of dipyridamole-thallium abnormalities in a diabetic population is much higher than that reported in nondiabetic patients and cannot be predicted by usual clinical indicators of heart disease. In addition, cardiovascular risk of vascular surgery can be optimally assessed by quantitative analysis of dipyridamole-thallium scintigraphy and identification of high- and low-risk subgroups.

  7. Assessment of the risk of cardiovascular disease in patients with rosacea.

    PubMed

    Egeberg, Alexander; Hansen, Peter R; Gislason, Gunnar H; Thyssen, Jacob P

    2016-08-01

    Recent studies have shown a higher prevalence of cardiovascular (CV) risk factors in patients with rosacea. However, it remains unknown whether rosacea represents an independent CV risk factor. We evaluated the risk of myocardial infarction, stroke, CV death, major adverse CV events, and all-cause mortality, respectively. Between January 1, 1997, and December 31, 2012, a total of 4948 patients with rosacea were identified and matched with 23,823 control subjects. We used Poisson regression to calculate incidence rate ratios. Adjusted incidence rate ratios were 0.75 (95% confidence intervals [CI] 0.57-1.00) for myocardial infarction, 1.08 (95% CI 0.86-1.35) for ischemic stroke, 1.01 (95% CI 0.61-1.67) for hemorrhagic stroke, 0.99 (95% CI 0.80-1.24) for CV death, 0.99 (95% CI 0.86-1.15) for major adverse CV events, and 0.95 (95% CI 0.85-1.06) for all-cause mortality. We were unable to distinguish between the different subtypes and severities of rosacea. In this population-based study, rosacea was not associated with increased risk of adverse CV outcomes or death. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  8. Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery.

    PubMed

    Duceppe, Emmanuelle; Parlow, Joel; MacDonald, Paul; Lyons, Kristin; McMullen, Michael; Srinathan, Sadeesh; Graham, Michelle; Tandon, Vikas; Styles, Kim; Bessissow, Amal; Sessler, Daniel I; Bryson, Gregory; Devereaux, P J

    2017-01-01

    The Canadian Cardiovascular Society Guidelines Committee and key Canadian opinion leaders believed there was a need for up to date guidelines that used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system of evidence assessment for patients who undergo noncardiac surgery. Strong recommendations included: 1) measuring brain natriuretic peptide (BNP) or N-terminal fragment of proBNP (NT-proBNP) before surgery to enhance perioperative cardiac risk estimation in patients who are 65 years of age or older, are 45-64 years of age with significant cardiovascular disease, or have a Revised Cardiac Risk Index score ≥ 1; 2) against performing preoperative resting echocardiography, coronary computed tomography angiography, exercise or cardiopulmonary exercise testing, or pharmacological stress echocardiography or radionuclide imaging to enhance perioperative cardiac risk estimation; 3) against the initiation or continuation of acetylsalicylic acid for the prevention of perioperative cardiac events, except in patients with a recent coronary artery stent or who will undergo carotid endarterectomy; 4) against α2 agonist or β-blocker initiation within 24 hours before surgery; 5) withholding angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker starting 24 hours before surgery; 6) facilitating smoking cessation before surgery; 7) measuring daily troponin for 48 to 72 hours after surgery in patients with an elevated NT-proBNP/BNP measurement before surgery or if there is no NT-proBNP/BNP measurement before surgery, in those who have a Revised Cardiac Risk Index score ≥1, age 45-64 years with significant cardiovascular disease, or age 65 years or older; and 8) initiating of long-term acetylsalicylic acid and statin therapy in patients who suffer myocardial injury/infarction after surgery.

  9. Cardiovascular investigations of airline pilots with excessive cardiovascular risk.

    PubMed

    Wirawan, I Made Ady; Aldington, Sarah; Griffiths, Robin F; Ellis, Chris J; Larsen, Peter D

    2013-06-01

    This study examined the prevalence of airline pilots who have an excessive cardiovascular disease (CVD) risk score according to the New Zealand Guideline Group (NZGG) Framingham-based Risk Chart and describes their cardiovascular risk assessment and investigations. A cross-sectional study was performed among 856 pilots employed in an Oceania based airline. Pilots with elevated CVD risk that had been previously evaluated at various times over the previous 19 yr were reviewed retrospectively from the airline's medical records, and the subsequent cardiovascular investigations were then described. There were 30 (3.5%) pilots who were found to have 5-yr CVD risk score of 10-15% or higher. Of the 29 pilots who had complete cardiac investigations data, 26 pilots underwent exercise electrocardiography (ECG), 2 pilots progressed directly to coronary angiograms and 1 pilot with abnormal echocardiogram was not examined further. Of the 26 pilots, 7 had positive or borderline exercise tests, all of whom subsequently had angiograms. One patient with a negative exercise test also had a coronary angiogram. Of the 9 patients who had coronary angiograms as a consequence of screening, 5 had significant disease that required treatment and 4 had either trivial disease or normal coronary arteries. The current approach to investigate excessive cardiovascular risk in pilots relies heavily on exercise electrocardiograms as a diagnostic test, and may not be optimal either to detect disease or to protect pilots from unnecessary invasive procedures. A more comprehensive and accurate cardiac investigation algorithm to assess excessive CVD risk in pilots is required.

  10. A novel approach to cardiovascular health by optimizing risk management (ANCHOR): a primary prevention initiative examining the impact of health risk factor assessment and management on cardiac wellness.

    PubMed

    Cox, Jafna L; Carr, Brendan; Vallis, T Michael; Szpilfogel, Claudine; O'Neill, Blair J

    2011-01-01

    Cardiovascular disease (CVD) represents an increasing burden to health care systems. Modifiable risk factors figure prominently in the population-attributable risk for premature coronary artery disease. Primary care is well placed to facilitate CVD risk improvement. We plan to evaluate the ability of a novel primary care intervention providing systematic risk factor screening, risk-weighted behavioural counselling and pharmacological intervention to achieve 2 objectives: (1) optimized management of global CVD risk of patients and (2) increased patient adherence to lifestyle and pharmaceutical interventions aimed at decreasing global CVD risk. A pre-post longitudinal prospective design with a nonrandomized comparison group is being undertaken in 2 geographically diverse primary care practices in Nova Scotia with differing reimbursement models. Participants will complete a readiness to change and pre-post health risk assessment (HRA), that will trigger a 1-year intervention individualized around risk and readiness. The primary outcome will be the proportion of participants with Framingham moderate and high-risk strata that reduce their absolute risk by 10% and 25%, respectively. The secondary outcome will be the proportion of moderate and high-risk participants who reduce their risk category. The impact of the intervention on clinical and behavioural variables will also be examined. Low risk participants will be separately analyzed. Data from participants unable to change from the high risk category because of diabetes mellitus or established atherosclerotic disease will also be analyzed separately, with changes in clinical measures from baseline being assessed. A health economic analysis is planned. Copyright © 2011 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  11. Therapeutic implications of selecting the SCORE (European) versus the D'AGOSTINO (American) risk charts for cardiovascular risk assessment in hypertensive patients

    PubMed Central

    Gómez-Marcos, Manuel A; Martínez-Salgado, Carlos; Martin-Cantera, Carlos; Recio-Rodríguez, José I; Castaño-Sánchez, Yolanda; Giné-Garriga, Maria; Rodriguez-Sanchez, Emiliano; García-Ortiz, Luis

    2009-01-01

    Background No comparisons have been made of scales estimating cardiovascular mortality and overall cardiovascular morbidity and mortality. The study objectives were to assess the agreement between the Framingham-D'Agostino cardiovascular risk (CVR) scale and the chart currently recommended in Europe (SCORE) with regard to identification of patients with high CVR, and to describe the discrepancies between them and the attendant implications for the treatment of hypertension and hyperlipidaemia. Methods A total of 474 hypertensive patients aged 40–65 years monitored in primary care were enrolled into the study. CVR was assessed using the Framingham-D'Agostino scale, which estimates the overall cardiovascular morbidity and mortality risk, and the SCORE chart, which estimates the cardiovascular mortality risk. Cardiovascular risk was considered to be high for values ≥ 20% and ≥ 5% according to the Framingham-D'Agostino and SCORE charts respectively. Kappa statistics was estimated for agreement in classification of patients with high CVR. The therapeutic recommendations in the 2007 European Guidelines on Cardiovascular Disease Prevention were followed. Results Mean patient age was 54.1 (SD 7.3), and 58.4% were males. A high CVR was found in 17.5% using the SCORE chart (25.3% males, 6.6% females) and in 32.7% using the D'Agostino method (56.9% males, 12,7% females). Kappa coefficient was 0.52, and increased to 0.68 when the high CVR threshold was established at 29% according to D'Agostino. Hypertensive patients with high SCORE and non-high D'Agostino (1.7%) were characterized by an older age, diabetes, and a lower atherogenic index, while the opposite situation (16.9%) was associated to males, hyperlipidaemia, and a higher atherogenic index. Variables with a greater weight in discrepancies were sex and smoking. A 32.0% according to SCORE and 33.5% according to D'Agostino would be candidates to receive antihypertensive treatment, and 15.8% and 27.3% respectively to

  12. Primordial and primary prevention programs for cardiovascular diseases: from risk assessment through risk communication to risk reduction. A review of the literature

    PubMed Central

    Lancarotte, Inês; Nobre, Moacyr Roberto

    2016-01-01

    The aim of this study was to identify and reflect on the methods employed by studies focusing on intervention programs for the primordial and primary prevention of cardiovascular diseases. The PubMed, EMBASE, SciVerse Hub-Scopus, and Cochrane Library electronic databases were searched using the terms ‘effectiveness AND primary prevention AND risk factors AND cardiovascular diseases’ for systematic reviews, meta-analyses, randomized clinical trials, and controlled clinical trials in the English language. A descriptive analysis of the employed strategies, theories, frameworks, applied activities, and measurement of the variables was conducted. Nineteen primary studies were analyzed. Heterogeneity was observed in the outcome evaluations, not only in the selected domains but also in the indicators used to measure the variables. There was also a predominance of repeated cross-sectional survey design, differences in community settings, and variability related to the randomization unit when randomization was implemented as part of the sample selection criteria; furthermore, particularities related to measures, limitations, and confounding factors were observed. The employed strategies, including their advantages and limitations, and the employed theories and frameworks are discussed, and risk communication, as the key element of the interventions, is emphasized. A methodological process of selecting and presenting the information to be communicated is recommended, and a systematic theoretical perspective to guide the communication of information is advised. The risk assessment concept, its essential elements, and the relevant role of risk perception are highlighted. It is fundamental for communication that statements targeting other people’s understanding be prepared using systematic data. PMID:27982169

  13. Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP)

    PubMed Central

    2013-01-01

    Background South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population. Methods South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar’s test (proportions) and paired t-tests (continuous measures). Results Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering

  14. Proactive Multifactorial Intervention Strategy Reduces the Risk of Cardiovascular Disease Estimated with Region-Specific Risk Assessment Models in Pacific Asian Patients Participating in the CRUCIAL Trial

    PubMed Central

    Cho, Eun Joo; Sutradhar, Santosh; Yunis, Carla; Westergaard, Mogens

    2013-01-01

    Despite race, ethnic, and regional differences in cardiovascular disease risk, many worldwide hypertension management guidelines recommend the use of the Framingham coronary heart disease (CHD) risk equation to guide treatment decisions. This subanalysis of the recently published CRUCIAL trial compared the treatment-related reductions in calculated CHD and stroke risk among Pacific Asian (PA) patients using a variety of region-specific risk assessment models. As a result, greater reductions in systolic and diastolic blood pressure, low-density lipoprotein cholesterol, and triglycerides were observed in the proactive multifactorial intervention (PMI) arm compared with the usual care arm at Week 52 for PA patients. The relative percentage change in 10-yr CHD risk between baseline and Week 52 in the PMI versus usual care arms was greatest using the NIPPON DATA80 fatal CHD model (LS [least square] mean difference -42.6%), and similar in the SCORE fatal CHD and Framingham total CHD models (LS mean difference -29.4% and -30.8%, respectively). The single-pill based PMI approach is consistently effective in reducing cardiovascular disease risk, evaluated using a variety of risk assessment models. (ClinicalTrials.gov registration number: NCT00407537) PMID:24339703

  15. Proactive multifactorial intervention strategy reduces the risk of cardiovascular disease estimated with region-specific risk assessment models in Pacific Asian patients participating in the CRUCIAL trial.

    PubMed

    Cho, Eun Joo; Kim, Jae Hyung; Sutradhar, Santosh; Yunis, Carla; Westergaard, Mogens

    2013-12-01

    Despite race, ethnic, and regional differences in cardiovascular disease risk, many worldwide hypertension management guidelines recommend the use of the Framingham coronary heart disease (CHD) risk equation to guide treatment decisions. This subanalysis of the recently published CRUCIAL trial compared the treatment-related reductions in calculated CHD and stroke risk among Pacific Asian (PA) patients using a variety of region-specific risk assessment models. As a result, greater reductions in systolic and diastolic blood pressure, low-density lipoprotein cholesterol, and triglycerides were observed in the proactive multifactorial intervention (PMI) arm compared with the usual care arm at Week 52 for PA patients. The relative percentage change in 10-yr CHD risk between baseline and Week 52 in the PMI versus usual care arms was greatest using the NIPPON DATA80 fatal CHD model (LS [least square] mean difference -42.6%), and similar in the SCORE fatal CHD and Framingham total CHD models (LS mean difference -29.4% and -30.8%, respectively). The single-pill based PMI approach is consistently effective in reducing cardiovascular disease risk, evaluated using a variety of risk assessment models. (ClinicalTrials.gov registration number: NCT00407537).

  16. HIV and General Cardiovascular Risk

    PubMed Central

    Capili, Bernadette; Anastasi, Joyce K.; Ogedegbe, Olugbenga

    2011-01-01

    The incidence of cardiovascular disease (CVD) is increasing in HIV-infected people. Risk factors such as hyperlipidemia, impaired glucose tolerance, and insulin resistance have become common. CVD in HIV may also be related to non-traditional risk factors including accumulation of visceral fat, inflammation secondary to HIV, and effects of some antiretroviral drugs. This cross-sectional study described the CVD risk factors of 123 adults living with HIV and calculated the 10-year estimate for general cardiovascular risk score. Results showed that approximately 25% of the participants were considered to be at high risk for developing CVD in the next 10 years. Increased waist circumference and longer duration of smoking habit were associated with elevated general cardiovascular risk scores. Similar to the general population, most of the identified risks could be modified through lifestyle management. PMID:21277230

  17. Evaluation of dietary habits and assessment of cardiovascular disease risk factors among Greek university students.

    PubMed

    Chourdakis, Michael; Tzellos, Thrasivoulos; Pourzitaki, Chryssa; Toulis, Konstantinos A; Papazisis, George; Kouvelas, Dimitrios

    2011-10-01

    The aim of this study was the evaluation of dietary habits in regard to cardiovascular risk status in university students in Northern Greece. 215 students (101 males) (age 21.5±2.3 years) participated in the study. Dietary intake was determined by using 3-day food record (1 weekend day). Recorded energy and nutrient intakes were compared to RDA and recommendations given by the American Heart Association (AHA). Students' smoking status and familial chronic diseases were recorded. A percentage of 55.8% (males) and 45.7% (females) were physically moderately active. When compared to AHA guidelines, the students had averagely significantly higher intake of total fat, saturated fat, sodium and dietary cholesterol and lower intake of polyunsaturated fat, monounsaturated fat, folate, vitamin E and fiber. 95% of them failed to meet all AHA dietary recommendations, with polyunsaturated to saturated fat ratio and the percentage of total fat being the top two failed parameters and sodium (10.2%) being the one less problematic. Dietary habits of Greek university students differ from what is considered as health promoting and, in the case that it they are not altered, may have an adverse effect on their CV health, despite the fact that their mean body weight is only moderately high. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Investigating patients' and general practitioners' views of computerised decision support software for the assessment and management of cardiovascular risk.

    PubMed

    Wilson, Anne; Duszynski, André; Turnbull, Deborah; Beilby, Justin

    2007-01-01

    This paper reports an evaluation of the usability and acceptability of a computer-based decision support program (EMPOWER) for cardiovascular risk from the perspectives of both general practitioners (GPs) and consumers. A qualitative research design utilised semi-structured telephone interviews to assess the program from participants' perspectives. Qualitative approaches included the use of purposeful sampling, the collection of open-ended data, and the analysis of text and personal interpretation of findings. The theoretical foundations for the methods chosen are explained. Consumers enjoyed being involved in the study and thought the program had benefits for encouraging confidence in seeking health care. Consumers reported feeling reassured about the processes followed during consultation. GPs found the application of the software program increased demands on their time but admired several features of the program, especially its educational advantages. Participants were of the opinion that the program would be of particular benefit to inexperienced GPs and newly diagnosed patients. Computer decision support programs are becoming more prevalent, but little is known about their usability and acceptability to both health professionals and consumers. The complexities of cardiovascular risk assessment and management can be adequately managed with such programs. As a contemporary report this study contributes to the growing knowledge required for developers of medical software and decision support systems to better understand the needs of end-users.

  19. Exercise for people with high cardiovascular risk.

    PubMed

    Seron, Pamela; Lanas, Fernando; Pardo Hernandez, Hector; Bonfill Cosp, Xavier

    2014-08-13

    When two or more cardiovascular risk factors occur in one individual, they may interact in a multiplicative way promoting cardiovascular disease. Exercise has proven to be effective in controlling individual risk factors but its effect on overall cardiovascular risk remains uncertain. To assess the effects of exercise training in people with increased cardiovascular risk but without a concurrent cardiovascular disease on general cardiovascular mortality, incidence of cardiovascular events, and total cardiovascular risk. A search was conducted in CENTRAL (The Cochrane Library 2013, Issue 10 of 12), Ovid MEDLINE (1946 to week 2 November 2013), EMBASE Classic + EMBASE via Ovid (1947 to Week 47 2013), CINAHL Plus with Full Text via EBSCO (to November 2013), Science Citation Index Expanded (SCI-EXPANDED) (1970 to 22 November 2013), and Conference Proceedings Citation Index - Science (CPCI-S) (1990 to 22 November 2013) on Web of Science (Thomson Reuters). We did not apply any date or language restrictions. Randomized clinical trials comparing aerobic or resistance exercise training versus no exercise or any standard approach that does not include exercise. Participants had to be 18 years of age or older with an average 10-year Framingham risk score of 10% for cardiovascular disease over 10 years, or with two or more cardiovascular risk factors, and no history of cardiovascular disease. The selection of studies and subsequent data collection process were conducted by two independent authors. Disagreements were solved by consensus. The results were reported descriptively. It was not possible to conduct a meta-analysis because of the high heterogeneity and high risk of bias in the included studies. A total of four studies were included that involved 823 participants, 412 in the exercise group and 411 in the control group. Follow-up of participants ranged from 16 weeks to 6 months. Overall, the included studies had a high risk of selection, detection, and attrition bias

  20. Cotinine-assessed second-hand smoke exposure and risk of cardiovascular disease in older adults.

    PubMed

    Jefferis, B J; Lawlor, D A; Ebrahim, S; Wannamethee, S G; Feyerabend, C; Doig, M; McMeekin, L; Cook, D G; Whincup, P H

    2010-06-01

    To examine whether second-hand smoke (SHS) exposure measured by serum cotinine is associated with increased coronary heart disease (CHD) and stroke risk among contemporary older British adults. Prospective population-based study with self-reported medical history and health behaviours. Fasting blood samples were analysed for serum cotinine and cardiovascular disease (CVD) risk markers. Primary care centres in 25 British towns in 1998-2001. 8512 60-79-year-old men and women selected from primary care registers. Fatal and non-fatal myocardial infarction (MI; n=445) and stroke (n=386) during median 7.8-year follow-up. Observational study of serum cotinine assayed from fasting blood sample using liquid chromatography tandem mass spectrometry method, and self-reported smoking history. Among 5374 non-smokers without pre-existing CVD, geometric mean cotinine was 0.15 ng/ml (IQR 0.05-0.30). Compared with non-smokers with cotinine < or =0.05 ng/ml, higher cotinine levels (0.06-0.19, 0.2-0.7 and 0.71-15.0 ng/ml) showed little association with MI; adjusted HRs were 0.92 (95% CI 0.63 to 1.35), 1.07 (0.73 to 1.55) and 1.09 (0.69 to 1.72), p(trend)=0.69. Equivalent HRs for stroke were 0.82 (0.55 to 1.23), 0.74 (0.48 to 1.13) and 0.69 (0.41 to 1.17), p(trend)=0.065. The adjustment for sociodemographic, behavioural and CVD risk factors had little effect on the results. The HR of MI for smokers (1-9 cigarettes/day) compared with non-smokers with cotinine < or =0.05 ng/ml was 2.14 (1.39 to 3.52) and 1.03 (0.52 to 2.04) for stroke. In contemporary older men and women, SHS exposure (predominantly at low levels) was not related to CHD or stroke risks, but we cannot rule out the possibility of modest effects at higher exposure levels.

  1. Cotinine-assessed second-hand smoke exposure and risk of cardiovascular disease in older adults

    PubMed Central

    Lawlor, D A; Ebrahim, S; Wannamethee, S G; Feyerabend, C; Doig, M; McMeekin, L; Cook, D G; Whincup, P H

    2010-01-01

    Objectives To examine whether second-hand smoke (SHS) exposure measured by serum cotinine is associated with increased coronary heart disease (CHD) and stroke risk among contemporary older British adults. Design Prospective population-based study with self-reported medical history and health behaviours. Fasting blood samples were analysed for serum cotinine and cardiovascular disease (CVD) risk markers. Setting Primary care centres in 25 British towns in 1998–2001. Patients 8512 60–79-year-old men and women selected from primary care registers. Main outcome measures Fatal and non-fatal myocardial infarction (MI; n=445) and stroke (n=386) during median 7.8-year follow-up. Main exposure Observational study of serum cotinine assayed from fasting blood sample using liquid chromatography tandem mass spectrometry method, and self-reported smoking history. Results Among 5374 non-smokers without pre-existing CVD, geometric mean cotinine was 0.15 ng/ml (IQR 0.05–0.30). Compared with non-smokers with cotinine ≤0.05 ng/ml, higher cotinine levels (0.06–0.19, 0.2–0.7 and 0.71–15.0 ng/ml) showed little association with MI; adjusted HRs were 0.92 (95% CI 0.63 to 1.35), 1.07 (0.73 to 1.55) and 1.09 (0.69 to 1.72), p(trend)=0.69. Equivalent HRs for stroke were 0.82 (0.55 to 1.23), 0.74 (0.48 to 1.13) and 0.69 (0.41 to 1.17), p(trend)=0.065. The adjustment for sociodemographic, behavioural and CVD risk factors had little effect on the results. The HR of MI for smokers (1–9 cigarettes/day) compared with non-smokers with cotinine ≤0.05 ng/ml was 2.14 (1.39 to 3.52) and 1.03 (0.52 to 2.04) for stroke. Conclusions In contemporary older men and women, SHS exposure (predominantly at low levels) was not related to CHD or stroke risks, but we cannot rule out the possibility of modest effects at higher exposure levels. PMID:20478864

  2. Gender disparities in the assessment and management of cardiovascular risk in primary care: the AusHEART study.

    PubMed

    Turnbull, Fiona; Arima, Hisatomi; Heeley, Emma; Cass, Alan; Chalmers, John; Morgan, Claire; Patel, Anushka; Peiris, David; Weekes, Andrew; Anderson, Craig

    2011-06-01

    Studies indicate ongoing gender-based differences in the prevention, detection and management of cardiovascular disease. The aims of this study were to determine whether there are differences in general practitioners' (GPs') perceptions of a patient's cardiovascular risk compared with the patient's estimated risk and in the patient's subsequent medical management according to patient sex. The Australian Hypertension and Absolute Risk Study (AusHEART) was a nationally representative, cluster-stratified, cross-sectional survey among 322 GPs. Each GP was asked to collect data on cardiovascular disease risk factors and their management in 15-20 consecutive patients (age ≥55 years) who presented between April and June, 2008. They were also asked to estimate each patient's absolute risk of a cardiovascular event in the next five years. The main outcomes were the Adjusted Framingham risk, GP estimated risk and proportion of patients receiving blood pressure-lowering, statin and antiplatelet therapy. A total of 5293 patients were recruited to the study, of whom 2968 (56%) were women. Among patients without established cardiovascular disease, the level of agreement between the GP estimated risk and the Adjusted Framingham risk was poor (<50%) and was similarly so for men (kappa coefficient 0.18; 95% confidence interval (CI) 0.14-0.21) and women (0.19; 95% CI 0.16-0.22; P homogeneity = 0.57). For patients with established cardiovascular disease, however, women were more likely to be assigned by the GP to a lower risk category (66% vs. 54%, P < 0.001) and less likely to be prescribed combination (blood pressure-lowering, statin and antiplatelet) (44% vs. 56%, P < 0.001) therapy compared with men, even after adjusting for patient age. Cardiovascular risk is underrecognized and undertreated in Australian primary care patients, with women apparently disproportionately affected. These findings underscore the importance of initiatives to raise awareness of

  3. Cardiovascular risk assessment in children: role of physical activity, family history and parental smoking on BMI and blood pressure.

    PubMed

    Giussani, Marco; Antolini, Laura; Brambilla, Paolo; Pagani, Massimo; Zuccotti, Gianvincenzo; Valsecchi, Maria G; Lucini, Daniela; Genovesi, Simonetta

    2013-05-01

    Aim of the study was to assess the role of family history, physical activity and parental smoking in the prediction of BMI, SBP and hypertension risk in children. In a paediatric primary care setting, a sample of 1310 children aged 5-14 years was systematically selected by 48 family paediatricians in northern Italy. BMI, waist circumference-to-height ratio (WtHr), SBP and DBP were measured and the information on the presence of small birth weight for gestational age (SGA) and early adiposity rebound (EAR) was collected. Data concerning exercise, video time, family history for cardiovascular diseases and parental smoking were derived from parental interview. Data were collected using an 'ad hoc designed' electronic sheet available online. Multiple linear regression showed that the presence of EAR, low exercise (<2 h/week), high video time (>2  h/day TV/videogames/computer) and parental smoking were associated to higher BMI (z-score; P < 0.005). Age, BMI (z-score), WtHr, presence of SGA, low exercise, high video time and family history of cardiovascular diseases were associated to SBP values (P < 0.03). Logistic regression analysis showed that factors related to risk of hypertension and prehypertension were BMI (z-score; odds ratio, OR 2.63; 95% confidence interval, CI 2.12-3.28), WtHr (OR 1.13; 95% CI 1.10-3.28) and low exercise (OR 1.58; 95% CI 1.12-2.24; P <0.01). Our study demonstrates that a simple tool like a cardiovascular multi-item sheet can provide useful information to paediatricians for child health. Physical exercise plays a pivotal role in obesity prevention and protection from hypertension risk.

  4. Subclinical cardiovascular disease assessment and its relationship with cardiovascular risk SCORE in a healthy adult population: A cross-sectional community-based study.

    PubMed

    Mitu, Ovidiu; Roca, Mihai; Floria, Mariana; Petris, Antoniu Octavian; Graur, Mariana; Mitu, Florin

    The aim of this study is to evaluate the relationship and the accuracy of SCORE (Systematic Coronary Risk Evaluation Project) risk correlated to multiple methods for determining subclinical cardiovascular disease (CVD) in a healthy population. This cross-sectional study included 120 completely asymptomatic subjects, with an age range 35-75 years, and randomly selected from the general population. The individuals were evaluated clinically and biochemical, and the SCORE risk was computed. Subclinical atherosclerosis was assessed by various methods: carotid ultrasound for intima-media thickness (cIMT) and plaque detection; aortic pulse wave velocity (aPWV); echocardiography - left ventricular mass index (LVMI) and aortic atheromatosis (AA); ankle-brachial index (ABI). SCORE mean value was 2.95±2.71, with 76% of subjects having SCORE <5. Sixty-four percent of all subjects have had increased subclinical CVD changes, and SCORE risk score was correlated positively with all markers, except for ABI. In the multivariate analysis, increased cIMT and aPWV were significantly associated with high value of SCORE risk (OR 4.14, 95% CI: 1.42-12.15, p=0.009; respectively OR 1.41, 95% CI: 1.01-1.96, p=0.039). A positive linear relationship was observed between 3 territories of subclinical CVD (cIMT, LVMI, aPWV) and SCORE risk (p<0.0001). There was evidence of subclinical CVD in 60% of subjects with a SCORE value <5. As most subjects with a SCORE value <5 have subclinical CVD abnormalities, a more tailored subclinical CVD primary prevention program should be encouraged. Copyright © 2016 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Marathon run: cardiovascular adaptation and cardiovascular risk.

    PubMed

    Predel, Hans-Georg

    2014-11-21

    The first marathon run as an athletic event took place in the context of the Olympic Games in 1896 in Athens, Greece. Today, participation in a 'marathon run' has become a global phenomenon attracting young professional athletes as well as millions of mainly middle-aged amateur athletes worldwide each year. One of the main motives for these amateur marathon runners is the expectation that endurance exercise (EE) delivers profound beneficial health effects. However, with respect to the cardiovascular system, a controversial debate has emerged whether the marathon run itself is healthy or potentially harmful to the cardiovascular system, especially in middle-aged non-elite male amateur runners. In this cohort, exercise-induced increases in cardiac biomarkers-troponin and brain natriuretic peptide-and acute functional cardiac alterations have been observed and interpreted as potential cardiac damage. Furthermore, in the cohort of 40- to 65-year-old males engaged in intensive EE, a significant risk for the development of atrial fibrillation has been identified. Fortunately, recent studies demonstrated a normalization of the cardiac biomarkers and the functional alterations within a short time frame. Therefore, these alterations may be perceived as physiological myocardial reactions to the strenuous exercise and the term 'cardiac fatigue' has been coined. This interpretation is supported by a recent analysis of 10.9 million marathon runners demonstrating that there was no significantly increased overall risk of cardiac arrest during long-distance running races. In conclusion, intensive and long-lasting EE, e.g. running a full-distance Marathon, results in high cardiovascular strain whose clinical relevance especially for middle-aged and older athletes is unclear and remains a matter of controversy. Furthermore, there is a need for evidence-based recommendations with respect to medical screening and training strategies especially in male amateur runners over the age of

  6. Assessment of the agreement between the Framingham and DAD risk equations for estimating cardiovascular risk in adult Africans living with HIV infection: a cross-sectional study.

    PubMed

    Noumegni, Steve Raoul; Ama, Vicky Jocelyne Moor; Assah, Felix K; Bigna, Jean Joel; Nansseu, Jobert Richie; Kameni, Jenny Arielle M; Katte, Jean-Claude; Dehayem, Mesmin Y; Kengne, Andre Pascal; Sobngwi, Eugene

    2017-01-01

    The Absolute cardiovascular disease (CVD) risk evaluation using multivariable CVD risk models is increasingly advocated in people with HIV, in whom existing models remain largely untested. We assessed the agreement between the general population derived Framingham CVD risk equation and the HIV-specific Data collection on Adverse effects of anti-HIV Drugs (DAD) CVD risk equation in HIV-infected adult Cameroonians. This cross-sectional study involved 452 HIV infected adults recruited at the HIV day-care unit of the Yaoundé Central Hospital, Cameroon. The 5-year projected CVD risk was estimated for each participant using the DAD and Framingham CVD risk equations. Agreement between estimates from these equations was assessed using the spearman correlation and Cohen's kappa coefficient. The mean age of participants (80% females) was 44.4 ± 9.8 years. Most participants (88.5%) were on antiretroviral treatment with 93.3% of them receiving first-line regimen. The most frequent cardiovascular risk factors were abdominal obesity (43.1%) and dyslipidemia (33.8%). The median estimated 5-year CVD risk was 0.6% (25th-75th percentiles: 0.3-1.3) using the DAD equation and 0.7% (0.2-2.0) with the Framingham equation. The Spearman correlation between the two estimates was 0.93 (p < 0.001). The kappa statistic was 0.61 (95% confident interval: 0.54-0.67) for the agreement between the two equations in classifying participants across risk categories defined as low, moderate, high and very high. Most participants had a low-to-moderate estimated CVD risk, with acceptable level of agreement between the general and HIV-specific equations in ranking CVD risk.

  7. Integrated and Translational Nonclinical In Vivo Cardiovascular Risk Assessment: Gaps and Opportunities

    EPA Science Inventory

    Cardiovascular (CV) safety concerns are a significant source of drug development attrition in the pharmaceutical industry today. Though current nonclinical testing paradigms have largely prevented catastrophic CV events in Phase I studies, many challenges relating to the inabil...

  8. Integrated and Translational Nonclinical In Vivo Cardiovascular Risk Assessment: Gaps and Opportunities

    EPA Science Inventory

    Cardiovascular (CV) safety concerns are a significant source of drug development attrition in the pharmaceutical industry today. Though current nonclinical testing paradigms have largely prevented catastrophic CV events in Phase I studies, many challenges relating to the inabil...

  9. [Cardiovascular risk factors in women].

    PubMed

    Cengel, Atiye

    2010-03-01

    It is estimated that at least 80% of patients with cardiovascular disease (CVD) have conventional risk factors and optimization of these risk factors can reduce morbidity and mortality due to this disease considerably. Contemporary women have increased burden of some of these risk factors such as obesity, metabolic syndrome and smoking. Turkish women have a worse CV risk profile than Turkish men in some aspects. Risk stratification systems such as Framingham have a tendency of underestimating the risk in women. Coronary artery disease remains in vessel wall for a longer period of time in women; therefore obstructive disease appear later in their lifespan necessitating risk stratification systems for estimating their lifetime risk.

  10. A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia.

    PubMed

    Nash, Mark S; Mendez, Armando J

    2007-06-01

    To examine percentages of persons with chronic paraplegia who qualify for lipid-lowering therapeutic lifestyle intervention (TLI) as assessed by authoritative guidelines. Cross-sectional. Academic medical center. Forty-one subjects (mean age +/- standard deviation, 34+/-11 y) with motor-complete paraplegia (American Spinal Injury Association grade A or B) at T6-L1 levels for greater than 2 years. Not applicable. Percentages of subjects qualifying for TLI were independently assessed and then compared using National Cholesterol Education Project Adult Treatment Panel (ATP) II (1994) and ATP III (2002) Guidelines. A total of 34.1% of subjects qualified for intervention based on the ATP II Guidelines and 63.4% based on ATP III (chi1(2) test=4.53; 2-tailed, P=.003). Seventy-six percent (31/41) of study participants had high-density lipoprotein cholesterol levels below the high-risk criterion of 40 mg/dL established by ATP III. Almost one third of subjects had hypertension, and 34.1% satisfied criteria for diagnosis of the metabolic syndrome. A high percentage of young, apparently healthy people with chronic paraplegia are at risk for cardiovascular disease and qualify for lipid-lowering TLI. Updated guidelines of the ATP III have increased the urgency for early risk assessment and intervention.

  11. Cardiovascular risk from water arsenic exposure in Vietnam: Application of systematic review and meta-regression analysis in chemical health risk assessment.

    PubMed

    Phung, Dung; Connell, Des; Rutherford, Shannon; Chu, Cordia

    2017-06-01

    A systematic review (SR) and meta-analysis cannot provide the endpoint answer for a chemical risk assessment (CRA). The objective of this study was to apply SR and meta-regression (MR) analysis to address this limitation using a case study in cardiovascular risk from arsenic exposure in Vietnam. Published studies were searched from PubMed using the keywords of arsenic exposure and cardiovascular diseases (CVD). Random-effects meta-regression was applied to model the linear relationship between arsenic concentration in water and risk of CVD, and then the no-observable-adverse-effect level (NOAEL) were identified from the regression function. The probabilistic risk assessment (PRA) technique was applied to characterize risk of CVD due to arsenic exposure by estimating the overlapping coefficient between dose-response and exposure distribution curves. The risks were evaluated for groundwater, treated and drinking water. A total of 8 high quality studies for dose-response and 12 studies for exposure data were included for final analyses. The results of MR suggested a NOAEL of 50 μg/L and a guideline of 5 μg/L for arsenic in water which valued as a half of NOAEL and guidelines recommended from previous studies and authorities. The results of PRA indicated that the observed exposure level with exceeding CVD risk was 52% for groundwater, 24% for treated water, and 10% for drinking water in Vietnam, respectively. The study found that systematic review and meta-regression can be considered as an ideal method to chemical risk assessment due to its advantages to bring the answer for the endpoint question of a CRA. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. [Assessment of health benefits from a nutrition program aimed at inmates with cardiovascular risk factors at Huelva Prison].

    PubMed

    Gil-Delgado, Y; Domínguez-Zamorano, J A; Martínez-Sánchez-Suárez, E

    2011-01-01

    Diet and lifestyle are important factors in improving cardiovascular health and preventing chronic diseases. Assessment of changes brought about in cardiovascular risk (CVR) and metabolic syndrome (MS) after inclusion in a nutritional program. Intervention, nonrandomized prospective cohort study carried out at Huelva prison in a one year period. Information about quarterly and bi-annual anthropometric and blood biochemical variables was obtained to assess changes in diet. A descriptive analysis with LC 95% and pre-post study was also completed, using T-Student quantitative variables and Wilcoxon test averages. Qualitative testing was performed using the Chi-square test. The sample consisted of 139 subjects, 44 patients were lost in the follow-up study and 95 completed the program. Diet modification took place in 86.3% of the cases. We obtained significant improvements in weight, body mass, fat mass, abdominal perimeter and diastolic blood pressure rate index variables (Table 3). We see a reduction in high and low CVR vs. medium CVR according to features of Framingham and REGICOR (without significance), remaining stable in the SCORE model (Table 4). Health education and proper diet improved anthropometric and biochemical parameters in these patients. This may imply a new tool in the health care repertoire that can be applied to other centres.

  13. Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations

    PubMed Central

    Tournadre, Anne; Mathieu, Sylvain; Soubrier, Martin

    2016-01-01

    Patients with inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis, have higher rates of cardiovascular mortality. While the increased cardiovascular risk is only explained to some extent, a lot of research is currently conducted to improve our understanding of its pathogenesis, risk stratification, and optimal cardiovascular risk management. This review sought to report epidemiological data pertaining to the cardiovascular disease burden in patients with inflammatory arthritis, underlying mechanisms accounting for excessive cardiovascular risk, along with recommendations regarding risk assessment and management in this patient population. PMID:27721904

  14. Lifetime Risks of Cardiovascular Disease

    PubMed Central

    Berry, Jarett D.; Dyer, Alan; Cai, Xuan; Garside, Daniel B.; Ning, Hongyan; Thomas, Avis; Greenland, Philip; Van Horn, Linda; Tracy, Russell P.; Lloyd-Jones, Donald M.

    2012-01-01

    BACKGROUND The lifetime risks of cardiovascular disease have not been reported across the age spectrum in black adults and white adults. METHODS We conducted a meta-analysis at the individual level using data from 18 cohort studies involving a total of 257,384 black men and women and white men and women whose risk factors for cardiovascular disease were measured at the ages of 45, 55, 65, and 75 years. Blood pressure, cholesterol level, smoking status, and diabetes status were used to stratify participants according to risk factors into five mutually exclusive categories. The remaining lifetime risks of cardiovascular events were estimated for participants in each category at each age, with death free of cardiovascular disease treated as a competing event. RESULTS We observed marked differences in the lifetime risks of cardiovascular disease across risk-factor strata. Among participants who were 55 years of age, those with an optimal risk-factor profile (total cholesterol level, <180 mg per deciliter [4.7 mmol per liter]; blood pressure, <120 mm Hg systolic and 80 mm Hg diastolic; nonsmoking status; and nondiabetic status) had substantially lower risks of death from cardiovascular disease through the age of 80 years than participants with two or more major risk factors (4.7% vs. 29.6% among men, 6.4% vs. 20.5% among women). Those with an optimal risk-factor profile also had lower lifetime risks of fatal coronary heart disease or nonfatal myocardial infarction (3.6% vs. 37.5% among men, <1% vs. 18.3% among women) and fatal or nonfatal stroke (2.3% vs. 8.3% among men, 5.3% vs. 10.7% among women). Similar trends within risk-factor strata were observed among blacks and whites and across diverse birth cohorts. CONCLUSIONS Differences in risk-factor burden translate into marked differences in the lifetime risk of cardiovascular disease, and these differences are consistent across race and birth cohorts. (Funded by the National Heart, Lung, and Blood Institute.) PMID

  15. The role of carotid ultrasound in assessing carotid atherosclerosis in individuals at low-to-intermediate cardiovascular risk.

    PubMed

    Coll, Blai; Betriu, Angels; Feinstein, Steve B; Valdivielso, Jose M; Zamorano, Jose L; Fernández, Elvira

    2013-12-01

    Detection of carotid atherosclerosis might help to better identify individuals susceptible to cardiovascular events. We aimed to quantify the number of participants with carotid atherosclerosis and low-to-intermediate cardiovascular risk according to the traditional risk factor scoring, and therefore with an elevated risk of cardiovascular events. Cross-sectional, observational study performed during a cardiovascular screening program. From a total of 3778 volunteers, low-to-intermediate cardiovascular risk individuals (N=2354) were identified and studied. Physical examination, blood test, and carotid ultrasound followed standard procedures. Common, bulb, and internal carotid arteries were examined and common carotid intima-media thickness was measured. SCORE risk value was calculated for all participants. Univariate and multivariate statistical analysis was performed. Mean age of participants was 58.9 (15) years, 43.8% were men, 23.7% had hypertension, and 20.5% had hypercholesterolemia. The mean SCORE value was 1.47 (1.4). Both carotid intima-media thickness and the prevalence of carotid plaques increased steadily and significantly (P<.005) as advanced decades of life were analyzed. Variables significantly related with the presence of carotid atherosclerosis were age, male sex, and systolic blood pressure. Interestingly, 592 (25.1%) individuals were reclassified to a higher risk due to the presence of carotid atherosclerosis. There was a clear dissociation between cardiovascular risk scoring and the presence of atherosclerosis, because 1 of 4 study participants at low-to-intermediate cardiovascular risk had carotid atherosclerosis. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  16. [Practicality of cardiovascular risk functions].

    PubMed

    Marrugat, Jaume; Elosua, Roberto; Icaza, Gloria; Morales-Salinas, Alberto; Dégano, Irene R

    2016-12-13

    Cardiovascular diseases prevention strategies require refinement because their incidence decreases very slowly. Risk functions were developed by including classical cardiovascular risk factors (age, sex, smoking, diabetes, blood pressure, and basic lipid profile) in cohorts followed more than 10 years. They are reasonably precise for population screening of, principally, coronary artery disease risk, required in all cardiovascular primary prevention clinical guidelines. Coronary artery disease risk functions classify patients in risk strata to concentrate the maximum therapeutic and life style effort in the highest risk groups, in which the number needed to treat and cost-effectiveness are optimal. By communicating the relative risk and vascular age to patients, increased motivation to comply with the proposed drug and life-style modifications can be achieved. Approximately 20% of the population 35 to 74 years old has an intermediate risk that requires reclassification into high or low risk because they concentrate 35% of population coronary artery disease events. Several biomarkers (biochemical, genetic or imaging) are being tested to improve coronary artery disease risk functions precision. Computerized systems of health facilities should incorporate, automated risk calculation in order to support the preventive task of health care providers.

  17. Current Status of Chemical Public Health Risks and Testing Guidelines for Chemical Cardiovascular Safety Assessments

    EPA Science Inventory

    The cardiovascular system, at all its various developmental and life stages, represents a critical target organ system that can be adversely affected by a variety of chemicals and routes of exposure. A World Health Organization report estimated the impact of environmental chemica...

  18. Current Status of Chemical Public Health Risks and Testing Guidelines for Chemical Cardiovascular Safety Assessments

    EPA Science Inventory

    The cardiovascular system, at all its various developmental and life stages, represents a critical target organ system that can be adversely affected by a variety of chemicals and routes of exposure. A World Health Organization report estimated the impact of environmental chemica...

  19. Cardiovascular risks of antiretroviral therapies.

    PubMed

    Mondy, Kristin; Tebas, Pablo

    2007-01-01

    The use of highly active antiretroviral therapy (HAART) has resulted in sustained reductions in mortality from HIV infection. In recent years, HAART has also been associated with metabolic complications that may increase patients' cardiovascular disease risk. Recent studies have begun to support a more complex interaction between HAART, HIV infection itself, and other traditional social and immunologic factors that may predispose patients to premature cardiovascular disease. Substantial progress has been made in the development of newer antiretroviral therapies that have a better metabolic profile with respect to dyslipidemia, hyperglycemia, and lipodystrophy. Optimal selection of metabolically neutral antiretroviral therapies, together with aggressive management of other modifiable coronary risk factors, may improve cardiovascular disease risk in the long term.

  20. Space radiation and cardiovascular disease risk

    PubMed Central

    Boerma, Marjan; Nelson, Gregory A; Sridharan, Vijayalakshmi; Mao, Xiao-Wen; Koturbash, Igor; Hauer-Jensen, Martin

    2015-01-01

    Future long-distance space missions will be associated with significant exposures to ionizing radiation, and the health risks of these radiation exposures during manned missions need to be assessed. Recent Earth-based epidemiological studies in survivors of atomic bombs and after occupational and medical low dose radiation exposures have indicated that the cardiovascular system may be more sensitive to ionizing radiation than was previously thought. This has raised the concern of a cardiovascular disease risk from exposure to space radiation during long-distance space travel. Ground-based studies with animal and cell culture models play an important role in estimating health risks from space radiation exposure. Charged particle space radiation has dense ionization characteristics and may induce unique biological responses, appropriate simulation of the space radiation environment and careful consideration of the choice of the experimental model are critical. Recent studies have addressed cardiovascular effects of space radiation using such models and provided first results that aid in estimating cardiovascular disease risk, and several other studies are ongoing. Moreover, astronauts could potentially be administered pharmacological countermeasures against adverse effects of space radiation, and research is focused on the development of such compounds. Because the cardiovascular response to space radiation has not yet been clearly defined, the identification of potential pharmacological countermeasures against cardiovascular effects is still in its infancy. PMID:26730293

  1. Space radiation and cardiovascular disease risk.

    PubMed

    Boerma, Marjan; Nelson, Gregory A; Sridharan, Vijayalakshmi; Mao, Xiao-Wen; Koturbash, Igor; Hauer-Jensen, Martin

    2015-12-26

    Future long-distance space missions will be associated with significant exposures to ionizing radiation, and the health risks of these radiation exposures during manned missions need to be assessed. Recent Earth-based epidemiological studies in survivors of atomic bombs and after occupational and medical low dose radiation exposures have indicated that the cardiovascular system may be more sensitive to ionizing radiation than was previously thought. This has raised the concern of a cardiovascular disease risk from exposure to space radiation during long-distance space travel. Ground-based studies with animal and cell culture models play an important role in estimating health risks from space radiation exposure. Charged particle space radiation has dense ionization characteristics and may induce unique biological responses, appropriate simulation of the space radiation environment and careful consideration of the choice of the experimental model are critical. Recent studies have addressed cardiovascular effects of space radiation using such models and provided first results that aid in estimating cardiovascular disease risk, and several other studies are ongoing. Moreover, astronauts could potentially be administered pharmacological countermeasures against adverse effects of space radiation, and research is focused on the development of such compounds. Because the cardiovascular response to space radiation has not yet been clearly defined, the identification of potential pharmacological countermeasures against cardiovascular effects is still in its infancy.

  2. Advanced lipoprotein testing for cardiovascular diseases risk assessment: a review of the novel approaches in lipoprotein profiling.

    PubMed

    Clouet-Foraison, Noémie; Gaie-Levrel, Francois; Gillery, Philippe; Delatour, Vincent

    2017-08-28

    With the increasing prevalence of cardiovascular diseases (CVD) worldwide, finding reliable and clinically relevant biomarkers to predict acute cardiovascular events has been a major aim of the scientific and medical community. Improvements of the understanding of the pathophysiological pathways of the disease highlighted the major role of lipoprotein particles, and these past decades have seen the emergence of a number of new methodologies to separate, measure and quantitate lipoproteins. Those methods, also known as advanced lipoprotein testing methods (ALT), have gained acceptance in the field of CVD risk assessment and have proven their clinical relevance. In the context of worldwide standardization and harmonization of biological assays, efforts have been initiated toward standardization of ALT methods. However, the complexity of lipoprotein particles and the multiple approaches and methodologies reported to quantify them have rendered these initiatives a critical issue. In this context and to better understand these challenges, this review presents a summary of the major methods available for ALT with the aim to point out the major differences in terms of procedures and quantities actually measured and to discuss the resulting comparability issues.

  3. High calcium scores in patients with a low Framingham risk of cardiovascular (CVS) disease: implications for more accurate CVS risk assessment in New Zealand.

