WorldWideScience

Sample records for prevent cardiovascular diseases

  1. Garlic for Cardiovascular Disease: Prevention or Treatment?

    Science.gov (United States)

    Alali, Feras Q; El-Elimat, Tamam; Khalid, Lila; Hudaib, Reema; Al-Shehabi, Tuqa Saleh; Eid, Ali H

    2017-01-01

    Cardiovascular disease (CVD) is the leading cause of global mortality with a substantial economic impact. The annual deaths are expected to increase in the next decade. An array of dietary supplements is being used by people worldwide to ameliorate cardiovascular risk factors. Garlic (Allium sativum L.), a top-selling herbal dietary supplement, is renowned for its wide range beneficial effects, particularly in the treatment and prevention of CVD. This review aims to present a thorough discussion of the available evidence-based data which support the use of garlic in the treatment or prevention of cardiovascular diseases, including atherosclerosis, hypertension, and hyperlipidemia. The molecular mechanisms underlying these effects are dissected as well. This review supports the notion that garlic has the potential to treat mild hypertension, to decrease hypercholesterolemia, and to prevent atherosclerosis. More clinical studies are essential to unequivocally understand the mechanisms underlying treatment or prevention of these cardiovascular conditions. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  2. Polypills for the prevention of Cardiovascular diseases.

    Science.gov (United States)

    Kolte, Dhaval; Aronow, Wilbert S; Banach, Maciej

    2016-11-01

    Cardiovascular diseases (CVD) remain the leading cause of death worldwide with an estimated 17.5 million deaths per year. Since its initial conception over a decade ago, the use of cardiovascular polypills has gained increasing momentum as a strategy to lower risk factor levels and prevent CVD. Several new data have emerged including the recent publication of the first outcomes trial using polypills. Areas covered: In this review, the authors summarize the current literature on the safety, efficacy, and cost-effectiveness of polypills for primary and secondary prevention of CVD, describe the current controversies in this field, and identify important areas for future research. The authors searched PubMed, CENTRAL, and ClinicalTrials.gov from inception till 25 June 2016 using the search term 'polypill.' Expert opinion: Cardiovascular polypills containing aspirin, statin, and one or more anti-hypertensive medications, along with lifestyle interventions, represent an attractive, safe, and cost-effective strategy for primary and secondary prevention of CVD. Future research efforts should focus on identifying patients who will benefit the most from the use of polypills, marketing several polypills with different components and doses, and developing novel regulatory strategies for making polypills more readily available in all countries worldwide.

  3. [Statins in primary prevention of cardiovascular disease].

    Science.gov (United States)

    Adham, S; Miranda, S; Doucet, J; Lévesque, H; Benhamou, Y

    2018-01-01

    Cardiovascular events are the second leading cause of death in France. The assessment of overall cardiovascular risk using a personalized assessment with weighting risk factors can predict the risk of cardiovascular events in ten years. The validated treatments to reduce cardiovascular mortality in primary prevention are few. The use of statins in primary prevention is discussed. We report in this review the updated conclusions from clinical trials regarding the treatment with statins in primary prevention. Copyright © 2017 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  4. [Cardiovascular disease prevention and life style modifications].

    Science.gov (United States)

    Baudet, M; Daugareil, C; Ferrieres, J

    2012-04-01

    Cardiovascular diseases are mainly caused by atherosclerosis, the development of which is highly dependent on our Western lifestyle. Slowing this pathology depends on the reduction of risk factors such as hypercholesterolemia, high blood pressure, smoking, lack of physical activity, excess weight and diabetes. Drug treatment exists and is very effective, but too often they treat the immediate abnormality such as diabetes, high blood pressure and hypercholesterolemia and not the underlying causes: poor eating habits, lack of physical activity and excess weight. These have a negative impact on endothelial function, oxidative stress, and can trigger inflammation, arrythmias and thrombosis. Cardiovascular prevention must therefore target sedentary lifestyle, excess weight, and favor low-calorie, low-salt food and Mediterranean diet. The way this diet works begins to be understood and goes beyond simple cardiovascular prevention. Therapeutic education holds a growing and complementary role in the Public Health system which should call upon the strengths of all healthcare professionals. Copyright © 2011. Published by Elsevier SAS.

  5. Aspirin for primary prevention of cardiovascular disease in diabetes mellitus

    OpenAIRE

    Pignone, Michael; Williams, Craig D.

    2010-01-01

    Aspirin is effective for the prevention of cardiovascular events in patients with a history of vascular disease, as so-called secondary prevention. In general populations with no history of previous myocardial infarction or stroke, aspirin also seems useful for primary prevention of cardiovascular events, although the absolute benefits are smaller than those seen in patients with previous cardiovascular disease. Patients with diabetes mellitus are at an increased risk of cardiovascular events...

  6. Cardiovascular disease: primary prevention, disease modulation and regenerative therapy.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2012-10-01

    Cardiovascular primary prevention and regeneration programs are the contemporary frontiers in functional metabolic vascular medicine. This novel science perspective harnesses our inherent ability to modulate the interface between specialized gene receptors and bioavailable nutrients in what is labeled as the nutrient-gene interaction. By mimicking a natural process through the conveyance of highly absorbable receptor specific nutrients, it is feasible to accelerate cell repair and optimize mitochondrial function, thereby achieving cardiovascular cure. We performed a comprehensive review of PubMed, EMBASE and Cochrane Review databases for articles relating to cardiovascular regenerative medicine, nutrigenomics and primary prevention, with the aim of harmonizing their roles within contemporary clinical practice. We searched in particular for large-scale randomized controlled trials on contemporary cardiovascular pharmacotherapies and their specific adverse effects on metabolic pathways which feature prominently in cardiovascular regenerative programs, such as nitric oxide and glucose metabolism. Scientific research on \\'cardiovascular-free\\' centenarians delineated that low sugar and low insulin are consistent findings. As we age, our insulin level increases. Those who can decelerate the rapidity of this process are prompting their cardiovascular rejuvenation. It is beginning to dawn on some clinicians that contemporary treatments are not only failing to impact on our most prevalent diseases, but they may be causing more damage than good. Primary prevention programs are crucial elements for a better outcome. Cardiovascular primary prevention and regeneration programs have enhanced clinical efficacy and quality of life and complement our conventional endovascular practice.

  7. Dietary nutrients in preventing cardiovascular diseases: a