    PubMed

    Ellis, Chris J; Legget, Malcolm E; Edwards, Colin; Van Pelt, Niels; Ormiston, John A; Christiansen, Jonathan; Winch, Helen; Osborne, Mark; Gamble, Greg

    2011-05-27

    New Zealand (NZ) patients are recommended to undergo an 'adjusted' Framingham score to assess their cardiovascular (CVS) risk. The current (2009) NZ CVS Risk Guideline does not recommend the use of a 'calcium score' as an additional risk tool, although it has been shown to be powerfully predictive of CVS events above the predictive power of traditional Framingham risk factors. Calcium scores of >400 are very strongly predictive of a future CVS event and give direct evidence of atheromatous disease in the coronary circulation. Identification of people with advanced, premature coronary atheroma would allow early treatment of those who may benefit from more vigorous preventative strategies, including statin therapy. Using a prospectively acquired, comprehensive database we audited the first 1000 patients (7 August 2006 to 28 November 2008) to undergo a 64-slice computed tomographic (CT) cardiac angiogram (GE Light Speed), which included a scan for a 'calcium score', at the Mercy Hospital, Auckland. We excluded 58 patients who had experienced one or more of a previous myocardial infarction (MI) (n=21), coronary artery bypass graft (CABG) surgery (n=15), percutaneous coronary intervention (PCI) (n=13) or stroke (n=21) and who therefore already had definite evidence of vascular disease and would be automatically placed in a high risk strata. We calculated each patient's Framingham risk from the original 'Anderson' equation, used by the 1996 NZ CVS risk Guideline, and the 'adjusted' Framingham 5-year CVS risk using the NZ Guidelines Group 2003/2009 recommendations, and then compared this with the observed calcium scores. The mean patient age was 56 (SD 9) years; 364 (39%) patients were female, 82% patients were Caucasian. 41% were current (4.6%) or previous (36%) cigarette smokers, 35% had a history of hypertension, 44% hyperlipidaemia and 5.6% had diabetes mellitus. The percentage of patients at 'low' 5-Year CVS risk (0-10% 5-year risk), using the 1996 and 2003

  4. High atherogenic index of plasma in subclinical hypothyroidism: Implications in assessment of cardiovascular disease risk

    PubMed Central

    James, Stephen R.; Ray, Lopamudra; Ravichandran, Kandasamy; Nanda, Sunil Kumar

    2016-01-01

    Background: A controversy exists regarding the association between subclinical hypothyroidism (SH) and dyslipidemia. Moreover, studies on lipid ratios and atherogenic index of plasma (AIP) in SH are rare, particularly in the Indian scenario. Aim: This study aimed to investigate abnormalities in conventional lipid profile, lipid ratios, and AIP in SH and attempted to correlate thyroid stimulating hormone (TSH) and AIP in SH. Materials and Methods: In this retrospective analysis of patient records of SH subjects and euthyroid subjects, age, free triiodothyronine, free thyroxine, TSH, total cholesterol, triglycerides, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol, lipid ratios, and AIP were compared between the two groups. The correlation of TSH and AIP in SH was studied. Spearman's correlation, Mann–Whitney U-test and logistic regression analysis were performed. Results: Triglyceride, triglyceride/HDL-C, and AIP were significantly higher in SH as compared to euthyroid group, but there was no correlation between TSH and AIP in SH. AIP emerged as the significant single factor associated with SH in multiple logistic regressions. Conclusion: The positive association of dyslipidemia and SH indicates a need for regular screening of these patients to enable early diagnosis and treatment of dyslipidemia. Even in patients who have a normal conventional lipid profile, lipid ratios, and AIP have to be calculated for better assessment of atherogenic risk. PMID:27730076

  5. Noninvasive Cardiovascular Risk Assessment of the Asymptomatic Diabetic Patient: The Imaging Council of the American College of Cardiology.

    PubMed

    Budoff, Matthew J; Raggi, Paolo; Beller, George A; Berman, Daniel S; Druz, Regina S; Malik, Shaista; Rigolin, Vera H; Weigold, Wm Guy; Soman, Prem

    2016-02-01

    Increased cardiovascular morbidity and mortality in patients with type 2 diabetes is well established; diabetes is associated with at least a 2-fold increased risk of coronary heart disease. Approximately two-thirds of deaths among persons with diabetes are related to cardiovascular disease. Previously, diabetes was regarded as a "coronary risk equivalent," implying a high 10-year cardiovascular risk for every diabetes patient. Following the original study by Haffner et al., multiple studies from different cohorts provided varying conclusions on the validity of the concept of coronary risk equivalency in patients with diabetes. New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk. Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment. The Imaging Council of the American College of Cardiology systematically reviewed all modalities commonly used for risk stratification in persons with diabetes mellitus and summarized the data and recommendations. This document reviews the evidence regarding the use of noninvasive testing to stratify asymptomatic patients with diabetes with regard to coronary heart disease risk and develops an algorithm for screening based on available data.

  6. Issues and challenges in the assessment, diagnosis and treatment of cardiovascular risk factors: Assessing the needs of cardiologists

    PubMed Central

    Hayes, Sean M; Dupuis, Martin; Murray, Suzanne

    2008-01-01

    Background This needs assessment, initiated by the Academy for Healthcare Education Inc. in cooperation with AXDEV Group Inc., explored the knowledge, attitudes, behavior, and skills of community-based and academic-affiliated U.S. cardiologists in the area of CV risk assessment, treatment, and management from July 2006 to December 2006. Methods The needs assessment used a multistage, mixed-method approach to collect, analyze, and verify data from two independent sources. The exploratory phase collected data from a representative sampling of U.S. cardiologists by means of qualitative panel meetings, one-on-one interviews, and quantitative questionnaires. In the validation phase, 150 cardiologists from across the United States completed a quantitative online questionnaire. Data were analyzed with standardized statistical methods. Results The needs assessment found that cardiologists have areas of weakness pertaining to their interpersonal skills, which may influence patient-physician communication and patient adherence. Cardiologists appeared to have little familiarity with or lend little credence to the concept of relative CV risk. In daily clinical practice, they faced challenges with regard to optimal patient outcome in areas of patient referral from primary-care providers, CV risk assessment and treatment, and patient monitoring. Community-based and academic-affiliated cardiologists appeared to be only moderately interested in educational interventions that pertain to CV risk-reduction strategies. Conclusion Educational interventions that target cardiologists' interpersonal skills to enhance their efficacy may benefit community-based and academic-affiliated specialists. Other desirable educational initiatives should address gaps in the patient referral process, improve patient knowledge and understanding of their disease, and provide supportive educational tools and materials to enhance patient-physician communication. PMID:18485225

  7. Cardiovascular assessment in the orthopaedic practice setting.

    PubMed

    Scherer, Susan A; Noteboom, J Timothy; Flynn, Timothy W

    2005-11-01

    As consumer access to physical therapy practice expands, it is important that physical therapists are familiar with and implementing accepted methods of identifying the cardiovascular status of their clients. Established guidelines for assessing cardiovascular risk prior to initiating aerobic exercise programs are available and can be readily adopted by physical therapists in diverse clinical settings. We have provided a process for integrating existing guidelines into clinical practice. Because little evidence exists regarding the clinical behaviors and knowledge of orthopedic physical therapists in the area of cardiovascular risk, we conducted a survey to assess current practice patterns. The results suggest that orthopedic physical therapists are performing cardiovascular screening at frequencies similar to other components of the history and systems review, but that monitoring baseline or exercising vital signs does not occur with every exercise session.

  8. Cardiovascular Risk Factors in Severely Obese Adolescents: The Teen Longitudinal Assessment of Bariatric Surgery (Teen-LABS) Study.

    PubMed

    Michalsky, Marc P; Inge, Thomas H; Simmons, Mark; Jenkins, Todd M; Buncher, Ralph; Helmrath, Michael; Brandt, Mary L; Harmon, Carroll M; Courcoulas, Anita; Chen, Michael; Horlick, Mary; Daniels, Stephen R; Urbina, Elaine M

    2015-05-01

    Severe obesity is increasingly common in the adolescent population but, as of yet, very little information exists regarding cardiovascular disease (CVD) risks in this group. To assess the baseline prevalence and predictors of CVD risks among severely obese adolescents undergoing weight-loss surgery. A prospective cohort study was conducted from February 28, 2007, to December 30, 2011, at the following 5 adolescent weight-loss surgery centers in the United States: Nationwide Children's Hospital in Columbus, Ohio; Cincinnati Children's Hospital Medical Center in Cincinnati, Ohio; Texas Children's Hospital in Houston; University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and Children's Hospital of Alabama in Birmingham. Consecutive patients aged 19 years or younger were offered enrollment in a long-term outcome study; the final analysis cohort consisted of 242 participants. This report examined the preoperative prevalence of CVD risk factors (ie, fasting hyperinsulinemia, elevated high-sensitivity C-reactive protein levels, impaired fasting glucose levels, dyslipidemia, elevated blood pressure, and diabetes mellitus) and associations between risk factors and body mass index (calculated as weight in kilograms divided by height in meters squared), age, sex, and race/ethnicity. Preoperative data were collected within 30 days preceding bariatric surgery. The mean (SD) age was 17 (1.6) years and median body mass index was 50.5. Cardiovascular disease risk factor prevalence was fasting hyperinsulinemia (74%), elevated high-sensitivity C-reactive protein levels (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%). The risk of impaired fasting glucose levels, elevated blood pressure, and elevated high-sensitivity C-reactive protein levels increased by 15%, 10%, and 6%, respectively, per 5-unit increase in body mass index (P < .01). Dyslipidemia (adjusted relative risk = 1.60 [95% CI

  9. Association of Risk Estimates of Three Different Cardiovascular Risk Assessment Tools with Carotid Intima Media Thickness in Patients with Type 2 Diabetes.

    PubMed

    Herath, Herath Mudiyanselage Meththananda; Weerarathna, Thilak Priyantha; Dulanjalee, Ranasinghe Bethmi Arachige Thilini; Jayawardana, Madumekala Rupasinghe; Edirisingha, Udara Priyadarshani; Rathnayake, Madushanka

    2016-07-01

    Risk assessment tools used to calculate the Cardiovascular Disease (CVD) risk such as the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes study (UKPDS) risk engine and the World Health Organization (WHO) risk score have not been tested on their ability to detect subclinical atherosclerosis in most developing countries. To study the association between the calculated CVD risk scores using each of these tools and Carotid Intima Medial Thickness (CIMT), a surrogate marker of atherosclerosis, in a group of patients with Type 2 diabetes (T2DM) in Sri Lanka. We calculated CVD risk scores of 68 randomly selected patients with T2DM with no history or symptoms of CVD and measured their CIMT using B-mode ultrasonography (USS). Carotid USS was considered positive when the maximum carotid IMT was 0.9mm or when arteriosclerotic plaques were detected. The 10-year CVD risk was calculated using the FRS, the UKPDS risk engine and the WHO risk score. Pearson correlation was used to study the association between CVD risk scores with CIMT. Of the 68 patients studied, 50% were males and their mean age (SD) was 56.9 (±9.6) years. The mean age at onset and duration of diabetes were 44.3(±9.1) and 12.2(±7.6) years respectively. Of the scoring methods, UKPDS tool had weak, but significantly positive (r = 0.26, p < 0.05) and FRS had positive but not significant association (r= 0. 21) with CIMT. There was a negative association between CIMT and WHO risk score (r= - 0.07). Of the three CVD risk assessment tools, both UKPDS risk engine and FRS have almost equal ability (former being marginally superior) in predicting underlying atherosclerotic vascular disease in patients with T2DM. Negative association of the WHO risk score with CIMT argues against its utility for CVD screening. These findings highlight the need for developing more sensitive and reliable CVD risk assessment tools for developing countries.

  10. Association of Risk Estimates of Three Different Cardiovascular Risk Assessment Tools with Carotid Intima Media Thickness in Patients with Type 2 Diabetes

    PubMed Central

    Weerarathna, Thilak Priyantha; Dulanjalee, Ranasinghe Bethmi Arachige Thilini; Jayawardana, Madumekala Rupasinghe; Edirisingha, Udara Priyadarshani; Rathnayake, Madushanka

    2016-01-01

    Introduction Risk assessment tools used to calculate the Cardiovascular Disease (CVD) risk such as the Framingham Risk Score (FRS), United Kingdom Prospective Diabetes study (UKPDS) risk engine and the World Health Organization (WHO) risk score have not been tested on their ability to detect subclinical atherosclerosis in most developing countries. Aim To study the association between the calculated CVD risk scores using each of these tools and Carotid Intima Medial Thickness (CIMT), a surrogate marker of atherosclerosis, in a group of patients with Type 2 diabetes (T2DM) in Sri Lanka. Materials and Methods We calculated CVD risk scores of 68 randomly selected patients with T2DM with no history or symptoms of CVD and measured their CIMT using B-mode ultrasonography (USS). Carotid USS was considered positive when the maximum carotid IMT was 0.9mm or when arteriosclerotic plaques were detected. The 10-year CVD risk was calculated using the FRS, the UKPDS risk engine and the WHO risk score. Pearson correlation was used to study the association between CVD risk scores with CIMT. Results Of the 68 patients studied, 50% were males and their mean age (SD) was 56.9 (±9.6) years. The mean age at onset and duration of diabetes were 44.3(±9.1) and 12.2(±7.6) years respectively. Of the scoring methods, UKPDS tool had weak, but significantly positive (r = 0.26, p < 0.05) and FRS had positive but not significant association (r= 0. 21) with CIMT. There was a negative association between CIMT and WHO risk score (r= - 0.07). Conclusion Of the three CVD risk assessment tools, both UKPDS risk engine and FRS have almost equal ability (former being marginally superior) in predicting underlying atherosclerotic vascular disease in patients with T2DM. Negative association of the WHO risk score with CIMT argues against its utility for CVD screening. These findings highlight the need for developing more sensitive and reliable CVD risk assessment tools for developing countries. PMID

  11. Assessment of the Cardiovascular Risk of Olmesartan Medoxomil-Based Treatment: Meta-Analysis of Individual Patient Data.

    PubMed

    Wang, Antonia C; Stellmacher, Ulf; Schumi, Jennifer; Tu, Nora; Reimitz, Paul-Egbert

    2016-12-01

    Results from two long-term studies (ROADMAP and ORIENT) indicated a numerical imbalance in the number of cardiovascular deaths between the olmesartan medoxomil (OM) and placebo groups. Our objective was to conduct an individual patient data meta-analysis to provide more complete information regarding OM-associated cardiovascular risks and/or benefits. We created an integrated database based on 191 clinical trials from the OM development program. Events were identified and adjudicated by an independent, blinded clinical events committee. The incidence of major cardiovascular events and total mortality for OM versus placebo/active control were evaluated, and the effect of OM on cardiovascular mortality (main endpoint of interest) and morbidity was calculated using a two-stage approach (Tian method). A total of 46 studies (~27,000 patients) met the US FDA-specified inclusion criteria (phase II-IV randomized, double-blind, placebo- or active-controlled studies [OM-based monotherapy or combination, double-blind period ≥28 days] and adult patients). The incidence of known adjudicated endpoints in the analysis of all studies combined was low among OM (0.11-0.53 %) and placebo/active control (0.08-0.76 %) groups. For cardiovascular mortality, the estimated risk difference (OM vs. control) was 0.00070 (95 % confidence interval [CI] -0.0011 to 0.0024; p = 0.60); the risk difference for each endpoint was <1/1000, with no statistically significant difference between groups. Results were similar with and without ROADMAP and ORIENT. The results from this meta-analysis did not show a clinically meaningful or statistically significant difference in cardiovascular risk between OM and the placebo/active control groups, and thus did not corroborate the numerical imbalance observed in ROADMAP and ORIENT.

  12. A qualitative study assessing cardiovascular risk factors: the accumulative stressors influencing societal integration of teenage African immigrants.

    PubMed

    Zlotnick, Cheryl; Goldblatt, Hadass; Shadmi, Efrat; Birenbaum-Carmeli, Daphna; Taychaw, Omer

    2015-08-15

    This study examines the nature of disparities in cardiovascular risk by exploring chronic stressors and other cardiovascular risk factors on youth of African descent who are integrating into an industrialized society. Qualitative data on cardiovascular risk and acclimation to the dominant society were collected from three groups of key informants: (1) community leaders; (2) youth; and (3) a community advisory group. Youth of Ethiopian descent engaged in the same western diets, computerized social networking, and habits in smoking and alcohol use as did youth from the dominant society. However, informants of Ethiopian descent encountered and witnessed racism, institutional discrimination and evidence of devaluing Ethiopian culture, influencing youths' ability to integrate into the society. Immigrant youth of Ethiopian descent face an accumulation of conflicting social support, psychosocial factors, and stressors, including: living in low-income, high-crime areas; encountering pervasive discrimination; acclimating to a new and industrialized culture; and navigating within an often unhospitable society. Contributing to these factors are changes in health behaviors such as adding processed foods and sugary drinks to the diet, increasing heavy alcohol use and substituting screen use for physical activity. The accumulative impact of these factors contributes to the marginalization of youth of Ethiopian descent in the dominant society and perpetuates a cycle of increasing cardiovascular risk.

  13. Assessment of Risk Factor for Cardiovascular Disease Using Heart Rate Variability in Postmenopausal Women: A Comparative Study between Urban and Rural Indian Women

    PubMed Central

    Narayanaswamy, Nikhil; Halahalli, Harsha; Mirajkar, Amrit M.

    2013-01-01

    Cardiovascular diseases are important causes of morbidity and mortality in postmenopausal women. A major determinant of cardiovascular health is the status of autonomic nervous system and assessment of Heart Rate Variability (HRV). Heart Rate Variability is a noninvasive and sensitive technique to evaluate cardiovascular autonomic control. Reduced HRV is an independent risk factor for the development of heart disease. This study evaluated the risk factors for cardiovascular diseases using HRV, between urban and rural Indian postmenopausal women ranging in age from 40 to 75 years. Findings of the analysis of HRV have showed that the total power which reflects overall modulation of cardiac autonomic activity (759 ± 100  versus 444 ± 65), the absolute power of high frequency which is surrogate of cardiovagal activity (247 ± 41  versus 163 ± 45), and low frequency that reflects cardiac sympathetic activity (205 ± 26  versus 127 ± 18) were significantly higher in urban women than that of their rural counterparts. Further, among the anthropometric measures, waist circumference was significantly correlated with indices of HRV. The study concludes that rural Indian women are associated with an additional risk beyond that of ageing and postmenopausal status when compared to the urban women. The higher central obesity could be the contributing factor for developing higher risk for cardiovascular disease among the rural women. PMID:23936672

  14. [A cross-sectional study to assess cardiovascular risk in the children of parents with diabetes mellitus or arterial hypertension].

    PubMed

    Gómez-García, A; Rangel-García, L; Alvarez-Aguilar, C

    2012-01-01

    Cardiovascular disease in adults is the first cause of death, and in adolescents under 15 years old, it is the third cause of death. The purpose of this study was to investigate which risk factors for cardiovascular disease have the children of parents with diabetes or hypertension. In a cross-sectional study conducted in the Family Medicine Unit No. 80 in Morelia, Michoacán, Mexico, were included 156 patients with diabetes mellitus, hypertension and without diabetes or hypertension (10 years of disease progression), and a biological child (age 7-15 years) to form pairs. Three groups were formed: child-parent with Diabetes; child-parent with Hypertension and child-parent without Diabetes or Hypertension. Medical history, body mass index, blood glucose, cholesterol, triglycerides, c-LDL, c-HDL and signs of metabolic syndrome were recorded. The frequency of signs of metabolic syndrome was higher in parents with Diabetes (28.8%), and in children of parents without either diabetes or hypertension (11.5%). In binomial children-parents with Diabetes, serum glucose (OR=4.50: 95% CI; 2.32-8.73, P<.0001) was the most important risk factor to develop cardiovascular disease; in binomial children-parents with Hypertension it was total cholesterol (OR=4.143: 95% CI; 1.996-8.60, P<.0001); and, in binomial children-parents without either Diabetes or Hypertension, the abdominal circumference (OR=3.429: 95% CI; 1.621-7.251, P<.0001) was the most important risk factor. We conclude that children of parents with or without diabetes mellitus or hypertension are at increased risk for developing cardiovascular disease. Longitudinal studies are required using non-pharmacological and pharmacological strategies that will have an impact on the most important risk factors for preventing cardiovascular disease. Copyright © 2011 Elsevier España, S.L. y SEMERGEN. All rights reserved.

  15. Online self-assessment of cardiovascular risk using the Joint British Societies (JBS3)-derived heart age tool: a descriptive study

    PubMed Central

    Patel, Riyaz S; Lagord, Catherine; Waterall, Jamie; Moth, Martin; Knapton, Mike; Deanfield, John E

    2016-01-01

    Objective A modified version of the Joint British Societies (JBS3) ‘heart age’ tool was introduced online to broaden access to personalised risk assessment to the general population and encourage participation in the National Health Service (NHS) Health Check programme. This study reports on its early uptake and the profiles of those who used the self-assessment tool to determine their own cardiovascular risk. Design Observational, retrospective analysis of online tool use. Setting Between February and July 2015, user data collected from the NHS Choices website, where the tool was hosted, were analysed anonymously using standard analytic packages. Results The online tool landing page was viewed 1.4 million times in the first 5 months, with increased activity following limited media coverage. Of the 575 782 users completing the data journey with a valid ‘heart age’ result, their demographic and risk factor profiles broadly resembled the population of England, although both younger users and males (60%) were over-represented. Almost 50% and 79% did not know or enter their blood pressure or total cholesterol values, respectively. Estimated heart age was higher than chronological age for 79% of all users, and also for 69% of younger users under 40 years who are at low 10-year risk and not invited for NHS Health Checks. Conclusions These data suggest a high level of public interest in self-assessment of cardiovascular risk when an easily understood metric is used, although a large number of users lack awareness of their own risk factors. The heart age tool was accessed by a group not easily reached by conventional approaches yet is at high cardiovascular risk and would benefit most from early and sustained risk reduction. These are both important opportunities for interventions to educate and empower the public to manage better their cardiovascular risk and promote population-level prevention. PMID:27683512

  16. Assessment of the cardiovascular risk and physical activity of individuals exercising at a public park in the city of são paulo.

    PubMed

    Forjaz, Cláudia L M; Tinucci, Taís; Bartholomeu, Teresa; Fernandes, Tiago E M; Casagrande, Vivian; Massucato, José Geraldo

    2002-07-01

    Physical exercise helps to prevent cardiovascular disorders. Campaigns promoting exercise have taken many people to the parks of our city. The most appropriate exercise for preventing cardiovascular disorders is the aerobic modality; inappropriate exercise acutely increases cardiovascular risk, especially in individuals at higher risk. Therefore, assessing the cardiovascular risk of these individuals and their physical activities is of practical value. In the Parque Fernando Costa, we carried out the project "Exercício e Coração" (Exercise and Heart) involving 226 individuals. Assessment of the cardiovascular risk and of the physical activity practiced by the individuals exercising at that park was performed with a questionnaire and measurement of the following parameters: blood pressure, weight, height, and waist/hip ratio. The individuals were lectured on the benefits provided by exercise and how to correctly exercise. Each participant received a customized exercise prescription. In regard to risk, 43% of the individuals had health problems and 7% of the healthy individuals had symptoms that could be attributed to heart disorders. High blood pressure was observed in a large amount of the population. In regard to the adequacy of the physical activity, the individuals exercised properly. The project was well accepted, because the participants not only appreciated the initiative, but also reported altering their exercise habits after taking part in the project. Data obtained in the current study point to the need to be more careful in assessing the health of individuals who exercise at parks, suggesting that city parks should have a sector designated for assessing and guiding physical activity.

  17. Digital thermal monitoring of vascular function: a novel tool to improve cardiovascular risk assessment.

    PubMed

    Gul, Khawar M; Ahmadi, Naser; Wang, Zhiying; Jamieson, Craig; Nasir, Khurram; Metcalfe, Ralph; Hecht, Harvey S; Hartley, Craig J; Naghavi, Morteza

    2009-05-01

    Digital thermal monitoring (DTM) of vascular function during cuff-occlusive reactive hyperemia relies on the premise that changes in fingertip temperature during and after an ischemic stimulus reflect changes in blood flow. To determine its utility in individuals with and without known coronary heart disease (CHD), 133 consecutive individuals (age 54 +/- 10 years, 50% male, 19 with known CHD) underwent DTM during and after 2 minutes of supra-systolic arm cuff inflation. Fingertip temperatures of the occluded and non-occluded fingertips were measured simultaneously. Post-cuff deflation temperature rebound (TR) was lower in the CHD patients and in those with an increased Framingham risk score (FRS) compared to the normal group. After adjustment for age, sex, and cardiac risk factors, TR was significantly lower in those with CHD compared to those without CHD (p < 0.05). This study demonstrates that vascular dysfunction measured by DTM is associated with CHD and an increased FRS, and could potentially be used to identify high-risk patients.

  18. Risk assessment for cardiovascular and respiratory mortality due to air pollution and synoptic meteorology in 10 Canadian cities.

    PubMed

    Vanos, Jennifer K; Hebbern, Christopher; Cakmak, Sabit

    2014-02-01

    Synoptic weather and ambient air quality synergistically influence human health. We report the relative risk of mortality from all non-accidental, respiratory-, and cardiovascular-related causes, associated with exposure to four air pollutants, by weather type and season, in 10 major Canadian cities for 1981 through 1999. We conducted this multi-city time-series study using Poisson generalized linear models stratified by season and each of six distinctive synoptic weather types. Statistically significant relationships of mortality due to short-term exposure to carbon monoxide, nitrogen dioxide, sulphur dioxide, and ozone were found, with significant modifications of risk by weather type, season, and mortality cause. In total, 61% of the respiratory-related mortality relative risk estimates were significantly higher than for cardiovascular-related mortality. The combined effect of weather and air pollution is greatest when tropical-type weather is present in the spring or summer. Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.

  19. Estimating Longitudinal Risks and Benefits From Cardiovascular Preventive Therapies Among Medicare Patients: The Million Hearts Longitudinal ASCVD Risk Assessment Tool: A Special Report From the American Heart Association and American College of Cardiology.

    PubMed

    Lloyd-Jones, Donald M; Huffman, Mark D; Karmali, Kunal N; Sanghavi, Darshak M; Wright, Janet S; Pelser, Colleen; Gulati, Martha; Masoudi, Frederick A; Goff, David C

    2017-03-28

    The Million Hearts Initiative has a goal of preventing 1 million heart attacks and strokes-the leading causes of mortality-through several public health and healthcare strategies by 2017. The American Heart Association and American College of Cardiology support the program. The Cardiovascular Risk Reduction Model was developed by Million Hearts and the Center for Medicare & Medicaid Services as a strategy to assess a value-based payment approach toward reduction in 10-year predicted risk of atherosclerotic cardiovascular disease (ASCVD) by implementing cardiovascular preventive strategies to manage the "ABCS" (aspirin therapy in appropriate patients, blood pressure control, cholesterol management, and smoking cessation). The purpose of this special report is to describe the development and intended use of the Million Hearts Longitudinal ASCVD Risk Assessment Tool. The Million Hearts Tool reinforces and builds on the "2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk" by allowing clinicians to estimate baseline and updated 10-year ASCVD risk estimates for primary prevention patients adhering to the appropriate ABCS over time, alone or in combination. The tool provides updated risk estimates based on evidence from high-quality systematic reviews and meta-analyses of the ABCS therapies. This novel approach to personalized estimation of benefits from risk-reducing therapies in primary prevention may help target therapies to those in whom they will provide the greatest benefit, and serves as the basis for a Center for Medicare & Medicaid Services program designed to evaluate the Million Hearts Cardiovascular Risk Reduction Model.

  20. Limitations in the conventional assessment of the incremental value of predictors of cardiovascular risk.

    PubMed

    Sniderman, Allan D; Pencina, Michael; Thanassoulis, George

    2015-06-01

    Whether a factor significantly increases the area under the curve (AUC) of a receiver operating characteristic analysis has become the standard test of its utility. Thus, in many studies, apolipoprotein B and LDL particle number have not increased the AUC significantly beyond that produced by the conventional markers, and guideline groups have concluded on this basis that they should not be added to routine clinical practice. This article demonstrates this conclusion to be invalid. In conventional analyses, no distinctions have been drawn as to whether a novel predictor is causal or whether it is highly correlated with other markers already included in the risk algorithm. However, correlation among the markers will profoundly affect the incremental effect of a factor on the AUC. This distinction is particularly critical for factors that have been shown to play a causal role in the production of clinical event. Accordingly, the AUC approach is valid to determine the total discriminatory ability of a set of variables but is not appropriate to allocate attributable risk among the members of the set. For correlated predictors that describe different aspects of the same variable such as non-HDL-C and apoB or LDL-C and LDL particle number, discordance analysis offers a simple valid alternative to capture and compare the independent information contained by each predictor.

  1. The aged cardiovascular risk patient.

    PubMed

    Priebe, H J

    2000-11-01

    factors contribute most of the increased perioperative risk related to advanced age. First, physiological ageing is accompanied by a progressive decline in resting organ function. Consequently, the reserve capacity to compensate for impaired organ function, drug metabolism and added physiological demands is increasingly impaired. Functional disability will occur more quickly and take longer to be cured. Second, ageing is associated with progressive manifestation of chronic disease which further limits baseline function and accelerates loss of functional reserve in the affected organ. Some of the age-related decline in organ function (e.g. impaired pulmonary gas exchange, diminished renal capacity to conserve and eliminate water and salt, or disturbed thermoregulation) will increase cardiovascular risk. The unpredictable interaction between age-related and disease-associated changes in organ functions, and the altered neurohumoral response to various forms of stress in the elderly may result in a rather atypical clinical presentation of a disease. This may, in turn, delay the correct diagnosis and appropriate treatment and, ultimately, worsen outcome. Third, related to the increased intake of medications and altered pharmacokinetics and pharmacodynamics, the incidence of untoward reactions to medications, anaesthetic agents, and medical and surgical interventions increases with advancing age. On the basis of various clinical studies and observations, it must be concluded that advanced age is an independent predictor of adverse perioperative cardiac outcome. It is to be expected that the aged cardiovascular risk patient carries an even higher perioperative cardiac risk than the younger cardiovascular risk patient. Although knowledge of the physiology of ageing should help reduce age-related complications, successful prophylaxis is hindered by the heterogeneity of age-related changes, unpredictable physiological and pharmacological interactions and diagnostic difficultie

  2. Cardiovascular Disease Population Risk Tool (CVDPoRT): predictive algorithm for assessing CVD risk in the community setting. A study protocol.

    PubMed

    Taljaard, Monica; Tuna, Meltem; Bennett, Carol; Perez, Richard; Rosella, Laura; Tu, Jack V; Sanmartin, Claudia; Hennessy, Deirdre; Tanuseputro, Peter; Lebenbaum, Michael; Manuel, Douglas G

    2014-10-23

    Recent publications have called for substantial improvements in the design, conduct, analysis and reporting of prediction models. Publication of study protocols, with prespecification of key aspects of the analysis plan, can help to improve transparency, increase quality and protect against increased type I error. Valid population-based risk algorithms are essential for population health planning and policy decision-making. The purpose of this study is to develop, evaluate and apply cardiovascular disease (CVD) risk algorithms for the population setting. The Ontario sample of the Canadian Community Health Survey (2001, 2003, 2005; 77,251 respondents) will be used to assess risk factors focusing on health behaviours (physical activity, diet, smoking and alcohol use). Incident CVD outcomes will be assessed through linkage to administrative healthcare databases (619,886 person-years of follow-up until 31 December 2011). Sociodemographic factors (age, sex, immigrant status, education) and mediating factors such as presence of diabetes and hypertension will be included as predictors. Algorithms will be developed using competing risks survival analysis. The analysis plan adheres to published recommendations for the development of valid prediction models to limit the risk of overfitting and improve the quality of predictions. Key considerations are fully prespecifying the predictor variables; appropriate handling of missing data; use of flexible functions for continuous predictors; and avoiding data-driven variable selection procedures. The 2007 and 2009 surveys (approximately 50,000 respondents) will be used for validation. Calibration will be assessed overall and in predefined subgroups of importance to clinicians and policymakers. This study has been approved by the Ottawa Health Science Network Research Ethics Board. The findings will be disseminated through professional and scientific conferences, and in peer-reviewed journals. The algorithm will be accessible

  3. [From bench to bicycle. Risk assessment in connection with sports activities and exercise programs in the primary and secondary prevention of cardiovascular diseases].

    PubMed

    Schulz, Olaf; Dürsch, Martin

    2003-08-01

    Due to encouraging results of studies investigating the effects of physical activity and training on cardiovascular diseases and due to the integration of preventive strategies into disease management programs by public health organizations, it is expected that a larger population, including cardiovascular patients, will increasingly participate in physical activity, fitness programs, and sports. However, a reduction in cardiovascular events and all-cause mortality by regular physical activity is accompanied by an increased mortality during exertion, as yet, there is no satisfactory definition of risk for all cardiovascular diseases and patient groups. A cost-effective preparticipation screening has to consider both the low incidence of events resulting from different diseases which requires subtle diagnostics and the intention of granting the larger population simple access to exercise programs and sports. There is a substantial difference in the risk profile for fatal events in athletes and young fitness program participants on the one hand and older (> 35 years) exercising people with a higher incidence of common cardiovascular diseases on the other. Additionally, a potential exercise-induced progression of chronic heart diseases should be excluded. New imaging techniques, laboratory markers, and genetic indicators will hopefully improve the quality of risk assessment. Establishing standards for diagnostics and risk assessment as well as different types of exercise and training programs, all of which need to be transformed into national guidelines, could help to reduce risks without limiting access to physical exercise and therapy. However, an element of risk will remain if rational cost-effectiveness ratios are to be applied.

  4. Laboratory-based versus non-laboratory-based method for assessment of cardiovascular disease risk: the NHANES I Follow-up Study cohort

    PubMed Central

    Gaziano, Thomas A; Young, Cynthia R; Fitzmaurice, Garrett; Atwood, Sidney; Gaziano, J Michael

    2008-01-01

    Summary Background Around 80% of all cardiovascular deaths occur in developing countries. Assessment of those patients at high risk is an important strategy for prevention. Since developing countries have limited resources for prevention strategies that require laboratory testing, we assessed if a risk prediction method that did not require any laboratory tests could be as accurate as one requiring laboratory information. Methods The National Health and Nutrition Examination Survey (NHANES) was a prospective cohort study of 14 407 US participants aged between 25–74 years at the time they were first examined (between 1971 and 1975). Our follow-up study population included participants with complete information on these surveys who did not report a history of cardiovascular disease (myocardial infarction, heart failure, stroke, angina) or cancer, yielding an analysis dataset N=6186. We compared how well either method could predict first-time fatal and non-fatal cardiovascular disease events in this cohort. For the laboratory-based model, which required blood testing, we used standard risk factors to assess risk of cardiovascular disease: age, systolic blood pressure, smoking status, total cholesterol, reported diabetes status, and current treatment for hypertension. For the non-laboratory-based model, we substituted body-mass index for cholesterol. Findings In the cohort of 6186, there were 1529 first-time cardiovascular events and 578 (38%) deaths due to cardiovascular disease over 21 years. In women, the laboratory-based model was useful for predicting events, with a c statistic of 0·829. The c statistic of the non-laboratory-based model was 0·831. In men, the results were similar (0·784 for the laboratory-based model and 0·783 for the non-laboratory-based model). Results were similar between the laboratory-based and non-laboratory-based models in both men and women when restricted to fatal events only. Interpretation A method that uses non

  5. Bootstrapping Validates Recommended Cost-Effective Use of Endocrine Data Bases for Cardiovascular Risk Assessment

    PubMed Central

    Hermida, R.C.; Halberg, F.; Bingham, C.; Pozo, F. Del

    1985-01-01

    On a data set of 12 endocrine variables in blood from a small number of clinically healthy adult women studied with systematically-placed samples around the clock and the seasons, pattern discrimination methods had singled out certain hormone values in certain seasons as classifiers for a high vs. low risk of developing diseases associated with a high blood pressure. Further evidence in support of such classifiers was obtained, first, by increasing the number of series from 1 to 3 age groups and, second, by extending the scope of the data on any one age group by bootstrapping. Classifier roles were strongly supported for plasma aldosterone and TSH originally by an analysis of variance and, in the case of aldosterone, by circannual cosinor analysis, as well as by the analysis of added data and by bootstrapping. Identification of classifiers provides cost-effective endocrine checks complementing the targetted automatic monitoring of blood pressure as part of a system of chrono-engineering for health maintenance.

  6. Red wine and cardiovascular risks.

    PubMed

    Lagrue-Lak-Hal, A H; Andriantsitohaina, R

    2006-12-01

    Numerous epidemiological studies indicate that a moderate intake of alcohol is associated with a reduced risk of morbidity and mortality secondary to cardiovascular diseases. Alcohol intake from any type of alcoholic beverage appears beneficial, but red wine seems to confer additional health benefits because of the presence of red wine polyphenolic compounds (RWPC). On the basis of clinical and experimental data, the favourable effect of moderate intake of alcohol results to its action on lipid profile, hemostatic parameters, and reduction of inflammation markers. RWPC exert numerous effects including antioxidant and free radical properties, anti-aggregatory platelet and anti-thrombotic activities. Moreover, RWPC are powerful vasodilators and contribute to the preservation of the integrity of the endothelium and inhibition of smooth muscle cell proliferation and migration. All these effects of red wine might interfere with atherosclerotic plaque development and stability, vascular thrombosis and occlusion. Although, red wine might be of therapeutic benefit in cardiovascular diseases, prospective controlled clinical studies are still lacking.

  7. Hyperuricemia as a risk factor for cardiovascular disease: clinical review.

    PubMed

    Gudiño Gomezjurado, Álvaro

    2016-11-15

    Cardiovascular diseases are one of the most important causes of morbidity and mortality worldwide. Several risk factors have been associated with the development of these pathologies. However, there is controversy about whether hyperuricemia is an independent risk factor for developing cardiovascular disease. To answer this question, we performed a recent literature review of relevant published material to assess the association of hyperuricemia with four major cardiovascular diseases: hypertension, coronary heart disease, heart failure and atrial fibrillation.

  8. Clinician time used for decision making: a best case workflow study using cardiovascular risk assessments and Ask Mayo Expert algorithmic care process models.

    PubMed

    North, Frederick; Fox, Samuel; Chaudhry, Rajeev

    2016-07-20

    Risk calculation is increasingly used in lipid management, congestive heart failure, and atrial fibrillation. The risk scores are then used for decisions about statin use, anticoagulation, and implantable defibrillator use. Calculating risks for patients and making decisions based on these risks is often done at the point of care and is an additional time burden for clinicians that can be decreased by automating the tasks and using clinical decision-making support. Using Morae Recorder software, we timed 30 healthcare providers tasked with calculating the overall risk of cardiovascular events, sudden death in heart failure, and thrombotic event risk in atrial fibrillation. Risk calculators used were the American College of Cardiology Atherosclerotic Cardiovascular Disease risk calculator (AHA-ASCVD risk), Seattle Heart Failure Model (SHFM risk), and CHA2DS2VASc. We also timed the 30 providers using Ask Mayo Expert care process models for lipid management, heart failure management, and atrial fibrillation management based on the calculated risk scores. We used the Mayo Clinic primary care panel to estimate time for calculating an entire panel risk. Mean provider times to complete the CHA2DS2VASc, AHA-ASCVD risk, and SHFM were 36, 45, and 171 s respectively. For decision making about atrial fibrillation, lipids, and heart failure, the mean times (including risk calculations) were 85, 110, and 347 s respectively. Even under best case circumstances, providers take a significant amount of time to complete risk assessments. For a complete panel of patients this can lead to hours of time required to make decisions about prescribing statins, use of anticoagulation, and medications for heart failure. Informatics solutions are needed to capture data in the medical record and serve up automatically calculated risk assessments to physicians and other providers at the point of care.

  9. Cardiovascular Risk in Women With PCOS

    PubMed Central

    Scicchitano, Pietro; Dentamaro, Ilaria; Carbonara, Rosa; Bulzis, Gabriella; Dachille, Annamaria; Caputo, Paola; Riccardi, Roberta; Locorotondo, Manuela; Mandurino, Cosimo; Matteo Ciccone, Marco

    2012-01-01

    Polycystic ovary syndrome (PCOS), or Stein-Leventhal syndrome, is a common endocrine disorder defined by two of the three following features: i) oligoovulation or anovulation, ii) clinical and/or biochemical signs of hyperandrogenism, or iii) polycystic ovaries, once the related endocrinological and gynaecological disorders have been excluded. PCOS does not exclusively involve the reproductive apparatus , it has a complex number of systemic relevancy symptoms. It leads to Metabolic Syndrome, with severe consequences on the cardiovascular apparatus. Many clinical studies have underlined the connection between PCOS and the cardiovascular risk profile of such female patients, due to a lipid/glucose altered metabolism, hypertension, systemic inflammatory condition (assessable by markers such as VES, TNF-alfa, citokines and C-reactive protein (hsPCR) levels), and vascular injuries. Considering the early onset of the disease, PCOS could be considered as a real cardiovascular risk factor which affects the quality of life seriously. The current review aimed to point out the main connections between PCOS and cardiovascular risk factors according to the latest findings coming from literature data analysis, and try to depict the great influences that such a common disease can have on the patients’ health integrity. PMID:23843832

  10. Perceptions of risk: understanding cardiovascular disease

    PubMed Central

    Webster, Ruth; Heeley, Emma

    2010-01-01

    Cardiovascular disease (CVD) is still the leading cause of death and disability worldwide despite the availability of well-established and effective preventive options. Accurate perception of a patient’s risk by both the patient and the doctors is important as this is one of the components that determine health-related behavior. Doctors tend to not use cardiovascular (CV) risk calculators and underestimate the absolute CV risk of their patients. Patients show optimistic bias when considering their own risk and consistently underestimate it. Poor patient health literacy and numeracy must be considered when thinking about this problem. Patients must possess a reasonably high level of understanding of numerical processes when doctors discuss risk, a level that is not possessed by large numbers of the population. In order to overcome this barrier, doctors need to utilize various tools including the appropriate use of visual aids to accurately communicate risk with their patients. Any intervention has been shown to be better than nothing in improving health understanding. The simple process of repeatedly conveying risk information to a patient has been shown to improve accuracy of risk perception. Doctors need to take responsibility for the accurate assessment and effective communication of CV risk in their patients in order to improve patient uptake of cardioprotective lifestyle choices and preventive medications. PMID:22312218

  11. [Cardiovascular risk factor prevalence in university students].

    PubMed

    García-Gulfo, María H; García-Zea, Jerson A

    2012-10-01

    Determining cardiovascular risk factor prevalence in university students from Medellin. A descriptive study of 112 students determined their lipid profile and a survey was conducted to assess their life-style and family history. There results were analyzed by gender using Chi² test and simple binary logistic regression. 82.1 % of the sample was female. A modifiable risk factor was found for at least 99.1 % of the study population: sedentary life-style (79.5 %), smoking (17 %), alcohol consumption (75.0 %), atherogenic diet (78.6 %), hypertension (1.8 %), some form of dyslipidemia (48.3 % BMI >25 (4.5 %)) and stress (86.7 %). At least one non-modifiable risk factor was identified in 77.7 % of the students. New intervention strategies are needed given the significant percentage of the target population ± 19 mean age having cardiovascular disease risk factors and young people must be encouraged to develop healthy life-styles to reduce cardiovascular risk factor prevalence.

  12. [Cardiovascular risk factors in Chilean university students].

    PubMed

    Chiang-Salgado, M T; Casanueva-Escobar, V; Cid-Cea, X; González-Rubilar, U; Olate-Mellado, P; Nickel-Paredes, F; Revello-Chiang, L

    1999-01-01

    To study the prevalence of cardiovascular risk factors in asymptomatic university students of both sexes, aged 18 to 25 years. Serum lipid levels were measured in a subsample of 293 subjects, using a Hitachi 717 chemical analyzer. Obesity was classified using body mass index (BMI) measurements. A self-applied questionnaire was used to collect data on sedentary life style, family history of cardiovascular disease and cigarette smoking. Statistical associations of lipid levels with lipidic and non-lipidic risk factors were assessed using Pearson's chi-square test and multiple regression. We found lipid risk levels in 29.2% for total cholesterol (CT), 16.2% for low-density lipoproteins (C-LDL) and 5% for high-density lipoproteins (C-HDL). The main non-lipidic factors were smoking (46.1%) and sedentarism (60.8%). Obesity, hypertension and parental history of myocardial infarction were present in 1.9%, 4.6% and 11%, respectively. We observed an association of a lipid risk profile with obesity, cigarette smoking and family history. The results show that sedentarism and smoking are associated with a lipid risk profile. These results call for the need to develop appropriate behavior strategies for the successful prevention of cardiovascular disease.

  13. Managing cardiovascular risk inpatients with metabolic syndrome.

    PubMed

    Nesto, Richard W

    2005-01-01

    The metabolic syndrome is a constellation of risk factors that contribute to the onset of type 2 diabetes mellitus and cardiovascular disease (CVD). CVD has been identified by the National Cholesterol Education Program (NCEP) as the primary clinical outcome of the metabolic syndrome. Although no algorithm is currently available for estimating the absolute risk of CVD for patients with the metabolic syndrome, screening for cardiovascular (CV) risk in these patients involves testing for lipoprotein abnormalities (namely, an analysis of specific low-density lipoprotein particle numbers) and an assessment of various surrogate markers for subclinical coronary artery disease. Such screening can be used to help predict the development of CVD and thereby allow for effective interventions to help prevent coronary events. Strategies for reducing CV risk in patients with the metabolic syndrome are multifactorial. In addition to placing an emphasis on therapeutic lifestyle changes that increase levels of physical activity, dietary modification, and weight reduction, several pharmacologic therapies are available. One novel approach for managing CV risk in patients with the metabolic syndrome involves the inhibition of the endocannabinoid system, including the use of rimonabant. A review of CV risk factors in patients with the metabolic syndrome is beneficial for clinicians to apply in the care of their patients, along with a discussion about strategies for identifying at-risk patients and managing CVD risk for these patients.

  14. [Risk of cardiovascular diseases in lead-exposed workers of crystal glassworks. Part II. Lead impact on the cardiovascular system based on ultrasound assessment of carotid arteries, electrocardiograms and ankle-brachial index].

    PubMed

    Doroszko, Adrian; Skoczyńska, Anna; Drozdz, Katarzyna; Kreczyńska, Bogusława

    2008-01-01

    Cardiovascular diseases are one of the most common causes of the prevalence and mortality in the general population. Progressing pollution of the environment, as well as occupational exposure to heavy metals, including lead, may potentially accelerate the development of these disorders. Lead is a well known risk factor of arterial hypertension, and may be involved in atherogenesis. The aim of this study was to assess the influence of occupational lead exposure on the activity of cardiovascular system (CVS). The study group comprised 153 potentially healthy volunteers, working in a crystal glass foundry. They were examined using ultrasound assessment of carotid arteries, electrocardiograms and ankle-brachial index (ABI). The toxicological assessment of the study group for occupational lead poisoning was performed. Correlations between the degree of intoxication and functional changes in CVS were analyzed. A negative linear correlation between blood lead level or fluorethylenepropylene (FEP) concentration and ABI values was shown, but only in a subgroup with normal lipid pattern. In the persons with higher blood lead levels, the higher values of arterial blood pressure and longer QT-space in electrocardiogram were evidenced. In addition, the right bundle branch block was more frequently observed (in 23% of workers). Lead may be an independent risk factor of cardiovascular diseases, especially in workers with normal lipid parameters. An increased arterial blood pressure and a decreased ankle-brachial index in the persons with normal cholesterol level can be regarded as a marker of this risk.

  15. [Hypertension and cardiovascular risk evaluation of Chinese cardiovascular physicians].

    PubMed

    Li, She-Chang; Yu, Jin-Ming; Zhang, Li-Jun; Zhan, Yi-Qiang; Zhang, Fen; Hu, Da-Yi

    2011-03-01

    To observe the prevalence, awareness, treatment and control rate of hypertension and to evaluate the 10-year absolute risk of coronary heart disease(CHD) and ischemic cardiovascular disease(ICVD) in Chinese cardiovascular physicians. A total of 4032 cardiovascular physicians (28 to 79 years old) from 386 hospitals in 31 provinces, autonomous regions and municipalities were randomly selected and received an epidemiologic survey of prevalence, awareness, and control of hypertension and evaluations of CHD and ICVD risk. The prevalence of hypertension in Chinese cardiovascular physicians was 13.1%. The awareness rate of hypertension in Chinese cardiovascular physicians was 81.7%. Hypertension treatment rate was 69.6% and blood pressure control rate was 44.6%. The prevalence of hypertension was higher in male physicians than in female physicians before the age of 55 years old. Ten-year absolute risk of CHD and ICVD was 0.08 and 0.03 in hypertensive physicians compared to 0.03 and 0.01 in non-hypertensive physicians. The results show suboptimal awareness, treatment and control rate in Chinese cardiovascular physicians for their own hypertension status.Physicians suffering from hypertension face higher risk for cardiovascular disease. It is therefore necessary to improve the self-monitoring of blood pressure in Chinese cardiovascular physicians.

  16. Cardiovascular risk assessment in type 2 diabetes mellitus: comparison of the World Health Organization/International Society of Hypertension risk prediction charts versus UK Prospective Diabetes Study risk engine.

    PubMed

    Herath, Herath M Meththananda; Weerarathna, Thilak Priyantha; Umesha, Dilini

    2015-01-01

    Patients with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular diseases, and assessment of their cardiac risk is important for preventive strategies. The Ministry of Health of Sri Lanka has recommended World Health Organization/International Society of Hypertension (WHO/ISH) charts for cardiac risk assessment in individuals with T2DM. However, the most suitable cardiac risk assessment tool for Sri Lankans with T2DM has not been studied. This study was designed to evaluate the performance of two cardiac risk assessments tools; WHO/ISH charts and UK Prospective Diabetes Study (UKPDS) risk engine. Cardiac risk assessments were done in 2,432 patients with T2DM attending a diabetes clinic in Southern Sri Lanka using the two risk assessment tools. Validity of two assessment tools was further assessed by their ability to recognize individuals with raised low-density lipoprotein (LDL) and raised diastolic blood pressure in a cohort of newly diagnosed T2DM patients (n=332). WHO/ISH charts identified 78.4% of subjects as low cardiac risk whereas the UKPDS risk engine categorized 52.3% as low cardiac risk (P<0.001). In the risk categories of 10%-<20%, the UKPDS risk engine identified higher proportions of patients (28%) compared to WHO/ISH charts (7%). Approximately 6% of subjects were classified as low cardiac risk (<10%) by WHO/ISH when UKPDS recognized them as cardiac risk of >20%. Agreement between the two tools was poor (κ value =0.144, P<0.01). Approximately 82% of individuals categorized as low cardiac risk by WHO/ISH had higher LDL cholesterol than the therapeutic target of 100 mg/dL. There is a significant discrepancy between the two assessment tools with WHO/ISH risk chart recognizing higher proportions of patients having low cardiac risk than the UKPDS risk engine. Risk assessment by both assessment tools demonstrated poor sensitivity in identifying those with treatable levels of LDL cholesterol and diastolic blood pressure.

  17. Assessing Level of Agreement for Atherosclerotic Cardiovascular Disease Risk Categorization Between Coronary Artery Calcium Score and the American College of Cardiology/American Heart Association Cardiovascular Prevention Guidelines and the Potential Impact on Treatment Recommendations.

    PubMed

    Isma'eel, Hussain; Min, David; Al-Shaar, Laila; Hachamovitch, Rory; Halliburton, Sandra; Gentry, James; Griffin, Brian; Schoenhagen, Paul; Phelan, Dermot

    2016-11-15

    The 2013 American College of Cardiology/American Heart Association cardiovascular prevention guidelines use a new pooled cohort equation (PCE) to predict 10-year risk of atherosclerotic cardiovascular disease (ASCVD) events which form the basis of treatment recommendations. Coronary artery calcium score (CACS) has been proposed as a means to assess atherosclerotic risk. We sought to study the level of agreement in predicted ASCVD risk by CACS and PCE-calculated models and the potential impact on therapy of additional CACS testing. We studied 687 treatment naive, consecutive patients (mean age 53.5 years, 72% men) who had a CACS study at our institution. Clinical and imaging data were recorded. ASCVD risk was calculated using the published PCE-based algorithm. CACS-based risk was categorized by previously published recommendations. Risk stratification comparisons were made and level of agreement calculated. In the cohort, mean ASCVD PCE-calculated risk was 5.3 ± 5.2% and mean CACS was 80 ± 302 Agatston units (AU). Of the intermediate PCE-calculated risk (5% to <7.5%) cohort, 85% had CACS <100 AU. Of the cohort categorized as reasonable to treat per the ASCVD prevention guidelines, 40% had a CACS of 0 AU and an additional 44% had CACS >0 but <100 AU. The level of agreement between the new PCE model of ASCVD risk and demonstrable coronary artery calcium is low. CACS testing may be most beneficial in those with an intermediate risk of ASCVD (PCE-calculated risk of 5% to <7.5%) where, in approximately half of patients, CACS testing significantly refined risk assessment primarily into a very low-risk category.

  18. Assessing the Associations Between Awareness of Myocardial Infarction Symptoms, Socioeconomic Factors, and Cardiovascular Disease Risk Factors Through Regression Models.

    PubMed

    Tran, Phoebe; Mittleman, Murray A

    2016-11-18

    There are few studies that consider the association between awareness of symptoms of acute myocardial infarction (MI), socioeconomic factors (household income, sex, race/ethnicity, and educational attainment), and cardiovascular (CVD) risk factors. It is important to understand these associations because there is evidence that suggests that disparities in the awareness of MI symptoms lead to disparities in delays in receiving treatment and outcomes of patients with MI. The study was to determine if there are disparities in the awareness of different MI symptoms among different groups with respect to self-reported race, ethnicity, education, age, and income (i.e., various SES factors) in the presence/absence of modifiable cardiovascular disease risk factors. We utilized the 2003-2009 Behavioral Risk Factor Surveillance Survey, a nationally representative telephone-based survey, to evaluate the relationships between five common symptoms of MI, socioeconomic factors, and four major modifiable CVD risk factors. We found that being college-educated, a higher household income, making $75,000 a year or more, being female, being non-Hispanic White, having hypertension, and exercising regularly were generally associated with a higher probability of being aware of the MI symptoms evaluated in this study. Additionally, awareness that jaw/back/neck pain and feeling weak/light-headed/faint are symptoms of MI were found to be consistently lower compared to that of other MI symptoms, ranging from 50 to 75%, across all SES factors and CVD risk factors. The findings from this study can serve as a useful guide to facilitating targeted educational efforts aimed at improving awareness of MI symptoms that may ultimately reduce disparities in the outcomes of patients at risk for MI.

  19. Randomized controlled trial to assess reduction of cardiovascular disease risk in patients with bipolar disorder: the Self-Management Addressing Heart Risk Trial (SMAHRT).

    PubMed

    Kilbourne, Amy M; Goodrich, David E; Lai, Zongshan; Post, Edward P; Schumacher, Karen; Nord, Kristina M; Bramlet, Margretta; Chermack, Stephen; Bialy, David; Bauer, Mark S

    2013-07-01

    Persons with bipolar disorder experience a disproportionate burden of medical conditions, notably cardiovascular disease (CVD), leading to impaired functioning and premature mortality. We hypothesized that the Life Goals Collaborative Care (LGCC) intervention, compared to enhanced usual care, would reduce CVD risk factors and improve physical and mental health outcomes in US Department of Veterans Affairs patients with bipolar disorder. Patients with an ICD-9 diagnosis of bipolar disorder and ≥ 1 CVD risk factor (N = 118) enrolled in the Self-Management Addressing Heart Risk Trial, conducted April 2008-May 2010, were randomized to LGCC (n = 58) or enhanced usual care (n = 60). Life Goals Collaborative Care included 4 weekly self-management sessions followed by tailored contacts combining health behavior change strategies, medical care management, registry tracking, and provider guideline support. Enhanced usual care included quarterly wellness newsletters sent during a 12-month period in addition to standard treatment. Primary outcome measures included systolic and diastolic blood pressure, nonfasting total cholesterol, and physical health-related quality of life. Of the 180 eligible patients identified for study participation, 134 were enrolled (74%) and 118 completed outcomes assessments (mean age = 53 years, 17% female, 5% African American). Mixed effects analyses comparing changes in 24-month outcomes among patients in LGCC (n = 57) versus enhanced usual care (n = 59) groups revealed that patients receiving LGCC had reduced systolic (β = -3.1, P = .04) and diastolic blood pressure (β = -2.1, P = .04) as well as reduced manic symptoms (β = -23.9, P = .01). Life Goals Collaborative Care had no significant impact on other primary outcomes (total cholesterol and physical health-related quality of life). Life Goals Collaborative Care, compared to enhanced usual care, may lead to reduced CVD risk factors, notably through decreased blood pressure, as well as

  20. Prevalence of cardiovascular risk factors in middle-aged type 2 diabetic automobile employees assessed at the workplace--the Praeford study.

    PubMed

    Schneider, Christian A; Herold, Gerd; Gysan, Detlev; Albus, Christian; Bjarnason-Wehrens, Birna; Predel, Hans-Georg

    2007-05-01

    The purpose of this study was to provide contemporary data on the prevalence of cardiovascular risk factors in middle-aged diabetic employees in Germany. Cardiovascular risk factors were assessed at the workplace in employees of the automobile industry who identified themselves as having type 2 diabetes mellitus. The proportion of subjects reaching the target values for hemoglobin A1c (HbA1c), systolic blood pressure, and low-density lipoprotein (LDL) cholesterol was analyzed. Among 4234 employees, 91 employees with diabetes were identified (mean age, 52 years). Only 7 of 91 (8%) diabetic employees achieved all three recommended target values. Blood pressure targets were achieved by 26%, HbA1c target value by 54%, and LDL target value by 31% of employees. Only a negligible proportion of working people with diabetes achieve the recommended target values. This sobering result questions current management modalities and calls for new treatment and monitoring strategies for working people with diabetes.

  1. Testosterone, cardiovascular risk, and hormonophobia.

    PubMed

    Morgentaler, Abraham

    2014-06-01

    A public outcry against testosterone (T) therapy has suddenly occurred based on two reports suggesting treatment was associated with increased cardiovascular (CV) risks. To analyze scientific and social bases for concerns regarding T therapy. Analysis of recent articles regarding CV risks with T and comparison with events surrounding publication of results of the Women's Health Initiative in 2002. In the first study, the percentage of individuals with an adverse event was lower by half in men who received T compared with untreated men (10.1% vs. 21.2%). However, an opposite conclusion was reached via complex statistics. The second study reported minor increased rate of nonfatal myocardial infarction (MI) up to 90 days after receiving a T prescription compared with the prior 12 months. However, there was no control group, so it is unknown whether this MI rate was increased, reduced, or unchanged compared with untreated men. Neither study provided substantive evidence of risk, yet these were lauded as proof of dangers, despite a substantial literature to the contrary. Similar events followed the publication of the Women's Health Initiative in 2002 when a media frenzy over increased risks with female hormone replacement therapy obscured the fact that the reported excess risk was clinically meaningless, at two events per 1,000 person-years. Stakeholders driving concerns regarding hormone risks are unlikely to be clinicians with real-world patient experience. The use of weak studies as proof of danger indicates that cultural (i.e., nonscientific) forces are at play. Negative media stories touting T's risks appear fueled by antipharma sentiment, anger against aggressive marketing, and antisexuality. This stance is best described as "hormonophobia." As history shows, evidence alone may be insufficient to alter a public narrative. The true outrage is that social forces and hysteria have combined to deprive men of a useful treatment without regard for medical science.

  2. Nurse management of cardiovascular risk factors in rheumatoid arthritis.

    PubMed

    Garcia-Diaz, Silvia; Corominas, Hèctor

    Rheumatoid arthritis (RA) is a chronic, multi-system inflammatory disease. The incidence and prevalence of RA varies considerably between geographic areas and over time; the prevalence of RA in adults aged > 20 years in Spain is around 0.5% (Carmona et al, 2002). People with RA also have extra-articular manifestations, presenting an increased cardiovascular morbidity and mortality risk; therefore, cardiovascular risk screening and management strategies are necessary in individuals with RA. The importance of interventions in the management of people with RA and cardiovascular risk factors is recognised by the European League Against Rheumatism (EULAR) recommendations (Peters et al, 2010). Rheumatology specialist nurses are well placed to include routine cardiovascular risk assessment for people with RA attending clinic, and to provide educational interventions to reduce cardiovascular risk, such as smoking cessation, weight loss, eating a balanced, low-fat diet and exercising regularly.

  3. Comorbidities and cardiovascular risk factors in patients with psoriasis*

    PubMed Central

    Baeta, Isabela Guimarães Ribeiro; Bittencourt, Flávia Vasques; Gontijo, Bernardo; Goulart, Eugênio Marcos Andrade

    2014-01-01

    BACKGROUND Psoriasis is a chronic inflammatory disease and its pathogenesis involves an interaction between genetic, environmental, and immunological factors. Recent studies have suggested that the chronic inflammatory nature of psoriasis may predispose to an association with other inflammatory diseases, especially cardiovascular diseases and metabolic disorders. OBJECTIVES To describe the demographic, clinical, epidemiological, and laboratory characteristics of a sample of psoriasis patients; to assess the prevalence of cardiovascular comorbidities in this group of patients; and to identify the cardiovascular risk profile using the Framingham risk score. METHODS We conducted a cross-sectional study involving the assessment of 190 patients. Participants underwent history and physical examination. They also completed a specific questionnaire about epidemiological data, past medical history, and comorbidities. The cardiovascular risk profile was calculated using the Framingham risk score. RESULTS Patients' mean age was 51.5 ± 14 years, and the predominant clinical presentation was plaque psoriasis (78.4%). We found an increased prevalence of systemic hypertension, type 2 diabetes, metabolic syndrome, and obesity. Increased waist circumference was also found in addition to a considerable prevalence of depression, smoking, and regular alcohol intake. Patients' cardiovascular risk was high according to the Framingham risk score, and 47.2% of patients had moderate or high risk of fatal and non-fatal coronary events in 10 years. CONCLUSIONS Patients had high prevalence of cardiovascular comorbidities, and high cardiovascular risk according to the Framingham risk score. Further epidemiological studies are needed in Brazil for validation of our results. PMID:25184912

  4. Effects of risk assessment and management programme for hypertension on clinical outcomes and cardiovascular disease risks after 12 months: a population-based matched cohort study.

    PubMed

    Yu, Esther Y T; Wan, Eric Y F; Wong, Carlos K H; Chan, Anca K C; Chan, Karina H Y; Ho, Sin-Yi; Kwok, Ruby L P; Lam, Cindy L K

    2017-03-01

    This study evaluated the effectiveness of a structured multidisciplinary risk assessment and management programme for patients with hypertension (RAMP-HT) who were managed in public primary care clinics but had suboptimal blood pressure (BP) control in improving BP, LDL-cholesterol (LDL-C) and predicted 10-year cardiovascular disease (CVD) risk after 12 months of intervention. A total of 10 262 hypertension patients with suboptimal BP despite treatment, aged less than 80 years and without existing CVD were enrolled in RAMP-HT between October 2011 and March 2012 from public general out-patient clinics in Hong Kong. Their clinical outcomes and predicted 10-year CVD risk were compared with a matched cohort of hypertension patients who were receiving usual care in general out-patient clinics without any RAMP-HT intervention by propensity score matching. Multivariable linear and logistic regressions were used to determine the independent effectiveness of RAMP-HT after adjusting for potential confounding variables. Compared with the usual care group after 12 months, significantly greater proportions of RAMP-HT participants achieved target BP (i.e. BP < 140/90 mmHg) (OR = 1.18, P < 0.01) and LDL-C levels (i.e. <3.4 mmol/l for patients with CVD risk ≤20% or <2.6 mmol/l for CVD risk >20%) (OR = 1.13, P < 0.01). RAMP-HT participants also had significantly greater reduction in predicted 10-year CVD risk by 0.44% (coefficient = -0.44, P < 0.01). The structured multidisciplinary RAMP-HT was more effective than usual care in achieving target BP, LDL-C and reducing predicted 10-year CVD risk in public primary care patients with suboptimal hypertension control after 12 months of intervention. A long-term follow-up should be conducted to confirm whether the improvement in clinical outcomes can be translated into actual reductions in CVD complications and mortalities and whether such approach is cost-effective.

  5. Cardiovascular risk factors in primary hyperparathyroidism.

    PubMed

    Luboshitzky, R; Chertok-Schaham, Y; Lavi, I; Ishay, A

    2009-04-01

    Severe primary hyperparathyroidism (PHP) has been associated with increased cardiovascular morbidity. Such an association in mild PHP is not known. We conducted a cross-sectional study to assess the correlation between mild and traditional PHP and emergent cardiovascular risk factors. A total of 139 patients with PHP (72 with severe PHP and indications for parathyroidectomy, 67 with mild PHP and no indications for surgery) and 111 control subjects, of similar age and body weight, were enrolled in this study. Participants had measurement of fasting blood levels of calcium, PTH, insulin, glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, interleukin-6, and C-reactive protein. Body mass index (BMI), waist and hip circumferences, blood pressure, homeostasis model assessment 2-insulin resistance index (IR) and the presence of metabolic syndrome (MS) were evaluated. Severe PHP patients had significantly higher rates of MS (37.5%), IR (38.9 %) vs mild PHP (34.3 and 23.9%, respectively) and controls (14.4 and 14.4%, respectively). Multivariate logistic-regression model, adjusted for age and BMI, and for age and waist size, revealed that severe PHP had significantly higher likelihood of cardiovascular risks [odds ratio (OR) 3.5, 95% confidence interval (CI) 1.5-8.125, p=0.004 for MS, and OR 3.7, 95% CI 1.64-8.29, p=0.002 for IR]. Serum calcium significantly predicted the presence of MS (OR 1.875, 95% CI 1.259-2.793, p=0.002) and IR (OR 2.043, 95% CI 1.365-3.057, p=0.002). Greater probability of MS and insulin resistance was observed in patients with severe PHP. Serum calcium is a predictor of these cardiovascular risk factors.

  6. A multivariate model for assessing eating patterns and their relationship to cardiovascular risk factors: the Bogalusa Heart Study.

    PubMed

    Nicklas, T A; Webber, L S; Thompson, B; Berenson, G S

    1989-06-01

    Eating patterns were studied in 1275 adolescents and young adults (aged 12-24 y). Factor analysis of 64 foods consumed weekly revealed 17 eating-pattern factors, accounting for 57% of the item variance. Factor I (12 food items from either the seafood or meat group) accounted for 8% of the variance, factor II (snacks), 5%, and factors III (fats and pasta) and IV (beef and chicken), 4% each. Remaining factors accounted for from 1.9% to 3.9%. The factors were effective in discriminating eating patterns across race and gender. Significant age effects were also noted for 10 of the 17 factors. Eating patterns for persons in the upper or lower quartiles differed consistently for specific cardiovascular (CV) risk factors. Use of this statistical model to identify differences in eating patterns by race, gender, and CV risk factors during maturation can assist health professionals in targeting food sources for changing eating behavior.

  7. Flow-mediated dilatation (FMD) and prevalence of cardiovascular risk factors: the value of FMD assessment in high risk patients is limited.

    PubMed

    Mizia-Stec, Katarzyna; Wieczorek, Joanna; Orszulak, Michał; Mizia, Magdalena; Gieszczyk-Strózik, Klaudia; Sikora-Puz, Agnieszka; Haberka, Maciej; Lasota, Bartosz; Chmiel, Artur

    2014-01-01

    Since flow-mediated dilatation (FMD) is influenced by different factors, its clinical usefulness and validation is widely discussed. To assess the major factors that determine FMD values in a wide range of subjects with and without cardiovascular (CV) risk factors/diseases (CVRF/CVD). 617 consecutive patients (mean age: 50.1 ± 14.9 years, males: 349/56.5%) hospitalised between 2005 and 2011 were enrolled into the study. Demographic data and CVRF/CVD with a significant impact on FMD values were analysed: hyperlipidaemia, active smoking, arterial hypertension, coronary artery disease, diabetes mellitus and heart valve disease. The population was divided depending on the number of coexisting CVRF/CVD (0-, 1-, 2-, 3-, 4-, 5-CVRF/CVD groups). The median FMD value in the entire group of patients was 10% (5-17). An analysis of the FMD percentage in particular groups showed significantly higher FMD values in patients without any CVRF/CVD (group 0), as well as in patients with one coexisting CVRF/CVD (group 1) compared to the other groups. The presence of two or more CVRF/CVD was not associated with a significantly higher FMD reduction. The analysis of patients with only one CVRF/CVD revealed the lowest FMD values in patients with coronary artery disease. FMD is related to the number of traditional CVRF/CVDs; however, coronary artery disease has the most significant influence on FMD decrease among analysed factors. The value of FMD assessment in high risk patients is limited.

  8. Egg consumption and cardiovascular risk

    PubMed

    Fuertes García, Antonio

    2016-07-12

    Diet, along with exercise, is the determining factor in primary prevention –and secondary– of cardiovascular disease (CVD). This disease remains the leading cause of death in our country, as well as neighboring countries. After the publication of the results of the study of the Seven Countries in 1980, egg consumption was discouraged because it was thought falsely that the consumption of it had the same harmful effect as saturated fats increasing CVD risk. This idea, that was proved wrong later, was in general accepted by the medical profession as much as the general population. Simultaneously numerous clinical studies were performed and they clearly contradict that belief, concluding that egg intake do not increase CVD risk. In conclusion, although the literature on this topic is abundant, we cite the works that seem most significant in this regard. Consequently and following the recommendations of the American Heart Association Guidelines, since 2000, we can conclude that intake of up to one egg a day does not modify the risk for CVD in healthy adults.

  9. Impact of telmisartan on cardiovascular outcome in hypertensive patients at high risk: a Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease subanalysis.

    PubMed

    Foulquier, Sébastien; Böhm, Michael; Schmieder, Roland; Sleight, Peter; Teo, Koon; Yusuf, Salim; Schumacher, Helmut; Unger, Thomas

    2014-06-01

    In the Telmisartan Randomised AssessmeNt Study in ACE iNtolerant subjects with cardiovascular Disease, all patients were at high cardiovascular risk, and a substantial proportion were hypertensive. We performed a post-hoc analysis to explore the hypothesis that telmisartan has a differential action in hypertensive vs. nonhypertensive patients. The primary four-fold endpoint (composite of cardiovascular death, myocardial infarction (MI), stroke, or hospitalization for heart failure), the secondary three-fold endpoint (cardiovascular death, MI, and stroke), the individual components, new onset of left ventricular hypertrophy (LVH), and new onset of albuminuria were analyzed. There was no evidence for a significantly differential treatment effect of telmisartan in hypertensive and nonhypertensive patients for any endpoints, although the occurrence of the secondary three-fold endpoint was significantly lower in the telmisartan group (13.0%) compared with placebo (15.0%, P < 0.05) only in hypertensive patients. Moreover, data from this post-hoc analysis suggest that MI may be less frequent in hypertensive patients treated with telmisartan (3.8 vs. 5.1%; P < 0.05). Telmisartan may also reduce new onset of LVH (nonhypertensive patients P < 0.05; hypertensive patients P < 0.001) in both subgroups, and new onset of microalbuminuria and macroalbuminuria in hypertensive patients (P < 0.001 and P < 0.01, respectively).The effect of telmisartan in hypertensive and nonhypertensive patients at high cardiovascular risk was not different. This post-hoc analysis suggests that MI may be further reduced by telmisartan in hypertensive patients. Further investigations are needed to study the hypotheses raised by this explanatory analysis.

  10. Assessing cardiovascular risk in children with chronic kidney disease. B-type natriuretic peptide: a potential new marker.

    PubMed

    Ariceta, Gema; Brooks, Ellen R; Langman, Craig B

    2005-12-01

    Elevated plasma B-type natriuretic peptide (BNP) level is a hallmark of altered left ventricular (LV) structure and function. Measurement of circulating BNP has proved to be a sensitive and specific diagnostic test for congestive heart failure (CHF) and coronary syndrome in adults. Further, BNP levels constitute a strong predictive marker for future cardiovascular (CV) events. In high CV risk populations, such as adults with hypertension or chronic kidney disease (CKD), increased BNP predicts CV morbidity and mortality in symptomatic or asymptomatic patients. However, caution is needed in interpreting plasma BNP levels, as they increase with both age and decreased renal function. Despite increasing evidence of the value of BNP in the medical literature in adults, data in children are limited to those with congenital heart disease. It is appropriate to analyze the potential application of this tool in children with CKD, a well-known factor for CV disease.

  11. Cardiovascular Risk in Diabetes Mellitus: Complication of the Disease or of Antihyperglycemic Medications.

    PubMed

    Alvarez, C A; Lingvay, I; Vuylsteke, V; Koffarnus, R L; McGuire, D K

    2015-08-01

    Cardiovascular disease is the principal complication and the leading cause of death for patients with diabetes (DM). The efficacy of antihyperglycemic treatments on cardiovascular disease risk remains uncertain. Cardiovascular risk factors are affected by antihyperglycemic medications, as are many intermediate markers of cardiovascular disease. Here we summarize the evidence assessing the cardiovascular effects of antihyperglycemic medications with regard to risk factors, intermediate markers of disease, and clinical outcomes.

  12. World Health Organization cardiovascular risk stratification and target organ damage.

    PubMed

    Piskorz, D; Bongarzoni, L; Citta, L; Citta, N; Citta, P; Keller, L; Mata, L; Tommasi, A

    2016-01-01

    Prediction charts allow treatment to be targeted according to simple markers of cardiovascular risk; many algorithms do not recommend screening asymptomatic target organ damage which could change dramatically the assessment. To demonstrate that target organ damage is present in low cardiovascular risk hypertensive patients and it is more frequent and severe as global cardiovascular risk increases. Consecutive hypertensive patients treated at a single Latin American center. Cardiovascular risk stratified according to 2013 WHO/ISH risk prediction chart America B. Left ventricular mass assessed by Devereux method, left ventricular hypertrophy considered >95g/m(2) in women and >115g/m(2) in men. Transmitral diastolic peak early flow velocity to average septal/lateral peak early diastolic relaxation velocity (E/e' ratio) measured cut off value >13. Systolic function assessed by tissue Doppler average interventricular septum/lateral wall mitral annulus rate systolic excursion (s wave). A total of 292 patients were included of whom 159 patients (54.5%) had cardiovascular risk of <10%, 90 (30.8%) had cardiovascular risk of 10-20% and 43 (14.7%) had cardiovascular risk of >20%. Left ventricular hypertrophy was detected in 17.6% low risk patients, 27.8% in medium risk and 23.3% in high risk (p<0.05), abnormal E/e' ratio was found in 13.8%, 31.1% and 27.9%, respectively (p<0.05). Mean s wave was 8.03+8, 8.1+9 and 8.7+1cm/s for low, intermediate and high risk patients, respectively (p<0.025). Target organ damage is more frequent and severe in high risk; one over four subjects was misclassified due to the presence of asymptomatic target organ damage. Copyright © 2015 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

  13. Childhood migration and cardiovascular risk.

    PubMed

    Schooling, Mary; Leung, Gabriel M; Janus, Edward D; Ho, Sai Yin; Hedley, Anthony J; Lam, Tai Hing

    2004-12-01

    Childhood living conditions have been hypothesized to be associated with the development of cardiovascular diseases and diabetes mellitus in adult life. We analysed, using logistic regression, the risk of self-reported diabetes, hypertension, hyperlipidaemia, and ischaemic heart disease in a population-based sample of 3643 Chinese men and 3778 Chinese women some of whom had experienced a change to more favourable economic conditions at different life stages through migration from mainland China to Hong Kong. Adjusting for socio-economic status, risk behaviours, and family history, the development of diabetes was associated with migration from China to Hong Kong in the first two decades of life, albeit with a decreasing intensity of effect (OR = 2.02, 95% CI: 1.18, 3.45, OR = 1.84, 95% CI: 1.27, 2.66, and OR = 1.72, 95% CI: 1.21, 2.45 for migration at ages 0-7, 8-17, and 18-24, respectively). The development of hypertension was mostly susceptible to environmental change during the growth spurt and puberty (migration at ages 8-17 OR = 1.56, 95% CI: 1.22, 1.99). The development of heart disease was associated with a sex-specific critical period in early childhood for men (migration at ages 0-7 OR = 3.17, 95% CI: 1.70, 5.91). Environmental change by migration throughout the first two decades of life can affect the development of diabetes, hypertension, hyperlipidaemia, and ischaemic heart disease, although adverse childhood conditions alone may not be a risk factor. Our results suggest that specific life course pathways may pre-dispose to these conditions and could be relevant to their aetiology in populations undergoing rapid development.

  14. Cardiovascular risk factors and lifestyle habits among preventive cardiovascular nurses.

    PubMed

    Fair, Joan M; Gulanick, Meg; Braun, Lynne T

    2009-01-01

    The cornerstone of cardiovascular disease prevention is the promotion of a healthy lifestyle and the identification and reduction of cardiovascular risk factors. Cardiology nurses play a major role in counseling patients about lifestyle and cardiovascular risk factors. We used an e-mail survey to elicit self-reported prevalence of cardiovascular risk factors and healthy lifestyles among the Preventive Cardiovascular Nurses Association (PCNA) members and compared their risk profiles with published data for American cardiologists, the Nurses' Health Study 2, and the Behavioral Risk Factor Surveillance Survey data for women. A total of 1,345 complete surveys were collected. The respondents were mostly women (96%), with mean (SD) age of 47.4 (8.7) years. More than 95% were not cigarette smokers, more than 50% had a healthy body mass index (<25), and more than 56% achieved the recommended levels of physical activity. Nevertheless, obesity (body mass index ≥ 30) was a health risk in one-fifth of PCNA respondents. The rates of hypertension (17%) and dyslipidemia (15%) were lower than rates reported in other national samples; however, the rate for family history of premature heart disease (20%) was similar to those reported in national samples. Since family history of premature heart disease may be a more significant risk factor in women, PCNA respondents with such a family history may require targeted interventions to further reduce their risk and improve their lifestyle behaviors. PCNA nurses have more favorable lifestyle profiles compared with national samples. It can be expected that nurses who know their risk factors and who follow healthy lifestyle behaviors will be more effective in these counseling roles.

  15. Randomised controlled pilot study to assess the feasibility of a Mediterranean Portfolio dietary intervention for cardiovascular risk reduction in HIV dyslipidaemia: a study protocol

    PubMed Central

    Thomas, G Neil; Hemming, Karla; Frost, Gary; Garcia-Perez, Isabel; Redwood, Sabi; Taheri, Shahrad

    2016-01-01

    Introduction HIV drug treatment has greatly improved life expectancy, but increased risk of cardiovascular disease remains, potentially due to the additional burdens of infection, inflammation and antiretroviral treatment. The Mediterranean Diet has been shown to reduce cardiovascular risk and mortality in the general population, but no evidence exists for this effect in the HIV population. This study will explore the feasibility of a randomised controlled trial (RCT) to examine whether a Mediterranean-style diet that incorporates a portfolio of cholesterol-lowering foods, reduces cardiovascular risk in people with HIV dyslipidaemia. Methods and analysis 60 adults with stable HIV infection on antiretroviral treatment and low-density lipoprotein cholesterol >3 mmol/L will be recruited from 3 West Midlands HIV services. Participants will be randomised 1:1 to 1 of 2 dietary interventions, with stratification by gender and smoking status. Participants allocated to Diet1 will receive advice to reduce saturated fat intake, and those to Diet2 on how to adopt the Mediterranean Portfolio Diet with additional cholesterol-lowering foods (nuts, stanols, soya, oats, pulses). Measurements of fasting blood lipids, body composition and arterial stiffness will be conducted at baseline, and month 6 and 12 of the intervention. Food intake will be assessed using the Mediterranean Diet Score, 3-day food diaries and metabolomic biomarkers. Questionnaires will be used to assess quality of life and process evaluation. Qualitative interviews will explore barriers and facilitators to making dietary changes, and participant views on the intervention. Qualitative data will be analysed using the Framework Method. Feasibility will be assessed in terms of trial recruitment, retention, compliance to study visits and the intervention. SD of outcomes will inform the power calculation of the definitive RCT. Ethics The West Midlands Ethics Committee has approved this study and informed consent

  16. Biomarkers of cardiovascular disease risk in women.

    PubMed

    Manson, JoAnn E; Bassuk, Shari S

    2015-03-01

    Cardiovascular disease (CVD), including coronary heart disease and stroke, is the leading cause of death among U.S. women and men. Established cardiovascular risk factors such as smoking, diabetes, hypertension, and elevated total cholesterol, and risk prediction models based on such factors, perform well but do not perfectly predict future risk of CVD. Thus, there has been much recent interest among cardiovascular researchers in identifying novel biomarkers to aid in risk prediction. Such markers include alternative lipids, B-type natriuretic peptides, high-sensitivity troponin, coronary artery calcium, and genetic markers. This article reviews the role of traditional cardiovascular risk factors, risk prediction tools, and selected novel biomarkers and other exposures in predicting risk of developing CVD in women. The predictive role of novel cardiovascular biomarkers for women in primary prevention settings requires additional study, as does the diagnostic and prognostic utility of cardiac troponins for acute coronary syndromes in clinical settings. Sex differences in the clinical expression and physiology of metabolic syndrome may have implications for cardiovascular outcomes. Consideration of exposures that are unique to, or more prevalent in, women may also help to refine cardiovascular risk estimates in this group.

  17. World Health Organization (WHO) and International Society of Hypertension (ISH) risk prediction charts: assessment of cardiovascular risk for prevention and control of cardiovascular disease in low and middle-income countries.

    PubMed

    Mendis, Shanthi; Lindholm, Lars H; Mancia, Giuseppe; Whitworth, Judith; Alderman, Michael; Lim, Stephen; Heagerty, Tony

    2007-08-01

    Cardiovascular disease (CVD) is the leading cause of the growing global disease burden due to non-communicable diseases. For successful prevention and control of CVD, strategies that focus on individuals need to complement population-wide strategies. Strategies that focus on individuals are cost effective only when targeted at high-risk groups. Risk prediction tools that easily and accurately predict an individual's absolute risk of CVD are key to targeting limited resources at high-risk individuals who are likely to benefit the most. Health systems in low-income countries do not have the basic infrastructure facilities to support resource-intensive risk prediction tools, particularly in primary healthcare. The WHO/ISH charts presented here, enable the prediction of future risk of heart attacks and strokes in people living in low and middle income countries, for the first time. Furthermore, since the charts use simple variables they can be applied even in low resource settings. Thus the WHO/ISH risk predication charts and the accompanying guideline will improve the effectiveness of cardiovascular risk management even in settings which do not have sophisticated technology.

  18. [Reliability and external validity of a questionnaire to assess the knowledge about risk and cardiovascular disease and in patients attending Spanish community pharmacies].

    PubMed

    Amariles, Pedro; Pino-Marín, Daniel; Sabater-Hernández, Daniel; García-Jiménez, Emilio; Roig-Sánchez, Inés; Faus, María José

    2016-11-01

    To determine the test-retest reliability of a questionnaire, with a validation preliminary, to assess knowledge of cardiovascular risk (CVR) and cardiovascular disease in patients attending community pharmacies in Spain. To complement the external validity, establishing the relationship between an educational activity and the increase in knowledge about CVR and cardiovascular disease. Sub-analysis of a controlled clinical study, EMDADER-CV, in which a questionnaire about knowledge concerning CVR was applied at 4 different times. Spanish Community Pharmacies. There were 323 patients in the control group, from the 640 who completed the study. Intraclass correlation coefficient to assess the reliability in 3 comparisons (post-educational activity with week 16, post-educational activity with week 32, and week 16 with week 32); and the non-parametric Friedman test to establish the relationship between an oral and written educational activity with increasing knowledge. For the 323 patients in the 3 comparisons, the intraclass correlation coefficient values were 0.624; 0.608 and 0.801, respectively (fair-good to excellent reliability). So, the Friedman test showed a statistically significant relationship between educational activity and increased knowledge (p < .0001). According to the intraclass correlation coefficient, the questionnaire aimed at assessing the knowledge on CVR and cardiovascular disease has a reliability between acceptable and excellent, which added to the previous validation, shows that the instrument meets the criteria of validity and reliability. Furthermore, the questionnaire showed the ability to relate an increase in knowledge with an educational intervention, feature that complements its external validity. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  19. High cardiovascular risk in Spanish workers.

    PubMed

    Sánchez Chaparro, M A; Calvo Bonacho, E; González Quintela, A; Cabrera, M; Sáinz, J C; Fernández-Labander, C; Quevedo-Aguado, L; Gelpi, J A; Fernández Meseguer, A; Brotons, C; de Teresa, E; González Santos, P; Román García, J

    2011-04-01

    To investigate the prevalence of high cardiovascular risk in the Spanish working population, and its distribution among different occupations and gender. Cross-sectional study of 309,955 workers (72.6% males, mean age 36.5 years, range 16-74 years), who underwent a routine medical check-up. Workers were classified as high, intermediate or low cardiovascular risk, according to the SCORE system. Workers with a relative risk greater than 4 were also considered as high-risk. The prevalence of high cardiovascular risk was 7.6% (95% CI 7.5-7.7) in males and 1.7% (95% CI 1.6-1.8) in females. After adjusting for age and gender, the prevalence of high cardiovascular risk was greater in workers from the Agriculture and Construction sectors than in those from Industry and Service sectors. The prevalence of high cardiovascular risk was higher in blue-collar than in white-collar occupations. A sizeable proportion of workers, especially blue-collar males, are at high cardiovascular risk. Knowledge of this risk for certain workers may serve as a basis for preventive strategies. Copyright © 2009. Published by Elsevier B.V.

  20. Cardiovascular risk factors—using repeated cross-sectional surveys to assess time trends in socioeconomic inequalities in neighbouring countries

    PubMed Central

    Hughes, John; Kabir, Zubair; Kee, Frank; Bennett, Kathleen

    2017-01-01

    Objectives This study compares trends in socioeconomic inequalities related to key cardiovascular risk factors in neighbouring countries Northern Ireland (NI) and the Republic of Ireland (RoI). Design Repeated cross-sectional studies. Setting Population based. Participants 3500–4000 in national surveys in NI and 5000–9000 in RoI, aged 20–69 years. Measures Educational attainment was used as a socioeconomic indicator by which the magnitude and direction of trends in inequalities for smoking, diabetes, obesity and physical inactivity in NI and RoI were examined between 1997/1998 and 2007/2011. Gender-specific relative and absolute inequalities were calculated using the Relative Index of Inequality (RII) and Slope Index of Inequality (SII) for both countries. Results In both countries, the prevalence of diabetes and obesity increased whereas levels of smoking and physical inactivity decreased over time. In NI relative inequalities increased for obesity (RII 1.1 in males and 2.1 in females in 2010/2011) and smoking (RII 4.5 in males and 4.2 in females in 2010/2011) for both genders and absolute inequalities increased for all risk factors in men and increased for diabetes and obesity in women. In RoI greater inequality was observed in women, particularly for smoking (RII 2.8 in 2007) and obesity (RII 8.2 in 2002) and in men for diabetes (RII 3.2 in 2002). Conclusions Interventions to reduce inequalities in risk factors, particularly smoking, obesity and diabetes are encouraged across both countries. PMID:28373251

  1. Noninvasive assessment of coronary vasodilation using cardiovascular magnetic resonance in patients at high risk for coronary artery disease

    PubMed Central

    Nguyen, Patricia K; Meyer, Craig; Engvall, Jan; Yang, Phillip; McConnell, Michael V

    2008-01-01

    Background Impaired coronary vasodilation to both endothelial-dependent and endothelial-independent stimuli have been associated with atherosclerosis. Direct measurement of coronary vasodilation using x-ray angiography or intravascular ultrasound is invasive and, thus, not appropriate for asymptomatic patients or for serial follow-up. In this study, high-resolution coronary cardiovascular magnetic resonance (CMR) was used to investigate the vasodilatory response to nitroglycerine (NTG) of asymptomatic patients at high risk for CAD. Methods A total of 46 asymptomatic subjects were studied: 13 high-risk patients [8 with diabetes mellitus (DM), 5 with end stage renal disease (ESRD)] and 33 age-matched controls. Long-axis and cross-sectional coronary artery images were acquired pre- and 5 minutes post-sublingual NTG using a sub-mm-resolution multi-slice spiral coronary CMR sequence. Coronary cross sectional area (CSA) was measured on pre- and post-NTG images and % coronary vasodilation was calculated. Results Patients with DM and ESRD had impaired coronary vasodilation to NTG compared to age-matched controls (17.8 ± 7.3% vs. 25.6 ± 7.1%, p = 0.002). This remained significant for ESRD patients alone (14.8 ± 7.7% vs. 25.6 ± 7.1%; p = 0.003) and for DM patients alone (19.8 ± 6.3% vs. 25.6 ± 7.1%; p = 0.049), with a non-significant trend toward greater impairment in the ESRD vs. DM patients (14.8 ± 7.7% vs. 19.8 ± 6.3%; p = 0.23). Conclusion Noninvasive coronary CMR demonstrates impairment of coronary vasodilation to NTG in high-risk patients with DM and ESRD. This may provide a functional indicator of subclinical atherosclerosis and warrants clinical follow up to determine prognostic significance. PMID:18513419

  2. Cardiovascular risk factor investigation: a pediatric issue

    PubMed Central

    Rodrigues, Anabel N; Abreu, Glaucia R; Resende, Rogério S; Goncalves, Washington LS; Gouvea, Sonia Alves

    2013-01-01

    Objectives To correlate cardiovascular risk factors (e.g., hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, sedentariness) in childhood and adolescence with the occurrence of cardiovascular disease. Sources A systematic review of books and selected articles from PubMed, SciELO and Cochrane from 1992 to 2012. Summary of findings Risk factors for atherosclerosis are present in childhood, although cardiovascular disease arises during adulthood. This article presents the main studies that describe the importance of investigating the risk factors for cardiovascular diseases in childhood and their associations. Significant rates of hypertension, obesity, dyslipidemia, and sedentariness occur in children and adolescents. Blood pressure needs to be measured in childhood. An increase in arterial blood pressure in young people predicts hypertension in adulthood. The death rate from cardiovascular disease is lowest in children with lower cholesterol levels and in individuals who exercise regularly. In addition, there is a high prevalence of sedentariness in children and adolescents. Conclusions Studies involving the analysis of cardiovascular risk factors should always report the prevalence of these factors and their correlations during childhood because these factors are indispensable for identifying an at-risk population. The identification of risk factors in asymptomatic children could contribute to a decrease in cardiovascular disease, preventing such diseases as hypertension, obesity, and dyslipidemia from becoming the epidemics of this century. PMID:23515212

  3. Cardiovascular risk factors in patients with asymptomatic primary hyperparathyroidism.

    PubMed

    García-Martín, Antonia; Reyes-García, Rebeca; García-Castro, José Miguel; Quesada-Charneco, Miguel; Escobar-Jiménez, Fernando; Muñoz-Torres, Manuel

    2014-12-01

    Patients with primary hyperparathyroidism (PHP), even asymptomatic, have an increased cardiovascular risk. However, data on reversibility or improvement of cardiovascular disorders with surgery are controversial. Our aims were to assess the prevalence of classic cardiovascular risk factors in patients with asymptomatic PHP, to explore their relationship with calcium and PTH levels, and analyze the effect of parathyroidectomy on those cardiovascular risk factors. A retrospective, observational study of two groups of patients with asymptomatic PHP: 40 patients on observation and 33 patients who underwent surgery. Clinical and biochemical data related to PHP and various cardiovascular risk factors were collected from all patients at baseline and one year after surgery in the operated patients. A high prevalence of obesity (59.9%), type 2 diabetes mellitus (25%), high blood pressure (47.2%), and dyslipidemia (44.4%) was found in the total sample, with no difference between the study groups. Serum calcium and PTH levels positively correlated with BMI (r=.568, P=.011, and r=.509, P=.026 respectively) in non-operated patients. One year after parathyroidectomy, no improvement occurred in the cardiovascular risk factors considered. Our results confirm the high prevalence of obesity, type 2 diabetes mellitus, high blood pressure, and dyslipidemia in patients with asymptomatic PHP. However, parathyroidectomy did not improve these cardiovascular risk factors. Copyright © 2014 SEEN. Published by Elsevier Espana. All rights reserved.

  4. Wiping Out CGRP: Potential Cardiovascular Risks.

    PubMed

    MaassenVanDenBrink, Antoinette; Meijer, Joris; Villalón, Carlos M; Ferrari, Michel D

    2016-09-01

    Migraine is a common episodic neurovascular brain disorder associated with increased risk of cardio- and cerebrovascular ischemia. Migraine headache is likely caused by activation of the trigeminovascular system and release of calcitonin gene-related peptide (CGRP). Monoclonal antibodies against CGRP or its receptor are currently being evaluated for the prevention of migraine attacks. Preliminary efficacy data are promising. However, because CGRP may act as a vasodilatory safeguard during cerebral and cardiac ischemia, CGRP blockade could transform transient mild ischemic events into full-blown infarcts. Here, we review the cerebro- and cardiovascular risks that might be associated with CGRP blockade and which clinical and preclinical studies should be conducted to better assess the potential safety issues of this new promising class of drug.

  5. Application of two versions of the WHO/international society of hypertension absolute cardiovascular risk assessment tools in a rural Bangladeshi population

    PubMed Central

    Fatema, Kaniz; Zwar, Nicholas Arnold; Milton, Abul Hasnat; Rahman, Bayzidur; Ali, Liaquat

    2015-01-01

    Objectives To estimate the absolute cardiovascular disease (CVD) risk burden in a remote rural Bangladeshi population using the ‘With’ and ‘Without’ Cholesterol versions of the WHO/International Society of Hypertension (WHO/ISH) CVD risk assessment chart (particularly suitable for low and middle-income countries due to less reliance on laboratory testing) and to evaluate the agreement between the two approaches. Design Cross-sectional study using data from a large prospective cohort of the North Bengal Non-Communicable Disease Programme (NB-NCDP) of Bangladesh. Setting General rural population from Thakurgaon district of Bangladesh. Participants 563 individuals who were categorised as having ‘no CVDs’ on screening by a questionnaire-based survey using the ‘WHO CVD-Risk Management Package’ developed in 2002. Main outcome measures Absolute CVD risk burden assessed using two versions of the WHO/ISH risk assessment charts for the South-East Asian Region-D. Results 10-year risk (moderate, high and very high) positivity was present among 21.5% and 20.2% of participants, respectively, using with and without cholesterol versions of the tool. The overall concordance rate for the two versions was 89.5% and they did not differ significantly in estimating the proportion of overall participants having higher levels of CVD. The projected drug requirement, however, showed a significant overestimation in the proportion of participants at both the threshold levels (p<0.002) on using ‘without’ as compared to ‘with’ cholesterol versions. Conclusions About one-fifth of the adult population in Bangladesh, even in a remote rural area, seem to be at risk of developing CVDs (25% of them at high risk and 25% at very high risk) within 10 years with males and females being almost equally vulnerable. PMID:26463220

  6. Aggregating traditional cardiovascular disease risk factors to assess the cardiometabolic health of childhood cancer survivors: An analysis from the Cardiac Risk Factors in Childhood Cancer Survivors Study

    PubMed Central

    Landy, David C.; Miller, Tracie L.; Lopez-Mitnik, Gabriela; Lipsitz, Stuart R.; Hinkle, Andrea S.; Constine, Louis S.; French, Carol A.; Rovitelli, Amy M. K.; Adams, M. Jacob; Lipshultz, Steven E.

    2011-01-01

    Background Childhood cancer survivors are at increased risk of cardiovascular disease (CVD), which may be associated with traditional CVD risk factors. We used CVD risk aggregation instruments to describe survivor cardiometabolic health and compared their results with sibling controls. Methods Traditional CVD risk factors measured in 110 survivors and 31 sibling controls between 15 and 39 years old were aggregated using Pathobiological Determinants of Atherosclerosis in Youth (PDAY) scores and the Framingham Risk Calculator (FRC) and expressed as ratios. The PDAY odds ratio represents the increased odds of currently having an advanced coronary artery lesion, and the FRC risk ratio represents the increased risk of having a myocardial infarction, stroke, or coronary death in the next 30 years. Ratios are relative to an individual of similar age and sex without CVD risk factors. Results The median PDAY odds ratio for survivors was 2.2 (interquartile range 1.3-3.3), with 17% N4. The median FRC risk ratio was 1.7 (interquartile range 1.0-2.0), with 12% N4. Survivors and siblings had similar mean PDAY odds ratios (2.33 vs 2.29, P = .86) and FRC risk ratios (1.72 vs 1.53, P = .24). Cancer type and treatments were not associated with cardiometabolic health. There was a suggested association for physical inactivity with PDAY odds ratios (r = 0.17, P = .10) and FRC risk ratios (r = 0.19, P = .12). Conclusions Cardiometabolic health is poor in childhood cancer survivors but not different than that of their siblings, highlighting the importance of managing traditional CVD risk factors and considering novel exposures in survivors. PMID:22305850

  7. Intradialytic hypotension and risk of cardiovascular disease.

    PubMed

    Stefánsson, Bergur V; Brunelli, Steven M; Cabrera, Claudia; Rosenbaum, David; Anum, Emmanuel; Ramakrishnan, Karthik; Jensen, Donna E; Stålhammar, Nils-Olov

    2014-12-05

    Patients undergoing hemodialysis have an elevated risk of cardiovascular disease-related morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role. This study retrospectively examined records of 39,497 hemodialysis patients during 2007 and 2008. US Renal Data System claims and dialysis provider data were used to determine outcomes. IDH was defined by current Kidney Disease Outcomes Quality Initiative guidelines (≥20 mmHg fall in systolic BP from predialysis to nadir intradialytic levels plus ≥2 responsive measures [dialysis stopped, saline administered, etc.]). IDWG was measured absolutely (in kilograms) and relatively (in percentages). IDH occurred in 31.1% of patients during the 90-day exposure assessment period. At baseline, the higher the IDWG (relative or absolute), the greater the frequency of IDH (P<0.001). For all-cause mortality, the median follow-up was 398 days (interquartile range, 231-602 days). Compared with patients without IDH, IDH was associated with all-cause mortality (7646 events; adjusted hazard ratio, 1.07 [95% confidence interval, 1.01 to 1.14]), myocardial infarction (2396 events; 1.20 [1.10 to 1.31]), hospitalization for heart failure/volume overload (8896 events; 1.13 [1.08 to 1.18]), composite hospitalization for heart failure/volume overload or cardiovascular mortality (10,805 events; 1.12 [1.08 to 1.17]), major adverse cardiac events (MACEs; myocardial infarction, stroke, cardiovascular mortality) (4994 events, 1.10 [1.03 to 1.17]), and MACEs+ (MACEs plus arrhythmia or hospitalization for heart failure/volume overload) (12

  8. [Subclinical hypothyroidism and cardiovascular risk].

    PubMed

    López Rubio, María Antonia; Tárraga López, Pedro Juan; Rodríguez Montes, José Antonio; Frías López, María del Carmen; Solera Albero, Juan; Bermejo López, Pablo

    2015-05-01

    Objetivos: Valorar si el hipotiroidismo subclínico puede comportarse como un factor de riesgo cardiovascular o un modificador del mismo, identificando variables epidemiológicas y riesgo cardiovascular estimado en una muestra de sujetos diagnosticados en la provincia de Albacete. Método: Estudio observacional, descriptivo y transversal realizado en Albacete durante la primera quincena de enero de 2012 en pacientes de ambos géneros con hipotiroidismo subclínico. Se analizaron las siguientes variables: glucemia basal, colesterol total, colesterol HDL, colesterol LDL, triglicéridos, TSH, T4, peso, talla, I.M.C., tensión arterial, antecedentes de patología cardiovascular, factores de riesgo cardiovascular y riesgo cardiovascular estimado. Resultados: Se obtuvieron 326 pacientes, con predominio femenino (79,2 %), menores de 65 años en el 78% y sin factores de riesgo cardiovascular en el 48,61%. La prevalencia de los factores de riesgo cardiovascular identificados fué: tabaquismo (33,2%), diabetes mellitus (24,9%), hipertensión arterial (23,4%), alteraciones lipídicas (28,9%) y fibrilación auricular (4,9 %). No se encontró asociación entre hipotiroidismo subclínico y la mayoría de los parámetros del perfil lipídico que condicionan un perfil pro-aterogénico, salvo con la hipertrigliceridemia. Asimismo, tampoco se constató asociación con riesgo cardiovascular aumentado. Conclusiones: El perfil del paciente con hipotiroidismo subclínico es una mujer de mediana edad sin factores de riesgo cardiovascular en la mitad de casos. Se ha encontrado relación entre hipotiroidismo subclínico e hipertrigliceridemia, pero no con el resto de parámetros del perfil lipídico, otros factores de riesgo cardiovascular o con aumento de dicho riesgo. Sin embargo, un 25% de diabéticos y un 22% de no diabéticos están en situación de riesgo cardiovascular moderado-alto.

  9. The Puerto Rico Cardiovascular Risk-Estimation Study (PRCaRES): an exploratory assessment of new patients in physicians' offices.

    PubMed

    Monsanto, Homero A; Renta-Muñoz, Antonio; Dones, Wistremundo; Comulada, Angel; Cidre, Carlos; Orengo, Juan Carlos

    2014-06-01

    To determine the risk of developing coronary heart disease (CHD) in a cross-sectional sample of Puerto Rico residents through an analysis of the 10-year Framingham risk score. An exploratory, retrospective, cross-sectional study of the medical records of patients 35 years or older who each visited the office of 1 of the 4 participating physicians on or after July 1, 2007. Data for 453 patients were extracted from the medical records, but 96 cases were excluded because of incomplete data or the patients' not fulfilling the inclusion criteria, thus yielding a total sample of 357 patients. The average patient age was 58 years old (+/- 11.8); the majority (58%) was female. Eight of 10 patients were either overweight or obese. Eighty-five percent reported having at least 1 cardio-metabolic condition. Of these, 72.3% self-reported having hypertension; 38.4%, dyslipidemia; and 37.8%, diabetes. Many patients were not at goal for blood pressure or for lipid and glucose parameters nor were these patients taking any medication for these conditions. Nearly one-third of the participants had a 10% or greater 10-year risk of developing CHD. Compared with women, men were 3.3 times more likely to have a 10-year CHD risk of 10% or greater and 4.2 times more likely to have a risk of 20% or greater. A substantial number of patients had risk factors for developing CHD and were not at goal for specific parameters. Larger scale epidemiological studies should be conducted to assess CHD risk in Puerto Rico so that public health initiatives to reduce this risk might be proposed.

  10. Cloud-Based Smart Health Monitoring System for Automatic Cardiovascular and Fall Risk Assessment in Hypertensive Patients.

    PubMed

    Melillo, P; Orrico, A; Scala, P; Crispino, F; Pecchia, L

    2015-10-01

    The aim of this paper is to describe the design and the preliminary validation of a platform developed to collect and automatically analyze biomedical signals for risk assessment of vascular events and falls in hypertensive patients. This m-health platform, based on cloud computing, was designed to be flexible, extensible, and transparent, and to provide proactive remote monitoring via data-mining functionalities. A retrospective study was conducted to train and test the platform. The developed system was able to predict a future vascular event within the next 12 months with an accuracy rate of 84 % and to identify fallers with an accuracy rate of 72 %. In an ongoing prospective trial, almost all the recruited patients accepted favorably the system with a limited rate of inadherences causing data losses (<20 %). The developed platform supported clinical decision by processing tele-monitored data and providing quick and accurate risk assessment of vascular events and falls.

  11. Cardiovascular risk assessment in diabetes mellitus: comparison of the general Framingham risk profile versus the World Health Organization/International Society of Hypertension risk prediction charts in Arabs--clinical implications.

    PubMed

    Al-Lawati, Jawad A; Barakat, Mohammed N; Al-Lawati, Najla A; Al-Maskari, Masoud Y; Elsayed, Medhat K; Mikhailidis, Dimitri P; Al-Zakwani, Ibrahim S

    2013-07-01

    We estimated the prevalence of cardiovascular disease (CVD) risk and its clinical implications among 1 110 Omani patients with type 2 diabetes mellitus (DM) using 2 different CVD risk tools: the general Framingham risk profile (GFRP) and the joint World Health Organization/International Society of Hypertension (WHO/ISH) risk prediction charts. The GFRP tool identified higher proportion of patients compared with joint WHO/ISH tool at 10-year CVD risk 10% to <20% and at 20% to <30%. At CVD risk ≥30%, both assessment tools identified similar proportions of patients (22% vs 24%; P=.120). Compared with WHO/ISH charts, the GFRP identified almost double the number of men eligible for aspirin treatment at CVD risk thresholds of ≥10% (86% vs 43%). In women, the proportions were, 66% and 45%, respectively. For statins, the figures were, 60% and 37%, for men and 28% and 36%, for women. In conclusion, the GFRP overestimates the number of patients eligible for primary prevention of CVD compared with the joint WHO/ISH method.

  12. Lipoprotein metabolism indicators improve cardiovascular risk prediction

    USDA-ARS?s Scientific Manuscript database

    Background: Cardiovascular disease risk increases when lipoprotein metabolism is dysfunctional. We have developed a computational model able to derive indicators of lipoprotein production, lipolysis, and uptake processes from a single lipoprotein profile measurement. This is the first study to inves...

  13. Agreement in cardiovascular risk rating based on anthropometric parameters

    PubMed Central

    Dantas, Endilly Maria da Silva; Pinto, Cristiane Jordânia; Freitas, Rodrigo Pegado de Abreu; de Medeiros, Anna Cecília Queiroz

    2015-01-01

    Objective To investigate the agreement in evaluation of risk of developing cardiovascular diseases based on anthropometric parameters in young adults. Methods The study included 406 students, measuring weight, height, and waist and neck circumferences. Waist-to-height ratio and the conicity index. The kappa coefficient was used to assess agreement in risk classification for cardiovascular diseases. The positive and negative specific agreement values were calculated as well. The Pearson chi-square (χ2) test was used to assess associations between categorical variables (p<0.05). Results The majority of the parameters assessed (44%) showed slight (k=0.21 to 0.40) and/or poor agreement (k<0.20), with low values of negative specific agreement. The best agreement was observed between waist circumference and waist-to-height ratio both for the general population (k=0.88) and between sexes (k=0.93 to 0.86). There was a significant association (p<0.001) between the risk of cardiovascular diseases and females when using waist circumference and conicity index, and with males when using neck circumference. This resulted in a wide variation in the prevalence of cardiovascular disease risk (5.5%-36.5%), depending on the parameter and the sex that was assessed. Conclusion The results indicate variability in agreement in assessing risk for cardiovascular diseases, based on anthropometric parameters, and which also seems to be influenced by sex. Further studies in the Brazilian population are required to better understand this issue. PMID:26466060

  14. Assessment of cardiovascular risk in paediatric peritoneal dialysis patients: a Turkish Pediatric Peritoneal Dialysis Study Group (TUPEPD) report.

    PubMed

    Bakkaloglu, Sevcan A; Saygili, Arda; Sever, Lale; Noyan, Aytul; Akman, Sema; Ekim, Mesiha; Aksu, Nejat; Doganay, Beyza; Yildiz, Nurdan; Duzova, Ali; Soylu, Alper; Alpay, Harika; Sonmez, Ferah; Civilibal, Mahmut; Erdem, Sevcan; Kardelen, Firat

    2009-11-01

    We aimed to clarify arteriosclerotic risk and to document possible relationships between cardiovascular risk factors and echocardiographic parameters in paediatric peritoneal dialysis (PD) patients. M-mode/Doppler/tissue Doppler echocardiographic studies and lipid/lipoproteins, homocysteine, high-sensitivity C-reactive protein (HS-CRP) levels and carotid intima-media thickness (CIMT) were determined in 59 patients (age: 14.2 +/- 4.5 years) and in 36 healthy subjects. Structural and functional cardiac abnormalities were observed in patients on maintenance dialysis. Increased left ventricular mass index (LVMI, P = 0.000), relative wall thickness (P = 0.000), myocardial performance index (MPI, P = 0.000) were documented in the patients. Lipoprotein (a) (P = 0.000), homocysteine (P = 0.001), HS-CRP (P = 0.000) and CIMT (P = 0.000) were significantly elevated in the patients. Left ventricular hypertrophy (LVH) was prevalent in 68% of the patients. Patients with LVH had higher levels of HS-CRP (P = 0.001) and CIMT (P = 0.028) than those without LVH. Haemoglobin was an independent predictor of LVMI (beta: -8.9, P = 0.001), while residual diuresis and CIMT were independent predictors of diastolic dysfunction (beta: -0.45, P = 0.034 and beta: 5.90, P = 0.008, respectively). Albumin (beta: -0.72, P = 0.018) and Kt/V urea (beta: -0.48, P = 0.012) were significant predictors of CIMT. There were positive correlations between LVMI and CIMT. HS-CRP was positively correlated with LVMI as well as CIMT. Elevated levels of atherosclerotic/ inflammatory risk factors, low haemoglobin levels and loss of residual renal function and their negative effects on heart are of remarkable importance in paediatric patients on maintenance peritoneal dialysis. Achieving recommended targets for haemoglobin, blood pressure and Kt/V urea, preserving residual renal function as well as managing inflammation and subsequent arteriosclerosis is obviously essential to improve the patients' prognosis.

  15. Invasively Measured Aortic Systolic Blood Pressure and Office Systolic Blood Pressure in Cardiovascular Risk Assessment: A Prospective Cohort Study.

    PubMed

    Laugesen, Esben; Knudsen, Søren T; Hansen, Klavs W; Rossen, Niklas B; Jensen, Lisette Okkels; Hansen, Michael G; Munkholm, Henrik; Thomsen, Kristian K; Søndergaard, Hanne; Bøttcher, Morten; Raungaard, Bent; Madsen, Morten; Hulman, Adam; Witte, Daniel; Bøtker, Hans Erik; Poulsen, Per L

    2016-09-01

    Aortic systolic blood pressure (BP) represents the hemodynamic cardiac and cerebral burden more directly than office systolic BP. Whether invasively measured aortic systolic BP confers additional prognostic value beyond office BP remains debated. In this study, office systolic BP and invasively measured aortic systolic BP were recorded in 21 908 patients (mean age: 63 years; 58% men; 14% with diabetes mellitus) with stable angina pectoris undergoing elective coronary angiography during January 2001 to December 2012. Multivariate Cox models were used to assess the association with incident myocardial infarction, stroke, and death. Discrimination and reclassification were assessed using Harrell's C and the Continuous Net Reclassification Index. Data were analyzed with and without stratification by diabetes mellitus status. During a median follow-up period of 3.7 years (range: 0.1-10.8 years), 422 strokes, 511 myocardial infarctions, and 1530 deaths occurred. Both office and aortic systolic BP were associated with stroke in patients with diabetes mellitus (hazard ratio per 10 mm Hg, 1.18 [95% confidence interval, 1.07-1.30] and 1.14 [95% confidence interval, 1.05-1.24], respectively) and with myocardial infarction in patients without diabetes mellitus (hazard ratio, 1.07 [95% confidence interval, 1.02-1.12] and 1.05 [95% confidence interval, 1.01-1.10], respectively). In models including both BP measurements, aortic BP lost statistical significance and aortic BP did not confer improvement in either C-statistics or net reclassification analysis. In conclusion, invasively measured aortic systolic BP does not add prognostic information about cardiovascular outcomes and all-cause mortality compared with office BP in patients with stable angina pectoris, either with or without diabetes mellitus. © 2016 American Heart Association, Inc.

  16. The BioImage Study: novel approaches to risk assessment in the primary prevention of atherosclerotic cardiovascular disease--study design and objectives.

    PubMed

    Muntendam, Pieter; McCall, Carol; Sanz, Javier; Falk, Erling; Fuster, Valentin

    2010-07-01

    The identification of asymptomatic individuals at risk for near-term atherothrombotic events to ensure optimal preventive treatment remains a challenging goal. In the BioImage Study, novel approaches are tested in a typical health-plan population. Based on certain demographic and risk characteristics on file with Humana Inc, a total of 7,687 men 55 to 80 years of age and women 60 to 80 years of age without evidence of atherothrombotic disease but presumed to be at risk for near-term atherothrombotic events were enrolled between January 2008 and June 2009. Those who met the prespecified eligibility criteria were randomized to a telephonic health survey only (survey only: n = 865), standard risk assessment (Framingham only: n = 718), or comprehensive risk assessment in a dedicated mobile facility equipped with advanced imaging tools (n = 6,104). Baseline examination included assessment of cardiovascular risk factors and screening for subclinical (asymptomatic) atherosclerosis with quantification of coronary artery calcification by computed tomography (CT), measurement of intima-media thickness, presence of carotid atherosclerotic plaques and abdominal aortic aneurysm by ultrasound, and ankle brachial index. Participants with one or more abnormal screening test results underwent advanced imaging with contrast-enhanced magnetic resonance imaging for carotid and aortic plaques, contrast-enhanced coronary CT angiography for luminal stenosis and noncalcified plaques, and 18F-fluorodeoxyglucose-positron emission tomography/CT for carotid and aortic plaque inflammation. Plasma, PAXgene RNA, and DNA samples were obtained, frozen, and stored for future biomarker discovery studies. All individuals will be followed until 600 major atherothrombotic events have occurred in those undergoing imaging. The BioImage Study will help identify those patients with subclinical atherosclerosis who are at risk for near-term atherothrombotic events and enable a more personalized management of

  17. Anthropometric indices as measures of body fat assessed by DXA in relation to cardiovascular risk factors in children and adolescents: NHANES 1999-2004

    PubMed Central

    Cui, Zhaohui; Truesdale, Kimberly P; Cai, Jianwen; Koontz, Michaela B; Stevens, June

    2015-01-01

    Objective Anthropometrics are commonly used indices of total and central adiposity. No study has compared anthropometric measurements to dual-energy X-ray absorptiometry (DXA) measurements as correlates of cardiovascular risks in a nationally representative sample of youth. We aimed to evaluate the validity of anthropometrics compared to DXA-assessed adiposity in relation to cardiovascular risks in youth aged 8-19 years. Methods Data were from the National Health and Nutrition Examination Survey 1999-2004 (n=7013). We examined the correlations between anthropometric and DXA measures of adiposity (i.e., body mass index (BMI) versus percent fat mass (%FM) and fat mass index, and waist circumference (WC) and waist-to-height ratio (WHtR) versus percent trunk fat mass (%TFM)) with nine cardiovascular risks, stratified by sex and age, or race-ethnicity. Results Anthropometric and DXA adiposity measures were significantly correlated with insulin (r: 0.48 to 0.66), C-reactive protein (r: 0.47 to 0.58), triglycerides (r: 0.15 to 0.41), high-density lipoprotein cholesterol (HDL-C, r: −0.44 to −0.22), systolic blood pressure (SBP, r: 0.10 to 0.31), low-density lipoprotein cholesterol (r: 0.09 to 0.30), total cholesterol (TC, r: 0.01 to 0.29) and glucose (r: 0.05 to 0.20). Only in all youth, BMI was more strongly correlated with SBP (0.22 vs. 0.12, P<0.0001) and HDL-C (−0.34 vs. −0.25, P<0.0001) than %FM; WC but not WHtR was more strongly correlated with HDL-C (−0.37 vs. −0.30, P<0.0001) but less strongly associated with TC (0.12 vs. 0.21, P<0.0001) than %TFM. Conclusions DXA adiposity measures do not produce stronger associations with cardiovascular risk factors in youth than BMI or WC. PMID:26405434

  18. Cardiovascular risk score and cardiovascular events among airline pilots: a case-control study.

    PubMed

    Wirawan, I Made Ady; Larsen, Peter D; Aldington, Sarah; Griffiths, Robin F; Ellis, Chris J

    2012-05-01

    A cardiovascular risk prediction score is routinely applied by aviation authorities worldwide. We examined the accuracy of the Framingham-based risk chart used by the New Zealand Civil Aviation Authority in predicting cardiovascular events among airline pilots. A matched case-control design was applied to assess the association of 5-yr cardiovascular risk score and cardiovascular events in Oceania-based airline pilots. Cases were pilots with cardiovascular events as recorded on their medical records. Each case was age and gender matched with four controls that were randomly selected from the pilot population. To collect data before the events, 5-yr retrospective evaluations were conducted. Over a 16-yr study period we identified 15 cases of cardiovascular events, 9 (60%) of which were sudden clinical presentations and only 6 (40%) of which were detected using cardiovascular screening. There were 8 cases (53%) and 16 controls (27%) who had a 5-yr risk of > or = 10-15%. Almost half of the events (7/15) occurred in pilots whose highest 5-yr risk was in the 5-10% range. Cases were 3.91 times more likely to have highest 5-yr risk score of > or =10-15% than controls (OR = 3.91, 95% CI 1.04-16.35). The accuracy of the highest risk scores were moderate (AUC = 0.723, 95% CI 0.583-0.863). The cutoff point of 10% is valid, with a specificity of 0.73, but low sensitivity (0.53). Despite a valid and appropriate cutoff point, the tool had low sensitivity and was unable to predict almost half of the cardiovascular events.

  19. Estimating change in cardiovascular disease and diabetes burdens due to dietary and metabolic factors in Korea 1998–2011: a comparative risk assessment analysis

    PubMed Central

    Cho, Yoonsu; Cudhea, Frederick; Park, Ju-Hyun; Lee, Jong-Tae; Mozaffarian, Dariush; Singh, Gitanjali

    2016-01-01

    Objectives Over the past 10 years, the burden of chronic diseases in Korea has increased. However, there are currently no quantitative estimates of how changes in diet and metabolic factors have contributed to these shifting burdens. This study aims to evaluate the contributions of dietary and metabolic risk factors to death from cardiometabolic diseases (CMDs) such as cardiovascular conditions, strokes and diabetes in Korea, and to estimate how these contributions have changed over the past 10 years (1998–2011). Design and methods We used data on 6 dietary and 4 metabolic risk factors by sex, age and year from the Korea National Health and Nutrition Examination Survey. The relative risks for the effects of the risk factors on CMD mortality were obtained from meta-analyses. The population-attributable fraction attributable to the risk factors was calculated by using a comparative risk assessment approach across sex and age strata (males and females, age groups 25–34, 35–44, 45–54, 55–64, 65–74 and 75+ years) from 1998 to 2011. Results The results showed that a suboptimal diet and high blood pressure were the main risk factors for CMD mortality in Korea. High blood pressure accounted for 127 096 (95% uncertainty interval (UI): 121 907 to 132 218) deaths from CMD. Among the individual dietary risk factors, a high intake of sodium (42 387 deaths; 95% UI: 42 387 to 65 094) and a low intake of fruit (50 244 deaths; 95% UI: 40 981 to 59 178) and whole grains (54 248 deaths; 95% UI: 47 020 to 61 343) were responsible for the highest number of CMD deaths in Korea. Conclusions Indicating the relative importance of risk factors in Korea, the results suggest that metabolic and dietary risk factors were major contributors to CMD mortality. PMID:28003293

  20. Relationship Between Sedentary Behavior and Cardiovascular Risk.

    PubMed

    Same, Robert V; Feldman, David I; Shah, Nishant; Martin, Seth S; Al Rifai, Mahmoud; Blaha, Michael J; Graham, Garth; Ahmed, Haitham M

    2016-01-01

    The majority of adults do not meet current guideline recommendations for moderate to vigorous physical activity. Recent research has linked a high amount of sedentary behavior with an increased risk of obesity, diabetes, the metabolic syndrome, cardiovascular disease, and death. This correlation with sedentary behavior even extends to individuals who meet recommended physical activity goals during the remainder of their day, which implies that sedentary behavior may represent a distinct cardiovascular risk factor that is independent of the overall amount of physical activity. During the past several years, there has been significant interest in identifying and understanding the mechanisms through which sedentary behavior affects cardiovascular health. In this review, we critically evaluate the literature pertaining to sedentary behavior and cardiovascular risk with an emphasis on studies published over the past year, and we suggest possible interventions that may help reduce sedentary behavior time.

  1. Modified lipoproteins as biomarkers of cardiovascular risk in diabetes mellitus.

    PubMed

    Sánchez-Quesada, José Luis; Pérez, Antonio

    2013-11-01

    Prevention of high incidence of cardiovascular disease in diabetes is one of the challenges of endocrinology. Validation of new biomarkers that may contribute to a better assessment of cardiovascular risk and help implement treatment strategies is one of the promising approaches in research on prevention and reduction of cardiovascular risk. Modification of low density lipoprotein (LDL) is a key element in development of atherosclerotic lesions. Several pathophysiological characteristics of diabetes are crucial for the LDL of these patients to have higher modification rates as compared to the healthy population. Diabetic dyslipidemia, hyperglycemia, and oxidative stress synergistically promote the occurrence of lipoperoxidation, glycosylation and glycoxidation processes, which will generate modified lipoproteins that stimulate development of atherosclerosis. This article reviews the role of different types of modified LDL in development of atherosclerosis in diabetes, as well as the possibility of using its quantification in cardiovascular risk prediction. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  2. [Cardiovascular risk factors in young people].

    PubMed

    Sánchez-Contreras, Mónica; Moreno-Gómez, Germán A; Marín-Grisales, Marta E; García-Ortiz, Luis H

    2009-01-01

    Cardiovascular disease (CVD) involves several disorders related to the formation and development of atherosclerotic processes. Several risk factors are involved in CVD aetiology; some of them (i.e. age, hypertension, obesity, dislipidemia and diabetes) have been clearly associated, whereas others have a variable level of association. An increase in cardiovascular risk factors has been recently reported in the young population; studies of cardiovascular risk factors in this population have shown that its cardiovascular risk profile could be different from that presented by older populations. This review presents a summary of reported cardiovascular risk factors in the young population and their causes which have been released and indexed in different databases. Most factors discussed are life-habit risk factors and represent direct targets for clinical intervention. We propose that primary CVD prevention should include a more detailed knowledge of the nature of the risk factors concerning the young population and could have a positive impact on CVD prevalence during the next few years.

  3. Estimating Cardiovascular Risk in Spain by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice.

    PubMed

    Amor, Antonio Jesús; Masana, Luis; Soriguer, Federico; Goday, Albert; Calle-Pascual, Alfonso; Gaztambide, Sonia; Rojo-Martínez, Gemma; Valdés, Sergio; Gomis, Ramón; Ortega, Emilio

    2015-05-01

    There are no nationwide, population-based studies in Spain assessing overall cardiovascular risk. We aimed to describe cardiovascular risk and achievement of treatment goals following the 2012 European Guidelines on cardiovascular disease prevention strategy. We also investigated clinical characteristics (non-classical risk factors) associated with moderate risk. Participants (n=2310, 58% women) aged 40 to 65 years from a national population-based study (Di@bet.es Study) were identified. First, a priori high/very-high risk individuals were identified. Next, total cardiovascular risk (Systematic Coronary Risk Evaluation equation including high-density lipoprotein cholesterol) was used to assess risk of a priori non-high risk individuals. Variables independently associated with moderate versus low-risk were investigated by multiple logistic regression analysis. Age-and-sex standardized (direct method) percentages of high/very-high, moderate, and low-risk were 22.8%, 43.5%, and 33.7%, respectively. Most men were at moderate (56.2%), while 55.4% of women were at low risk. Low-density lipoprotein cholesterol (< 70,<100, < 115 mg/dL) and blood pressure (<140/90 mmHg) goals for very-high, high and moderate risk were met in 15%, 26% and 46%, and 77%, 68% and 85% of the individuals, respectively. Body mass index, high triglycerides concentrations, diastolic blood pressure, and low Mediterranean diet adherence (in women) were independently associated with moderate (versus low) risk. Cardiovascular risk in Spain is mainly moderate in men and low in women. Achievement of treatment goals in high-risk individuals should be improved. The prevalence of non-classical cardiovascular risk factors is elevated in subjects at moderate risk, an important aspect to consider in a population-based strategy to decrease cardiovascular disease in the most prevalent group. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  4. Cardiovascular risk in nonobese hypertensive adolescents: a study based on plasma biomarkers and ultrasonographic assessment of early atherosclerosis.

    PubMed

    Głowińska-Olszewska, B; Tołwińska, J; Łuczyński, W; Konstantynowicz, J; Bossowski, A

    2013-03-01

    The objective of this study was to investigate the vascular status, left-ventricular mass and biomarkers of endothelial activation in hypertensive (HT) adolescents, with particular attention to comparing nonobese with obese patients. Seventy-nine newly diagnosed HT adolescents aged 15.1±2.1 years (divided into 34 nonobese and 45 obese) were compared with 35 healthy volunteers. Intima-media thickness (IMT), flow-mediated dilation (FMD) and left-ventricular mass index (LVMi) were determined using ultrasound. Adhesion molecules and inflammatory interleukins (ILs), together with lipids and insulin resistance (HOMA), were also studied. HT obese adolescents had higher triglycerides, HOMA, and elevated levels of interleukin-6, tumor necrosis factor-α, soluble intercellular adhesion molecule-1 and soluble E-selectin compared with controls and nonobese HT patients. FMD was lower in HT groups (8.5±4.5% in nonobese, P=0.004; 8.1±4.9%, P=0.01 in obese vs 12.5±4.9%; in control), and IMT was higher (0.52±0.06 mm, P<0.001 in nonobese; 0.54±0.05 mm, P<0.001 in obese vs 0.42±0.05 mm in control). Higher LVMi was found in both HT groups, with the highest value in the nonobese group being 37.8±5.3 g m(-2.7) vs 28.4±5.3 g m(-2.7) in controls (P=0.003). In conclusion, nonobese HT adolescents had the same early cardiovascular deteriorations assessed ultrasonographically as their obese HT peers, although metabolic alterations and endothelial activation measured as plasma biomarkers were more pronounced in obese individuals. The potential mechanisms of early atherosclerosis in nonobese HT adolescents need further evaluation in prospective studies because these factors may differ considerably from those found in young obese individuals with HT.

  5. EULAR task force recommendations on annual cardiovascular risk assessment for patients with rheumatoid arthritis: an audit of the success of implementation in a rheumatology outpatient clinic.

    PubMed

    Ikdahl, Eirik; Rollefstad, Silvia; Olsen, Inge C; Kvien, Tore K; Hansen, Inger Johanne Widding; Soldal, Dag Magnar; Haugeberg, Glenn; Semb, Anne Grete

    2015-01-01

    EULAR recommendations for cardiovascular disease (CVD) risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA). We evaluated the recording of CVD risk factors (CVD-RF) in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC) and a structured arthritis clinic (AC). In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE): 21.0. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients.

  6. EULAR Task Force Recommendations on Annual Cardiovascular Risk Assessment for Patients with Rheumatoid Arthritis: An Audit of the Success of Implementation in a Rheumatology Outpatient Clinic

    PubMed Central

    Ikdahl, Eirik; Rollefstad, Silvia; Olsen, Inge C.; Kvien, Tore K.; Hansen, Inger Johanne Widding; Soldal, Dag Magnar; Haugeberg, Glenn; Semb, Anne Grete

    2015-01-01

    Objective. EULAR recommendations for cardiovascular disease (CVD) risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA). We evaluated the recording of CVD risk factors (CVD-RF) in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC) and a structured arthritis clinic (AC). Methods. In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. Results. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE): 21.0. Conclusion. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients. PMID:25815322

  7. Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardio-metabolic risk factors between 1980 and 2010: comparative risk assessment

    PubMed Central

    2015-01-01

    Summary Background Elevated blood pressure and glucose, serum cholesterol, and body mass index (BMI) are risk factors for cardiovascular diseases (CVDs); some of these factors also increase the risk of chronic kidney disease (CKD) and diabetes. We estimated CVD, CKD, and diabetes mortality attributable to these four cardio-metabolic risk factors for all countries and regions between 1980 and 2010. Methods We used data on risk factor exposure by country, age group, and sex from pooled analysis of population-based health surveys. Relative risks for cause-specific mortality were obtained from pooling of large prospective studies. We calculated the population attributable fractions (PAF) for each risk factor alone, and for the combination of all risk factors, accounting for multi-causality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific PAFs by the number of disease-specific deaths from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all inputs to the final estimates. Findings In 2010, high blood pressure was the leading risk factor for dying from CVDs, CKD, and diabetes in every region, causing over 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths; and cholesterol for 10%. After accounting for multi-causality, 63% (10.8 million deaths; 95% confidence interval 10.1–11.5) of deaths from these diseases were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7.1 million deaths; 6.6–7.6) in 1980. The mortality burden of high BMI and glucose nearly doubled between 1980 and 2010. At the country level, age-standardised death rates attributable to these four risk factors surpassed 925 deaths per 100,000 among men in Belarus, Mongolia, and Kazakhstan, but were below 130 deaths per 100,000 for women and below 200 for men in some

  8. Integrative Treatments to Reduce Risk for Cardiovascular Disease

    PubMed Central

    Bradley, Ryan; Oberg, Erica

    2010-01-01

    Recognizing the contribution and interrelatedness of lipoprotein risk factors is critical to prioritizing treatment strategies for cardiovascular risk reduction. Lipoprotein factors still dominate risk for developing cardiovascular disease, including myocardial infarction. Some emerging risk factors such as C-reactive protein are gaining acceptance due to recent prospective clinical trials demonstrating clinical benefit in reducing these markers. Other emerging risk factors, including lipoprotein particle size, remain to be validated. In this second article of a 2-part series, we will begin with a review of formal risk assessment, discussing the contribution of multiple “risky” and “healthy” components that play a part in overall cardiovascular health. Following risk assessment, we will discuss evidence-based integrative therapies that can be used to modify any risky lipoprotein and inflammatory patient profiles, including medications, functional foods, supplements, and lifestyle approaches. The focus is on low-density lipoproteins, high-density lipoproteins, triglycerides, and C-reactive protein. Understanding the interrelatedness of lipoprotein risk factors, and finding efficient methods of treating multiple risk factors simultaneously, will not only improve the long-term health of patients but will also save on the expenditure of healthcare dollars for unnecessary testing and ineffective treatments. Integrative practitioners who understand the contribution of lifestyle factors, and who have numerous effective treatment options at their disposal, are well positioned to counsel patients on cardiovascular disease prevention. PMID:21461347

  9. Integrated Clinical Decision Support Systems Promote Absolute Cardiovascular Risk Assessment: An Important Primary Prevention Measure in Aboriginal and Torres Strait Islander Primary Health Care.

    PubMed

    Matthews, Veronica; Burgess, Christopher P; Connors, Christine; Moore, Elizabeth; Peiris, David; Scrimgeour, David; Thompson, Sandra C; Larkins, Sarah; Bailie, Ross

    2017-01-01

    Aboriginal and Torres Strait Islander Australians experience a greater burden of disease compared to non-Indigenous Australians. Around one-fifth of the health disparity is caused by cardiovascular disease (CVD). Despite the importance of absolute cardiovascular risk assessment (CVRA) as a screening and early intervention tool, few studies have reported its use within the Australian Indigenous primary health care (PHC) sector. This study utilizes data from a large-scale quality improvement program to examine variation in documented CVRA as a primary prevention strategy for individuals without prior CVD across four Australian jurisdictions. We also examine the proportion with elevated risk and follow-up actions recorded. We undertook cross-sectional analysis of 2,052 client records from 97 PHC centers to assess CVRA in Indigenous adults aged ≥20 years with no recorded chronic disease diagnosis (2012-2014). Multilevel regression was used to quantify the variation in CVRA attributable to health center and client level factors. The main outcome measure was the proportion of eligible adults who had CVRA recorded. Secondary outcomes were the proportion of clients with elevated risk that had follow-up actions recorded. Approximately 23% (n = 478) of eligible clients had documented CVRA. Almost all assessments (99%) were conducted in the Northern Territory. Within this jurisdiction, there was wide variation between centers in the proportion of clients with documented CVRA (median 38%; range 0-86%). Regression analysis showed health center factors accounted for 48% of the variation. Centers with integrated clinical decision support systems were more likely to document CVRA (OR 21.1; 95% CI 5.4-82.4; p < 0.001). Eleven percent (n = 53) of clients were found with moderate/high CVD risk, of whom almost one-third were under 35 years (n = 16). Documentation of follow-up varied with respect to the targeted risk factor. Fewer than 30% with abnormal blood

  10. Randomised controlled pilot study to assess the feasibility of a Mediterranean Portfolio dietary intervention for cardiovascular risk reduction in HIV dyslipidaemia: a study protocol.

    PubMed

    Stradling, Clare; Thomas, G Neil; Hemming, Karla; Frost, Gary; Garcia-Perez, Isabel; Redwood, Sabi; Taheri, Shahrad

    2016-02-08

    HIV drug treatment has greatly improved life expectancy, but increased risk of cardiovascular disease remains, potentially due to the additional burdens of infection, inflammation and antiretroviral treatment. The Mediterranean Diet has been shown to reduce cardiovascular risk and mortality in the general population, but no evidence exists for this effect in the HIV population. This study will explore the feasibility of a randomised controlled trial (RCT) to examine whether a Mediterranean-style diet that incorporates a portfolio of cholesterol-lowering foods, reduces cardiovascular risk in people with HIV dyslipidaemia. 60 adults with stable HIV infection on antiretroviral treatment and low-density lipoprotein cholesterol >3 mmol/L will be recruited from 3 West Midlands HIV services. Participants will be randomised 1:1 to 1 of 2 dietary interventions, with stratification by gender and smoking status. Participants allocated to Diet1 will receive advice to reduce saturated fat intake, and those to Diet2 on how to adopt the Mediterranean Portfolio Diet with additional cholesterol-lowering foods (nuts, stanols, soya, oats, pulses). Measurements of fasting blood lipids, body composition and arterial stiffness will be conducted at baseline, and month 6 and 12 of the intervention. Food intake will be assessed using the Mediterranean Diet Score, 3-day food diaries and metabolomic biomarkers. Questionnaires will be used to assess quality of life and process evaluation. Qualitative interviews will explore barriers and facilitators to making dietary changes, and participant views on the intervention. Qualitative data will be analysed using the Framework Method. Feasibility will be assessed in terms of trial recruitment, retention, compliance to study visits and the intervention. SD of outcomes will inform the power calculation of the definitive RCT. The West Midlands Ethics Committee has approved this study and informed consent forms. This trial is the first to test

  11. Androgen deprivation therapy and cardiovascular risk.

    PubMed

    Punnen, Sanoj; Cooperberg, Matthew R; Sadetsky, Natalia; Carroll, Peter R

    2011-09-10

    The potential association between androgen deprivation therapy (ADT) and cardiovascular mortality (CVM) remains controversial. This study assessed mortality outcomes in a large national registry to further elucidate the association between treatment selection and cause of mortality. A total of 7,248 men in the CaPSURE registry were analyzed. Treatment was categorized as local only, primary ADT monotherapy, local treatment plus ADT, and watchful waiting/active surveillance (WW/AS). Competing hazards survival analysis was performed for prostate cancer-specific mortality (PCSM), CVM, and all-cause mortality. A propensity score-adjusted and a propensity-matched analysis were undertaken to adjust for imbalances in covariates among men receiving various treatments. Patients treated with ADT or WW/AS had a higher likelihood of PCSM than those treated with local therapy alone. Patients treated with primary ADT had an almost two-fold greater likelihood of CVM (HR, 1.94; 95% CI, 1.29 to 2.97) than those treated with local therapy alone; however, patients treated with WW/AS had a greater than two-fold increased risk of CVM (HR, 2.46; 95% CI, 1.53 to 3.95). A propensity-matching algorithm in a subset of 1,391 patients was unable to find a significant difference in CVM between those who did or did not receive ADT. Patients matched on propensity to receive ADT did not show an association between ADT and CVM. This suggests that potential unmeasured variables affecting treatment selection may confound the relationship between ADT use and cardiovascular risk. However, an association may yet exist, because the propensity score could not include all known risk factors for CVM.

  12. Cardiovascular Risk Factors in Severely Obese Adolescents

    PubMed Central

    Michalsky, Marc P.; Inge, Thomas H.; Simmons, Mark; Jenkins, Todd M.; Buncher, Ralph; Helmrath, Michael; Brandt, Mary L.; Harmon, Carroll M.; Courcoulas, Anita; Chen, Michael; Horlick, Mary; Daniels, Stephen R.; Urbina, Elaine M.

    2015-01-01

    IMPORTANCE Severe obesity is increasingly common in the adolescent population but, as of yet, very little information exists regarding cardiovascular disease (CVD) risks in this group. OBJECTIVE To assess the baseline prevalence and predictors of CVD risks among severely obese adolescents undergoing weight-loss surgery. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study was conducted from February 28, 2007, to December 30, 2011, at the following 5 adolescent weight-loss surgery centers in the United States: Nationwide Children’s Hospital in Columbus, Ohio; Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio; Texas Children’s Hospital in Houston; University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania; and Children’s Hospital of Alabama in Birmingham. Consecutive patients aged 19 years or younger were offered enrollment in a long-term outcome study; the final analysis cohort consisted of 242 participants. MAIN OUTCOMES AND MEASURES This report examined the preoperative prevalence of CVD risk factors (ie, fasting hyperinsulinemia, elevated high-sensitivity C-reactive protein levels, impaired fasting glucose levels, dyslipidemia, elevated blood pressure, and diabetes mellitus) and associations between risk factors and body mass index (calculated as weight in kilograms divided by height in meters squared), age, sex, and race/ethnicity. Preoperative data were collected within 30 days preceding bariatric surgery. RESULTS The mean (SD) age was 17 (1.6) years and median body mass index was 50.5. Cardiovascular disease risk factor prevalence was fasting hyperinsulinemia (74%), elevated high-sensitivity C-reactive protein levels (75%), dyslipidemia (50%), elevated blood pressure (49%), impaired fasting glucose levels (26%), and diabetes mellitus (14%). The risk of impaired fasting glucose levels, elevated blood pressure, and elevated high-sensitivity C-reactive protein levels increased by 15%, 10%, and 6%, respectively, per 5-unit

  13. The Wild Wild West: A Framework to Integrate mHealth Software Applications and Wearables to Support Physical Activity Assessment, Counseling and Interventions for Cardiovascular Disease Risk Reduction

    PubMed Central

    Lobelo, Felipe; Kelli, Heval M.; Tejedor, Sheri Chernetsky; Pratt, Michael; McConnell, Michael V.; Martin, Seth S.; Welk, Gregory J.

    2017-01-01

    Physical activity (PA) interventions constitute a critical component of cardiovascular disease (CVD) risk reduction programs. Objective mobile health (mHealth) software applications (apps) and wearable activity monitors (WAMs) can advance both assessment and integration of PA counseling in clinical settings and support community-based PA interventions. The use of mHealth technology for CVD risk reduction is promising, but integration into routine clinical care and population health management has proven challenging. The increasing diversity of available technologies and the lack of a comprehensive guiding framework are key barriers for standardizing data collection and integration. This paper reviews the validity, utility and feasibility of implementing mHealth technology in clinical settings and proposes an organizational framework to support PA assessment, counseling and referrals to community resources for CVD risk reduction interventions. This integration framework can be adapted to different clinical population needs. It should also be refined as technologies and regulations advance under an evolving health care system landscape in the United States and globally. PMID:26923067

  14. The Wild Wild West: A Framework to Integrate mHealth Software Applications and Wearables to Support Physical Activity Assessment, Counseling and Interventions for Cardiovascular Disease Risk Reduction.

    PubMed

    Lobelo, Felipe; Kelli, Heval M; Tejedor, Sheri Chernetsky; Pratt, Michael; McConnell, Michael V; Martin, Seth S; Welk, Gregory J

    2016-01-01

    Physical activity (PA) interventions constitute a critical component of cardiovascular disease (CVD) risk reduction programs. Objective mobile health (mHealth) software applications (apps) and wearable activity monitors (WAMs) can advance both assessment and integration of PA counseling in clinical settings and support community-based PA interventions. The use of mHealth technology for CVD risk reduction is promising, but integration into routine clinical care and population health management has proven challenging. The increasing diversity of available technologies and the lack of a comprehensive guiding framework are key barriers for standardizing data collection and integration. This paper reviews the validity, utility and feasibility of implementing mHealth technology in clinical settings and proposes an organizational framework to support PA assessment, counseling and referrals to community resources for CVD risk reduction interventions. This integration framework can be adapted to different clinical population needs. It should also be refined as technologies and regulations advance under an evolving health care system landscape in the United States and globally. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Cardiovascular disease risk stratification and comparison in a California population.

    PubMed

    Lin, Z; Meng, Y-Y; Leung, K-M; Jatulis, D E; Welsh, N J; Zaher, C A; Legorreta, A P

    2001-01-01

    This study was designed to identify the need for primary prevention of cardiovascular disease in an HMO population and to develop appropriate interventions for individuals in different risk groups, based on risk stratification and comparison. The analysis is based on a cross-sectional survey of the HMO members of a large employer group. Respondents (n=17,878) were stratified based on the Framingham model; 34% of respondents without cardiovascular disease were classified as moderate to high attributable risk for the disease, and 66% were classified as low attributable risk. Results of logistic regression analyses suggest that, compared with respondents with pre-existing cardiovascular disease, moderate- to high-risk respondents are more likely to smoke, have unhealthy diets, and be overweight, hypertensive, and hypercholesterolemic. More low-risk respondents had unhealthy diets than did those with pre-existing cardiovascular disease. There were no differences between these groups for physical activity and stress. Respondents had fewer modifiable risk factors and healthier lifestyles than did those who were at risk. These findings suggest that primary prevention should be enhanced, especially among those with significantly increased risk for the disease. Moreover, the approaches of this project-population-based risk assessment, stratification, and comparison-were instrumental in identifying the target population and designing appropriate interventions. (c) 2001 by CHF, Inc.

  16. Bariatric surgery, lipoprotein metabolism and cardiovascular risk.

    PubMed

    Tailleux, Anne; Rouskas, Konstantinos; Pattou, François; Staels, Bart

    2015-08-01

    To summarize recent epidemiological, preclinical and clinical studies on the effects of Roux-en-Y-gastric bypass (RYGBP) surgery on cardiovascular risk factors and the underlying mechanisms. Although RYGBP has mechanical effects on the gastrointestinal tract, the reduced gastric pouch and intestinal calorie absorption cannot fully explain the metabolic improvements. Obesity predisposes to cardiovascular risk factors such as dyslipidemia, type 2 diabetes, nonalcoholic fatty liver disease and hypertension. In contrast to the limited success of pharmacological and lifestyle interventions, RYGBP induces sustained weight loss, metabolic improvements and decreases morbidity/mortality. In line, RYGBP reduces cardiovascular risk factors. Although the mechanisms are not entirely understood, RYGBP induces complex changes in the gut affecting other organs through endocrine and metabolic signals from the intestine to all key metabolic organs, which can link RYGBP and decreased cardiovascular risk. Here, we discuss the roles of changes in lipid absorption and metabolism, bile acid metabolism, gut hormones and the microbiote as potential mechanisms in the decreased cardiovascular risk and metabolic improvement after RYGBP.

  17. Cardiovascular disease risk in women with migraine.

    PubMed

    Rockett, Fernanda Camboim; Perla, Alexandre da Silveira; Perry, Ingrid D Schweigert; Chaves, Márcia L Fagundes

    2013-09-06

    Studies suggest a higher prevalence of unfavourable cardiovascular risk factors amongst migraineurs, but results have been conflicting. The aim of this study was to investigate traditional and newly recognized risk factors as well as other surrogate markers of cardiovascular risk in obese and normal weight women with migraine. Fifty-nine adult female probands participated in this case-control study. The sample was divided into normal weight and obese migraineurs and age- and body mass index-matched control groups. The following cardiovascular risk factors were analyzed: serum levels of lipids, fasting glucose, and insulin; insulin resistance; blood pressure; smoking (categorized as current, past or never); Framingham 10-year risk of general cardiovascular disease score; C-reactive protein; family history of cardiovascular disease; physical activity; sleep disturbances; depression; and bioelectrical impedance phase angle. The means of continuous variables were compared using Student's t-test for independent samples or the Mann-Whitney U-test (for 2 groups) and ANOVA or the Kruskal-Wallis test (for 4 groups) depending on the distribution of data. All migraineurs were sedentary irrespective of nutritional status. Migraineurs had higher depression scores and shorter sleep duration, and obese migraineurs, in particular, had worse sleep quality scores. Insulin resistance and insulinaemia were associated with obesity, and obese migraineurs had lower HDL-c than normal weight controls and migraineurs. Also, the Framingham risk score was higher in obese migraineurs. These findings suggest that female migraineurs experience marked inactivity, depression, and some sleep disturbance, that higher insulin resistance and insulinaemia are related to obesity, and that obesity and migraine probably exert overlapping effects on HDL-c levels and Framingham 10-year cardiovascular risk.

  18. Cardiovascular disease risk in women with migraine

    PubMed Central

    2013-01-01

    Background Studies suggest a higher prevalence of unfavourable cardiovascular risk factors amongst migraineurs, but results have been conflicting. The aim of this study was to investigate traditional and newly recognized risk factors as well as other surrogate markers of cardiovascular risk in obese and normal weight women with migraine. Methods Fifty-nine adult female probands participated in this case–control study. The sample was divided into normal weight and obese migraineurs and age- and body mass index-matched control groups. The following cardiovascular risk factors were analyzed: serum levels of lipids, fasting glucose, and insulin; insulin resistance; blood pressure; smoking (categorized as current, past or never); Framingham 10-year risk of general cardiovascular disease score; C-reactive protein; family history of cardiovascular disease; physical activity; sleep disturbances; depression; and bioelectrical impedance phase angle. The means of continuous variables were compared using Student’s t-test for independent samples or the Mann–Whitney U-test (for 2 groups) and ANOVA or the Kruskal-Wallis test (for 4 groups) depending on the distribution of data. Results All migraineurs were sedentary irrespective of nutritional status. Migraineurs had higher depression scores and shorter sleep duration, and obese migraineurs, in particular, had worse sleep quality scores. Insulin resistance and insulinaemia were associated with obesity, and obese migraineurs had lower HDL-c than normal weight controls and migraineurs. Also, the Framingham risk score was higher in obese migraineurs. Conclusion These findings suggest that female migraineurs experience marked inactivity, depression, and some sleep disturbance, that higher insulin resistance and insulinaemia are related to obesity, and that obesity and migraine probably exert overlapping effects on HDL-c levels and Framingham 10-year cardiovascular risk. PMID:24011175

  19. Cardiovascular Technology Program Needs Assessment.

    ERIC Educational Resources Information Center

    Oakland Community Coll., Farmington, MI. Office of Institutional Planning and Analysis.

    In 1990/91, a study was conducted by Oakland Community College (OCC) to evaluate the need for a proposed Cardiovascular Technology program. Fifty-two local hospitals were surveyed to gather information on the employment demand, employment benefits and career preparation requirements for cardiovascular technologists (CVTs), yielding a 62% response…

  20. Framingham Risk Score underestimates cardiovascular disease risk in severe psoriatic patients: implications in cardiovascular risk factors management and primary prevention of cardiovascular disease.

    PubMed

    Torres, Tiago; Sales, Rita; Vasconcelos, Carlos; Martins da Silva, Berta; Selores, Manuela

    2013-11-01

    Severe psoriasis has been associated with increase cardiovascular mortality, due to a higher prevalence of traditional cardiovascular risk factors and premature atherosclerosis, as a consequence of its systemic inflammation. Recently, it has been estimated that severe psoriasis may confer an increased 6.2% on long-term risk of cardiovascular disease based on Framingham Risk Score, which can have practical implications in the treatment of cardiovascular risk factors and primary prevention of cardiovascular disease, as treatment guidelines account for the risk of cardiovascular disease in treatment goals. The aim of this study was to analyze the influence of the attributable risk of severe psoriasis on long-term risk of cardiovascular disease and its implication on the correct treatment of cardiovascular risk factors and primary prevention of cardiovascular disease on a real-world cohort of patients. One hundred severe psoriasis patients without psoriatic arthritis or previous cardiovascular disease were evaluated and it was found that more than half of the patients were reclassified to a higher cardiovascular risk category with important clinical implications on the correct management of their cardiovascular risk factors and primary prevention of cardiovascular disease, as a considerable proportion of patients with hypertension, hypercholesterolemia and coronary heart disease equivalent risk were not being correctly managed.

  1. Cardiovascular risk in hypertensive patients: results of the Pandora project.

    PubMed

    Cocchi, Roberto; Degli Esposti, Ezio; Ruffo, Pierfrancesco; Buda, Stefano; Valpiani, Giorgia; Sturani, Alessandra

    2002-01-01

    The aim of the Pandora project is to collect epidemiological information, check diagnostic and therapeutic pathways, and assess outcomes in a large hypertensive population. This report presents the results on patients enrolled in the study between 1997-1999. Twenty-one general practitioners working in the Ravenna Local Health Service took part in the study. They were supplied with IBM compatible PCs and were trained to enter the patient's data (age, gender, familiarity for cardiovascular diseases, smoking, hospitalisations for cardiovascular disorders, diabetes, blood pressure, total cholesterolemia, creatininemia, antihypertensive therapy) on So.Ge.Pa. software. Cardiovascular risk factors were assessed according to the WHO - ISH joint committee recommendations. 2,608 treated hypertensive patients were enrolled, 65% of whom showed inadequate blood pressure control. The prevalence of inadequate BP control was higher in patients on multiple-drug antihypertensive therapy compared with those on monotherapy (71.9% vs. 47.9%), in older than in younger patients (70.7% vs. 56.1%) and in patients with three cardiovascular risk factors, or diabetes, or affected target organs, compared to those with two or less risk factors (72.4% vs. 63.3%), (p < 0.001 for all). 63.6% of patients were at risk for age, 36.6% for family history of cardiovascular diseases and 31.7% for severe hypercholesterolemia. BP control was inadequate in a large percentage of patients, but it was particularly unsatisfactory in the elderly and in patients with high cardiovascular risk. A cluster of cardiovascular risk factors was found in both adequately and inadequately controlled hypertensive patients.

  2. Hormonal contraception and risk of cardiovascular disease. An international perspective.

    PubMed

    Farley, T M; Collins, J; Schlesselman, J J

    1998-03-01

    The most frequent major adverse effect of hormonal contraception is an increased risk of cardiovascular disease. The effect on the risk of venous thromboembolism (VTE), ischemic and hemorrhagic stroke, and myocardial infarction (MI) differs and is strongly influenced by smoking and the presence of other cardiovascular risks factors, such as hypertension and diabetes mellitus. The incidence of each disease rises with age and there are differences in risk among hormonal contraceptive preparations. This article provides a framework within which to assess the balance of risks among types of hormonal contraceptives according to individual circumstances. Data on cardiovascular disease mortality rates in women of reproductive age in different countries of the world were compiled from nationally reported statistics and supplemented where possible with reported disease incidence rates. Risks associated with current use of hormonal contraception were compiled from the most recent publications on the cardiovascular effects of steroid hormone contraception. These were combined to estimate the total cardiovascular incidence and mortality according to baseline cardiovascular risk and individual characteristics. Mortality rates for cardiovascular diseases are very low in women of reproductive age. Myocardial infarction mortality rates rise from < 0.4 per 100,000 woman-years at age 15-24 years to the range 2 to 7 per 100,000 woman-years at age 35-44 years. Stroke mortality rates similarly rise steeply with age and are between 3 and 5 times higher than those for MI. VTE mortality rates rise less steeply with age and are approximately one-tenth the MI mortality rates at age 35-44 years. The adverse effect of oral contraceptives (OC) on the risk of VTE is the most important contributor to the total number of cardiovascular cases attributable to OC use. The increased risk of stroke and MI dominate the patterns of mortality in OC users and smokers. The additional risks attributable to

  3. Credit scores, cardiovascular disease risk, and human capital

    PubMed Central

    Israel, Salomon; Caspi, Avshalom; Belsky, Daniel W.; Harrington, HonaLee; Hogan, Sean; Houts, Renate; Ramrakha, Sandhya; Sanders, Seth; Poulton, Richie; Moffitt, Terrie E.

    2014-01-01

    Credit scores are the most widely used instruments to assess whether or not a person is a financial risk. Credit scoring has been so successful that it has expanded beyond lending and into our everyday lives, even to inform how insurers evaluate our health. The pervasive application of credit scoring has outpaced knowledge about why credit scores are such useful indicators of individual behavior. Here we test if the same factors that lead to poor credit scores also lead to poor health. Following the Dunedin (New Zealand) Longitudinal Study cohort of 1,037 study members, we examined the association between credit scores and cardiovascular disease risk and the underlying factors that account for this association. We find that credit scores are negatively correlated with cardiovascular disease risk. Variation in household income was not sufficient to account for this association. Rather, individual differences in human capital factors—educational attainment, cognitive ability, and self-control—predicted both credit scores and cardiovascular disease risk and accounted for ∼45% of the correlation between credit scores and cardiovascular disease risk. Tracing human capital factors back to their childhood antecedents revealed that the characteristic attitudes, behaviors, and competencies children develop in their first decade of life account for a significant portion (∼22%) of the link between credit scores and cardiovascular disease risk at midlife. We discuss the implications of these findings for policy debates about data privacy, financial literacy, and early childhood interventions. PMID:25404329

  4. Credit scores, cardiovascular disease risk, and human capital.

    PubMed

    Israel, Salomon; Caspi, Avshalom; Belsky, Daniel W; Harrington, HonaLee; Hogan, Sean; Houts, Renate; Ramrakha, Sandhya; Sanders, Seth; Poulton, Richie; Moffitt, Terrie E

    2014-12-02

    Credit scores are the most widely used instruments to assess whether or not a person is a financial risk. Credit scoring has been so successful that it has expanded beyond lending and into our everyday lives, even to inform how insurers evaluate our health. The pervasive application of credit scoring has outpaced knowledge about why credit scores are such useful indicators of individual behavior. Here we test if the same factors that lead to poor credit scores also lead to poor health. Following the Dunedin (New Zealand) Longitudinal Study cohort of 1,037 study members, we examined the association between credit scores and cardiovascular disease risk and the underlying factors that account for this association. We find that credit scores are negatively correlated with cardiovascular disease risk. Variation in household income was not sufficient to account for this association. Rather, individual differences in human capital factors—educational attainment, cognitive ability, and self-control—predicted both credit scores and cardiovascular disease risk and accounted for ∼45% of the correlation between credit scores and cardiovascular disease risk. Tracing human capital factors back to their childhood antecedents revealed that the characteristic attitudes, behaviors, and competencies children develop in their first decade of life account for a significant portion (∼22%) of the link between credit scores and cardiovascular disease risk at midlife. We discuss the implications of these findings for policy debates about data privacy, financial literacy, and early childhood interventions.

  5. Barriers to women's cardiovascular risk knowledge.

    PubMed

    Liewer, Linda; Mains, Douglas A; Lykens, Kristine; René, Antonio A

    2008-01-01

    Cardiovascular disease (CVD) is the leading cause of death for women in the United States, resulting in a greater emphasis on research and methods for addressing issues relating to this health problem both nationally and worldwide. The authors' purpose was to identify barriers to women's cardiovascular risk knowledge, both personal and organizational, through key informant interviews of health leaders at 10 community health organizations. Analysis showed an overall lack of awareness of CVD risk for women. Culture, finance, and lack of awareness and easily accessible programs implicated the importance of physicians as health care providers and educators for women patients.

  6. Risk of Cardiovascular Disease Using Framingham Risk Score in Korean Cancer Survivors

    PubMed Central

    So, Ji-Hyun; Shin, Jin-Young; Park, Wan

    2016-01-01

    Background Cardiovascular disease is an important cause of morbidity and mortality in cancer survivors. The aim of this study was to investigate the modifiable cardiovascular disease risk factors and 10-year probability of the disease based on the Framingham risk score in cancer survivors, compared with the general population. Methods A total of 1,225 cancer survivors and 5,196 non-cancer controls who participated in the 2007–2013 Korea National Health and Nutrition Examination Surveys were enrolled. We assessed modifiable cardiovascular disease risk factors including smoking, body mass index, physical inactivity, high blood pressure, high cholesterol, and elevated blood glucose level. The 10-year probability of cardiovascular disease was determined by applying the Framingham cardiovascular disease risk equation among cancer survivors and non-cancer controls, ranging from 30 to 74 years old who had no overt cardiovascular diseases. Results The proportion of subjects who had higher fasting glucose levels, hemoglobin A1c levels, systolic blood pressure, and low density lipoprotein cholesterol levels, and those who had lower high density lipoprotein cholesterol levels was significantly higher in the cancer survivors than in the non-cancer controls. The average 10-year probability of cardiovascular disease among the cancer survivors was higher than that in the non-cancer controls in both men and women. The average 10-year probability of cardiovascular disease in relation to the cancer type was significantly higher in patients with hepatic, colon, lung, breast, and gastric cancer. Conclusion Cancer survivors have a higher cardiovascular disease risk and 10-year probability of cardiovascular disease than non-cancer controls. Control of cardiovascular disease risk factors and implementation of a well-defined cardiovascular disease prevention program are needed for treating cancer survivors. PMID:27468342

  7. Total adult cardiovascular risk in Central America.

    PubMed

    Barceló, A; Gregg, E W; Wong-McClure, R; Meiners, M; Ramirez-Zea, M; Segovia, J

    2015-12-01

    To evaluate prevalence of cardiovascular risk among adults 40 years and older using population-based samples from six Central American countries. Risk factors were derived from a multi-national cross-sectional survey implemented in 2003-2006, which included a sample of 4 202 participants aged 40 years and older. Charts produced by the World Health Organization and the International Society of Hypertension for the Region of the Americas sub-region B were used to predict risk on the basis of factors including age, sex, blood pressure, total serum cholesterol, smoking status, and diabetes status. Overall, 85.9% of the population was classified as having < 10% risk for cardiovascular events during the following ten years. The likelihood of being in this risk group decreased with age in both males and females. Four percent of respondents were identified as having > 20% risk. More than 75% of those with a 30-40% risk had previously been identified by health services, and an additional 23% were identified during the study, suggesting they could be diagnosed by opportunistic screening for diabetes, hypertension and hypercholesterolemia. Results of bivariate analysis showed that respondents who were male, older, obese and/or less educated had higher risk for cardiovascular events, but a multivariate analysis including education indicated highest risks for older, obese, and less educated females. Measuring cardiovascular disease risk identifies most cases of (or at risk for) diabetes, hypertension and hypercholesterolemia among adults 40 years and older. This strategy can facilitate implementation of control programs and decrease disabilities and premature mortality.

  8. Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index in adults: U.S. Preventive Services Task Force recommendation statement.

    PubMed

    Moyer, Virginia A

    2013-09-03

    Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for peripheral artery disease (PAD). The USPSTF reviewed the evidence on the use of resting ankle-brachial index (ABI) as a screening test for PAD or as a risk predictor for cardiovascular disease (CVD). The review focused on resting ABI as the sole screening method; the diagnostic performance of ABI testing in primary care populations, unselected populations, and asymptomatic populations; the predictive value of ABI testing for major CVD outcomes in primary care or unselected populations; and the effect of treatment on general CVD and PAD-specific morbidity in patients with asymptomatic or minimally symptomatic PAD. This recommendation applies to asymptomatic adults who do not have a known diagnosis of PAD, CVD, severe chronic kidney disease, or diabetes. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk assessment with the ABI in adults. (I statement).

  9. Telemedicine cardiovascular risk reduction in veterans.

    PubMed

    Melnyk, S Dee; Zullig, Leah L; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Stechuchak, Karen M; Edelman, David; Rakley, Susan; Morey, Miriam; Bosworth, Hayden B

    2013-04-01

    Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical pharmacy specialist-, telephone-administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk. Randomized controlled trial including patients with hypertension (blood pressure >150/100 mm Hg) or elevated low density liporotein (>130 mg/dL). Longitudinal changes in CVD risk profile and improvement in health behaviors over time will be examined. Given the national prevalence of CVD and the dismal rates of risk factor control, intensive but easily disseminated interventions are required to treat this epidemic. This study will be an important step in testing the effectiveness of a behavioral and medication intervention to improve CVD control among Veterans. Published by Mosby, Inc.

  10. Turkish assessment of SURF (SUrvey of Risk Factor Management) study: Control rates of cardiovascular risk factors derived from databases of 15 different levels of health centers in Turkey.

    PubMed

    Tokgözoğlu, Lale; Oğuz, Aytekin; Balcı, Mustafa Kemal; Temizhan, Ahmet; Güldal Altunoğlu, Esma; Bektaş, Osman; Aslan, Güler; Iyigün, Özgün; Kara, Ahmet; Tanrıverdi Pınar, Handan; Yavuz, Saffet; Tekin, Murat; Ercan, Saffet; Çelik, Selda; Sezgin Meriçliler, Özlem; Bozkurt Çakır, İrem

    2017-07-01

    The aim of this study was to evaluate the adherence to recommendations for secondary prevention and the achievement of treatment targets for the control of risk factors in patients with established coronary heart disease (CHD) who were followed-up at various healthcare facilities in Turkey. According to the protocol of the international Survey of Risk Factor Management study, questionnaire forms were completed and demographic, anthropometric, and laboratory data of CHD patients who were followed-up at a total of 15 selected primary, secondary, and tertiary healthcare centers were recorded. Among a total of 724 CHD patients (69.8% male; mean age: 63.3±10.7 years) included in the study, 18.4% were current smokers, only 19.1% had normal body mass index, and 22.1% had waist circumference below the limit of abdominal obesity. Physical activity was insufficient in 53% of the patients, 47.3% had low high-density lipoprotein cholesterol value, 46% had triglyceride level above 150 mg/dL, and 67% had glycated hemoglobin value of 6.5% or above. Of all the patients, 88.1% were using antiplatelet drugs, 71.4% were using beta-blockers, 55.7% were using statins, and 41.9% were using angiotensin-converting enzyme inhibitors/angiotensin receptor blockers. Blood pressure was under control in 56.7% of the hypertensive patients using antihypertensive drugs, and the proportion of diabetic patients who reached glycemic control targets using antidiabetic drugs was 35.9%. Low-density lipoprotein cholesterol was below 70 mg/dL in 12.2% of the patients using statins. According to the data obtained, among Turkish CHD patients, the control rate of cardiovascular risk factors is low, and implementation of the recommendations regarding lifestyle modification and medication use for secondary prevention in the current guidelines are insufficient.

  11. Association of MR-proadrenomedullin with cardiovascular risk factors and subclinical cardiovascular disease.

    PubMed

    Neumann, Johannes Tobias; Tzikas, Stergios; Funke-Kaiser, Anne; Wilde, Sandra; Appelbaum, Sebastian; Keller, Till; Ojeda-Echevarria, Francisco; Zeller, Tanja; Zwiener, Isabella; Sinning, Christoph R; Jagodzinski, Annika; Schnabel, Renate B; Lackner, Karl J; Münzel, Thomas; Blankenberg, Stefan; Wild, Philipp S; Sydow, Karsten

    2013-06-01

    Midregional proadrenomedullin (MR-proADM) is a protein, which exerts various effects on the cardiovascular system. Recent studies underscored its prognostic implications in patients with acute dyspnea and cardiovascular diseases. Therefore, we aimed to determine the distribution of MR-proADM in the general population and to reveal potential associations of MR-proADM with cardiovascular risk factors and measures of subclinical cardiovascular disease. MR-proADM plasma concentrations were determined in individuals of the population-based cohort of the Gutenberg Health Study (N = 5000) using a commercially available fluoroimmunoassay. Individuals were enrolled between April 2007 and October 2008. Subclinical cardiovascular disease was assessed using echocardiographic and functional measures of myocardial and vascular function. The mean age of the study population was 55.5 ± 10.9 years. In the overall population we determined a median MR-proADM plasma concentration of 0.44 nmol/L in men and women. MR-proADM concentrations were elevated in individuals with hypertension, diabetes, dyslipidemia, known cardiovascular disease, heart failure, peripheral artery disease, atrial fibrillation, and history of myocardial infarction and stroke. In men, we observed a positive association of MR-proADM with reduced ejection fraction, intraventricular septal diameter, wall thickness, and echocardiographic measures of diastolic dysfunction. In this study, we present age-dependent reference values for MR-proADM in a representative population sample. Elevated MR-proADM plasma concentrations were strongly associated with classical cardiovascular risk factors and manifest cardiovascular diseases. Furthermore, we revealed a gender-specific association with echocardiographic measures of hypertension. MR-proADM seems to be a promising prognostic biomarker for subclinical and manifest cardiovascular disease. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  12. [Prognostic assessment for formation of a group of cardiovascular high risk among personnel participating in atomic submarines utilization].

    PubMed

    Sosiukin, A E; Vasiliuk, V B; Ivanchenko, A V; Saenko, S A; Semenchuk, O A; Dokhov, M A; Verveda, A B

    2014-01-01

    Ultrasound scanning of main vessels (common carotid, internal carotid, common and superficial femoral, posterior tibial arteries) in staffers of shipyard "Nerpa"--branch of JSC "Shipbuilding center Zvezdochka" (Snezhnogorsk city Murmansk region)--engaged into atomic submarines utilization. Findings are atherosclerotic changes in common carotid and common femoral arteries--increased thickness of intima-media complex over the reference values or atherosclerotic plaque formation. The changes were maximal in a group of males aged over 50 with length of service over 25 years. Discriminant analysis helped to suggest a mathematic model to forecast cardiovascular diseases in personnel of "Nerpa" shipyard.

  13. [Vigilance level for cardiovascular risk factors in schizophrenic patients].

    PubMed

    Rouillon, F; Van Ganse, E; Vekhoff, P; Arnaud, R; Depret-Bixio, L; Dillenschneider, A

    2015-02-01

    Schizophrenic patients have increased cardiovascular risk factors and morbi-mortality as compared with the general population. To assess the level of French psychiatrists vigilance regarding cardiovascular risk factors in schizophrenic patients. Prospective, transverse, multicentric observational study implemented in France in 2007 and conducted by psychiatrists with a liberal activity. The included patients had to meet the following selection criteria: patients ≥ 18 years old, fulfilling the DSM-IV-TR criteria for schizophrenia, treated or not treated for their schizophrenia, with an ambulatory follow-up, without schizophreniform, schizoaffective, or other psychotic disorder. The psychiatrists "vigilance level" for a given cardiovascular risk factor was defined as a systematic investigation of this cardiovascular risk factor for at least 75% of the schizophrenic patients included in the study by the psychiatrist. A total of 382 psychiatrists included 2242 patients, the data collected for 2222 patients were finally analysed. The mean age was 41 years old, 59% were men. The mean BMI was 27 kg/m(2), 34% of the patients were overweight, 23% were obese. The paranoid and residual schizophrenia were the most frequently described subtypes of the disease (41.3 and 25.0% respectively), 58% of the patients were moderately or markedly ill according to the CGI-S scale. Most of the patients were treated with atypical antipsychotics (77%). Only 58% of the psychiatrists were vigilant for the weight of their patients, 38% for the arterial tension, 25% for the family history of premature coronary disease, 14% for the glycemia, 12% for the triglycerides, 10% for HDL cholesterol, 6% for the waist measurement; 35% of the psychiatrists were vigilant for no cardiovascular risk factor. Less than 30% of the psychiatrists recommended their patients to other specialists to manage cardiovascular disorders. Similarly to other countries, French psychiatrists provide insufficient care of

  14. Does fitness improve the cardiovascular risk profile in obese subjects?

    PubMed

    Halland, H; Lønnebakken, M T; Saeed, S; Midtbø, H; Cramariuc, D; Gerdts, E

    2017-06-01

    Good cardiorespiratory fitness has been suggested to reduce the risk of cardiovascular disease in obesity. We explored the association of fitness with the prevalences of major cardiovascular risk factor like hypertension (HT), diabetes and metabolic syndrome (MetS) in overweight and obese subjects. Clinical data from 491 participants in the FAT associated CardiOvasculaR dysfunction (FATCOR) study were analyzed. Physical fitness was assessed by ergospirometry, and subjects with at least good level of performance for age and sex were classified as fit. HT subtypes were identified from clinic and 24-h ambulatory blood pressure in combination. Diabetes was diagnosed by oral glucose tolerance test. MetS was defined by the American Heart Association and National Heart, Lung and Blood Institute criteria. The participants were on average 48 years old (60% women), and mean body mass index (BMI) was 32 kg/m(2). 28% of study participants were classified as fit. Fitness was not associated with lower prevalences of HT or HT subtypes, diabetes, MetS or individual MetS components (all p > 0.05). In multivariable regression analysis, being fit was characterized by lower waist circumference, BMI < 30 kg/m(2), non-smoking and a higher muscle mass (all p < 0.05). In the FATCOR population, fitness was not associated with a lower prevalence of major cardiovascular risk factors like HT, diabetes or MetS. Given the strong association of cardiovascular risk factor burden with risk of clinical cardiovascular disease, these findings challenge the notion that fitness alone is associated with lower risk of cardiovascular disease in obesity. Copyright © 2017 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

  15. Serum triglycerides and risk of cardiovascular disease.

    PubMed

    Boullart, A C I; de Graaf, J; Stalenhoef, A F

    2012-05-01

    Dyslipidemia, especially elevated serum levels of cholesterol, is causally related to cardiovascular disease. The specific role of triglycerides has long been controversial. In this article we discuss the role of serum triglycerides in relation to the risk of cardiovascular disease. First, the (patho)physiology of triglycerides is described, including the definition and a short summary of the primary and secondary causes of hypertriglyceridemia. Furthermore, we will give an overview of the published epidemiological studies concerning hypertriglyceridemia and cardiovascular disease to support the view that triglyceride-rich lipoproteins are an independently associated risk factor. Finally, treatment strategies and treatment targets are discussed. This article is part of a Special Issue entitled Triglyceride Metabolism and Disease. Copyright © 2011 Elsevier B.V. All rights reserved.

  16. Seasonal variations of selected cardiovascular risk factors.

    PubMed

    Kelly, Gregory S

    2005-12-01

    This article reviews research on selected biomarkers of cardiovascular risk - cholesterol and other lipids, C-reactive protein (CRP), fibrinogen, homocysteine - in the attempt to determine the existence of a predictable seasonal chronobiological pattern of variation. Studies dating as far back as the 1930s have reported seasonal variations in cholesterol levels. Statistically significant seasonal changes in lipid levels have been found in individuals irrespective of the country where the research has been conducted, and irrespective of the age, sex, ethnicity, and baseline lipid levels of the study subjects. While not all studies have been in complete agreement on either the amplitude (degree of seasonal change) or month/s of highest lipid levels, a strong winter/summer difference has been found in most studies. Existing evidence for an independent effect of season in variation of CRP is weak. Studies have consistently reported significant seasonal variations in fibrinogen levels. While other biological factors clearly interact to affect fibrinogen variability, seasonality appears to be an independent source of variability. Evidence from several studies points to a lack of seasonal variability in homocysteine levels. Although seasonal variability is just one source of periodicity influencing biological function and assessments in clinical practice, for some biomarkers, including lipids and fibrinogen, it is a source of variability that warrants consideration prior to a decision to treat and in assessing response to interventions.

  17. Cardiovascular Risk Reduction in Children.

    ERIC Educational Resources Information Center

    Murray, David M.; And Others

    1987-01-01

    The paper presents a community model for reducing the risk of coronary heart disease in children and youth. The model addresses the individual, the family, social groups, and the larger social and physical environments. Exemplary programs are described and recommendations are made for additional research and program development. (Author/DB)

  18. Cardiovascular risk awareness, treatment, and control in urban Latin America.

    PubMed

    Silva, Honorio; Hernandez-Hernandez, Rafael; Vinueza, Raul; Velasco, Manuel; Boissonnet, Carlos Pablo; Escobedo, Jorge; Silva, H Elif; Pramparo, Palmira; Wilson, Elinor

    2010-01-01

    Effective prevention and treatment of cardiovascular diseases require regular screening for risk factors, high awareness of the condition, effective treatment of the identified risk factors, and adherence to the prescribed treatment. The Cardiovascular Risk Factor Multiple Evaluation in Latin America study was a cross-sectional, population-based, observational study of major cardiovascular risk factors-including hypertension, diabetes, and hypercholesterolemia-in 7 Latin American cities. This report presents data on assessment, diagnosis, extent, and effectiveness of treatment, adherence to treatment, and reasons for nonadherence. Data were collected through household questionnaire-based interviews administered to 5383 men and 6167 women, 25-64 years of age, living in the following cities: Barquisimeto, Venezuela; Bogota, Colombia; Buenos Aires, Argentina; Lima, Peru; Mexico City, Mexico; Quito, Ecuador; and Santiago, Chile. Participants also completed a clinic visit for anthromorphometric and laboratory assessments. Rates of prior diagnosis of hypertension and diabetes were high (64% and 78% of affected individuals, respectively) but relatively low for hypercholesterolemia (41%). The majority of affected individuals (hypercholesterolemia 88%, diabetes 67%, and hypertension 53%) were untreated. Among individuals who were receiving pharmacologic treatment, targets for control of hypertension, diabetes, and hypercholesterolemia were achieved by 51%, 16%, and 52%, respectively. Adherence to treatment was observed in 69% of individuals with hypertension, 63% with diabetes, and 66% with hypercholesterolemia. Forgetfulness was the major cause of nonadherence for all 3 conditions. There is a substantial need for increasing patient education, diagnosis, treatment, adherence, and control of cardiovascular risk factors in the 7 Latin American cities.

  19. Cardiovascular risk scores for coronary atherosclerosis.

    PubMed

    Yalcin, Murat; Kardesoglu, Ejder; Aparci, Mustafa; Isilak, Zafer; Uz, Omer; Yiginer, Omer; Ozmen, Namik; Cingozbay, Bekir Yilmaz; Uzun, Mehmet; Cebeci, Bekir Sitki

    2012-10-01

    The objective of this study was to compare frequently used cardiovascular risk scores in predicting the presence of coronary artery disease (CAD) and 3-vessel disease. In 350 consecutive patients (218 men and 132 women) who underwent coronary angiography, the cardiovascular risk level was determined using the Framingham Risk Score (FRS), the Modified Framingham Risk Score (MFRS), the Prospective Cardiovascular Münster (PROCAM) score, and the Systematic Coronary Risk Evaluation (SCORE). The area under the curve for receiver operating characteristic curves showed that FRS had more predictive value than the other scores for CAD (area under curve, 0.76, P < or = 0.001), but all scores had good specificity and positive predictive value. For 3-vessel disease, the FRS had better predictive value than the other scores (area under curve, 0.74, P < or = 0.001), but all scores had good specificity and negative predictive value. The risk scores (FRS, MFRS, PROCAM, and SCORE) may predict the presence and severity of coronary atherosclerosis.The FRS had better predictive value than the other scores.

  20. Preventing renal and cardiovascular risk by renal function assessment: insights from a cross-sectional study in low-income countries and the USA.

    PubMed

    Cravedi, Paolo; Sharma, Sanjib Kumar; Bravo, Rodolfo Flores; Islam, Nazmul; Tchokhonelidze, Irma; Ghimire, Madhav; Pahari, Bishnu; Thapa, Sanjeev; Basnet, Anil; Tataradze, Avtandil; Tinatin, Davitaia; Beglarishvili, Lela; Fwu, Chyng-Wen; Kopp, Jeffrey B; Eggers, Paul; Ene-Iordache, Bogdan; Carminati, Sergio; Perna, Annalisa; Chianca, Antonietta; Couser, William G; Remuzzi, Giuseppe; Perico, Norberto

    2012-01-01

    To assess the prevalence of microalbuminuria and kidney dysfunction in low-income countries and in the USA. Cross-sectional study of screening programmes in five countries. Screening programmes in Nepal, Bolivia, the USA (National Health and Nutrition Examination Survey (NHANES) 2005-2008) Bangladesh and Georgia. General population in Nepal (n=20 811), Bolivia (n=3436) and in the USA (n=4299) and high-risk subjects in Bangladesh (n=1518) and Georgia (n=1549). Estimated glomerular filtration rate (eGFR)<60ml/min/1.73 m(2) and microalbuminuria (defined as urinary albumin creatinine ratio values of 30-300 mg/g) were the main outcome measures. The cardiovascular (CV) risk was also evaluated on the basis of demographic, clinical and blood data. The prevalence of eGFR<60ml/min/1.73 m(2) was 19%, 3.2% and 7% in Nepal, Bolivia and the USA, respectively. In Nepal, 7% of subjects were microalbuminuric compared to 8.6% in the USA. The prevalence of participants with predicted 10-year CV disease (CVD) risk ≥10% was 16.9%, 9.4% and 17% in Nepal, Bolivia and in the USA, respectively. In Bangladesh and Georgia, subjects with eGFR<60 ml/min/1.73 m(2) were 8.6% and 4.9%, whereas those with microalbuminuria were 45.4% and 56.5%, respectively. Predicted 10-year CVD risk ≥10% was 25.4% and 25% in Bangladesh and Georgia, respectively. Renal abnormalities are common among low-income countries and in the USA. Prevention programmes, particularly focused on those with renal abnormalities, should be established worldwide to prevent CVD and progression to end-stage renal disease.

  1. Controlling risk factors in cardiovascular diseases.

    PubMed

    Tuomilehto, J; Puska, P; Salonen, J; Nissinen, A

    1980-10-01

    In response to community demands to do something about the highest rates of cardiovascular diseases in the world that were found in the country of North Karelia, Finland, a comprehensive community control programme was set up in 1972. The main objective was to reduce the high rates by reducing level of smoking, serum cholesterol and blood pressure. The success of the programme was evaluated by examining independent representative population samples in 1972 and in 1977 in North Karelia and a matched control county. A decrease in the individual risk factors was found among the population aged 25-29 at the outset. This reduction was mainly based on favourable changes in lifestyle that took place through the whole community. In low as well as in high socioeconomic groups risk factor reductions occurred. At the same time morbidity and mortality from cardiovascular diseases fell in North Karelia. The intensified health education was not accompanied by adverse emotional or psychosomatic reactions that could be measured. Since there are results from a series of experimental and controlled studies on success of risk factor reduction, this evidence should be used in development and implementation of prevention programmes for cardiovascular diseases. Primary prevention of cardiovascular diseases today requires efficient programmes because they are forming the leading cause of death in majority of the countries where reliable mortality statistics are available.

  2. Water chemistry and cardiovascular disease risk

    SciTech Connect

    Watson, A.P.; Zeighami, E.A.

    1985-01-01

    The evidence linking cardiovascular disease risk and water quality parameters was weighed and analyzed to identify major gaps in understanding reasons for the regional differences in cardiovascular disease mortality in the United States. Epidemiologic studies evaluating occupational and public health exposure to nitrates, carbon monoxide, carbon disulfide, fibrogenic dusts, heavy metals and trace elements, chlorides, and hydro- and fluorocarbons were analyzed. Intake of cholesterol, calcium, and magnesium from food items, cooking water enhancement, and drinking water were also appraised. Based on the current state of knowledge, it is our judgment that the drinking water characteristics of highest priority from the standpoint of cardiovascular disease risks are calcium/magnesium content and chlorine treatment. The potential importance of cadmium, lead, nitrate(s), and chloride/sodium concentrations also needs to be considered. We present working hypotheses to evaluate the role(s) of these parameters and a discussion of variables that should be considered in any study design addressing the association between cardiovascular disease risk and water quality. Important variables are sample size, biological endpoint events (mortality, incidence, clinical determination), population characteristics, drinking water parameters, and dietary intake estimates. 207 references, 6 figures, 17 tables.

  3. Red Blood Cell Eicosapentaenoic Acid Inversely Relates to MRI-Assessed Carotid Plaque Lipid Core Burden in Elders at High Cardiovascular Risk.

    PubMed

    Bargalló, Núria; Gilabert, Rosa; Romero-Mamani, Edwin-Saúl; Cofán, Montserrat; Calder, Philip C; Fitó, Montserrat; Corella, Dolores; Salas-Salvadó, Jordi; Ruiz-Canela, Miguel; Estruch, Ramon; Ros, Emilio; Sala-Vila, Aleix

    2017-09-20

    Supplemental marine omega-3 eicosapentaenoic acid (EPA) has an anti-atherosclerotic effect. Clinical research on EPA supplied by the regular diet and atherosclerosis is scarce. In the framework of the PREvención con DIeta MEDiterránea (PREDIMED) trial, we conducted a cross-sectional study in 161 older individuals at high vascular risk grouped into different stages of carotid atherosclerosis severity, including those without ultrasound-detected atheroma plaque (n = 38), with plaques <2.0 mm thick (n = 65), and with plaques ≥2.0 mm (n = 79). The latter were asked to undergo contrast-enhanced 3T magnetic resonance imaging (MRI) and were subsequently grouped into absence (n = 31) or presence (n = 27) of MRI-detectable plaque lipid, a main feature of unstable atheroma plaques. We determined the red blood cell (RBC) proportion of EPA (a valid marker of long-term EPA intake) at enrolment by gas chromatography. In multivariate models, EPA related inversely to MRI-assessed plaque lipid volume, but not to maximum intima-media thickness of internal carotid artery, plaque burden, or MRI-assessed normalized wall index. The inverse association between EPA and plaque lipid content in patients with advanced atherosclerosis supports the notion that this fatty acid might improve cardiovascular health through stabilization of advanced atheroma plaques.

  4. Impact of using different SCORE tables for estimating cardiovascular risk.

    PubMed

    Brotons, Carlos; Moral, Irene; Soriano, Núria; Cuixart, Lluís; Osorio, Dimelza; Bottaro, David; Puig, Mireia; Joaniquet, Xavier; Marcos, Albert; Casasa, Albert

    2014-02-01

    In Spain, various SCORE tables are available to estimate cardiovascular risk: tables for low-risk countries, tables calibrated for the Spanish population, and tables that include high-density lipoprotein values. The aim of this study is to assess the impact of using one or another SCORE table in clinical practice. In a cross-sectional study carried out in two primary health care centers, individuals aged 40 to 65 years in whom blood pressure and total cholesterol levels were recorded between March 2010 and March 2012 were selected. Patients with diabetes or a history of cardiovascular disease were excluded. Cardiovascular risk was calculated using SCORE for low-risk countries, SCORE with high-density lipoprotein cholesterol, and the calibrated SCORE. Cardiovascular risk was estimated in 3716 patients. The percentage of patients at high or very high risk was 1.24% with SCORE with high-density lipoprotein cholesterol, 4.73% with the low-risk SCORE, and 15.44% with the calibrated SCORE (P<.01). Treatment with lipid-lowering drugs would be recommended in 10.23% of patients using the calibrated SCORE, 3.12% of patients using the low-risk SCORE, and 0.67% of patients using SCORE with high-density lipoprotein cholesterol. The calibrated SCORE table classifies a larger number of patients at high or very high risk than the SCORE for low-risk countries or the SCORE with high-density lipoprotein cholesterol. Therefore, its use would imply treating more patients with lipid-lowering medication. Validation studies are needed to assess the most appropriate SCORE table for use in our setting. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  5. Influence of Conventional Cardiovascular Risk Factors and Lifestyle Characteristics on Cardiovascular Disease After Hematopoietic Cell Transplantation

    PubMed Central

    Chow, Eric J.; Baker, K. Scott; Lee, Stephanie J.; Flowers, Mary E.D.; Cushing-Haugen, Kara L.; Inamoto, Yoshihiro; Khera, Nandita; Leisenring, Wendy M.; Syrjala, Karen L.; Martin, Paul J.

    2014-01-01

    Purpose To determine the influence of modifiable lifestyle factors on the risk of cardiovascular disease after hematopoietic cell transplantation (HCT). Patients and Methods HCT survivors of ≥ 1 year treated from 1970 to 2010 (n = 3,833) were surveyed from 2010 to 2011 on current cardiovascular health and related lifestyle factors (smoking, diet, recreational physical activity). Responses (n = 2,362) were compared with those from a matched general population sample (National Health and Nutrition Examination Survey [NHANES]; n = 1,192). Results Compared with NHANES participants, HCT survivors (median age, 55.9 years; median 10.8 years since HCT; 71.3% allogeneic) had higher rates of cardiomyopathy (4.0% v 2.6%), stroke (4.8% v 3.3%), dyslipidemia (33.9% v 22.3%), and diabetes (14.3% v 11.7%; P < .05 for all comparisons). Prevalence of hypertension was similar (27.9% v 30.0%), and survivors were less likely to have ischemic heart disease (6.1% v 8.9%; P < .01). Among HCT survivors, hypertension, dyslipidemia, and diabetes were independent risk factors for ischemic heart disease and cardiomyopathy, and smoking was associated with ischemic heart disease and diabetes (odds ratios [ORs], 1.8 to 2.1; P = .02). Obesity was a risk factor for post-transplantation hypertension, dyslipidemia, and diabetes (ORs ≥ 2.0; P < .001). In contrast, lower fruit/vegetable intake was associated with greater risk of dyslipidemia and diabetes (ORs, 1.4 to 1.8; P ≤ .01), and lower physical activity level was associated with greater risk of hypertension and diabetes (ORs, 1.4 to 1.5; P < .05). Healthier lifestyle characteristics among HCT survivors attenuated risk of all cardiovascular conditions assessed. Conclusion Attention of clinicians to conventional cardiovascular risk factors and modifiable lifestyle characteristics offers hope of reducing serious cardiovascular morbidity after HCT. PMID:24297944

  6. Association Between Leisure Time Physical Activity, Cardiopulmonary Fitness, Cardiovascular Risk Factors, and Cardiovascular Workload at Work in Firefighters

    PubMed Central

    Yu, Clare C.W.; Au, Chun T.; Lee, Frank Y.F.; So, Raymond C.H.; Wong, John P.S.; Mak, Gary Y.K.; Chien, Eric P.; McManus, Alison M.

    2015-01-01

    Background Overweight, obesity, and cardiovascular disease risk factors are prevalent among firefighters in some developed countries. It is unclear whether physical activity and cardiopulmonary fitness reduce cardiovascular disease risk and the cardiovascular workload at work in firefighters. The present study investigated the relationship between leisure-time physical activity, cardiopulmonary fitness, cardiovascular disease risk factors, and cardiovascular workload at work in firefighters in Hong Kong. Methods Male firefighters (n = 387) were randomly selected from serving firefighters in Hong Kong (n = 5,370) for the assessment of cardiovascular disease risk factors (obesity, hypertension, diabetes mellitus, dyslipidemia, smoking, known cardiovascular diseases). One-third (Target Group) were randomly selected for the assessment of off-duty leisure-time physical activity using the short version of the International Physical Activity Questionnaire. Maximal oxygen uptake was assessed, as well as cardiovascular workload using heart rate monitoring for each firefighter for four “normal” 24-hour working shifts and during real-situation simulated scenarios. Results Overall, 33.9% of the firefighters had at least two cardiovascular disease risk factors. In the Target Group, firefighters who had higher leisure-time physical activity had a lower resting heart rate and a lower average working heart rate, and spent a smaller proportion of time working at a moderate-intensity cardiovascular workload. Firefighters who had moderate aerobic fitness and high leisure-time physical activity had a lower peak working heart rate during the mountain rescue scenario compared with firefighters who had low leisure-time physical activities. Conclusion Leisure-time physical activity conferred significant benefits during job tasks of moderate cardiovascular workload in firefighters in Hong Kong. PMID:26929827

  7. [Cardiovascular risk parameters, metabolic syndrome and alcohol consumption by workers].

    PubMed

    Vicente-Herrero, María Teófila; López González, Ángel Arturo; Ramírez-Iñiguez de la Torre, María Victoria; Capdevila-García, Luisa; Terradillos-García, María Jesús; Aguilar-Jiménez, Encarna

    2015-04-01

    Prevalence of alcohol consumption is high in the general population and generates specific problems at the workplace. To establish benchmarks between levels of alcohol consumption and cardiovascular risk variables and metabolic syndrome. A cross-sectional study of 7,644 workers of Spanish companies (2,828 females and 4,816 males). Alcohol consumption and its relation to cardiovascular risk was assessed using Framingham calibrated for the Spanish population (REGICOR) and SCORE, and metabolic syndrome was assessed using modified ATPIII and IDF criteria and Castelli and atherogenic index and triglycerides/HDL ratio. A multivariate analysis was performed using logistic regression and odds ratios were estimated. Statistically significant differences were seen in the mean values of the different parameters studied in prevalence of metabolic syndrome, for both sexes and with modified ATPIII, IDF and REGICOR and SCORE. The sex, age, alcohol, and smoking variables were associated to cardiovascular risk parameters and metabolic syndrome. Physical exercise and stress are only associated to with some of them. The alcohol consumption affects all cardiovascular risk parameters and metabolic syndrome, being more negative the result in high level drinkers. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  8. Importance of regional specificity of T-wave alternans in assessing risk for cardiovascular mortality and sudden cardiac death during routine exercise testing.

    PubMed

    Leino, Johanna; Verrier, Richard L; Minkkinen, Mikko; Lehtimäki, Terho; Viik, Jari; Lehtinen, Rami; Nikus, Kjell; Kööbi, Tiit; Turjanmaa, Väinö; Kähönen, Mika; Nieminen, Tuomo

    2011-03-01

    T-wave alternans (TWA) indicates increased risk for life-threatening arrhythmias. However, the regional distribution and predictivity of TWA among precordial leads remain unknown. We analyzed the magnitude and prognostic power of TWA in precordial leads separately and in combination during routine exercise stress testing in the largest TWA study conducted to date. The Finnish Cardiovascular Study (FINCAVAS) enrolled consecutive patients (n = 3,598, 56 ± 13 [mean ± standard deviation] years old, 2,164 men, 1,434 women) with a clinically indicated exercise test with bicycle ergometer. TWA was analyzed with the time-domain modified moving average method. During a follow-up of 55 months (interquartile range of 35-78 months), 231 patients died; 97 deaths were cardiovascular, and 46 were classified as sudden cardiac deaths (SCDs). In Cox analysis after adjustment for common coronary risk factors, each 20-μV increase in TWA in leads V1-V6 multiplied the hazard ratio for cardiovascular mortality by 1.486-fold (95% confidence interval [CI] 1.127-1.952; P = .005). Each 20-μV increase in TWA in lead V5 amplified the hazard ratio for cardiovascular mortality by 1.545 (95% CI 1.150-2.108; P = .004) and for SCD by 1.576 (95% CI 1.041-2.412; P = .033). Maximum TWA monitored from anterolateral precordial lead V5 is the strongest predictor of cardiovascular mortality and SCD during routine exercise testing in our analysis. Higher TWA values indicate greater cardiovascular mortality and SCD risk, supporting the concept that quantification of TWA should receive more attention. Copyright © 2011. Published by Elsevier Inc.

  9. [Elevated blood pressure as cardiovascular risk factor].

    PubMed

    Kowalewski, Wiesław; Hebel, Kazimiera

    2013-01-01

    Cardiovascular diseases for decades have been and still are the main and current health problem of the Polish society and there are many reasons for these diseases. Hypertension is one of the major risk factors for developing cardiovascular disease. The factors significantly increasing risk the of cardiovascular disease are in addition to high blood pressure, smoking (also passive), high blood fats (cholesterol and its HDL, LDL fractions as well as triglyceride levels, obesity, lack of exercise, diabetes and hereditary features. Other important factors which play an important role are external factors such as e.g. environmental pollution, lifestyle, stress. Prediction of cardiovascular disease should start from the evaluation of the fetal period because low birth weight may be a risk of coronary heart disease, hypertension, obesity or diabetes in adulthood. The authors of the referred tests showed that the level of blood pressure observed during childhood is closely associated with the level of blood pressure in adults and is also dependent on the body weight. Since the issue of the effects of high pressure on the cardiovascular system is inherent in the issue of the metabolic syndrome, it should be mentioned also that another causative factor may be an irregularity in the removal of urine from the body and the amount of insulin. The control of hypertension is a complex problem, at least in view of the wide range of adverse factors affecting the human body: hypertension is often either a constituent of other lesions. Therefore, it is difficult to treat high blood pressure in the strict sense; more often it is a combination therapy based on pharmacology caused for other reasons.

  10. Cardiovascular Risk among Older Women in a Havana Health Area.

    PubMed

    Armas, Nurys Bárbara; Hernández, Yesenia de la Caridad; Dueñas, Alfredo F; García, Reynaldo de la Noval; Castillo, Antonio

    2008-04-01

    Introduction Cardiovascular morbidity and mortality increase in women after menopause. Various scoring models assess qualitative risk of cardiovascular disease. The Framingham Heart Study global risk score is among the most widely used. Objective Determine level of coronary heart disease risk among women aged ≥60 years in a Havana health catchment area (geographic area whose residents are served by the M�rtires del Corynthia Polyclinic, in the Plaza de la Revoluci�n municipality of Havana). Methods A descriptive, cross-sectional study was conducted in 2006. Universe: all women (3,396) aged ≥60 years in the catchment area, attended at the primary care level by the Polyclinic and 42 neighborhood family doctor-and-nurse offices. Equal probability sample: 1,082 women meeting the inclusion criteria, chosen through single-stage cluster sampling considering a <10% error margin for estimates for this parameter, a 95% confidence interval (CI) and a design effect of 1.5. Absolute frequencies and percentages were calculated to summarize the qualitative data obtained. Results were presented as tables. Results The most common cardiovascular risk factors found in this study were: physical inactivity, 74.9%; hypertension (HTN), 70.6%; abdominal obesity, 53%; reported family history of coronary heart disease (CHD), 41.8%; diabetes mellitus (DM), 21.8%; and cigarette smoking, 17.2%. Scoring according to number of risk factors present in each individual, 79.3% of these women fell into the high- or moderate-risk categories. Conclusion The large number of women categorized as high- or moderate-risk for coronary heart disease in this population emphasizes the need for preventive actions aimed at reducing these figures. Cardiovascular diseases, vascular diseases, ischemic heart disease, coronary heart disease, postmenopause, woman, aged, risk factors, risk assessment, hypertension, high blood pressure, lifestyle, diabetes mellitus, obesity, abdominal adipose tissue, body mass

  11. Validity of cardiovascular risk prediction models in kidney transplant recipients.

    PubMed

    Mansell, Holly; Stewart, Samuel Alan; Shoker, Ahmed

    2014-01-01

    Predicting cardiovascular risk is of great interest in renal transplant recipients since cardiovascular disease is the leading cause of mortality. To conduct a systematic review to assess the validity of cardiovascular risk prediction models in this population. Five databases were searched (MEDLINE, EMBASE, SCOPUS, CINAHL, and Web of Science) and cohort studies with at least one year of follow-up were included. Variables that described population characteristics, study design, and prognostic performance were extracted. The Quality in Prognostic Studies (QUIPS) tool was used to evaluate bias. Seven studies met the criteria for inclusion, of which, five investigated the Framingham risk score and three used a transplant-specific model. Sample sizes ranged from 344 to 23,575, and three studies lacked sufficient event rates to confidently reach conclusion. Four studies reported discrimination (as measured by c-statistic), which ranged from 0.701 to 0.75, while only one risk model was both internally and externally validated. The Framingham has underestimated cardiovascular events in renal transplant recipients, but these studies have not been robust. A risk prediction model has been externally validated at least on one occasion, but comprehensive validation in multiple cohorts and impact analysis are recommended before widespread clinical application is advocated.

  12. An assessment of community health workers’ ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study

    PubMed Central

    Gaziano, Thomas A; Abrahams-Gessel, Shafika; Denman, Catalina A; Montano, Carlos Mendoza; Khanam, Masuma; Puoane, Thandi; Levitt, Naomi S

    2016-01-01

    Summary Background Cardiovascular disease contributes substantially to the non-communicable disease (NCD) burden in low-income and middle-income countries, which also often have substantial health personnel shortages. In this observational study we investigated whether community health workers could do community-based screenings to predict cardiovascular disease risk as effectively as could physicians or nurses, with a simple, non-invasive risk prediction indicator in low-income and middle-income countries. Methods This observation study was done in Bangladesh, Guatemala, Mexico, and South Africa. Each site recruited at least ten to 15 community health workers based on usual site-specific norms for required levels of education and language competency. Community health workers had to reside in the community where the screenings were done and had to be fluent in that community’s predominant language. These workers were trained to calculate an absolute cardiovascular disease risk score with a previously validated simple, non-invasive screening indicator. Community health workers who successfully finished the training screened community residents aged 35–74 years without a previous diagnosis of hypertension, diabetes, or heart disease. Health professionals independently generated a second risk score with the same instrument and the two sets of scores were compared for agreement. The primary endpoint of this study was the level of direct agreement between risk scores assigned by the community health workers and the health professionals. Findings Of 68 community health worker trainees recruited between June 4, 2012, and Feb 8, 2013, 42 were deemed qualified to do fieldwork (15 in Bangladesh, eight in Guatemala, nine in Mexico, and ten in South Africa). Across all sites, 4383 community members were approached for participation and 4049 completed screening. The mean level of agreement between the two sets of risk scores was 96 8% (weighted κ =0 948, 95% CI 0 936–0

  13. An assessment of community health workers' ability to screen for cardiovascular disease risk with a simple, non-invasive risk assessment instrument in Bangladesh, Guatemala, Mexico, and South Africa: an observational study.

    PubMed

    Gaziano, Thomas A; Abrahams-Gessel, Shafika; Denman, Catalina A; Montano, Carlos Mendoza; Khanam, Masuma; Puoane, Thandi; Levitt, Naomi S

    2015-09-01

    Cardiovascular disease contributes substantially to the non-communicable disease (NCD) burden in low-income and middle-income countries, which also often have substantial health personnel shortages. In this observational study we investigated whether community health workers could do community-based screenings to predict cardiovascular disease risk as effectively as could physicians or nurses, with a simple, non-invasive risk prediction indicator in low-income and middle-income countries. This observation study was done in Bangladesh, Guatemala, Mexico, and South Africa. Each site recruited at least ten to 15 community health workers based on usual site-specific norms for required levels of education and language competency. Community health workers had to reside in the community where the screenings were done and had to be fluent in that community's predominant language. These workers were trained to calculate an absolute cardiovascular disease risk score with a previously validated simple, non-invasive screening indicator. Community health workers who successfully finished the training screened community residents aged 35-74 years without a previous diagnosis of hypertension, diabetes, or heart disease. Health professionals independently generated a second risk score with the same instrument and the two sets of scores were compared for agreement. The primary endpoint of this study was the level of direct agreement between risk scores assigned by the community health workers and the health professionals. Of 68 community health worker trainees recruited between June 4, 2012, and Feb 8, 2013, 42 were deemed qualified to do fieldwork (15 in Bangladesh, eight in Guatemala, nine in Mexico, and ten in South Africa). Across all sites, 4383 community members were approached for participation and 4049 completed screening. The mean level of agreement between the two sets of risk scores was 96·8% (weighted κ=0·948, 95% CI 0·936-0·961) and community health workers showed

  14. Preeclampsia: exposing future cardiovascular risk in mothers and their children.

    PubMed

    Anderson, Cindy M

    2007-01-01

    There is an increased risk for future cardiovascular disease in women who have had preeclampsia. In infants born to mothers with preeclampsia, there is growing evidence of increased risk for both cardiovascular disease and preeclampsia. Epidemiologic and experimental data provide a strong link between intrauterine exposure to preeclampsia and subsequent risk for the development of cardiovascular disease in women.

  15. Homocysteine in relation to C-reactive protein and low-density lipoprotein cholesterol in assessment of cardiovascular risk.

    PubMed

    Herrmann, W; Obeid, R; Hübner, U; Jouma, M; Geisel, J

    2004-12-01

    Coronary vascular disease (CVD) is a chronic, multifactorial disease that occurs often in individuals without known risk factors. We investigated the predictive value of homocysteine (Hcy) in relation to C-reactive protein (CRP) and low-density lipoprotein (LDL)-cholesterol in patients with confirmed coronary disease. The study included 87 German and 92 Syrian patients in addition to 87 German and 64 Syrian control individuals. Patients and controls were of comparable age, lifestyles and cultural background. Patients of both ethnic groups had significantly higher concentrations of Hcy and C-reactive protein compared to the controls. The lipids were higher only in Syrian patients compared to the controls. Elevated concentrations of Hcy or that of CRP (>75th percentiles) were associated with increased probability for CVD. In both population groups, the risk increased markedly in subjects who had elevated concentrations of Hcy and CRP or those who had elevated concentrations of Hcy and LDL-cholesterol. The results emphasize that detemination of Hcy may improve the predictive value of C-reactive protein and the LDL-cholesterol. Measurements of these markers are especially important for identification of patients at high risk for CVD.

  16. The Finnish Cardiovascular Study (FINCAVAS): characterising patients with high risk of cardiovascular morbidity and mortality

    PubMed Central

    Nieminen, Tuomo; Lehtinen, Rami; Viik, Jari; Lehtimäki, Terho; Niemelä, Kari; Nikus, Kjell; Niemi, Mari; Kallio, Janne; Kööbi, Tiit; Turjanmaa, Väinö; Kähönen, Mika

    2006-01-01

    Background The purpose of the Finnish Cardiovascular Study (FINCAVAS) is to construct a risk profile – using genetic, haemodynamic and electrocardiographic (ECG) markers – of individuals at high risk of cardiovascular diseases, events and deaths. Methods and design All patients scheduled for an exercise stress test at Tampere University Hospital and willing to participate have been and will be recruited between October 2001 and December 2007. The final number of participants is estimated to reach 5,000. Technically successful data on exercise tests using a bicycle ergometer have been collected of 2,212 patients (1,400 men and 812 women) by the end of 2004. In addition to repeated measurement of heart rate and blood pressure, digital high-resolution ECG at 500 Hz is recorded continuously during the entire exercise test, including the resting and recovery phases. About 20% of the patients are examined with coronary angiography. Genetic variations known or suspected to alter cardiovascular function or pathophysiology are analysed to elucidate the effects and interactions of these candidate genes, exercise and commonly used cardiovascular medications. Discussion FINCAVAS compiles an extensive set of data on patient history, genetic variation, cardiovascular parameters, ECG markers as well as follow-up data on clinical events, hospitalisations and deaths. The data enables the development of new diagnostic and prognostic tools as well as assessments of the importance of existing markers. PMID:16515696

  17. Association between erectile dysfunction and cardiovascular risk in individuals with type-2 diabetes without overt cardiovascular disease

    PubMed Central

    Meena, Babu Lal; Kochar, Dhanpat Kumar; Agarwal, Tulsi Das; Choudhary, Raghvendra; Kochar, Abhishek

    2009-01-01

    Background: Erectile dysfunction in type-2 diabetes may be an independent marker for coronary artery disease. Present study was undertaken to investigate whether type-2 diabetic patients with erectile dysfunction without having overt cardiovascular disease had increased cardiovascular risk. Aim: To find out correlation between ED and cardiovascular risk in diabetic patients. Methods: Fifty type-2 diabetic patients were assessed for erectile dysfunction using international index of erectile dysfunction (IIEF-5), which include questionnaire and cardiovascular risk assessment by multiparameter cardiovascular analysis device (periscope). Results: The prevalence of erectile dysfunction in type-2 diabetics was very high (78%), mild, moderate and severe ED was present in 6, 36 and 36%, respectively. The total cardiovascular risk was more in patients with ED in comparison to patients without ED (34.87 ± 18.82 vs 20.91 ± 11.03 p = 0.002). The mean 10-years coronary risk and cardiac risk was 12.00 + 9.60 and 22.23 + 14.14 (p = 0.029) and 13.36 ± 1.22 and 28.85 ± 4.13 (p 0.002) in patients without ED and with ED respectively. The mean vascular and atherosclerosis risk was 28.73 ± 13.94 and 39.38 ± 19.51 (p > 0.05) and 26.18 ± 10.31 and 33.92 ± 13.40 (p > 0.05) in patients without ED and with ED, respectively. Total cardiovascular risk was found to increase with age, duration of diabetes and HbA1c levels. Conclusion: The total cardiovascular risk increases with increasing severity of erectile dysfunction in type-2 diabetic patients without having overt cardiovascular disease. PMID:20336196

  18. Cardiovascular risk in Mozambique: who should be treated for hypertension?

    PubMed Central

    Damasceno, Albertino; Padrão, Patricia; Silva-Matos, Carla; Prista, António; Azevedo, Ana; Lunet, Nuno

    2014-01-01

    Aim To estimate the proportion of Mozambicans eligible for pharmacological treatment for hypertension, according to single risk factor and total cardiovascular risk approaches. Methods A representative sample of Mozambicans aged 40–64 years (n = 1116) was evaluated according to the WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). We measured blood pressure (BP) and 12-h fasting blood glucose levels and collected data on sociodemographic characteristics, smoking, and use of antidiabetic and antihypertensive drugs. We estimated the 10-year risk of a fatal or nonfatal major cardiovascular event (WHO/lnternational Society of Hypertension risk prediction charts), and computed the proportion of untreated participants eligible for pharmacological treatment for hypertension, according to BP values alone and accounting also for the total cardiovascular risk (WHO guidelines for assessment and management of cardiovascular diseases). Results Among the Mozambicans aged 40–64 years and not taking antihypertensive drugs, less than 4% were classified as having cardiovascular risk at least 20% whereas the prevalence of SBP/DBP at least 140/90 mmHg was nearly 40%. A total of 19.8% of 40–64-year-olds would be eligible for pharmacological treatment of hypertension according to the WHO guidelines, all of whom had SBP/DBP at least 160/100 mmHg. Conclusion Among the Mozambicans aged 40–64 years not taking antihypertensive drugs and having SBP/DBP at least 140/90 mmHg, only half were eligible for pharmacological treatment according to the WHO guidelines. Taking the latter into account, when defining strategies to control hypertension at a population level, may allow a more efficient use of the scarce resources available in developing settings. PMID:24220589

  19. Psychophysiological risk markers of cardiovascular disease.

    PubMed

    Hamer, Mark; Malan, Leone

    2010-09-01

    Acute psychophysiological stress testing, involving measurement of cardiovascular and biological responses to laboratory-induced mental stress, is an important tool to investigate mechanisms that might account for the association between psychosocial stress and cardiovascular diseases (CVD). Accumulating evidence has demonstrated associations of disturbed psychophysiological responses with sub-clinical measures of atherosclerosis, hypertension, and metabolic risk. The complex pattern of stress responding is influenced by individual differences, such as coping style, race and ethnicity, genetics, background stress, and lifestyle habits, which should be taken into account when interpreting results. For example, an unique interplay between cardiac and vascular responses in black Africans and African Americans is thought to contribute towards a heightened risk of hypertension in this group. Whether or not psychophysiological risk markers provide prognostic information over and above that of established risk markers is not clear. In summary, controlled trials that examine if the modification of psychophysiological responses through lifestyle and psychosocial interventions can reduce the risk of CVD outcomes are needed to establish causality. Further work is also required that examines the associations of ambulatory responses to real life stress in relation to risk of CVD.

  20. Modifying women's risk for cardiovascular disease.

    PubMed

    McCauley, Kathleen M

    2007-01-01

    To present current recommendations for cardiovascular disease risk reduction in women. Medline databases were searched from 1990 to 2006 using keywords women and cardiovascular risk, hypertension, cholesterol, and hormone replacement therapy, as well as Web sites from scientific associations such as the American Heart Association, American College of Cardiology, Agency for Health Research and Quality, and the Centers for Disease Control for relevant scientific statements and guidelines. Randomized controlled trials, particularly those that have influenced current practice recommendations, scientific statements, and clinical practice guidelines were selected. Factors contributing to women's particular risk and current practice recommendations. Current research has clarified the importance of regular exercise (at least 30 minutes/day most days of the week); abstinence from smoking; a diet focused on whole grains, fruits, vegetables, and low-fat protein sources; and maintenance of normal weight. This lifestyle combined with a partnership with a health care provider to maintain a normal blood pressure (115/75 mm Hg) and optimal lipoproteins through pharmacotherapy when indicated can prevent 82% of cardiovascular disease events in women.

  1. Patients’ Perceptions of Cholesterol, Cardiovascular Disease Risk, and Risk Communication Strategies

    PubMed Central

    Goldman, Roberta E.; Parker, Donna R.; Eaton, Charles B.; Borkan, Jeffrey M.; Gramling, Robert; Cover, Rebecca T.; Ahern, David K.

    2006-01-01

    PURPOSE Despite some recent improvement in knowledge about cholesterol in the United States, patient adherence to cholesterol treatment recommendations remains suboptimal. We undertook a qualitative study that explored patients’ perceptions of cholesterol and cardiovascular disease (CVD) risk and their reactions to 3 strategies for communicating CVD risk. METHODS We conducted 7 focus groups in New England using open-ended questions and visual risk communication prompts. The multidisciplinary study team performed qualitative content analysis through immersion/crystallization processes and analyzing coded reports using NVivo qualitative coding software. RESULTS All participants were aware that “high cholesterol” levels adversely affect health. Many had, however, inadequate knowledge about hypercholesterolemia and CVD risk, and few knew their cholesterol numbers. Many assumed they had been tested and their cholesterol concentrations were healthy, even if their physicians had not mentioned it. Standard visual representations showing statistical probabilities of risk were assessed as confusing and uninspiring. A strategy that provides a cardiovascular risk-adjusted age was evaluated as clear, memorable, relevant, and potentially capable of motivating people to make healthful changes. A few participants in each focus group were concerned that a cardiovascular risk-adjusted age that was greater than chronological age would frighten patients. CONCLUSIONS Complex explanations about cholesterol and CVD risk appear to be insufficient for motivating behavior change. A cardiovascular risk-adjusted age calculator is one strategy that may engage patients in recognizing their CVD risk and, when accompanied by information about risk reduction, may be helpful in communicating risk to patients. PMID:16735521

  2. Cardiovascular risk management in rheumatoid arthritis patients still suboptimal: the Implementation of Cardiovascular Risk Management in Rheumatoid Arthritis project.

    PubMed

    van den Oever, Inge A M; Heslinga, Maaike; Griep, Ed N; Griep-Wentink, Hanneke R M; Schotsman, Rob; Cambach, Walter; Dijkmans, Ben A C; Smulders, Yvo M; Lems, Willem F; Boers, Maarten; Voskuyl, Alexandre E; Peters, Mike J L; van Schaardenburg, Dirkjan; Nurmohamed, Micheal T

    2017-09-01

    To assess the 10-year cardiovascular (CV) risk score and to identify treatment and undertreatment of CV risk factors in patients with established RA. Demographics, CV risk factors and prevalence of cardiovascular disease (CVD) were assessed by questionnaire. To calculate the 10-year CV risk score according to the Dutch CV risk management guideline, systolic blood pressure was measured and cholesterol levels were determined from fasting blood samples. Patients were categorized into four groups: indication for treatment but not treated; inadequately treated, so not meeting goals (systolic blood pressure ⩽140 mmHg and/or low-density lipoprotein ⩽2.5 mmol/l); adequately treated; or no treatment necessary. A total of 720 consecutive RA patients were included, 375 from Reade and 345 from the Antonius Hospital. The mean age of patients was 59 years (s.d. 12) and 73% were female. Seventeen per cent of the patients had a low 10-year CV risk (<10%), 21% had an intermediate risk (10-19%), 53% a high risk (⩾20%) and 9% had CVD. In total, 69% had an indication for preventive treatment (cholesterol-lowering or antihypertensive drugs). Of those, 42% received inadequate treatment and 40% received no treatment at all. Optimal CV risk management remains a major challenge and better awareness and management are urgently needed to reduce the high risk of CVD in the RA population.

  3. Epigenetic Changes in Diabetes and Cardiovascular Risk

    PubMed Central

    Keating, Samuel T; Plutzky, Jorge; El-Osta, Assam

    2016-01-01

    Cardiovascular complications remain the leading causes of morbidity and premature mortality in patients with diabetes. Studies in humans and preclinical models demonstrate lasting gene expression changes in the vasculopathies initiated by previous exposure to high glucose concentrations and the associated overproduction of reactive oxygen species. The molecular signatures of chromatin architectures that sensitize the genome to these and other cardiometabolic risk factors of the diabetic milieu are increasingly implicated in the biologic memory underlying cardiovascular complications and now widely considered as promising therapeutic targets. Atherosclerosis is a complex heterocellular disease where the contributing cell types possess distinct epigenomes shaping diverse gene expression. While the extent that pathological chromatin changes can be manipulated in human cardiovascular disease remains to be established, the clinical applicability of epigenetic interventions will be greatly advanced by a deeper understanding of the cell type-specific roles played by writers, erasers, and readers of chromatin modifications in the diabetic vasculature. This review details a current perspective of epigenetic mechanisms of macrovascular disease in diabetes, and highlights recent key descriptions of chromatinized changes associated with persistent gene expression in endothelial, smooth muscle, and circulating immune cells relevant to atherosclerosis. Furthermore we discuss the challenges associated with pharmacological targeting of epigenetic networks to correct abnormal or deregulated gene expression as a strategy to alleviate the clinical burden of diabetic cardiovascular disease. PMID:27230637

  4. Comparison of pediatric perioperative risk assessment by ASA physical status and by NARCO-SS (neurological, airway, respiratory, cardiovascular, other-surgical severity) scores.

    PubMed

    Udupa, Ashwin N; Ravindra, Madhavi N; Chandrika, Y R; Chandrakala, K R; Bindu, N; Watcha, Mehernoor F

    2015-03-01

    ASA-PS is a widely used perioperative health assessment method, but with poor reproducibility. A novel objective, pediatric-specific risk classification system based on Neurological, Airway, Respiratory, Cardiovascular, Other categories and Surgical Severity (NARCO-SS) has been validated in only one US center. Independent external validation of the NARCO-SS and comparison with the ASA-PS in predicting perioperative outcomes. Preoperative ASA-PS and NARCO-SS scores were assigned to 387 children by pediatric anesthesia consultants at a tertiary care center in India and predefined perioperative adverse events and escalation of care recorded. Spearman's correlations determined the relationship between outcomes and scores and kappa statistics for interobserver reliability. The predictive performance of the ASA-PS and NARCO-SS was evaluated by the area under the receiver operating characteristics curves (AUC-ROC) for discrimination and Pearson's chi-square for calibration. NARCO-SS and ASA scores had significant Spearman's correlation coefficients with perioperative outcomes and moderate interobserver reliability. The NARCO-SS showed greater discrimination than the ASA-PS (AUC-ROC 0.778 vs 0.710 for escalation of care and 0.822 vs 0.724 for adverse events, P < 0.01). However, both scores had poor calibration (Pearson's chi-square, P < 0.0001). Individual NARCO-SS categories for neurological and airway lacked statistically significant Spearman's correlations. NARCO-SS is a valid risk stratification tool that is better than the ASA-PS in discriminating children with adverse perioperative outcomes. The poor calibration of both scores suggests neither can reliably predict perioperative outcomes in individual patients. Modification of neurological and airway categories may improve the predictive accuracy of the NARCO-SS. © 2014 John Wiley & Sons Ltd.

  5. 2013 ambulatory blood pressure monitoring recommendations for the diagnosis of adult hypertension, assessment of cardiovascular and other hypertension-associated risk, and attainment of therapeutic goals.

    PubMed

    Hermida, Ramón C; Smolensky, Michael H; Ayala, Diana E; Portaluppi, Francesco

    2013-04-01

    Correlation between systolic (SBP) and diastolic (DBP) blood pressure (BP) level and target organ damage, cardiovascular disease (CVD) risk, and long-term prognosis is much greater for ambulatory BP monitoring (ABPM) than daytime office measurements. The 2013 ABPM guidelines specified herein are based on ABPM patient outcomes studies and constitute a substantial revision of current knowledge. The asleep SBP mean and sleep-time relative SBP decline are the most significant predictors of CVD events, both individually as well as jointly when combined with other ABPM-derived prognostic markers. Thus, they should be preferably used to diagnose hypertension and assess CVD and other associated risks. Progressive decrease by therapeutic intervention of the asleep BP mean is the most significant predictor of CVD event-free interval. The 24-h BP mean is not recommended to diagnose hypertension because it disregards the more valuable clinical information pertaining to the features of the 24-h BP pattern. Persons with the same 24-h BP mean may display radically different 24-h BP patterns, ranging from extreme-dipper to riser types, representative of markedly different risk states. Classification of individuals by comparing office with either the 24-h or awake BP mean as "masked normotensives" (elevated clinic BP but normal ABPM), which should replace the terms of "isolated office" or "white-coat hypertension", and "masked hypertensives" (normal clinic BP but elevated ABPM) is misleading and should be avoided because it disregards the clinical significance of the asleep BP mean. Outcome-based ABPM reference thresholds for men, which in the absence of compelling clinical conditions are 135/85 mmHg for the awake and 120/70 mmHg for the asleep SBP/DBP means, are lower by 10/5 mmHg for SBP/DBP in uncomplicated, low-CVD risk, women and lower by 15/10 mmHg for SBP/DBP in male and female high-risk patients, e.g., with diabetes, chronic kidney disease (CKD), and/or past CVD

  6. Cardiovascular Risk Factors in Cluster Headache.

    PubMed

    Lasaosa, S Santos; Diago, E Bellosta; Calzada, J Navarro; Benito, A Velázquez

    2017-06-01

     Patients with cluster headache tend to have a dysregulation of systemic blood pressure such as increased blood pressure variability and decreased nocturnal dipping. This pattern of nocturnal nondipping is associated with end-organ damage and increased risk of cardiovascular disease.  To determine if cluster headache is associated with a higher risk of cardiovascular disease.  Cross-sectional study of 33 cluster headache patients without evidence of cardiovascular disease and 30 age- and gender-matched healthy controls. Ambulatory blood pressure monitoring was performed in all subjects. We evaluate anthropometric, hematologic, and structural parameters (carotid intima-media thickness and ankle-brachial index).  Of the 33 cluster headache patients, 16 (48.5%) were nondippers, a higher percentage than expected. Most of the cluster headache patients (69.7%) also presented a pathological ankle-brachial index. In terms of the carotid intima-media thickness values, 58.3% of the patients were in the 75th percentile, 25% were in the 90th percentile, and 20% were in the 95th percentile. In the control group, only five of the 30 subjects (16.7%) had a nondipper pattern ( P  =   0.004), with 4.54% in the 90th and 95th percentiles ( P  =   0.012 and 0.015).  Compared with healthy controls, patients with cluster headache presented a high incidence (48.5%) of nondipper pattern, pathological ankle-brachial index (69.7%), and intima-media thickness values above the 75th percentile. These findings support the hypothesis that patients with cluster headache present increased risk of cardiovascular disease.

  7. Impact of gestational risk factors on maternal cardiovascular system.

    PubMed

    Perales, María; Santos-Lozano, Alejandro; Sanchis-Gomar, Fabian; Luaces, María; Pareja-Galeano, Helios; Garatachea, Nuria; Barakat, Rubén; Lucia, Alejandro

    2016-07-01

    Scarce evidence is available on the potential cardiovascular abnormalities associated with some common gestational complications. We aimed to analyze the potential maternal cardiac alterations related to gestational complications, including body mass index (BMI) >25 kg/m(2), gaining excessive weight, or developing antenatal depression. The design of this study was a secondary analysis of a randomized controlled trial. Echocardiography was performed to assess cardiovascular indicators of maternal hemodynamic, cardiac remodeling and left ventricular (LV) function in 59 sedentary pregnant women at 20 and 34 weeks of gestation. Starting pregnancy with a BMI >25 kg/m(2), gaining excessive weight, and developing antenatal depression had no cardiovascular impact on maternal health (P value >0.002). Depressed women were more likely to exceed weight gain recommendations than non-depressed women (P value <0.002). The evaluated gestational complications seem not to induce cardiovascular alterations in hemodynamic, remodeling and LV function indicators. However, developing antenatal depression increases the risk of an excessive weight gain. This finding is potentially important because excessive weight gain during pregnancy associates with a higher risk of cardiovascular diseases (CVD) later in life.

  8. Impact of gestational risk factors on maternal cardiovascular system

    PubMed Central

    Perales, María; Santos-Lozano, Alejandro; Luaces, María; Pareja-Galeano, Helios; Garatachea, Nuria; Barakat, Rubén; Lucia, Alejandro

    2016-01-01

    Background Scarce evidence is available on the potential cardiovascular abnormalities associated with some common gestational complications. We aimed to analyze the potential maternal cardiac alterations related to gestational complications, including body mass index (BMI) >25 kg/m2, gaining excessive weight, or developing antenatal depression. Methods The design of this study was a secondary analysis of a randomized controlled trial. Echocardiography was performed to assess cardiovascular indicators of maternal hemodynamic, cardiac remodeling and left ventricular (LV) function in 59 sedentary pregnant women at 20 and 34 weeks of gestation. Results Starting pregnancy with a BMI >25 kg/m2, gaining excessive weight, and developing antenatal depression had no cardiovascular impact on maternal health (P value >0.002). Depressed women were more likely to exceed weight gain recommendations than non-depressed women (P value <0.002). Conclusions The evaluated gestational complications seem not to induce cardiovascular alterations in hemodynamic, remodeling and LV function indicators. However, developing antenatal depression increases the risk of an excessive weight gain. This finding is potentially important because excessive weight gain during pregnancy associates with a higher risk of cardiovascular diseases (CVD) later in life. PMID:27500154

  9. Telemedicine Cardiovascular Risk Reduction in Veterans

    PubMed Central

    Melnyk, S. Dee; Zullig, Leah L.; McCant, Felicia; Danus, Susanne; Oddone, Eugene; Bastian, Lori; Olsen, Maren; Stechuchak, Karen M.; Edelman, David; Rakley, Susan; Morey, Miriam; Bosworth, Hayden B

    2013-01-01

    Background Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical Pharmacy Specialist (CPS), telephone administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk. Methods Randomized controlled trial including patients with hypertension (blood pressure (BP) > 150/100 mmHg) or elevated low density liporotein (LDL) (> 130 mg/dl). Longitudinal changes in CVD risk profile and improvement in health behaviors over time will be examined. Conclusion Given the national prevalence of CVD and the dismal rates of risk factor control; intensive, but easily disseminated interventions are required to treat this epidemic. This study will be an important step in testing the effectiveness of a behavioral and medication intervention to improve CVD control among Veterans. PMID:23537965

  10. [Type 2 diabetes mellitus and cardiovascular risk factors: is comprehensive treatment required?].

    PubMed

    Nadal, Josep Franch; Gutiérrez, Pedro Conthe

    2013-09-01

    Diabetes mellitus, especially type 2, is a metabolic disease involving the coexistence of several cardiovascular risk factors. Affected patients are therefore at high cardiovascular risk (2-3 times higher than that of men in the general population and 2-6 times higher than that of women). Cardiovascular disease is the main cause of death in the diabetic population, followed by cancer. Cardiovascular risk cannot be compared between diabetic patients and persons who have already shown one or more manifestations of cardiovascular disease (such as myocardial infarction). Single risk factors should be evaluated in combination with other risk factors and a person's cardiovascular risk should be individually assessed. Cardiovascular risk assessment in patients with diabetes through current calculations methods is complex because their ability to predict risk in individuals is very low. Studies such as that by Steno have demonstrated the validity of a comprehensive strategy to control all the risk factors present in persons with type 2 diabetes mellitus, which can reduce the development of micro- and macrovascular complications and mortality by almost 50%. The present article reviews each of the classical cardiovascular risk factors (hypertension, dyslipidemia, smoking, obesity, sedentariness) in relation to diabetes, as well as their recommended targets and the benefits of their control. In view of the above, a comprehensive approach is recommended to control the multiple risk factors that can coexist in persons with type 2 diabetes mellitus. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  11. [Therapeutic Strategies. Cardiovascular risk and dyslipidemia in elderly and women].

    PubMed

    Morales, Clotilde; Royuela, Meritxell

    2013-01-01

    The management of cardiovascular risk and dyslipidemia are justified in guidelines. In the elderly, when they are in primary prevention, recommendations are controversial, even if there is evidence in reducing morbidity. In secondary prevention, between 65 and 85 years, there is enough evidence to recommend statins. The decision to start or to continue further treatment must be complemented by comprehensive assessment of the risk-benefit factor. In elderly patients we have to support in decision-making, we take clinical judgment and not just the age criteria. In women the risk is underestimated and may be untreated. The recomendations are the same as in men. During pregnancy there are particular recommendations.

  12. [Assessment of control of cardiovascular risk factors in obese posmenopausal women after monitoring a structured dietary education and exercise program. (SÍSIFO Program)].

    PubMed

    García Soto, Z M; Montoro García, S; Leal Hernández, M; Abellán Alemán, J

    2016-01-01

    Evaluate the influence of a specific program of physical exercise on cardiovascular risk, quality of life and eating habits of menopausal women. Prospective, intervention study previous-after without control group for three months. 66 menopausal women were included. The intervention consisted of a structured diet and exercise program. Biochemical, anthropometric, dietary and life quality parameters were determined before and three months after surgery. After the intervention a decrease in weight (4.4±2,3kg) and BMI (1.83±0.84kg/m(2)) (p<.05) occurs. A decrease in SBP (p<.05) was also observed. The fasting glucose went down 13.75±11.11mg/dl and HbA1c fell by 0.19±0,12%, both with p<.05. The lipid profile follows a similar behavior, highlighting a decline of 8± 6.2mg/dl in LDL cholesterol values (p<.05). The score on the measured cardiovascular risk by the Framingham tables decreases by 3% postoperatively (p<.05). Regarding the quality of life, it is significantly improved in all analyzed areas. The application of a structured exercise and diet program improves close monitoring parameters associated with cardiovascular risk of the women studied. It also improves the quality of life and dietary habits. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Increased cardiovascular risk associated with diabetes in Dallas County.

    PubMed

    Das, Sandeep R; Vaeth, Patrice A C; Stanek, Harold G; de Lemos, James A; Dobbins, Robert L; McGuire, Darren K

    2006-05-01

    Diabetes mellitus is a major public health problem in the United States. We assess the prevalence of diabetes in Dallas County, quantify the association between diabetes and subclinical cardiovascular disease, and assess the use of evidence-based cardiovascular disease risk-modifying therapies. This study uses data from 3392 participants aged 30 to 65 years from the Dallas Heart Study, a probability-based, multiethnic sample of residents living in Dallas County, Texas. Three primary outcomes were examined: (1) diabetes prevalence, (2) adjusted odds ratios for detectable coronary calcium stratified by diabetes diagnosis status, and (3) rates of use of evidence-based cardiovascular disease risk-modifying therapies among subjects with diabetes stratified by diabetes diagnosis status. The estimated prevalence of diabetes in Dallas County was 7.8%, with >40% of diabetic patients undiagnosed before participation in the Dallas Heart Study. Both previously diagnosed and previously undiagnosed diabetes were independently associated with the presence of coronary artery calcium (diagnosed: OR 3.55, 95% CI 1.56-8.05) (undiagnosed: OR 2.98, 95% CI 1.39-6.39). The rates of use of aspirin, angiotensin-converting enzyme inhibitors, and statins were suboptimal, and blood pressure and low-density lipoprotein cholesterol targets were rarely met, especially among subjects with previously undiagnosed diabetes. Diabetes is prevalent and is associated with subclinical cardiovascular disease; this association is present even at the time of diagnosis. Despite the cardiovascular risk associated with diabetes, evidence-based risk-modifying therapies continue to be underused, and therapeutic targets remain unmet, especially among people unaware of their diabetes diagnosis.

  14. Cost effectiveness of ramipril treatment for cardiovascular risk reduction

    PubMed Central

    Malik, I; Bhatia, V; Kooner, J

    2001-01-01

    OBJECTIVE—To assess the cost effectiveness of ramipril treatment in patients at low, medium, and high risk of cardiovascular death.
DESIGN—Population based cost effectiveness analysis from the perspective of the health care provider in the UK. Effectiveness was modelled using data from the HOPE (heart outcome prevention evaluation) trial. The life table method was used to predict mortality in a medium risk cohort, as in the HOPE trial (2.44% annual mortality), and in low and high risk groups (1% and 4.5% annual mortality, respectively).
SETTING—UK population using 1998 government actuary department data.
MAIN OUTCOME MEASURE—Cost per life year gained at five years and lifetime treatment with ramipril.
RESULTS—Cost effectiveness was £36 600, £13 600, and £4000 per life year gained at five years and £5300, £1900, and £100 per life year gained at 20 years (lifetime treatment) in low, medium, and high risk groups, respectively. Cost effectiveness at 20 years remained well below that of haemodialysis (£25 000 per life year gained) over a range of potential drug costs and savings. Treatment of the HOPE population would cost the UK National Health Service (NHS) an additional £360 million but would prevent 12 000 deaths per annum.
CONCLUSIONS—Ramipril is cost effective treatment for cardiovascular risk reduction in patients at medium, high, and low pretreatment risk, with a cost effectiveness comparable with the use of statins. Implementation of ramipril treatment in a medium risk population would result in a major reduction in cardiovascular deaths but would increase annual NHS spending by £360 million.


Keywords: angiotensin converting enzyme inhibitor; cardiovascular risk; cost effectiveness; ramipril PMID:11303006

  15. [Cardiovascular pharmacotherapy. Risks and adverse effects].

    PubMed

    Voigt, N; Heijman, J; Dobrev, D

    2014-03-01

    Adverse side effects of drugs are a significantly underestimated problem in modern medicine. In this review article, we summarize common adverse side effects of cardiovascular drugs. In particular, we highlight the factors promoting these adverse side effects in patients, including reduced hepatic or renal clearance in elderly patients that often requires dosage adjustment. Pharmacodynamic and pharmacokinetic interactions between drugs (e.g. through the cytochrome P450 system or P-glycoproteins) can modify the plasma concentration of many compounds, thereby also increasing the likelihood of unwanted side effects. The most prominent cardiac side effects include arrhythmias, e.g. atrioventricular (AV) block, drug-induced long-QT syndrome and torsade de pointes and altered inotropy. Non-cardiac side effects are subsequently discussed grouped by drug class. A better understanding of the risks and side effects of cardiovascular drugs is expected to reduce the mortality and morbidity associated with adverse side effects.

  16. [Burnout syndrome: a "true" cardiovascular risk factor].

    PubMed

    Cursoux, Pauline; Lehucher-Michel, Marie-Pascale; Marchetti, Hélène; Chaumet, Guillaume; Delliaux, Stéphane

    2012-11-01

    The burnout syndrome is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment in individuals professionally involved with others. The burnout syndrome is poorly recognized, particularly in France, as a distinct nosology from adaptation troubles, stress, depression, or anxiety. Several tools quantifying burnout and emotional exhaustion exist, the most spread is the questionnaire called Maslach Burnout Inventory. The burnout syndrome alters cardiovascular function and its neuroregulation by autonomic nervous system and is associated with: increased sympathetic tone to heart and vessels after mental stress, lowered physiological post-stress vagal rebound to heart, and lowered arterial baroreflex sensitivity. Job strain as burnout syndrome seems to be a real independent cardiovascular risk factor. Oppositely, training to manage emotions could increase vagal tone to heart and should be cardio-protective.

  17. Cardiovascular risks associated with incident and prevalent periodontal disease.

    PubMed

    Yu, Yau-Hua; Chasman, Daniel I; Buring, Julie E; Rose, Lynda; Ridker, Paul M

    2015-01-01

    While prevalent periodontal disease associates with cardiovascular risk, little is known about how incident periodontal disease influences future vascular risk. We compared effects of incident versus prevalent periodontal disease in developing major cardiovascular diseases (CVD), myocardial infarction (MI), ischaemic stroke and total CVD. In a prospective cohort of 39,863 predominantly white women, age ≥45 years and free of cardiovascular disease at baseline were followed for an average of 15.7 years. Cox proportional hazard models with time-varying periodontal status [prevalent (18%), incident (7.3%) versus never (74.7%)] were used to assess future cardiovascular risks. Incidence rates of all CVD outcomes were higher in women with prevalent or incident periodontal disease. For women with incident periodontal disease, risk factor adjusted hazard ratios (HRs) were 1.42 (95% CI, 1.14-1.77) for major CVD, 1.72 (1.25-2.38) for MI, 1.41 (1.02-1.95) for ischaemic stroke and 1.27 (1.06-1.52) for total CVD. For women with prevalent periodontal disease, adjusted HRs were 1.14 (1.00-1.31) for major CVD, 1.27 (1.04-1.56) for MI, 1.12 (0.91-1.37) for ischaemic stroke and 1.15 (1.03-1.28) for total CVD. New cases of periodontal disease, not just those that are pre-existing, place women at significantly elevated risks for future cardiovascular events. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Cardiovascular Risks Associated with Incident and Prevalent Periodontal Disease

    PubMed Central

    Yu, Yau-Hua; Chasman, Daniel I; Buring, Julie E; Rose, Lynda; Ridker, Paul M

    2014-01-01

    Aim While prevalent periodontal disease associates with cardiovascular risk, little is known about how incident periodontal disease influences future vascular risk. We compared effects of incident versus prevalent periodontal disease in developing major cardiovascular diseases (CVD), myocardial infarction (MI), ischemic stroke and total CVD. Material and Methods In a prospective cohort of 39863 predominantly white women, age ≥ 45 years and free of cardiovascular disease at baseline were followed for an average of 15.7 years. Cox proportional hazard models with time-varying periodontal status (prevalent [18%], incident [7.3%] vs. never [74.7%]) were used to assess future cardiovascular risks. Results Incidence rates of all CVD outcomes were higher in women with prevalent or incident periodontal disease. For women with incident periodontal disease, risk factor adjusted hazard ratios (HRs) were 1.42 (95% CI, 1.14–1.77) for major CVD, 1.72 (1.25–2.38) for MI, 1.41(1.02–1.95) for ischemic stroke, and 1.27(1.06–1.52) for total CVD. For women with prevalent periodontal disease, adjusted HRs were 1.14 (1.00–1.31) for major CVD, 1.27 (1.04–1.56) for MI, 1.12(0.91–1.37) for ischemic stroke, and 1.15(1.03–1.28) for total CVD. Conclusion New cases of periodontal disease, not just those that are pre-existing, place women at significantly elevated risks for future cardiovascular events. PMID:25385537

  19. Cardiovascular

    NASA Image and Video Library

    Overview of Cardiovascular research which addresses risks of space flight, including adaptive changes to the cephalad fluid shift (such as reduced circulating blood volume), potential for heart rhy...

  20. [Motivation to change unhealthy life styles and cardiovascular risk].

    PubMed

    Pérez-Manchón, David; Alvarez-García, Gema María; González-López, Esteban

    2014-01-01

    Study the relationship between motivation to change unhealthy life styles and cardiovascular risk. Cross sectional study, random, stratified by age, carried out in the field of primary care with a sample of 369 people. It was felt that with smoking or smoking cessation active consumption less than a year, the physical habit was valued at work and leisure, food habits were assessed in adherence to mediterranean diet and the stages of motivation were categorized precontemplative phase to maintenance phase. The cardiovascular risk was stratified with the SCORE table calibrated in Spain. The 49.6% were men and 50.4% were women, with an average age of 41.2 years. The prevalence of smoking was 31.4% (95% CI 26.56-36,30), 58% in sedentary lifestyle (95% CI 52.27-62,63) and 68% for bad diet (95% CI 63.97-73,69). The 69.8% of smokers, 77.8% of sedentary and 48.4% of people without proper diet was precontemplative to change their lifestyles. Precontemplative stages in unhealthy life styles have association with risk factors and increase the global cardiovascular risk. The transtheoretical model is a useful tool for the assessment of unhealthy behaviors in lifestyles. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  1. [Cardiovascular risk factors in users with severe mental disorder].

    PubMed

    Paños-Martínez, Montserrat; Patró-Moncunill, Ester; Santiago-Barragán, Ángel-María; Marti-Mestre, Marc; Torralbas-Ortega, Jordi; Escayola-Maranges, Anna; Granero-Lázaro, Alberto

    2016-01-01

    To identify the prevalence of the cardiovascular risk (RCV) in users with a Severe Mental Disorder (SMD) attended in mental health service in ParcTaulí (Sabadell - Barcelona). This is an observational, descriptive and transversal study of the factors of cardiovascular risk in 789 users with SMD. The instrument used was the scale of assessment of the Registre Gironí del Cor, which estimates the risk of cardiovascular disease. 26.6% of the sample has RCV (22.5% moderate, 3.8% high and 0.3% very high). The analysis of the modifiable risk factors shows that 16.5% of the patients are hypertensive, 55.2% are smokers, 19.77% have hyperglycaemia (8.2% of whom are diagnosed of diabetes mellitus), 40.2% have obesity, 36.2% overweight and 47.27% hypercholesterolemia. The study confirms that the prevalence of the RVC in SMD users is greater than the RCV in general population and it's associated to the presence of modifiable risk factors. Health education carried out by nurses is the best to prevent the RCV in SMD users. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  2. Cardiovascular Risk Factors of Taxi Drivers.

    PubMed

    Elshatarat, Rami Azmi; Burgel, Barbara J

    2016-06-01

    In the United States (U.S.), cardiovascular disease (CVD) is a major leading cause of death. Despite the high mortality rate related to CVD, little is known about CVD risk factors among urban taxi drivers in the U.S. A cross-sectional design was used to identify the predictors of high cardiovascular risk factors among taxi drivers. Convenience sampling method was used to recruit 130 taxi drivers. A structured questionnaire was used to obtain the data. The sample was male (94 %), age mean (45 ± 10.75) years, married (54 %), born outside of the USA (55 %), had some college or below (61.5 %), night drivers (50.8 %), and driving on average 9.7 years and 41 h/week. About 79 % of them were eligible for CVD prevention, and 35.4 % had high CVD risk factors (4-9 risk factors). A CVD high-risk profile had a significant relationship with the subjects who were ≥55 years old; had hypertension, diabetes, or hyperlipidemia; were drinking alcohol ≥2 times/week; and had insufficient physical activity. Subjects who worked as a taxi driver for more than 10 years (OR 4.37; 95 % CI 1.82, 10.50) and had mental exertion from cab driving >5 out of 10 (OR 2.63; 95 % CI 1.05, 6.57) were more likely to have a CVD high-risk profile. As a conclusion, system-level or worksite interventions include offering healthy food at taxi dispatching locations, creating a work culture of frequent walking breaks, and interventions focusing on smoking, physical activity, and weight management. Improving health insurance coverage for this group of workers is recommended.

  3. Sortilin and the risk of cardiovascular disease.

    PubMed

    Coutinho, Maria Francisca; Bourbon, Mafalda; Prata, Maria João; Alves, Sandra

    2013-10-01

    Plasma low-density lipoprotein cholesterol (LDL-C) levels are a key determinant of the risk of cardiovascular disease, which is why many studies have attempted to elucidate the pathways that regulate its metabolism. Novel latest-generation sequencing techniques have identified a strong association between the 1p13 locus and the risk of cardiovascular disease caused by changes in plasma LDL-C levels. As expected for a complex phenotype, the effects of variation in this locus are only moderate. Even so, knowledge of the association is of major importance, since it has unveiled a new metabolic pathway regulating plasma cholesterol levels. Crucial to this discovery was the work of three independent teams seeking to clarify the biological basis of this association, who succeeded in proving that SORT1, encoding sortilin, was the gene in the 1p13 locus involved in LDL metabolism. SORT1 was the first gene identified as determining plasma LDL levels to be mechanistically evaluated and, although the three teams used different, though appropriate, experimental methods, their results were in some ways contradictory. Here we review all the experiments that led to the identification of the new pathway connecting sortilin with plasma LDL levels and risk of myocardial infarction. The regulatory mechanism underlying this association remains unclear, but its discovery has paved the way for considering previously unsuspected therapeutic targets and approaches. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. [Cardiovascular risk factors in Tlemcen (Algeria)].

    PubMed

    Latifa, Boukli Hacène; Kaouel, Meguenni

    2007-01-01

    Cardiovascular risk factors were studied in a random representative sample of the urban community of Tlemcen, aged 20 years or older. The study included 805 subjects (participation rate: 72%). This study showed a high prevalence of hypertension (32.7%), diabetes (16.1%), cigarette smoking (17.1%, but 36.8% among men), blood cholesterol levels > 6.2 mmol/L (6.3%) and obesity (19.2% and significantly higher in women than in men: 27.9% vs 10.5%). These results show that the prevalence of hypertension is very high among women, reaching levels observed in industrialized countries.

  5. Cardiovascular disease risk reduction with sleep apnea treatment

    PubMed Central

    Jean-Louis, Girardin; Brown, Clinton D; Zizi, Ferdinand; Ogedegbe, Gbenga; Boutin-Foster, Carla; Gorga, Joseph; McFarlane, Samy I

    2014-01-01

    Cardiovascular diseases are the leading cause of death among adults in developed countries. An increase in prevalent cardiovascular risk factors (e.g., obesity, hypertension and diabetes) has led to a concerted effort to raise awareness of the need to use evidence-based strategies to help patients at risk of developing cardiovascular disease and to reduce their likelihood of suffering a stroke. Sleep apnea has emerged as an important risk factor for the development of cardiovascular disease. Epidemiologic and clinical evidence has prompted the American Heart Association to issue a scientific statement describing the need to recognize sleep apnea as an important target for therapy in reducing cardiovascular disease risks. This article examines evidence supporting associations of sleep apnea with cardiovascular disease and considers evidence suggesting cardiovascular risk reductions through sleep apnea treatment. Perspectives on emerging therapeutic approaches and promising areas of clinical and experimental research are also discussed. PMID:20602560

  6. Genetic profiling for risk reduction in human cardiovascular disease.

    PubMed

    Puckelwartz, Megan J; McNally, Elizabeth M

    2014-03-12

    Cardiovascular disease is a major health concern affecting over 80,000,000 people in the U.S. alone. Heart failure, cardiomyopathy, heart rhythm disorders, atherosclerosis and aneurysm formation have significant heritable contribution. Supported by familial aggregation and twin studies, these cardiovascular diseases are influenced by genetic variation. Family-based linkage studies and population-based genome-wide association studies (GWAS) have each identified genes and variants important for the pathogenesis of cardiovascular disease. The advent of next generation sequencing has ushered in a new era in the genetic diagnosis of cardiovascular disease, and this is especially evident when considering cardiomyopathy, a leading cause of heart failure. Cardiomyopathy is a genetically heterogeneous disorder characterized by morphologically abnormal heart with abnormal function. Genetic testing for cardiomyopathy employs gene panels, and these panels assess more than 50 genes simultaneously. Despite the large size of these panels, the sensitivity for detecting the primary genetic defect is still only approximately 50%. Recently, there has been a shift towards applying broader exome and/or genome sequencing to interrogate more of the genome to provide a genetic diagnosis for cardiomyopathy. Genetic mutations in cardiomyopathy offer the capacity to predict clinical outcome, including arrhythmia risk, and genetic diagnosis often provides an early window in which to institute therapy. This discussion is an overview as to how genomic data is shaping the current understanding and treatment of cardiovascular disease.

  7. Cardiovascular disease and modifiable cardiometabolic risk factors.

    PubMed

    Cannon, Christopher P

    2007-01-01

    Cardiovascular disease (CVD) is the leading cause of death in the United States and many parts of the world. Potentially modifiable risk factors for CVD include tobacco use, physical inactivity, hypertension, elevated low-density lipoprotein cholesterol, and a cluster of interrelated metabolic risk factors. Over the last several decades, efforts to prevent or treat CVD risk factors have resulted in significantly lower rates of CVD-related mortality. However, many patients never achieve adequate control of CVD risk factors even when these factors have been identified. In addition, the growing prevalence of obesity and type 2 diabetes mellitus (DM) threatens to undermine the improvements in CVD that have been achieved. In the United States, approximately two thirds of adults are overweight or obese, and even modest excess body weight is associated with a significantly increased risk of CVD-related mortality. Lifestyle interventions to promote weight loss reduce the risk of CVD-related illness but are difficult for patients to sustain over long periods of time. The increased incidence of obesity has also contributed to significant increases in the prevalence of other important CVD risk factors, including hypertension, dyslipidemia, insulin resistance, and type 2 DM. Pharmacologic therapies are currently available to address individual CVD risk factors, and others are being evaluated, including endocannabinoid receptor antagonists, inhibitors of peroxisome proliferator-activated receptor subtypes alpha and gamma, and several agents that modulate the activity of glucagon-like peptide-1. The new agents have the potential to significantly improve several CVD risk factors with a single medication and may provide clinicians with several new strategies to reduce the long-term risk of CVD.

  8. [The promotion of health and integrated prevention of risk factors for cardiovascular diseases].

    PubMed

    Ribeiro, Amanda Gomes; Cotta, Rosângela Minardi Mitre; Ribeiro, Sônia Machado Rocha

    2012-01-01

    Cardiovascular diseases are currently the most common causes of morbimortality worldwide. In the context of disease prevention, actions creating favorable health environments and promoting healthy choices prove fundamental. Intervention programs with a community basis have been introduced in different countries since the beginning of the 1970s, aiming to modify cardiovascular risk factors and decrease morbidity and mortality due to cardiovascular diseases. In such experiences, the importance of public policies and cardiovascular risk vigilance systems needs to be stressed, permitting a more accurate assessment of the magnitude of the problem and the development of more cost-effective actions. The scope of this bibliographical study was to describe community-geared experiences in many countries in the campaign against cardiovascular diseases through health promotion and primary prevention of risk factors, as well as to identify in Brazil the vigilance actions of the risk factors of non-transmissible chronic diseases, stressing the strategic challenges facing the Family Health Program in tackling cardiovascular diseases.

  9. Cardiovascular complications of Rheumatoid Arthritis - Assessment, prevention and treatment

    PubMed Central

    Kaplan, Mariana J.

    2010-01-01

    Synopsis Morbidity and mortality rates are higher in individuals with rheumatoid arthritis (RA) than in the general population. Ischemic heart disease and heart failure now represent one of the most common causes of death in RA. Indeed, RA appears to represent an independent risk factor for ischemic heart disease, similar to diabetes mellitus. However, no clear guidelines with regards to cardiovascular disease diagnosis and prevention in RA have been developed. This review highlights recent investigations on the assessment, prevention and treatment of cardiovascular disease in RA. PMID:20510241

  10. Cardiovascular risk stratification in familial hypercholesterolaemia

    PubMed Central

    Sharifi, Mahtab; Rakhit, Roby D; Humphries, Steve E; Nair, Devaki

    2016-01-01

    Familial hypercholesterolaemia (FH) is a common autosomal-dominant disorder in most European countries. Patients with FH are characterised by a raised level of low-density lipoprotein cholesterol and a high risk of premature coronary heart disease (CHD). Currently there is no consensus regarding the clinical utility to predict future coronary events or testing for the presence of subclinical atherosclerotic disease in asymptomatic patients with FH. Family screening of patients with FH as recommended by the UK National Institute of Health and Care Excellence guideline would result in finding many young individuals with a diagnosis of FH who are clinically asymptomatic. The traditional CHD risk scores, that is, the Framingham score, are insufficient in risk prediction in this group of young individuals. In addition, a better understanding of the genetic aetiology of the FH phenotype and CHD risk in monogenic FH and polygenic hypercholesterolaemia is needed. Non-invasive imaging methods such as carotid intima-media thickness measurement might produce more reliable information in finding high-risk patients with FH. The potential market authorisation of novel therapeutic agents such as PCSK9 monoclonal inhibitors makes it essential to have a better screening programme to prioritise the candidates for treatment with the most severe form of FH and at higher risk of coronary events. The utility of new imaging techniques and new cardiovascular biomarkers remains to be determined in prospective trials. PMID:27126396

  11. [Cardiovascular polypill in high risk patients].

    PubMed

    Lafeber, Melvin; Spiering, Wilko; Bots, Michiel L; de Valk, Vincent; Visseren, Frank L J; Grobbee, Diederick E

    2011-01-01

    The initial theoretical concept of a polypill was a fixed-dosed combination pill containing an antiplatelet agent, a cholesterol-lowering agent and multiple blood pressure-lowering agents aimed at the prevention of atherosclerotic vascular disease in the population aged 55 years and up. The reduction in the risk of cardiovascular disease does not depend on the cholesterol level and blood pressure at the start of treatment. The pharmacological reduction in risk factors in individuals with a high risk of atherosclerotic vascular disease is often suboptimal, partly due to the complexity of the guidelines and low adherence to the therapy. A polypill may offer opportunities for improvement. Research has shown that the use of combination products leads to a greater reduction in risk factors than the use of separate substances, possibly through improved adherence to the therapy. The use of a polypill in the prevention of vascular disease in high-risk patients may lead to a more effective reduction in risk, a decrease in costs and a reduction in pharmacological expenditure.

  12. Relationship between practice organization and cardiovascular risk factor recording in general practice.

    PubMed Central

    van Drenth, B B; Hulscher, M E; van der Wouden, J C; Mokkink, H G; Van Weel, C; Grol, R P

    1998-01-01

    BACKGROUND: Research findings suggest that the level of cardiovascular risk factor recording in general practice is not yet optimal. Several studies indicate a relation between the organization of cardiovascular disease prevention at practice level and cardiovascular risk factor recording. AIM: To explore the relation between the organization of cardiovascular disease prevention and risk factor recording in general practice. METHOD: A cross-sectional study was conducted using data on adherence to selected practice guidelines and on cardiovascular risk factor recording from 95 general practices. Practice guidelines were developed beforehand in a consensus procedure. Adherence was assessed by means of a questionnaire and practice observations. Risk factor recording was assessed by an audit of 50 medical records per practice. RESULTS: Factor analysis of risk factor recording revealed three dimensions explaining 76% of the variance: recording of health-related behaviour, recording of clinical parameters, and recording of medical background parameters. Adherence to the guideline 'proactively invite patients to attend for assessment of cardiovascular risk' was related to a higher recording level in all three dimensions. Practice characteristics did not show a consistent relationship to the level of risk factor recording. CONCLUSION: This study indicates that the presence of a system of proactive invitation was related to the recording of cardiovascular risk factors in medical records in general practice. PMID:9624746

  13. Thyroid Function, Cardiovascular Risk Factors, and Incident Atherosclerotic Cardiovascular Disease: The Atherosclerosis Risk in Communities (ARIC) Study.

    PubMed

    Martin, Seth S; Daya, Natalie; Lutsey, Pamela L; Matsushita, Kunihiro; Fretz, Anna; McEvoy, John W; Blumenthal, Roger S; Coresh, Josef; Greenland, Philip; Kottgen, Anna; Selvin, Elizabeth

    2017-09-01

    Cardiovascular outcomes in mild thyroid dysfunction (treatment controversial) and moderate or severe dysfunction (treatment standard) remain uncertain. To examine cross-sectional and prospective associations of thyroid function with cardiovascular risk factors and events. In the Atherosclerosis Risk in Communities Study, we measured concentrations of thyrotropin, free thyroxine, and total triiodothyronine (T3) in stored serum samples originally collected in 1990-1992. We used multivariable linear regression to assess cross-sectional associations of thyroid function with cardiovascular risk factors and Cox regression to assess prospective associations with cardiovascular events. Follow-up occurred through 31 December 2014. General community. Black and white men and women from the United States, without prior myocardial infarction (MI), stroke, or heart failure. Cross-sectional outcomes were blood pressure, glycemic markers, and blood lipids. Prospective outcomes were adjudicated fatal and nonfatal MI and stroke. Among 11,359 participants (57 ± 6 years, 58% women), thyroid function was more strongly associated with blood lipids than blood pressure or glycemic measures. Mean adjusted differences in low-density lipoprotein cholesterol were +15.1 (95% confidence interval: 10.5 to 19.7) and +3.2 (0.0 to 6.4) mg/dL in those with moderate/severe and mild chemical hypothyroidism, relative to euthyroidism; an opposite pattern was seen in hyperthyroidism. Similar differences were seen in triglycerides and non-high-density lipoprotein cholesterol. With a 22.5-year median follow-up, 1102 MIs and 838 strokes occurred, with similar outcomes among baseline thyroid function groups and by T3 concentrations. Hypothyroidism is associated with hyperlipidemia, but the magnitude is small in mild chemical hypothyroidism, and cardiovascular outcomes are similar between thyroid function groups.

  14. Cardiovascular risk factors in polycystic ovary syndrome.

    PubMed

    Karaer, A; Cavkaytar, S; Mert, I; Buyukkagnici, U; Batioglu, S

    2010-05-01

    A total of 31 women with polycystic ovary syndrome (PCOS) and 31 healthy age/body mass index matched controls were compared for serum hormones, basal and oral-glucose stimulated glucose, insulin, homocysteine, high sensitive C-reactive protein (hsCRP) and lipid levels. The women with PCOS had significantly higher serum fasting insulin, homocysteine, total cholesterol and LDL cholesterol level than controls, whereas no differences were detected in serum fasting or OGTT 60th- and 120th-minute glucose concentrations, hsCRP, HDL cholesterol, VLDL cholesterol and triglyceride levels between PCOS and control women. Insulin resistance was found in 54.8% (17/31) of PCOS patients by glucose: insulin (G/I) ratio, whereas only 29.0% (9/31) of control women (p = 0.04). Multivariate linear regression analysis revealed that only waist/hip ratio was independent determinants of G/I ratio. PCOS is associated with some biochemical and clinical risk factors for cardiovascular disease. Therefore, patients with PCOS should undergo comprehensive evaluation for recognised cardiovascular risk factors.

  15. HIV Therapy, Metabolic Syndrome, and Cardiovascular Risk

    PubMed Central

    Pao, Vivian; Lee, Grace A.; Grunfeld, Carl

    2011-01-01

    People with HIV infection have metabolic abnormalities that resemble metabolic syndrome (hypertriglyceridemia, low high-density lipoprotein cholesterol, and insulin resistance), which is known to predict increased risk of cardiovascular disease (CVD). However, there is not one underlying cause for these abnormalities and they are not linked to each other. Rather, individual abnormalities can be affected by the host response to HIV itself, specific HIV drugs, classes of HIV drugs, HIV-associated lipoatrophy, or restoration to health. Furthermore, one component of metabolic syndrome, increased waist circumference, occurs less frequently in HIV infection. Thus, HIV infection supports the concept that metabolic syndrome does not represent a syndrome based on a common underlying pathophysiology. As might be predicted from these findings, the prevalence of CVD is higher in people with HIV infection. It remains to be determined whether CVD rates in HIV infection are higher than might be predicted from traditional risk factors, including smoking. PMID:18366987

  16. Cardiovascular risk, lipids and pregnancy: preeclampsia and the risk of later life cardiovascular disease.

    PubMed

    Charlton, Francesca; Tooher, Jane; Rye, Kerry-Anne; Hennessy, Annemarie

    2014-03-01

    It has been widely thought that the effects of hypertension in pregnancy reversed after delivery and hypertension values returned to their pre-pregnancy level as it was seen as a disease of short duration in otherwise healthy young women. However, recent studies have demonstrated that the principal underlying abnormality, endothelial dysfunction, remains in women who had preeclampsia and that it is this damage that increases the risk of developing cardiovascular disease (CVD) in later life. The contributions of hypertension and dyslipidaemia before and during the pregnancy are also important and contribute to future risk. Serum lipids are complex and change dramatically in pregnancy. In general there is an increase in most plasma lipid components, notably triglycerides, total cholesterol and the major particles of HDL and LDL. Aberrations or exaggerations in this shift (i.e. decrease HDL and a greater increase in LDL) are associated with poor outcomes of pregnancy such as preeclampsia. Long term cardiovascular disease is influenced by preeclampsia and in part potentially by the lipid changes which escalate late in disease. Whether we can influence the risk of preeclampsia by controlling cardiovascular risk factors preceding or during preeclampsia, or cardiovascular disease after preeclampsia is yet to be determined. Ultimately, strategies to control lipid concentrations will only be viable when we understand the safety to the mother at the time of the pregnancy, and to the foetus both immediately and in the very long term. Strategies to control blood pressure are well established in the non-pregnant population, and previous preeclampsia and gestational hypertension should be considered in any cardiovascular risk profile. Whether control of blood pressure in the pregnancy per se is of any longer term benefit is also yet to be determined.

  17. Epigenetics and cardiovascular risk in childhood.

    PubMed

    Martino, Francesco; Magenta, Alessandra; Pannarale, Giuseppe; Martino, Eliana; Zanoni, Cristina; Perla, Francesco M; Puddu, Paolo E; Barillà, Francesco

    2016-08-01

    Cardiovascular disease (CVD) can arise at the early stages of development and growth. Genetic and environmental factors may interact resulting in epigenetic modifications with abnormal phenotypic expression of genetic information without any change in the nucleotide sequence of DNA. Maternal dietary imbalance, inadequate to meet the nutritional needs of the fetus can lead to intrauterine growth retardation, decreased gestational age, low birth weight, excessive post-natal growth and metabolic alterations, with subsequent appearance of CVD risk factors. Fetal exposure to high cholesterol, diabetes and maternal obesity is associated with increased risk and progression of atherosclerosis. Maternal smoking during pregnancy and exposure to various environmental pollutants induce epigenetic alterations of gene expression relevant to the onset or progression of CVD. In children with hypercholesterolemia and/or obesity, oxidative stress activates platelets and monocytes, which release proinflammatory and proatherogenic substances, inducing endothelial dysfunction, decreased Doppler flow-mediated dilation and increased carotid intima-media thickness. Primary prevention of atherosclerosis should be implemented early. It is necessary to identify, through screening, high-risk apparently healthy children and take care of them enforcing healthy lifestyle (mainly consisting of Mediterranean diet and physical activity), prescribing nutraceuticals and eventual medications, if required by a high-risk profile. The key issue is the restoration of endothelial function in the reversible stage of atherosclerosis. Epigenetics may provide new markers for an early identification of children at risk and thereby develop innovative therapies and specific nutritional interventions in critical times.

  18. Cardiovascular risk in operators under radiofrequency electromagnetic radiation.

    PubMed

    Vangelova, Katia; Deyanov, Christo; Israel, Mishel

    2006-03-01

    The aim of the study was to assess the long-term effects of radiofrequency electromagnetic radiation (EMR) on the cardiovascular system. Two groups of exposed operators (49 broadcasting (BC) station and 61 TV station operators) and a control group of 110 radiorelay station operators, matched by sex and age, with similar job characteristics except for the radiofrequency EMR were studied. The EMR exposure was assessed and the time-weighted average (TWA) was calculated. The cardiovascular risk factors arterial pressure, lipid profile, body mass index, waist/hip ratio, smoking, and family history of cardiovascular disease were followed. The systolic and diastolic blood pressure (SBP and DBP), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly higher in the two exposed groups. It was found that the radiofrequency EMR exposure was associated with greater chance of becoming hypertensive and dyslipidemic. The stepwise multiple regression equations showed that the SBP and TWA predicted the high TC and high LDL-C, while the TC, age and abdominal obesity were predictors for high SBP and DBP. In conclusion, our data show that the radiofrequency EMR contributes to adverse effects on the cardiovascular system.

  19. BELFAST centenarians: a case of optimised cardiovascular risk?

    PubMed

    Bennati, E; Murphy, A; Cambien, F; Whitehead, A S; Archbold, G P R; Young, I S; Rea, I M

    2010-01-01

    Centenarians are reservoirs of genetic and environmental information to successful ageing and local centenarian groups may help us to understand some of these secrets. The current centenarian cohort in Belfast survived the 1970s epidemic of death from coronary heart disease in Northern Ireland, where cardiovascular mortality was almost highest in the world. These centenarians provided an opportunity to assess biological and genetic factors important in cardiovascular risk and ageing. Thirty-five (27 female, 8 male) centenarians, participants of the Belfast Elderly Longitudinal Free-living Ageing STudy (BELFAST), were community-living and of good cognition at enrollment. Centenarians showed median Body Mass Index (BMI) at 25.7, systolic blood pressure 140 mmHg and diastolic blood pressure 90 mmHg respectively, and fasting glucose of 5.54 mmol/l with no sex-related difference. Lipoproteins showed median cholesterol 5.3, High Density Lipoprotein (HDL) 1.10 and Low Density Lipoprotein (LDL) 3.47 micromol/l respectively. Centenarian smokers showed no different blood pressure or lipid measurements compared with non-smokers. Malondialdehyde, a measure of lipid peroxidation, was low at 1.19, and measures of antioxidant status showed variable results. Male centenarians did not carry any of the vascular risk genotypes studied-Apolipoprotein E (ApoE), Angiotensin-Converting Enzyme (ACE) and Methylenetetrafolatedehydrogenase reductase (MTFHR), though this was not true for female centenarians. This small local study shows, apart from age, that Belfast centenarians carry a reasonably optimized risk profile with respect to cardiovascular disease. There is also some evidence suggesting that vascular risk factors and genotypes may be tolerated differently between the male and female centenarians. Maintaining an optimized cardiovascular risk profile seems likely to improve the chance of becoming a centenarian, especially for males.

  20. Ambulatory blood pressure monitoring: importance of sampling rate and duration--48 versus 24 hours--on the accurate assessment of cardiovascular risk.

    PubMed

    Hermida, Ramón C; Ayala, Diana E; Fontao, María J; Mojón, Artemio; Fernández, José R

    2013-03-01

    Independent prospective studies have found that ambulatory blood pressure (BP) monitoring (ABPM) is more closely correlated with target organ damage and cardiovascular disease (CVD) risk than clinic BP measurement. This is based on studies in which BP was sampled every 15-30 min for ≤24 h, without taking into account that reproducibility of any estimated parameter from a time series to be potentially used for CVD risk assessment might depend more on monitoring duration than on sampling rate. Herein, we evaluated the influence of duration (48 vs. 24 h) and sampling rate of BP measurements (form every 20-30 min up to every 2 h) on the prognostic value of ABPM-derived parameters. We prospectively studied 3344 subjects (1718 men/1626 women), 52.6 ± 14.5 yrs of age, during a median follow-up of 5.6 yrs. Those with hypertension at baseline were randomized to ingest all their prescribed hypertension medications upon awakening or ≥1 of them at bedtime. At baseline, BP was measured at 20-min intervals from 07:00 to 23:00 h and at 30-min intervals at night for 48 h, and physical activity was simultaneously monitored every min by wrist actigraphy to accurately derive the awake and asleep BP means. Identical assessment was scheduled annually and more frequently (quarterly) if treatment adjustment was required. ABPM profiles were modified to generate time series of identical 48-h duration but with data sampled at 1- or 2-h intervals, or shorter, i.e., first 24 h, time series with data sampled at the original rate (daytime 20-min intervals/nighttime 30-min intervals). Bland-Altman plots indicated that the range of individual differences in the estimated awake and asleep systolic (SBP) and diastolic BP (DBP) means between the original and modified ABPM profiles was up to 3-fold smaller for data sampled every 1 h for 48 h than for data sampled every 20-30 min for the first 24 h. Reduction of ABPM duration to just 24 h resulted in error of the

  1. [FINDRISC Test: Relationship between cardiovascular risk parameters and scales in Spanish Mediterranean population].

    PubMed

    López-González, Ángel Arturo; García-Agudo, Sheila; Tomás-Salvá, Matías; Vicente-Herrero, María Teófila; Queimadelos-Carmona, Milagros; Campos-González, Irene

    2017-01-01

    The Finnish Diabetes Risk Score (FINDRISC) questionnaire has been used to assess the risk of type 2 diabetes and metabolic syndrome. The objetive was to assess the relationship between different scales related to cardiovascular risk and FINDRISC questionnaire. Values of different anthropometric and clinical parameters (body mass index, waist circumference, waist to height ratio, blood pressure), analytical parameters (lipid profile, blood glucose) and scales related to cardiovascular risk (atherogenic index, metabolic syndrome, REGICOR, SCORE, heart age and vascular age) were determined on the basis of the value of the FINDRISC questionnaire. All analyzed parameters related to cardiovascular risk were getting worse at the same time that the value of the FINDRISC questionnaire increased. There is a close relationship between FINDRISC questionnaire values and those obtained in the different parameters by which cardiovascular risk was measured directly or indirectly.

  2. Vitamin E and risk of cardiovascular diseases: a review of epidemiologic and clinical trial studies.

    PubMed

    Cordero, Zorabel; Drogan, Dagmar; Weikert, Cornelia; Boeing, Heiner

    2010-05-01

    Cardiovascular diseases are the leading cause of worldwide mortality. There is strong epidemiologic evidence for a beneficial effect of vitamin E on cardiovascular disease risk. However, conflicting results have been reported by intervention studies. To assess the potential benefit of vitamin E intake on the risk of cardiovascular diseases, fifty-nine published reports from observational studies, retrospective and prospective, randomised clinical trials, meta-analyses as well as pooling analyses were reviewed. The paper provides a detailed discussion about design, quality and limitations of these studies with regard to the evidence of the hypothesized relationship between vitamin E and cardiovascular diseases.

  3. Cardiovascular risks to young persons on the athletic field.

    PubMed

    Maron, B J

    1998-09-01

    Sudden cardiac deaths of young athletes, which are usually associated with physical exertion, continue to achieve high public visibility and generate considerable concern. Despite broad community participation in sports, such catastrophes are uncommon, occurring in about 1/200000 high school athletes per academic year. Various unsuspected congenital cardiovascular diseases are usually responsible; the most common lesions are hypertrophic cardiomyopathy and several congenital coronary artery anomalies. Selected reports suggest that arrhythmogenic right ventricular dysplasia may be a more common cause of these deaths than previously suspected. In some trained athletes with borderline increases in thickness of the left ventricular wall, mild morphologic expression of hypertrophic cardiomyopathy can often be distinguished from the physiologic consequences of athlete's heart by noninvasive clinical assessment and testing. In addition, the recognized cardiovascular risks of the athletic field are now extended to include cardiac arrest resulting from relatively modest, nonpenetrating chest blows produced by projectiles (such as baseballs) or bodily contact in the absence of underlying cardiac disease and without structural injury to the chest wall or heart. These uncommon but usually fatal events seem to result when chest impact occurs precisely during the vulnerable phase of repolarization, and they may be reduced by use of softer baseballs. Preparticipation screening for cardiovascular disease, consisting of standard history and physical examination, is customary practice for most high school and college athletes in the United States. Evidence suggests, however, that the present screening process for cardiovascular disease in high school athletes may be largely inadequate, given the content of the approved screening questionnaires (which serve as guidelines for the process) and the use of examiners with little cardiovascular training. This emphasizes the need for

  4. Collaborative Cardiovascular Risk Reduction in Primary Care II (CCARP II)

    PubMed Central

    Yakiwchuk, Erin M.; Jorgenson, Derek; Mansell, Kerry; Laubscher, Tessa; LeBras, Marlys

    2013-01-01

    Background: Previous pharmacist interventions to reduce cardiovascular (CV) risk have been limited by low patient enrolment. The primary aim of this study was to implement a collaborative pharmacist intervention that used a systematic case-finding procedure to identify and manage patients with uncontrolled CV risk factors. Methods: This was an uncontrolled, program implementation study. We implemented a collaborative pharmacist intervention in a primary care clinic. All adults presenting for an appointment with a participating physician were systematically screened and assessed for CV risk factor control by the pharmacist. Recommendations for risk factor management were communicated on a standardized form, and the level of pharmacist follow-up was determined on a case-by-case basis. We recorded the proportion of adults exhibiting a moderate to high Framingham risk score and at least 1 uncontrolled risk factor. In addition, we assessed before-after changes in CV risk factors. Results: Of the 566 patients who were screened prior to visiting a participating physician, 186 (32.9%) exhibited moderate or high CV risk along with at least 1 uncontrolled risk factor. Physicians requested pharmacist follow-up for 60.8% (113/186) of these patients. Of the patients receiving the pharmacist intervention, 65.5% (74/113) were at least 50% closer to 1 or more of their risk factor targets by the end of the study period. Significant risk factor improvements from baseline were also observed. Discussion: Through implementation of a systematic case-finding approach that was carried out by the pharmacist on behalf of the clinic team, a large number of patients with uncontrolled risk factors were identified, assessed and managed with a collaborative intervention. Conclusion: Systematic case finding appears to be an important part of a successful intervention to identify and manage individuals exhibiting uncontrolled CV risk factors in a primary care setting. PMID:24093040

  5. Patients' knowledge of risk and protective factors for cardiovascular disease.

    PubMed

    Wartak, Siddharth A; Friderici, Jennifer; Lotfi, Amir; Verma, Ashish; Kleppel, Reva; Naglieri-Prescod, Deborah; Rothberg, Michael B

    2011-05-15

    Coronary heart disease is the leading cause of death in the United States. The American Heart Association has proposed improving overall cardiovascular health by promoting 7 components of ideal cardiovascular health, including health behaviors (not smoking, regular exercise, and healthy diet) and health factors (ideal body mass index, cholesterol, blood pressure, and blood glucose). The patients' knowledge of these 7 components is unknown. We performed a cross-sectional survey of patients at 4 primary care and 1 cardiology clinic. The survey measured demographic data, personal behaviors/health factors, cardiovascular disease history, and knowledge about these 7 components. A multivariate model was developed to assess patient characteristics associated with high knowledge scores. Of the 2,200 surveys distributed, 1,702 (77%) were returned with sufficient responses for analysis. Of these, 49% correctly identified heart disease as the leading cause of death, and 37% (95% confidence interval [CI] 35% to 39%) correctly identified all 7 components. The average respondent identified 4.9 components (95% CI 4.7 to 5.0). The lowest recognition rates were for exercise (57%), fruit/vegetable consumption (58%), and diabetes (63%). In a multivariate model, knowledge of all 7 components was positively associated with high school education or greater (odds ratio 2.43, 95% CI 1.68 to 3.52) and white ethnicity (odds ratio 1.78, 95% CI 1.27 to 2.50), and negatively associated with attending an urban neighborhood clinic (odds ratio 0.60, 95% CI 0.44 to 0.82). In conclusion, just >1/3 of patients could identify all 7 components of ideal cardiovascular health. Educational efforts should target patients in low socioeconomic strata and focus on improving knowledge about healthy diet and regular exercise. Although patients with diabetes were more likely than those without diabetes to recognize their risk, 1 in 5 were not aware that diabetes is a risk factor for cardiovascular disease.

  6. Development and validation of a cardiovascular risk prediction model for Japanese: the Hisayama study.

    PubMed

    Arima, Hisatomi; Yonemoto, Koji; Doi, Yasufumi; Ninomiya, Toshiharu; Hata, Jun; Tanizaki, Yumihiro; Fukuhara, Masayo; Matsumura, Kiyoshi; Iida, Mitsuo; Kiyohara, Yutaka

    2009-12-01

    The objective of this paper is to develop a new risk prediction model of cardiovascular disease and to validate its performance in a general population of Japanese. The Hisayama study is a population-based prospective cohort study. A total of 2634 participants aged 40 years or older were followed up for 14 years for incident cardiovascular disease (stroke and coronary heart disease (myocardial infarction, coronary revascularization and sudden cardiac death)). We used data among a random two-thirds (the derivation cohort, n=1756) to develop a new risk prediction model that was then tested to compare observed and predicted outcomes in the remaining one-third (the validation cohort, n=878). A multivariable cardiovascular risk prediction model was developed that incorporated age, sex, systolic blood pressure, diabetes, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and smoking. We assessed the performance of the model for predicting individual cardiovascular event among the validation cohort. The risk prediction model demonstrated good discrimination (c-statistic=0.81; 95% confidence interval, 0.77 to 0.86) and calibration (Hosmer-Lemeshow chi(2)-statistic=6.46; P=0.60). A simple risk score sheet based on the cardiovascular risk prediction model was also presented. We developed and validated a new cardiovascular risk prediction model in a general population of Japanese. The risk prediction model would provide a useful guide to estimate absolute risk of cardiovascular disease and to treat individual risk factors.

  7. Cardiovascular risk factors in children. Should they concern the pediatrician?

    PubMed

    Berenson, G S; Frank, G C; Hunter, S M; Srinivasan, S R; Voors, A W; Webber, L S

    1982-09-01

    There is evidence that atherosclerosis, coronary artery disease, and essential hypertension begin early in life. The Bogalusa (La) Heart Study has examined cardiovascular risk factors and their determinants during the pediatric age span in a total community study. Reliable measurements were obtained and then analyzed to identify "tracking" of risk factors over time and clusters or aggregations of various risk factors at high levels. Serum lipoprotein levels, obesity, BP, and plasma insulin levels were all correlated after a glucose load, implying causal interrelationships. Although such relationship are only partly elucidated, the associations potentially enhance premature atherosclerosis. Certain kinds of behavior, for example cigarette smoking and type A behavior, may also contribute to early coronary artery disease. Our observations suggest that practicing physicians should assess risk factors in children and encourage changes in life-style to combat the high incidence of coronary artery disease and essential hypertension in the United States.

  8. [Cardiovascular risk factors and life and occupational stress among policemen].

    PubMed

    Czaja-Miturai, Izabela; Merecz-Kot, Dorota; Szymczak, Wieslaw; Bortkiewicz, Alicja

    2013-01-01

    Several studies have shown an association between work-related stress and risk factors for cardiovascular disease. ever, only a few studies concerned the police. The aim of this study was to assess the relationship between the general and work-related stress, and the functioning of the circulatory system in the police staff. The study group consisted of 126 policemen (aged 37.8 +/- 7.3 years), with average employment duration of 14.4 +/- 7 years. The study comprised the assessment of health status based on the medical examination and medical history of identified diseases, cardiovascular risk factors and symptoms, dietary habits, physical activity, intake of drugs, data on the family history, determinations of serum total cholesterol, HDL and LDL fractions, triglycerides, and fasting glycemia . The stress level was assessed using the Questionnaire for the Subjective Assessment of Work and Perceived Stress Scale. On medical examination hypertension was found in 36% of the people under study. Chest discomfort was reported by 60% of the subjects. Average body mass index (BMI), serum cholesterol and LDI, were elevated (22.7 +/- 4.1, 222.6 +/- 41.7 mg/dl and 142.7 +/- 39.7 mg/dl, respectively). Mean triglyceride, HDL fraction and fasting glucose levels were normal in the whole group. The levels of general and occupational stress were 34.914.8 and 128.0+33.3, respectively, being higher than in other occupational groups. In the group with the highest level of stress, there were significantly more people with circulatory problems (81%), drinking strong alcohol at least once a week (27%), working in a 3-shift system (40.5%) and working overtime (44%). The results show that the police are a group at high risk of developing cardiovascular diseases due to work-related stress.

  9. Systematic screening for cardiovascular risk at pharmacies

    PubMed Central

    Rohla, Miklos; Haberfeld, Heinz; Sinzinger, Helmut; Kritz, Harald; Tscharre, Maximilian; Freynhofer, Matthias K; Huber, Kurt; Weiss, Thomas W

    2016-01-01

    Background Early identification and treatment of cardiovascular risk factors (CVRFs) is essential to prevent excess morbidity, mortality and healthcare-related costs. We sought to investigate whether an active screening programme at pharmacies could identify a significant proportion of patients with previously undetected CVRFs. Methods and results Between April and July 2013, 184 pharmacies in Lower Austria enrolled a total of 6800 participants, in whom body mass index (BMI), blood pressure (BP), total cholesterol and blood glucose were measured. Mean age was 58±17 years and 67.8% were women. 21% of men and 16% of women had a BMI≥30 kg/m2. The crude prevalence of diabetes mellitus (DM) was 7%, hypercholesterolaemia was identified in 57%, and 44% had elevated BP. Among fasting individuals (n=1814), DM was found in 18%. In total, 30% were confronted with a CVRF they were previously unaware of, and pharmacists recommended 45% of all participants to actively consult a physician. A first-time diagnosis of a CVRF was most frequent in the age groups between 25 and 64 (32% of participants). Conclusions This pharmacy-based approach for cardiovascular risk screening found similar overall prevalences of CVRFs as reported by national surveys, but revealed underdiagnoses, particularly in lower age groups. A previously unknown CVRF was identified in every third individual, frequently prompting the pharmacists to recommend the consultation of a physician. An active screening approach at pharmacies might therefore serve as an effective alternative to the public preventive medical examination, particularly in younger age groups. PMID:27738518

  10. [The role of inflammatory biomarkers in cardiovascular risk stratification].

    PubMed

    Пузік, Світлана Г

    The increase in cardiovascular diseases requires the search for ways to predict complications based on research additional to traditional risk factors, conduct a study of the formation mechanisms of these complications and to design new treatment strategies. To get an idea about the relationship between inflammation in the blood vessels, atherosclerosis and cardiovascular consequences based on the study of the role of biomarkers of inflammation. the literature on the estimation of risk development of cardiovascular diseases based on the study of the role of biomarkers of vascular inflammation; bibliographic, a systematic approach. Algorithm stratification of cardiovascular risk includes a review of the traditional risk factors for the purpose of preventive therapy. A large number of cases of cardiovascular events (myocardial infarction, stroke) occurs in bessimptomnom patients with normal lipid. The use of additional risk factors for development of cerebral and cardiac disorders will allow to foresee the consequences and to prevent mortality from cardiovascular disease. Study of the role of inflammation in development of cardiovascular diseases allows the use of SB and PL-ФЛА2 as an important additional cardiovascular markers, independent of traditional risk factors. The use of biomarkers LP-ФЛА2 and SB specific to vascular inflammation, allows to establish the relationship between endovascular inflammation, atherosclerosis development and progression of cardiovascular diseases and to prevent cerebral and cardiac disorders in patients with traditional risk factor .

  11. Use of Chronic Kidney Disease to Enhance Prediction of Cardiovascular Risk in Those at Medium Risk.

    PubMed

    Chia, Yook Chin; Lim, Hooi Min; Ching, Siew Mooi

    2015-01-01

    Based on global cardiovascular (CV) risk assessment for example using the Framingham risk score, it is recommended that those with high risk should be treated and those with low risk should not be treated. The recommendation for those of medium risk is less clear and uncertain. We aimed to determine whether factoring in chronic kidney disease (CKD) will improve CV risk prediction in those with medium risk. This is a 10-year retrospective cohort study of 905 subjects in a primary care clinic setting. Baseline CV risk profile and serum creatinine in 1998 were captured from patients record. Framingham general cardiovascular disease risk score (FRS) for each patient was computed. All cardiovascular disease (CVD) events from 1998-2007 were captured. Overall, patients with CKD had higher FRS risk score (25.9% vs 20%, p = 0.001) and more CVD events (22.3% vs 11.9%, p = 0.002) over a 10-year period compared to patients without CKD. In patients with medium CV risk, there was no significant difference in the FRS score among those with and without CKD (14.4% vs 14.6%, p = 0.84) However, in this same medium risk group, patients with CKD had more CV events compared to those without CKD (26.7% vs 6.6%, p = 0.005). This is in contrast to patients in the low and high risk group where there was no difference in CVD events whether these patients had or did not have CKD. There were more CV events in the Framingham medium risk group when they also had CKD compared those in the same risk group without CKD. Hence factoring in CKD for those with medium risk helps to further stratify and identify those who are actually at greater risk, when treatment may be more likely to be indicated.

  12. Hepatitis Risk Assessment

    MedlinePlus

    ... please visit this page: About CDC.gov . Hepatitis Risk Assessment Recommend on Facebook Tweet Share Compartir Viral Hepatitis. Are you at risk? Take this 5 minute Hepatitis Risk Assessment developed ...

  13. A Comparative Assessment of Non-Laboratory-Based versus Commonly Used Laboratory-Based Cardiovascular Disease Risk Scores in the NHANES III Population

    PubMed Central

    Pandya, Ankur; Weinstein, Milton C.; Gaziano, Thomas A.

    2011-01-01

    Background National and international primary CVD risk screening guidelines focus on using total CVD risk scores. Recently, we developed a non-laboratory-based CVD risk score (inputs: age, sex, smoking, diabetes, systolic blood pressure, treatment of hypertension, body-mass index), which can assess risk faster and at lower costs compared to laboratory-based scores (inputs include cholesterol values). We aimed to assess the exchangeability of the non-laboratory-based risk score to four commonly used laboratory-based scores (Framingham CVD [2008, 1991 versions], and Systematic COronary Risk Evaluation [SCORE] for low and high risk settings) in an external validation population. Methods and Findings Analyses were based on individual-level, score-specific rankings of risk for adults in the Third National Health and Nutrition Examination Survey (NHANES III) aged 25–74 years, without history of CVD or cancer (n = 5,999). Risk characterization agreement was based on overlap in dichotomous risk characterization (thresholds of 10-year risk >10–20%) and Spearman rank correlation. Risk discrimination was assessed using receiver operator characteristic curve analysis (10-year CVD death outcome). Risk characterization agreement ranged from 91.9–95.7% and 94.2–95.1% with Spearman correlation ranges of 0.957–0.980 and 0.946–0.970 for men and women, respectively. In men, c-statistics for the non-laboratory-based, Framingham (2008, 1991), and SCORE (high, low) functions were 0.782, 0.776, 0.781, 0.785, and 0.785, with p-values for differences relative to the non-laboratory-based score of 0.44, 0.89, 0.68 and 0.65, respectively. In women, the corresponding c-statistics were 0.809, 0.834, 0.821, 0.792, and 0.792, with corresponding p-values of 0.04, 0.34, 0.11 and 0.09, respectively. Conclusions Every score discriminated risk of CVD death well, and there was high agreement in risk characterization between non-laboratory-based and laboratory-based risk scores, which

  14. Association of grip strength with cardiovascular risk markers.

    PubMed

    Gubelmann, Cédric; Vollenweider, Peter; Marques-Vidal, Pedro

    2017-03-01

    Background Mechanisms underlying the association between grip strength and cardiovascular mortality are poorly understood. We aimed to assess the association of grip strength with a panel of cardiovascular risk markers. Design The study was based on a cross-sectional analysis of 3468 adults aged 50-75 years (1891 women) from a population-based sample in Lausanne, Switzerland. Methods Grip strength was measured using a hydraulic hand dynamometer. Cardiovascular risk markers included anthropometry, blood pressure, lipids, glucose, adiposity, inflammatory and other metabolic markers. Results In both genders, grip strength was negatively associated with fat mass (Pearson correlation coefficient: women: -0.170, men: -0.198), systolic blood pressure (women: -0.096, men: -0.074), fasting glucose (women: -0.048, men: -0.071), log-transformed leptin (women: -0.074, men: -0.065), log-transformed high-sensitivity C-reactive protein (women: -0.101, men: -0.079) and log-transformed homocysteine (women: -0.109, men: -0.060). In men, grip strength was also positively associated with diastolic blood pressure (0.068), total (0.106) and low density lipoprotein-cholesterol (0.082), and negatively associated with interleukin-6 (-0.071); in women, grip strength was negatively associated with triglycerides (-0.064) and uric acid (-0.059). After multivariate adjustment, grip strength was negatively associated with waist circumference (change per 5 kg increase in grip strength: -0.82 cm in women and -0.77 cm in men), fat mass (-0.56% in women; -0.27% in men) and high-sensitivity C-reactive protein (-6.8% in women; -3.2% in men) in both genders, and with body mass index (0.22 kg/m(2)) and leptin (-2.7%) in men. Conclusion Grip strength shows only moderate associations with cardiovascular risk markers. The effect of muscle strength as measured by grip strength on cardiovascular disease does not seem to be mediated by cardiovascular risk markers.

  15. A Community-Based Assessment of Hypertension and Some Other Cardiovascular Disease Risk Factors in Ngaoundéré, Cameroon

    PubMed Central

    Derew, Diana

    2016-01-01

    Background and Objective. Cardiovascular diseases are primary causes of death worldwide with well documented risk factors whose varying impacts added to the complexity in CVD management dictate the need for region-specific studies. We aimed at investigating the interactions between CVD risk factors and hypertension in Ngaoundéré. Methods. A cross-sectional survey was carried out from March to August 2014. Sociodemographic, fasting blood glucose, blood pressure, and anthropometric data were recorded. Statistical analyses were carried out using SAS software version 9.1. Results. 700 adults resident in Ngaoundéré for at least two years consented and were included in the survey. Abdominal obesity, physical inactivity, and hypertension were the dominant risk factors recording 51.1%, 35.4%, and 20.4%, respectively. The prevalence of hyperglycaemia, tobacco consumption, obesity, and alcohol consumption was 5.6%, 8.3%, 9.6%, and 18.1%, respectively. Advanced age, hyperglycaemia, a divorced marital status, and alcohol consumption were independent determinants of high blood pressure. Conclusion. Physical inactivity, abdominal obesity, and hypertension were the most prevalent CVD risk factors, and the role of advanced age and hyperglycaemia in the occurrence of high blood pressure was reiterated. Health programs need to focus on effective screening, prevention, and control of CVDs in the Adamawa Region and Cameroon at large. PMID:28097019

  16. Reliability of Cardiovascular Risk Calculators to Estimate Accurately the Risk of Cardiovascular Disease in Patients With Sarcoidosis.

    PubMed

    Ungprasert, Patompong; Matteson, Eric L; Crowson, Cynthia S

    2017-09-01

    Chronic inflammation is an independent risk factor for cardiovascular disease (CVD), but most risk calculators, including the Framingham risk score (FRS) and the American College of Cardiology (ACC)/American Heart Association (AHA) risk score do not account for it. These calculators underestimate cardiovascular risk in patients with rheumatoid arthritis and systemic lupus erythematosus. To date, how these scores perform in the estimation of CVD risk in patients with sarcoidosis has not been assessed. In this study, the FRS and the ACC/AHA risk score were calculated for a previously identified cohort of patients with incident cases of sarcoidosis in Olmsted County, Minnesota, United States, from 1989 to 2013 as well as their gender- and age-matched comparators. The standardized incidence ratio (SIR) was estimated as the ratio of the predicted and observed numbers of CVD events. All CVD events were identified by diagnosis codes and were verified by individual medical record reviews. The predicted number of CVD events among 188 cases by FRS was 11.8 and the observed number of CVD events was 34, which corresponded to an SIR of 2.88 (95% confidence interval 2.06 to 4.04). FRS underestimated the risk of CVD events in patients with sarcoidosis by gender, age and severity of sarcoidosis. The predicted number of CVD events among cases by ACC/AHA risk score was 4.6 and the observed number of CVD events was 19, corresponding to an SIR of 4.11 (95% confidence interval 2.62 to 6.44). In conclusion, the FRS and the ACC/AHA risk score underestimate the risk of CVD in patients with sarcoidosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Traditional and Nontraditional Cardiovascular Risk Factors in Comorbid Insomnia and Sleep Apnea

    PubMed Central

    Luyster, Faith S.; Kip, Kevin E.; Buysse, Daniel J.; Aiyer, Aryan N.; Reis, Steven E.; Strollo, Patrick J.

    2014-01-01

    Objectives: Insomnia and sleep apnea frequently co-occur and are independently associated with an increased risk of cardiovascular disease, but little is known about cardiovascular disease risk among individuals with comorbid insomnia and sleep apnea. The current study examined traditional risk factors and a physiologic biomarker of cardiovascular risk in comorbid insomnia and sleep apnea. Design: Community-based participatory research study. Participants: The sample comprised 795 participants without preexisting cardiovascular disease from the Heart Strategies Concentrating On Risk Evaluation (Heart SCORE) study. Measurements and Results: Participants were assessed for symptoms of insomnia and sleep apnea risk, as well as for presence of obesity, smoking, a sedentary lifestyle, hypertension, dyslipidemia, and diabetes. Baseline resting brachial artery diameter was measured by B-mode ultrasonography. A total of 138 participants (17.4%) met criteria for insomnia syndrome alone, 179 (22.5%) were at high risk for sleep apnea alone, 95 (11.9%) reported both insomnia syndrome and high sleep apnea risk, and 383 (48.2%) reported having neither insomnia nor sleep apnea symptoms Both high sleep apnea risk alone and comorbid insomnia and high sleep apnea risk groups had greater frequencies of obesity, sedentary lifestyle, hypertension, and three or more traditional cardiovascular risk factors and significantly larger brachial artery diameters than the insomnia alone group and those without insomnia or sleep apnea symptoms. No differences in traditional cardiovascular risk factors or brachial artery diameter were found between the high sleep apnea risk and comorbid groups. Conclusions: These findings suggest that sleep apnea is a major contributor to cardiovascular risk and co-occurring insomnia does not appear to add to this risk. Citation: Luyster FS; Kip KE; Buysse DJ; Aiyer AN; Reis SE; Strollo PJ. Traditional and nontraditional cardiovascular risk factors in comorbid

  18. Changes in diet, cardiovascular risk factors and modelled cardiovascular risk following diagnosis of diabetes: 1-year results from the ADDITION-Cambridge trial cohort

    PubMed Central

    Savory, L A; Griffin, S J; Williams, K M; Prevost, A T; Kinmonth, A-L; Wareham, N J; Simmons, R K

    2014-01-01

    Aims To describe change in self-reported diet and plasma vitamin C, and to examine associations between change in diet and cardiovascular disease risk factors and modelled 10-year cardiovascular disease risk in the year following diagnosis of Type 2 diabetes. Methods Eight hundred and sixty-seven individuals with screen-detected diabetes underwent assessment of self-reported diet, plasma vitamin C, cardiovascular disease risk factors and modelled cardiovascular disease risk at baseline and 1 year (n = 736) in the ADDITION-Cambridge trial. Multivariable linear regression was used to quantify the association between change in diet and cardiovascular disease risk at 1 year, adjusting for change in physical activity and cardio-protective medication. Results Participants reported significant reductions in energy, fat and sodium intake, and increases in fruit, vegetable and fibre intake over 1 year. The reduction in energy was equivalent to an average-sized chocolate bar; the increase in fruit was equal to one plum per day. There was a small increase in plasma vitamin C levels. Increases in fruit intake and plasma vitamin C were associated with small reductions in anthropometric and metabolic risk factors. Increased vegetable intake was associated with an increase in BMI and waist circumference. Reductions in fat, energy and sodium intake were associated with reduction in HbA1c, waist circumference and total cholesterol/modelled cardiovascular disease risk, respectively. Conclusions Improvements in dietary behaviour in this screen-detected population were associated with small reductions in cardiovascular disease risk, independently of change in cardio-protective medication and physical activity. Dietary change may have a role to play in the reduction of cardiovascular disease risk following diagnosis of diabetes. PMID:24102972

  19. Fat distribution, physical activity and cardiovascular risk among adolescent girls.

    PubMed

    White, J; Jago, R

    2013-03-01

    It is not clear whether changes in waist circumference (WC), sums of skinfold thickness (SSF), or levels of physical activity (PA) during adolescence are associated with cardiovascular risk factors, or if associations are independent or interactive. In a US cohort of adolescent girls (n = 617-904) girls, examined at ages 12 and 14, WC, SSF, PA, systolic and diastolic blood pressure (SBP & DBP) were assessed. Fasting blood samples were used to determine concentrations of triglycerides (TG), cholesterol (TC), high and low density lipoproteins (HDL-C and LDL-C), and apolipoprotein A1 and B (Apo-A1 and Apo-B). After adjustment for change in SSF and PA, increases in WC were associated with change in TG (z = 1.73, 95% CI = 0.77, 2.69), TC (z = 0.45, 95% CI = 0.01, 0.90), HDL-C (z = -0.18, 95% CI = -0.37, -0.01), LDL-C (z = 0.41, 95% CI = 0.03, 0.80), Apo-A1 (z = -0.52, 95% CI = -1.02, -0.02), Apo-B (z = 0.60, 95% CI = 0.24, 0.97) and SBP levels (z = 0.31, 95% CI = 0.15, 0.47). Associations between changes in SSF and PA with cardiovascular risk were eliminated after adjustment for WC, and all interactions between WC, SSF and PA were non-significant at conventional levels. Changes in WC were independently associated with the development of cardiovascular risk factors, whereas changes in SSF and PA were not. Clinicians should consider the routine screening of WC to monitor cardiovascular health in adolescent girls. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. Cardiovascular Risk Factor Levels in Adults with Mental Retardation.

    ERIC Educational Resources Information Center

    Rimmer, James H.; And Others

    1994-01-01

    Comparison of cardiovascular risk factors (blood lipids, obesity, and smoking) in 329 adults with mental retardation residing in various settings with subjects in the Framingham Offspring Study found that adults with mental retardation had cardiovascular risk profiles similar to those of individuals without mental retardation. (Author/DB)

  1. Special Diabetes Program for Indians: Retention in Cardiovascular Risk Reduction

    ERIC Educational Resources Information Center

    Manson, Spero M.; Jiang, Luohua; Zhang, Lijing; Beals, Janette; Acton, Kelly J.; Roubideaux, Yvette

    2011-01-01

    Purpose: This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. Design and Methods: Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American…

  2. Special Diabetes Program for Indians: Retention in Cardiovascular Risk Reduction

    ERIC Educational Resources Information Center

    Manson, Spero M.; Jiang, Luohua; Zhang, Lijing; Beals, Janette; Acton, Kelly J.; Roubideaux, Yvette

    2011-01-01

    Purpose: This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. Design and Methods: Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American…

  3. Evaluation of Cardiovascular Risk Scores Applied to NASA's Astronant Corps

    NASA Technical Reports Server (NTRS)

    Jain, I.; Charvat, J. M.; VanBaalen, M.; Lee, L.; Wear, M. L.

    2014-01-01

    In an effort to improve cardiovascular disease (CVD) risk prediction, this analysis evaluates and compares the applicability of multiple CVD risk scores to the NASA Astronaut Corps which is extremely healthy at selection.

  4. Coconut oil consumption and cardiovascular risk factors in humans.

    PubMed

    Eyres, Laurence; Eyres, Michael F; Chisholm, Alexandra; Brown, Rachel C

    2016-04-01

    Coconut oil is being heavily promoted as a healthy oil, with benefits that include support of heart health. To assess the merits of this claim, the literature on the effect of coconut consumption on cardiovascular risk factors and outcomes in humans was reviewed. Twenty-one research papers were identified for inclusion in the review: 8 clinical trials and 13 observational studies. The majority examined the effect of coconut oil or coconut products on serum lipid profiles. Coconut oil generally raised total and low-density lipoprotein cholesterol to a greater extent than cis unsaturated plant oils, but to a lesser extent than butter. The effect of coconut consumption on the ratio of total cholesterol to high-density lipoprotein cholesterol was often not examined. Observational evidence suggests that consumption of coconut flesh or squeezed coconut in the context of traditional dietary patterns does not lead to adverse cardiovascular outcomes. However, due to large differences in dietary and lifestyle patterns, these findings cannot be applied to a typical Western diet. Overall, the weight of the evidence from intervention studies to date suggests that replacing coconut oil with cis unsaturated fats would alter blood lipid profiles in a manner consistent with a reduction in risk factors for cardiovascular disease.

  5. Coconut oil consumption and cardiovascular risk factors in humans

    PubMed Central

    Eyres, Michael F.; Chisholm, Alexandra; Brown, Rachel C.

    2016-01-01

    Coconut oil is being heavily promoted as a healthy oil, with benefits that include support of heart health. To assess the merits of this claim, the literature on the effect of coconut consumption on cardiovascular risk factors and outcomes in humans was reviewed. Twenty-one research papers were identified for inclusion in the review: 8 clinical trials and 13 observational studies. The majority examined the effect of coconut oil or coconut products on serum lipid profiles. Coconut oil generally raised total and low-density lipoprotein cholesterol to a greater extent than cis unsaturated plant oils, but to a lesser extent than butter. The effect of coconut consumption on the ratio of total cholesterol to high-density lipoprotein cholesterol was often not examined. Observational evidence suggests that consumption of coconut flesh or squeezed coconut in the context of traditional dietary patterns does not lead to adverse cardiovascular outcomes. However, due to large differences in dietary and lifestyle patterns, these findings cannot be applied to a typical Western diet. Overall, the weight of the evidence from intervention studies to date suggests that replacing coconut oil with cis unsaturated fats would alter blood lipid profiles in a manner consistent with a reduction in risk factors for cardiovascular disease. PMID:26946252

  6. Endothelial function and cardiovascular risk stratification in menopausal women.

    PubMed

    Mulvagh, S L; Behrenbeck, T; Lahr, B A; Bailey, K R; Zais, T G; Araoz, P A; Miller, V M

    2010-02-01

    Peripheral arterial, endothelium-dependent, flow-mediated reactive hyperemia is reduced in individuals with atherosclerosis. This study tested the hypothesis that digital tonometry, as a surrogate of endothelial function, is useful to stratify cardiovascular risk in recently menopausal women who are asymptomatic for cardiovascular disease. Women undergoing screening for the Kronos Early Estrogen Prevention Study (KEEPS) were evaluated for conventional risk factors, flow-mediated reactive hyperemia by digital tonometry (RHI), carotid intima-media thickness (CIMT) by ultrasound, and coronary arterial calcium (CAC) by 64-slice CT scanner. One hundred and two non-diabetic Caucasian women (53.0 +/- 2.3 years old, 18.0 +/- 9.0 months past their last menses) participated; 72% were never-smokers. Fourteen women had positive CAC scores (range 0.5-133 Agatston units); CIMT ranged from 0.57 to 1.06 mm. RHI ranged from 1.26 to 5.44. RHI did not correlate with time past menopause, CAC, CIMT, total cholesterol or low density lipoprotein cholesterol. The significant negative correlation of RHI with body mass index (r = -0.21, p = 0.031) was lost in non-smokers (r = - 0.17, p = 0.14). There was also a negative correlation of high density lipoprotein cholesterol with CAC, both in the overall group and non-smokers (rho = -0.20, p = 0.05 and rho = -0.27, p = 0.02, respectively). RHI varies widely in healthy women within the first 3 years of menopause. RHI was not associated with standard risk assessment algorithms, CAC or CIMT. RHI may indicate an additional, independent component and non-invasive tool to further stratify cardiovascular risk in recently menopausal women. As KEEPS continues, data on RHI will provide information regarding hormonal therapy, endovascular biology and atherosclerotic risk.

  7. Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study

    PubMed Central

    2014-01-01

    Background It is unknown whether individuals at high cardiovascular risk sustain a benefit in cardiovascular disease from increased olive oil consumption. The aim was to assess the association between total olive oil intake, its varieties (extra virgin and common olive oil) and the risk of cardiovascular disease and mortality in a Mediterranean population at high cardiovascular risk. Methods We included 7,216 men and women at high cardiovascular risk, aged 55 to 80 years, from the PREvención con DIeta MEDiterránea (PREDIMED) study, a multicenter, randomized, controlled, clinical trial. Participants were randomized to one of three interventions: Mediterranean Diets supplemented with nuts or extra-virgin olive oil, or a control low-fat diet. The present analysis was conducted as an observational prospective cohort study. The median follow-up was 4.8 years. Cardiovascular disease (stroke, myocardial infarction and cardiovascular death) and mortality were ascertained by medical records and National Death Index. Olive oil consumption was evaluated with validated food frequency questionnaires. Multivariate Cox proportional hazards and generalized estimating equations were used to assess the association between baseline and yearly repeated measurements of olive oil intake, cardiovascular disease and mortality. Results During follow-up, 277 cardiovascular events and 323 deaths occurred. Participants in the highest energy-adjusted tertile of baseline total olive oil and extra-virgin olive oil consumption had 35% (HR: 0.65; 95% CI: 0.47 to 0.89) and 39% (HR: 0.61; 95% CI: 0.44 to 0.85) cardiovascular disease risk reduction, respectively, compared to the reference. Higher baseline total olive oil consumption was associated with 48% (HR: 0.52; 95% CI: 0.29 to 0.93) reduced risk of cardiovascular mortality. For each 10 g/d increase in extra-virgin olive oil consumption, cardiovascular disease and mortality risk decreased by 10% and 7%, respectively. No significant

  8. Lifestyle decreases risk factors for cardiovascular diseases.

    PubMed

    Slavícek, Jaroslav; Kittnar, Otomar; Fraser, Gary E; Medová, Eva; Konecná, Jana; Zizka, Robert; Dohnalová, Alena; Novák, Vladimir

    2008-12-01

    The morbidity and mortality of cardiovascular diseases is high in the developed countries. The lifestyle changes are capable to decrease it by 50%. The aim of the present study was to measure the parameters of some risk factors before and after a one-week NEW START rehabilitative retreat. 1349 volunteers, 320 men, 1029 woman, mean age 51 +/- 14.5 (SD) years participated in 30 rehabilitative retreats from 1999-2006 in the Czech Republic, using a low-fat, low-energy, lacto-ovo-vegetarian diet and exercise, in a stress-free environment. Body weight, height, BMI, blood pressure, heart rate, serum cholesterol and blood glucose were measured. Body weight decreased in 1223 measured persons from 71.2 +/- 14.38 (SD) to 70.6 +/- 14.02 kg (p<0.0001), BMI (1,046 measured persons) from 25.1 +/- 4.60 (SD) to 24.8+4.49 (SD) kg/m2 (p<0.0001), systolic blood pressure (1,218 persons) from 129.8 +/- 23.02 (SD) to 123.8 +/- 21.52 (SD) mmHg (p<0.0001), diastolic blood pressure (1210 persons) from 79.8 +/- 12.7 (SD) to 77.5 +/- 11.6 (SD) mmHg (p<0.0001), serum cholesterol (998 persons) from 4.86 +/- 0.95 (SD) to 4.32 +/- 0.77 (SD) mmol (p<0.0001), blood glucose (544 persons) from 4.31 +/- 1.59 (SD) to 3.88 +/- 1.33 (SD) mmol (p<0.0001). Heart rate was not significantly decreased. The parameters were lower in lacto-ovo vegetarians and Seventh-day Adventists than in controls who never observed the diet and avail the lifestyle programs. The parameters were nonsignificantly changed one year after finishing the retreat in the sample of 68 persons showing the positive effect of retreats. Our results showed, that the intake of a low-fat, low-energy diet, over the course of one week in a stress-free environment, had positive impact on the risk factors of cardiovascular diseases.

  9. Inflammation, Infection, and Future Cardiovascular Risk

    ClinicalTrials.gov

    2016-03-15

    Cardiovascular Diseases; Coronary Disease; Cerebrovascular Accident; Myocardial Infarction; Venous Thromboembolism; Heart Diseases; Infection; Chlamydia Infections; Cytomegalovirus Infections; Helicobacter Infections; Herpesviridae Infections; Inflammation

  10. A review of ground-based heavy-ion radiobiology relevant to space radiation risk assessment: Part II. Cardiovascular and immunological effects

    SciTech Connect

    Blakely, Eleanor A.; Chang, Polly Y.

    2007-02-26

    The future of manned space flight depends on an analysis of the numerous potential risks of travel into deep space. Currently no radiation dose limits have been established for these exploratory missions. To set these standards more information is needed about potential acute and late effects on human physiology from appropriate radiation exposure scenarios, including pertinent radiation types and dose rates. Cancer risks have long been considered the most serious late effect from chronic daily relatively low-dose exposures to the complex space radiation environment. However, other late effects from space radiation exposure scenarios are under study in ground-based accelerator facilities and have revealed some unique particle radiation effects not observed with conventional radiations. A comprehensive review of pertinent literature that considers tissue effects of radiation leading to functional detriments in specific organ systems has recently been published (NCRP National Council on Radiation Protection and Measurements, Information Needed to Make Radiation Protection Recommendations for Space Missions Beyond Low-Earth Orbit, Report 153, Bethesda, MD, 2006). This paper highlights the review of two non-cancer concerns from this report: cardiovascular and immunological effects.

  11. Interpreting Hemoglobin A1C in Combination With Conventional Risk Factors for Prediction of Cardiovascular Risk

    PubMed Central

    Jarmul, Jamie A.; Pignone, Michael; Pletcher, Mark J.

    2015-01-01

    Background Hemoglobin A1C (HbA1C) is associated with increased risk of cardiovascular events, but its use for prediction of cardiovascular disease (CVD) events in combination with conventional risk factors has not been well defined. Methods and Results To understand the effect of HbA1C on CVD risk in the context of other CVD risk factors, we analyzed HbA1C and other CVD risk factor measurements in 2000 individuals aged 40-79 years old without pre-existing diabetes or cardiovascular disease from the 2011-2012 NHANES survey. The resulting regression model was used to predict the HbA1C distribution based on individual patient characteristics. We then calculated post-test 10-year atherosclerotic cardiovascular disease (ASCVD) risk incorporating the actual versus predicted HbA1C, according to established methods, for a set of example scenarios. Age, gender, race/ethnicity and traditional cardiovascular risk factors were significant predictors of HbA1C in our model, with the expected HbA1C distribution being significantly higher in non-Hispanic black, non-Hispanic Asian and Hispanic individuals than non-Hispanic white/other individuals. Incorporating the expected HbA1C distribution into pretest ASCVD risk has a modest effect on post-test ASCVD risk. In the patient examples we assessed, having an HbA1C < 5.7% reduced post-test risk by 0.4%-2.0% points, whereas having an HbA1C ≥ 6.5% increased post-test risk by 1.0%-2.5% points, depending on the scenario. The post-test risk increase from having an HbA1C ≥ 6.5 % tends to approximate the risk increase from being five years older in age. Conclusions HbA1C has modest effects on predicted ASCVD risk when considered in the context of conventional risk factors. PMID:26349840

  12. [Cardiovascular risk reduction: impact of an international project].

    PubMed

    Colle, B; Brusaferro, S

    2008-01-01

    The Euroaction project, promoted by European Society of Cardiology, aims to determine whether a nurse co-ordinated, multidisciplinary, family based preventive cardiology programme could help more patients and their families achieve the recommended European lifestyle, risk factor and therapeutic goals for cardiovascular disease prevention. EUROACTION was evaluated in a paired cluster randomized controlled trial, and the primary care branch included 6 European countries. Consecutive patients > 50 years and < 80 years, with no history of cardiovascular disease, were prospectively identified by the general practitioners with one of the following: (i) high total cardiovascular risk (HeartScore > or = 5% over 10 years, either now or when projected to age 60 years) and on no medical treatment for blood pressure, lipids or diabetes; (ii) on treatment with anti-hypertensive and/or lipid-lowering drug therapies started in the last year but with no diabetes; (iii) diagnosed with diabetes mellitus (treated by diet alone or with oral hypoglycaemic drug therapy and/or insulin) within the last three years in both intervention and usual care practices. All eligible high risk individuals and their partners were then invited by the nurse for an assessment of their lifestyle, risk factors and therapeutic management as soon as possible after identification. In the primary care intervention branch 1019 patients have been enrolled with no differences by sex and mean age 62, while in the control branch 1005 patients were recruited with mean age 63, female were 43%. The main results show that Intervention group (I) had a statistically significant improvement compared to Usual Care (UC) in the assumption of recommended quantity of fruit and vegetables (78.4% I vs 38.8% UC p=0.005), in the weight loss (weight loss > al 5% in subjects with BMI > 25 kg/m2) (16.5% I vs 6.8% UC p=0.005), in blood pressure control both in people specifically treated with drugs and untreated (respectively 52% I

  13. Cardiovascular disease risk of abdominal obesity vs. metabolic abnormalities.

    PubMed

    Wildman, Rachel P; McGinn, Aileen P; Lin, Juan; Wang, Dan; Muntner, Paul; Cohen, Hillel W; Reynolds, Kristi; Fonseca, Vivian; Sowers, MaryFran R

    2011-04-01

    It remains unclear whether abdominal obesity increases cardiovascular disease (CVD) risk independent of the metabolic abnormalities that often accompany it. Therefore, the objective of this study was to evaluate the independent effects of abdominal obesity vs. metabolic syndrome and diabetes on the risk for incident coronary heart disease (CHD) and stroke. The Framingham Offspring, Atherosclerosis Risk in Communities, and Cardiovascular Health studies were pooled to assess the independent effects of abdominal obesity (waist circumference >102 cm for men and >88 cm for women) vs. metabolic syndrome (excluding the waist circumference criterion) and diabetes on risk for incident CHD and stroke in 20,298 men and women aged ≥45 years. The average follow-up was 8.3 (s.d. 1.9) years. There were 1,766 CVD events. After adjustment for demographic factors, smoking, alcohol intake, number of metabolic syndrome components, and diabetes, abdominal obesity was not significantly associated with an increased risk of CVD (hazard ratio (HR) (95% confidence interval): 1.09 (0.98, 1.20)). However, after adjustment for demographics, smoking, alcohol intake, and abdominal obesity, having 1-2 metabolic syndrome components, the metabolic syndrome and diabetes were each associated with a significantly increased risk of CVD (2.12 (1.80, 2.50), 2.82 (1.92, 4.12), and 5.33 (3.37, 8.41), respectively). Although abdominal obesity is an important clinical tool for identification of individuals likely to possess metabolic abnormalities, these data suggest that the metabolic syndrome and diabetes are considerably more important prognostic indicators of CVD risk.

  14. Calcium Supplement Intake and Risk of Cardiovascular Disease in Women

    PubMed Central

    Paik, Julie M.; Curhan, Gary C.; Sun, Qi; Rexrode, Kathryn M.; Manson, JoAnn E.; Rimm, Eric B.; Taylor, Eric N.

    2014-01-01

    Background Some recent reports suggest that calcium supplements may increase cardiovascular disease (CVD) risk. Purpose The objective was to examine the independent associations between calcium supplement use and risk of CVD. Methods We conducted a prospective cohort study of supplemental calcium use and incident CVD in 74,245 women in the Nurses' Health Study (1984–2008) free of CVD and cancer at baseline. Calcium supplement intake was assessed every four years. Outcomes were incident coronary heart disease (CHD) (nonfatal or fatal MI) and stroke (ischemic or hemorrhagic), confirmed by medical record review. Results During 24 years of follow-up, 4,565 cardiovascular events occurred (2,709 CHD and 1,856 strokes). At baseline, women who took calcium supplements had higher levels of physical activity, smoked less, and had lower trans fat intake compared with those who did not take calcium supplements. After multivariable adjustment for age, body mass index, dietary calcium, vitamin D intake, and other CVD risk factors, the relative risk of CVD for women taking >1,000mg/day of calcium supplements compared with none was 0.82 (95% CI 0.74 to 0.92; p for trend <0.001). For women taking >1,000mg/day of calcium supplements compared with none, the multivariable-adjusted relative risk for CHD was 0.71 (0.61 to 0.83; p for trend<0.001) and for stroke was 1.03 (0.87 to 1.21; p for trend=0.61). The relative risks were similar in analyses limited to non-smokers, women without hypertension, and women who had regular physical exams. Conclusions Our findings do not support the hypothesis that calcium supplement intake increases CVD risk in women. PMID:24803331

  15. [Cardiovascular risk profiles by occupation in Madrid region, Spain].

    PubMed

    Zimmermann Verdejo, Marta; González Gómez, María Fernanda; Galán Labaca, Iñaki

    2010-01-01

    It is well known the association between cardiovascular risks and life styles. In addition, all these factors could be strongly associated with working conditions. The aim of this study was to describe the association between some cardiovascular risk factors and occupations in order to define strategies focused on health promotion at workplace. 16.048 questionnaires were analysed from the Surveillance System for Non-transmissible Diseases Risk Factors (SIVFRENT) for Madrid region. The surveys of eight consecutive years (2000-2007) were aggregated and analysed. Seven risk factors for cardiovascular diseases were studied (diet, overweight, sedentary work, physical activity, alcohol and tobacco consumption and high blood pressure). An indicator of exposure was created based on these seven risk factors. The association between cardiovascular risk factors and occupations was calculated for age and gender effects adjustment. Sedentary work (prevalence: 44,2%) and tobacco consumption (prevalence: 33,1%) were the most common risk factors found . To accumulate more than two cardiovascular risk factors was statistically higher in men (27,4%) than in women (15%). The highest risk was found for tree occupations: Drivers (OR:1,78; 95% CI:1,45-2,18), Administrative secretaries (OR:1,83; 95% CI:1,64-2,05) and Direction managers(OR:1,25; 95% CI:1,09-1,44). Drives, Secretaries and Managers seem to have a higher vulnerability for some cardiovascular risk factors.

  16. A summary and critical assessment of the 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular disease risk in adults: filling the gaps.

    PubMed

    Lopez-Jimenez, Francisco; Simha, Vinaya; Thomas, Randal J; Allison, Thomas G; Basu, Ananda; Fernandes, Regis; Hurst, R Todd; Kopecky, Stephen L; Kullo, Iftikhar J; Mulvagh, Sharon L; Thompson, Warren G; Trejo-Gutierrez, Jorge F; Wright, R Scott

    2014-09-01

    The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines has recently released the new cholesterol treatment guideline. This update was based on a systematic review of the evidence and replaces the previous guidelines from 2002 that were widely accepted and implemented in clinical practice. The new cholesterol treatment guideline emphasizes matching the intensity of statin treatment to the level of atherosclerotic cardiovascular disease (ASCVD) risk and replaces the old paradigm of pursuing low-density lipoprotein cholesterol targets. The new guideline also emphasizes the primacy of the evidence base for statin therapy for ASCVD risk reduction and lists several patient groups that will not benefit from statin treatment despite their high cardiovascular risk, such as those with heart failure (New York Heart Association class II-IV) and patients undergoing hemodialysis. The guideline has been received with mixed reviews and significant controversy. Because of the evidence-based nature of the guideline, there is room for several questions and uncertainties on when and how to use lipid-lowering therapy in clinical practice. The goal of the Mayo Clinic Task Force in the assessment, interpretation, and expansion of the ACC/AHA cholesterol treatment guideline is to address gaps in information and some of the controversial aspects of the newly released cholesterol management guideline using additional sources of evidence and expert opinion as needed to guide clinicians on key aspects of ASCVD risk reduction.

  17. Dairy food intake is positively associated with cardiovascular health: findings from Observation of Cardiovascular Risk Factors in Luxembourg study.

    PubMed

    Crichton, Georgina E; Alkerwi, Ala'a

    2014-12-01

    Conflicting findings have been reported about dairy food consumption and risk for cardiovascular disease. Furthermore, few studies have examined dairy food intake in relation to cardiovascular health and the incorporation of lifestyle factors such as diet and physical activity. This study examined whether dairy food consumption was associated with cardiovascular health, recently defined by the American Heart Association. Data were analyzed from 1352 participants from the Observation of Cardiovascular Risk Factors in Luxembourg survey. A validated food frequency questionnaire was used to measure intakes of milk, yogurt, cheese, dairy desserts, ice cream, and butter. Seven cardiovascular health metrics were assessed: smoking, body mass index, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose. A total cardiovascular health score (CHS) was determined by summing the total number of health metrics at ideal levels. It was hypothesized that greater dairy food consumption (both low fat and whole fat) would be associated with better global cardiovascular health, as indicated by a higher CHS. Total dairy food intake was positively associated with the CHS. Higher intakes of whole fat milk, yogurt, and cheese were associated with better cardiovascular health. Even when controlling for demographic and dietary variables, those who consumed at least 5 servings per week of these dairy products had a significantly higher CHS than those who consumed these products less frequently. Higher total whole fat dairy food intake was also associated with other positive health behaviors, including being a nonsmoker, consuming the suggested dietary intakes of recommended foods, and having a normal body mass index. Increased dairy food consumption was associated with better cardiovascular health. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. C-reactive protein levels in patients at cardiovascular risk: EURIKA study

    PubMed Central

    2014-01-01

    Background Elevated C-reactive protein (CRP) levels are associated with high cardiovascular risk, and might identify patients who could benefit from more carefully adapted risk factor management. We have assessed the prevalence of elevated CRP levels in patients with one or more traditional cardiovascular risk factors. Methods Data were analysed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov Identifier: NCT00882336), which included patients (aged ≥50 years) from 12 European countries with at least one traditional cardiovascular risk factor but no history of cardiovascular disease. Analysis was also carried out on the subset of patients without diabetes mellitus who were not receiving statin therapy. Results In the overall population, CRP levels were positively correlated with body mass index and glycated haemoglobin levels, and were negatively correlated with high-density lipoprotein cholesterol levels. CRP levels were also higher in women, those at higher traditionally estimated cardiovascular risk and those with greater numbers of metabolic syndrome markers. Among patients without diabetes mellitus who were not receiving statin therapy, approximately 30% had CRP levels ≥3 mg/L, and approximately 50% had CRP levels ≥2 mg/L, including those at intermediate levels of traditionally estimated cardiovascular risk. Conclusions CRP levels are elevated in a large proportion of patients with at least one cardiovascular risk factor, without diabetes mellitus who are not receiving statin therapy, suggesting a higher level of cardiovascular risk than predicted according to conventional risk estimation systems. Trial registration ClinicalTrials.gov Identifier: NCT00882336 PMID:24564178

  19. Cardiovascular risk prediction tools for populations in Asia

    PubMed Central

    Collaboration, Asia Pacific Cohort Studies

    2007-01-01

    Background Cardiovascular risk equations are traditionally derived from the Framingham Study. The accuracy of this approach in Asian populations, where resources for risk factor measurement may be limited, is unclear. Objective To compare “low‐information” equations (derived using only age, systolic blood pressure, total cholesterol and smoking status) derived from the Framingham Study with those derived from the Asian cohorts, on the accuracy of cardiovascular risk prediction. Design Separate equations to predict the 8‐year risk of a cardiovascular event were derived from Asian and Framingham cohorts. The performance of these equations, and a subsequently “recalibrated” Framingham equation, were evaluated among participants from independent Chinese cohorts. Setting Six cohort studies from Japan, Korea and Singapore (Asian cohorts); six cohort studies from China; the Framingham Study from the US. Participants 172 077 participants from the Asian cohorts; 25 682 participants from Chinese cohorts and 6053 participants from the Framingham Study. Main results In the Chinese cohorts, 542 cardiovascular events occurred during 8 years of follow‐up. Both the Asian cohorts and the Framingham equations discriminated cardiovascular risk well in the Chinese cohorts; the area under the receiver–operator characteristic curve was at least 0.75 for men and women. However, the Framingham risk equation systematically overestimated risk in the Chinese cohorts by an average of 276% among men and 102% among women. The corresponding average overestimation using the Asian cohorts equation was 11% and 10%, respectively. Recalibrating the Framingham risk equation using cardiovascular disease incidence from the non‐Chinese Asian cohorts led to an overestimation of risk by an average of 4% in women and underestimation of risk by an average of 2% in men. Interpretation A low‐information Framingham cardiovascular risk prediction tool, which, when recalibrated with

  20. Testosterone in men with hypogonadism and high cardiovascular risk, Pros.

    PubMed

    Rosano, Giuseppe M C; Vitale, Cristiana; Fini, Massimo

    2015-11-01

    Although numerous randomized studies have shown that testosterone replacement therapy (TRT) improves intermediate outcomes in patients at risk and in those with proven cardiovascular disease (CVD), results derived mainly from registries and observational studies have suggested an increased cardiovascular risk in elderly men receiving often supra-therapeutic doses of testosterone. Recent meta-analyses have shown that when testosterone has been used in patients with pre-existing cardiovascular conditions, the effect on the disease has been either beneficial or neutral. Similar results have been reported in hypo- and eugonadal men. Contrasting results have been reported by two trials of testosterone treatment in frail elderly men. Reports from poorly analyzed databases have reported an increased risk of cardiovascular events with testosterone use. More recently, a population-based study showed no increased cardiovascular risk of testosterone replacement in hypogonadal men. Available data from controlled clinical trials suggest that the use of testosterone in elderly men does not increase cardiovascular risk nor the risk of events. Studies in men with CVD, angina, or heart failure report a benefit from testosterone replacement in men with or without hypogonadism. Therefore, at present, the cardiovascular benefits of TRT in elderly men outweigh the risks. This is particularly evident in those men with pre-existing CVD.

  1. Total cardiovascular risk profile of Taiwanese vegetarians.

    PubMed

    Chen, C-W; Lin, Y-L; Lin, T-K; Lin, C-T; Chen, B-C; Lin, C-L

    2008-01-01

    Although the health benefits of vegetarian diets have been well documented among Western population, there are geographic differences of vegetarian diets and the health benefits of the Taiwanese vegetarian diet have not been studied extensively. In addition to conventional risk factors, homocysteine and high-sensitivity C-reactive protein (hs-CRP) levels have been found to predict first atherothrombotic events. We undertook this study to examine the total risk profile of Taiwanese vegetarians. A total of 198 healthy subjects (99 vegetarians and 99 omnivores) were recruited. Fasting blood samples were analyzed for glucose, cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), white blood cell count, hs-CRP and homocysteine. There was no significant difference in age, body mass index, blood glucose, white blood cell count, triglyceride and HDL-C between the two groups. The vegetarian group had significantly more females (65.7 vs 46.5%); lower body weight (58.66+/-11.13 vs 62.88+/-12.24 kg); shorter height (159.14+/-7.88 vs 162.53 +/-8.14 cm); lower total cholesterol (184.74+/-33.23 vs 202.01+/-41.05 mg/dl); and lower LDL-C (119.63+/-31.59 vs 135.89+/-39.50 mg/dl). Hs-CRP was significantly lower (0.14+/-0.23 vs 0.23+/-0.44 mg/dl, P=0.025), whereas homocysteine was significantly higher (10.97+/-6.69 vs 8.44+/-2.50 micromol/l, P=0.001) in vegetarians than omnivores. Taiwanese vegetarians have lower total cholesterol, LDL-C and hs-CRP levels, and higher homocysteine levels than omnivores. Owing to different predictive value of each risk factor, the Taiwanese vegetarians had a better cardiovascular risk profile than omnivores. Whether the Taiwanese vegetarian diet should be supplemented with vitamin B(12) to lower serum homocysteine level remains to be addressed.

  2. [Cardiovascular risk factors and carotid atherosclerosis detected by ultrasonography].

    PubMed

    Cantú-Brito, C; Rodríguez-Saldaña, J; Reynoso-Marenco, M T; Marmolejo-Henderson, R; Barinagarrementeria-Aldatz, F

    1999-01-01

    To assess the frequency of carotid atherosclerosis and its relation to cardiovascular risk factors in a general elderly population of Mexico City. B-mode ultrasonography was performed to investigate carotid atherosclerosis in 145 CUPA (a research project) participants, between July 1993 and January 1996. The outcome was then related to cardiovascular risk factors. Prevalence of ultrasound-detected carotid atherosclerosis was 64.8%. Intimal-medial thickening was detected in 64 subjects (44.1%) and carotid plaques in 82 (56.5%); Fifty-two subjects had both intimal-medial thickening and plaques. However, only 8 subjects had carotid plaques with severe stenosis (5.5%). There were no significant differences in the prevalence of atherosclerotic lesions (male 61.9%, female 66.0%). Carotid atherosclerosis was significantly associated with age (p < 0.0001), high blood pressure (p < 0.001), isolated systolic hypertension (p = 0.01), hypercholesterolemia (p = 0.04), and diabetes mellitus (p = 0.06). Prevalence of carotid atherosclerosis increased progressively with the number of vascular risk factors. There was a high prevalence of carotid atherosclerosis in this general elderly population of Mexico City, and was almost equal to that reported in developed western countries. Age, hypertension, hypercholesterolemia, and diabetes were the strongest predictors of atherosclerosis.

  3. Education and hypertension: impact on global cardiovascular risk.

    PubMed

    Di Chiara, Tiziana; Scaglione, Alessandra; Corrao, Salvatore; Argano, Christiano; Pinto, Antonio; Scaglione, Rosario

    2017-06-28

    Improving cardiovascular risk prediction continues to be a major challenge and effective prevention of cardiovascular disease. Accordingly, several studies have recently reported on the role of cardiovascular risk education. This study was designed to evaluate the impact of education on global cardiovascular risk in hypertensive patients. The study population consisted of 223 consecutive hypertensive outpatients. Their educational status was categorized according to the number of years of formal education as follows: (1) low education (less than 10 years) and (2) medium-high education (10-15 years). In both groups, cardiometabolic comorbidities, global cardiovascular risk and echocardiographic measurements were analysed. Less educated hypertensive subjects were characterized by a significantly higher prevalence of patients with metabolic syndrome (MetS) (p < .01), greater global cardiovascular risk (p < .001), and a higher consumption of antihypertensive drugs (p < .01) rather than medium-high educated hypertensive subjects. In the same subjects, a significant increase in microalbuminuria (MA) (p < .01) and a significant decrease in E/A (p < .001) ratio was found. Univariate analysis indicated that global cardiovascular risk correlated directly with waist-hip ratio, mean blood pressure, MA, left ventricular mass index, MetS and inversely with education (r = -0.45; p < .001). Education was independently (p < .001) associated with global CV risk. Our data suggest that education may be considered the best predictor of global cardiovascular risk in hypertensives and thus has to be evaluated in the strategies of hypertension and cardiovascular risk management.

  4. Cardiovascular risk factors in scholars (RIVACANGAS).

    PubMed

    Mera-Gallego, Rocío; García-Rodríguez, Patricia; Fernández-Cordeiro, Marta; Rodríguez-Reneda, Ángeles; Vérez-Cotelo, Natalia; Andrés-Rodríguez, N Floro; Fornos-Pérez, J Antonio; Rica-Echevarría, Itxaso

    2016-12-01

    The current guidelines for treatment of high blood pressure do not include any section dedicated to hypertension in children and adolescents or to cardiovascular disease (CVD) prevention strategies in that age group. Our study was aimed at identifying cardiovascular risk factors (CVRFs) in an adolescent sample. A cross-sectional study of a sample of adolescents aged 12 to 17years (n=630), conducted from October 2014 to February 2015 in four schools in Cangas do Morrazo (Pontevedra). Sociodemographic variables: age, sex, personal and family history of hypertension and diabetes (DM). Anthropometric variables: body mass index (BMI, kg/m(2)), waist circumference (WC, cm), waist/height index (WHI), blood pressure (mmHg). The study sample consisted of 295 female and 335 male adolescents (mean age: 13.8±1.4). CVR-related conditions: hypercholesterolemia (7.1%), CVD (1.7%), hypertension (0.8%) and diabetes (0.3%). BMI (22.0±3,8) was higher in males (22.4±3.8 vs. 21.0±3.2; P<.01). Overweight was greater in females (27.6% vs. 19.7%; P<.05). Seven percent of subjects were obese, 63.8% had systolic BP >P90 and 23.7% had diastolic BP >P90. Waist circumference positively correlated with age (r=0.1669; P<.0001) and was greater in males (75.4±10.9 vs. 72.9±8.9; P<0.01); 27.1% of adolescents had a waist circumference >P75, and 7.5% >P90. Eighty-four (13.3%) adolescents had two CVRFs (overweight+another). Despite their young age, more than 10% of school children had two CVRFs. Abnormal SBP levels were seen in more than 50%, 20% were overweight, and only 75% had normal waist circumference values. Copyright © 2016 SEEN. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Risk Assessment: Evidence Base

    NASA Technical Reports Server (NTRS)

    Johnson-Throop, Kathy A.

    2007-01-01

    Human systems PRA (Probabilistic Risk Assessment: a) Provides quantitative measures of probability, consequence, and uncertainty; and b) Communicates risk and informs decision-making. Human health risks rated highest in ISS PRA are based on 1997 assessment of clinical events in analog operational settings. Much work remains to analyze remaining human health risks identified in Bioastronautics Roadmap.

  6. RESIDUAL RISK ASSESSMENTS - RESIDUAL RISK ...

    EPA Pesticide Factsheets

    This source category previously subjected to a technology-based standard will be examined to determine if health or ecological risks are significant enough to warrant further regulation for Coke Ovens. These assesments utilize existing models and data bases to examine the multi-media and multi-pollutant impacts of air toxics emissions on human health and the environment. Details on the assessment process and methodologies can be found in EPA's Residual Risk Report to Congress issued in March of 1999 (see web site). To assess the health risks imposed by air toxics emissions from Coke Ovens to determine if control technology standards previously established are adequately protecting public health.

  7. Different Impacts of Cardiovascular Risk Factors on Oxidative Stress

    PubMed Central

    Mansego, Maria L.; Redon, Josep; Martinez-Hervas, Sergio; Real, Jose T.; Martinez, Fernando; Blesa, Sebastian; Gonzalez-Albert, Veronica; Saez, Guillermo T.; Carmena, Rafael; Chaves, Felipe J.

    2011-01-01

    The objective of the study was to evaluate oxidative stress (OS) status in subjects with different cardiovascular risk factors. With this in mind, we have studied three models of high cardiovascular risk: hypertension (HT) with and without metabolic syndrome, familial hypercholesterolemia (FH) and familial combined hyperlipidemia (FCH) with and without insulin resistance. Oxidative stress markers (oxidized/reduced glutathione ratio, 8-oxo-deoxyguanosine and malondialdehide) together with the activity of antioxidant enzyme triad (superoxide dismutase, catalase, glutathione peroxidase) and activation of both pro-oxidant enzyme (NAPDH oxidase components) and AGTR1 genes, as well as antioxidant enzyme genes (CuZn-SOD, CAT, GPX1, GSR, GSS and TXN) were measured in mononuclear cells of controls (n = 20) and patients (n = 90) by assessing mRNA levels. Activity of some of these antioxidant enzymes was also tested. An increase in OS and pro-oxidant gene mRNA values was observed in patients compared to controls. The hypertensive group showed not only the highest OS values, but also the highest pro-oxidant activation compared to those observed in the other groups. In addition, in HT a significantly reduced antioxidant activity and mRNA induction of antioxidant genes were found when compared to controls and the other groups. In FH and FCH, the activation of pro-oxidant enzymes was also higher and antioxidant ones lower than in the control group, although it did not reach the values obtained in hypertensives. The thioredoxin system was more activated in patients as compared to controls, and the highest levels were in hypertensives. The increased oxidative status in the presence of cardiovascular risk factors is a consequence of both the activation of pro-oxidant mechanisms and the reduction of the antioxidant ones. The altered response of the main cytoplasmic antioxidant systems largely contributes to OS despite the apparent attempt of the thioredoxin system to control it. PMID

  8. Early identification of cardiovascular risk using genomics and proteomics

    PubMed Central

    Kullo, Iftikhar J.; Cooper, Leslie T.

    2010-01-01

    Coronary heart disease (CHD) will soon become the leading cause of death and morbidity in the world. Early detection and treatment of CHD is thus imperative to improve global health. Atherosclerosis of the coronary arteries is a complex multifactorial disease process involving multiple pathways that can be influenced by both genetic and environmental factors. With the recent advances in genomics and proteomics, many new risk factors with small-to-moderate effects are likely to be identified. Additionally, individualized risk stratification and targeted therapy may become feasible; each individual could potentially be assessed with a panel of tests for genomic and proteomic markers and, on the basis of the individual’s composite risk profile, preventive and therapeutic steps could then be undertaken. With a multimarker approach, it may also be possible to identify alterations in pathways involved in atherogenesis, rather than focus on individual risk factors. In this article, we use the specific example of atherosclerosis to discuss the role of genomics and proteomics in cardiovascular risk assessment. PMID:20440292

  9. Troponin I and cardiovascular risk prediction in the general population: the BiomarCaRE consortium

    PubMed Central

    Blankenberg, Stefan; Salomaa, Veikko; Makarova, Nataliya; Ojeda, Francisco; Wild, Philipp; Lackner, Karl J.; Jørgensen, Torben; Thorand, Barbara; Peters, Annette; Nauck, Matthias; Petersmann, Astrid; Vartiainen, Erkki; Veronesi, Giovanni; Brambilla, Paolo; Costanzo, Simona; Iacoviello, Licia; Linden, Gerard; Yarnell, John; Patterson, Christopher C.; Everett, Brendan M.; Ridker, Paul M.; Kontto, Jukka; Schnabel, Renate B.; Koenig, Wolfgang; Kee, Frank; Zeller, Tanja; Kuulasmaa, Kari

    2016-01-01

    Aims Our aims were to evaluate the distribution of troponin I concentrations in population cohorts across Europe, to characterize the association with cardiovascular outcomes, to determine the predictive value beyond the variables used in the ESC SCORE, to test a potentially clinically relevant cut-off value, and to evaluate the improved eligibility for statin therapy based on elevated troponin I concentrations retrospectively. Methods and results Based on the Biomarkers for Cardiovascular Risk Assessment in Europe (BiomarCaRE) project, we analysed individual level data from 10 prospective population-based studies including 74 738 participants. We investigated the value of adding troponin I levels to conventional risk factors for prediction of cardiovascular disease by calculating measures of discrimination (C-index) and net reclassification improvement (NRI). We further tested the clinical implication of statin therapy based on troponin concentration in 12 956 individuals free of cardiovascular disease in the JUPITER study. Troponin I remained an independent predictor with a hazard ratio of 1.37 for cardiovascular mortality, 1.23 for cardiovascular disease, and 1.24 for total mortality. The addition of troponin I information to a prognostic model for cardiovascular death constructed of ESC SCORE variables increased the C-index discrimination measure by 0.007 and yielded an NRI of 0.048, whereas the addition to prognostic models for cardiovascular disease and total mortality led to lesser C-index discrimination and NRI increment. In individuals above 6 ng/L of troponin I, a concentration near the upper quintile in BiomarCaRE (5.9 ng/L) and JUPITER (5.8 ng/L), rosuvastatin therapy resulted in higher absolute risk reduction compared with individuals <6 ng/L of troponin I, whereas the relative risk reduction was similar. Conclusion In individuals free of cardiovascular disease, the addition of troponin I to variables of established risk score improves prediction of

  10. Awareness of Individual Cardiovascular Risk Factors and Self-Perception of Cardiovascular Risk in Women.

    PubMed

    Monsuez, Jean-Jacques; Pham, Tai; Karam, Nicole; Amar, Laurence; Chicheportiche-Ayache, Corinne; Menasché, Philippe; Desnos, Michel; Dardel, Paul; Weill, Isabelle

    2017-09-01

    Cardiovascular risk factors (CVRFs) self-perception by women may be inaccurate. A questionnaire was completed anonymously Online by women who self-reported their personal CVRF levels including age, weight, contraceptive use, menopausal status, smoking, diet and physical activities. Self-perceived risk was matched to actual cardiovascular risk according to the Framingham score. Among 5,240 young and middle-aged women with a high educational level, knowledge of personal CVRFs increased with age, from 51-90% for blood pressure (BP), 22-45% for blood glucose and 15-47% for blood cholesterol levels, between 30 and 65 years, respectively. This knowledge was lower for smoking compared with nonsmoking women: 62.5% vs. 74.5% for BP (P < 0.001), 22.7% vs. 33.8% for blood glucose (P < 0.001), 21.9% vs. 32.0% for cholesterol levels (P < 0.001). Knowledge of BP level was reduced among women using an estrogen-progestogen contraception (56.8% vs. 62.1%, P = 0.0031) and even more reduced among smokers (52.2%, P < 0.001). Conversely, women with leisure-time physical or sportive activity (60.5%), were less overweight or obese (22.4% vs. 34.2%, P < 0.001). They reported better knowledge of BP (72.4% vs. 68.3%, P < 0.001), blood cholesterol (31.1% vs. 26.4%, P < 0.001) and glucose levels (32.7% vs. 27.8%, P < 0.001). Self-perceived cardiovascular risk was rated low by 1,279 (20.4%), moderate by 3,710 (63.3%) and high by 893 (16.3%) women. Among 3,386 women tested using the Framingham score, 40.8% were at low, 25.2% at moderate and 33.8% at high risk. Knowledge of CVRFs and self-perception of individual risk are inaccurate in women. Educational interventions should be emphasized. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  11. Obesity and Cardiovascular Disease: a Risk Factor or a Risk Marker?

    PubMed

    Mandviwala, Taher; Khalid, Umair; Deswal, Anita

    2016-05-01

    In the USA, 69 % of adults are either overweight or obese and 35 % are obese. Obesity is associated with an increased incidence of various cardiovascular disorders. Obesity is a risk marker for cardiovascular disease, in that it is associated with a much higher prevalence of comorbidities such as diabetes, hypertension, and metabolic syndrome, which then increase the risk for cardiovascular disease. However, in addition, obesity may also be an independent risk factor for the development of cardiovascular disease. Furthermore, although obesity has been shown to be an independent risk factor for several cardiovascular diseases, it is often associated with improved survival once the diagnosis of the cardiovascular disease has been made, leading to the term "obesity paradox." Several pathways linking obesity and cardiovascular disease have been described. In this review, we attempt to summarize the complex relationship between obesity and cardiovascular disorders, in particular coronary atherosclerosis, heart failure, and atrial fibrillation.

  12. Perceived health, life satisfaction, and cardiovascular risk factors among elderly Korean immigrants and elderly Koreans.

    PubMed

    Sin, Mo-Kyung; Chae, Young-Ran; Choe, Myoung-Ae; Murphy, Patrick; Kim, Jeungim; Jeon, Mi-Yang

    2011-03-01

    Acknowledging that changes in sociocultural environment influence health status, the purpose of this study was to compare perceived health, life satisfaction, and cardiovascular health in elderly Korean immigrants and elderly Koreans. In this cross-sectional study, a convenience sample of 88 elderly Korean immigrants and 295 elderly Koreans 65 and older were recruited from Korean communities in the United States and Korea. Respondents' perceived health was measured by self-assessment; life satisfaction was self-assessed using a dichotomous scale of general satisfaction with life; and cardiovascular health status was surveyed by self-report of major diagnosed cardiovascular risk factors (i.e., hypertension, hyperlipidemia, diabetes mellitus) and body mass index measurement for obesity. Despite having better perceived health and life satisfaction, elderly Korean immigrants also had higher prevalence of cardiovascular risk factors. The findings provide health care providers with useful information for effective health assessment of minority immigrants.

  13. Cardiovascular disease risk in young people with type 1 diabetes.

    PubMed

    Snell-Bergeon, Janet K; Nadeau, Kristen

    2012-08-01

    Cardiovascular disease (CVD) is the most frequent cause of death in people with type 1 diabetes (T1D), despite modern advances in glycemic control and CVD risk factor modification. CVD risk identification is essential in this high-risk population, yet remains poorly understood. This review discusses the risk factors for CVD in young people with T1D, including hyperglycemia, traditional CVD risk factors (dyslipidemia, smoking, physical activity, hypertension), as well as novel risk factors such as insulin resistance, inflammation, and hypoglycemia. We present evidence that adverse changes in cardiovascular function, arterial compliance, and atherosclerosis are present even during adolescence in people with T1D, highlighting the need for earlier intervention. The methods for investigating cardiovascular risk are discussed and reviewed. Finally, we discuss the observational studies and clinical trials which have thus far attempted to elucidate the best targets for early intervention in order to reduce the burden of CVD in people with T1D.

  14. Maternal relationship during adolescence predicts cardiovascular disease risk in adulthood.

    PubMed

    Doom, Jenalee R; Gunnar, Megan R; Clark, Cari Jo

    2016-04-01

    The current study investigated whether greater maternal support during adolescence is associated with lower levels of cardiovascular disease (CVD) risk in adulthood, and whether maternal support serves as a moderator or a mediator of the socioeconomic status (SES) and CVD risk association. In addition, potential moderators and mediators of the association between adult CVD risk and adolescent maternal support and SES were tested. Using the National Longitudinal Study of Adolescent to Adult Health (n = 11,013), we examined relations between maternal support during adolescence (M = 15.3 years) and CVD risk in young adulthood (M = 28.7 years) via path analysis. Maternal support was assessed by a composite of adolescent and mother report. CVD risk was calculated with a Framingham-based prediction model that uses age, sex, body mass index, smoking, systolic blood pressure, diabetes, and use of antihypertensive medication. Greater maternal support in adolescence was related to lower CVD risk in young adulthood (B = -0.56, 95% CI: -0.91 to -0.20, p < .01). The interaction between adolescent SES and maternal support was not significant, (p > .05), but there was an interaction between maternal support and race such that African American adolescents were more sensitive than Whites to the effects of maternal support on CVD risk (B = -0.90, 95% CI: -1.56, -0.25, p < .01). In addition, there was no evidence that maternal support mediated the association between SES and CVD risk (p > .05), and there was no association between SES and maternal support (p > .05), adjusting for confounders. However, the relations of adolescent maternal support and SES to adult CVD risk were mediated by young adult health behaviors and financial stress but not by depressive symptoms. Greater maternal support during adolescence appears to act independently of SES when impacting CVD risk and may operate through health behaviors and financial stress. (PsycINFO Database Record (c) 2016 APA, all rights

  15. Emerging Cardiovascular Risk Research: Impact of Pets on Cardiovascular Risk Prevention

    PubMed Central

    Schreiner, Pamela J.

    2016-01-01

    Animals interact with humans in multiple ways, including as therapy and service animals, commercially as livestock, as wildlife, and in zoos. But the most common interaction is as companion animals in our homes, with an estimated 180 million cats and dogs living in US households. While pet ownership has been reported to have many health benefits, the findings are inconsistent. Cardiovascular risk factors such as lipids, glucose, obesity, and heart rate variability have improved, worsened, or remained the same in the limited number of studies considering companion animals. Physical activity increases have more consistently been linked with dog ownership, although whether this reflects antecedent motivation or direct benefit from the dog is unclear. Allergies and asthma also are variably linked to pet ownership and are confounded by family history of atopy and timing of exposure to pet dander. The benefits of companion animals are most likely to be through reduction in depression, anxiety, and social isolation, but these studies have been largely cross-sectional and may depend on degree of bonding of the owner with the animal. Positive relationships show measurably higher oxytocin with lower cortisol and alpha-amylase levels. Finally, pet ownership is also a marker of better socioeconomic status and family stability, and if companion animals are to provide cardiovascular risk benefit, the route should perhaps be through improved education and opportunity for ownership. PMID:27547289

  16. Emerging Cardiovascular Risk Research: Impact of Pets on Cardiovascular Risk Prevention.

    PubMed

    Schreiner, Pamela J

    2016-02-01

    Animals interact with humans in multiple ways, including as therapy and service animals, commercially as livestock, as wildlife, and in zoos. But the most common interaction is as companion animals in our homes, with an estimated 180 million cats and dogs living in US households. While pet ownership has been reported to have many health benefits, the findings are inconsistent. Cardiovascular risk factors such as lipids, glucose, obesity, and heart rate variability have improved, worsened, or remained the same in the limited number of studies considering companion animals. Physical activity increases have more consistently been linked with dog ownership, although whether this reflects antecedent motivation or direct benefit from the dog is unclear. Allergies and asthma also are variably linked to pet ownership and are confounded by family history of atopy and timing of exposure to pet dander. The benefits of companion animals are most likely to be through reduction in depression, anxiety, and social isolation, but these studies have been largely cross-sectional and may depend on degree of bonding of the owner with the animal. Positive relationships show measurably higher oxytocin with lower cortisol and alpha-amylase levels. Finally, pet ownership is also a marker of better socioeconomic status and family stability, and if companion animals are to provide cardiovascular risk benefit, the route should perhaps be through improved education and opportunity for ownership.

  17. Cardiovascular risk factors in young adults: a literature review.

    PubMed

    Tran, Dieu-My T; Zimmerman, Lani M

    2015-01-01

    This extensive literature review focuses on cardiovascular risk factors in young adults, with an emphasis on hyperlipidemia and hypertension. Multiple studies have confirmed that hyperlipidemia and hypertension during young adulthood are associated with coronary heart disease (CHD) in later decades, and CHD is one type of cardiovascular disease. The primary risk factors identified in the literature that are predictive of CHD are age; gender; race/ethnicity; smoking status; high blood pressure; and elevated lipid levels, especially low-density lipoprotein cholesterol. The current guidelines are insufficient to address screening and treatment in young adults with cardiovascular risk factors. Future studies are warranted to confirm the extent of cardiovascular risks in young adults, which can then be targeted to this population for prevention and intervention strategies.

  18. Impact of treatment exposures on cardiovascular risk and insulin resistance in childhood cancer survivors.

    PubMed

    Baker, K Scott; Chow, Eric J; Goodman, Pamela J; Leisenring, Wendy M; Dietz, Andrew C; Perkins, Joanna L; Chow, Lisa; Sinaiko, Alan; Moran, Antoinette; Petryk, Anna; Steinberger, Julia

    2013-11-01

    Childhood cancer survivors (CCS) are more insulin resistant and have higher levels of several cardiovascular risk factors even while still children. This study examines specific treatment exposures associated with cardiovascular risk factors and insulin resistance. CCS of ages 9 to 18 years at study entry and in remission 5 years or more from diagnosis (n = 319) and 208 sibling controls were recruited into this cross-sectional study that included physiologic assessment of insulin resistance (hyperinsulinemic euglycemic clamp) and assessment of cardiovascular risk factors. Regression and recursive tree modeling were used to ascertain treatment combinations associated with insulin resistance and cardiovascular risk. Mean current age of CCS was 14.5 years and 54% were male (siblings 13.6 years, 54% male). Diagnoses included leukemia (35%), brain tumors (36%), solid tumors (33%), or lymphoma (6%). Among CCS, analysis of individual chemotherapy agents failed to find associations with cardiovascular risk factors or insulin resistance. Compared with siblings, insulin resistance was significantly higher in CCS who received platinum plus cranial radiotherapy (CRT, 92% brain tumors) and in those who received steroids but no platinum (majority leukemia). Insulin resistance did not differ between CCS who received surgery alone versus siblings. Within survivor comparisons failed to elucidate treatment combinations that increased insulin resistance compared with those who received surgery only. Exposure to platinum, CRT, or steroids is associated with insulin resistance and cardiovascular risk factors and should be taken into consideration in the development of screening recommendations for cardiovascular risk. Earlier identification of CCS who may benefit from targeted prevention efforts may reduce their future risk of cardiovascular disease. ©2013 AACR

  19. A study of cardiovascular risk factors and its knowledge among school children of Delhi.

    PubMed

    George, Grace Mary; Sharma, Kamlesh Kumari; Ramakrishnan, Sivasubramaniam; Gupta, Sanjeev Kumar

    2014-01-01

    Data on the knowledge of cardiovascular risk factors among Indian school children are limited. Aim of the study was to assess the prevalence of cardiovascular risk factors and its knowledge among school children of Delhi. We performed a cross-sectional survey among 485 school children studying in classes 6, 7 and 8 in two government and one private school in New Delhi using convenience sampling. Cardiovascular risk factors (physical activity, diet and smoking), knowledge about risk factors and family profile were assessed using a structured self report questionnaire. Weight, height and blood pressure measurements were taken. The mean age of the studied school children was 12.8 ± 1.6 years. The prevalence of overweight and obesity was 9.5% and 11.5% respectively. The prevalence of prehypertension, stage 1 hypertension and stage 2 hypertension was 12.4%, 6.8% and 1.4% respectively. Of the total, 43.8% were physically active for at least 1 hour per day on all 7 days of the previous week. Daily consumption of fruits and vegetables was reported by 42% and 76% of the school children respectively. Nearly 5% of the school children reported to have used any form of tobacco. One fifth of the school children had a family history of cardiovascular disease. Of the total, 25.4% had adequate knowledge regarding cardiovascular risk factors. Cardiovascular risk factors are highly prevalent among school children. Importantly, school children lack adequate knowledge regarding cardiovascular risk factors. School based interventions are required for cardiovascular risk reduction in childhood. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  20. Assessment of Myocardial Ischemia with Cardiovascular Magnetic Resonance

    PubMed Central

    Heydari, Bobak; Jerosch-Herold, Michael; Kwong, Raymond Y.

    2014-01-01

    Assessment of myocardial ischemia in symptomatic patients remains a common and challenging clinical situation faced by physicians. Risk stratification by presence of ischemia provides important utility for both prognostic assessment and management. Unfortunately, current noninvasive modalities possess numerous limitations and have limited prognostic capacity. More recently, ischemia assessment by cardiovascular magnetic resonance (CMR) has been shown to be a safe, available, and potentially cost-effective alternative with both high diagnostic and prognostic accuracy. Cardiovascular magnetic resonance has numerous advantages over other noninvasive methods, including high temporal and spatial resolution, relatively few contraindications, and absence of ionizing radiation. Furthermore, studies assessing the clinical utility and cost effectiveness of CMR in the short-term setting for patients without evidence of an acute myocardial infarction have also demonstrated favorable results. This review will cover techniques of ischemia assessment with CMR by both stress-induced wall motion abnormalities as well as myocardial perfusion imaging. The diagnostic and prognostic performance studies will also be reviewed, and the use of CMR for ischemia assessment will be compared with other commonly used noninvasive modalities. PMID:22014487

  1. Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations.

    PubMed

    Selvarajah, Sharmini; Haniff, Jamaiyah; Kaur, Gurpreet; Guat Hiong, Tee; Bujang, Adam; Chee Cheong, Kee; Bots, Michiel L

    2013-02-25

    Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening.

  2. Identification of effective screening strategies for cardiovascular disease prevention in a developing country: using cardiovascular risk-estimation and risk-reduction tools for policy recommendations

    PubMed Central

    2013-01-01

    Background Recent increases in cardiovascular risk-factor prevalences have led to new national policy recommendations of universal screening for primary prevention of cardiovascular disease in Malaysia. This study assessed whether the current national policy recommendation of universal screening was optimal, by comparing the effectiveness and impact of various cardiovascular screening strategies. Methods Data from a national population based survey of 24 270 participants aged 30 to 74 was used. Five screening strategies were modelled for the overall population and by gender; universal and targeted screening (four age cut-off points). Screening strategies were assessed based on the ability to detect high cardiovascular risk populations (effectiveness), incremental effectiveness, impact on cardiovascular event prevention and cost of screening. Results 26.7% (95% confidence limits 25.7, 27.7) were at high cardiovascular risk, men 34.7% (33.6, 35.8) and women 18.9% (17.8, 20). Universal screening identified all those at high-risk and resulted in one high-risk individual detected for every 3.7 people screened, with an estimated cost of USD60. However, universal screening resulted in screening an additional 7169 persons, with an incremental cost of USD115,033 for detection of one additional high-risk individual in comparison to targeted screening of those aged ≥35 years. The cost, incremental cost and impact of detection of high-risk individuals were more for women than men for all screening strategies. The impact of screening women aged ≥45 years was similar to universal screening in men. Conclusions Targeted gender- and age-specific screening strategies would ensure more optimal utilisation of scarce resources compared to the current policy recommendations of universal screening. PMID:23442728

  3. Lipoprotein (a) and cardiovascular risk factors in children and adolescents.

    PubMed

    Palmeira, Ástrid Camêlo; Leal, Adriana Amorim de F; Ramos, Nathaly de Medeiros N; Neto, José de Alencar F; Simões, Mônica Oliveira da S; Medeiros, Carla Campos M

    2013-12-01

    To review the relationship between lipoprotein (a) [Lp(a)] and other risk factors for cardiovascular disease (CVD) in children and adolescents. This systematic review included studies from 2001 to 2011, a ten-year time period. Epidemiological studies with children and/or adolescents published in English, Portuguese or Spanish and fully available online were included. The searches were performed in Science Direct, PubMed/Medline, BVS (Biblioteca Virtual em Saúde) and Cochrane Library databases, using the following combination of key-words: "lipoprotein a" and "cardiovascular diseases" and "obesity". Overall, 672 studies were obtained but only seven were included. Some stud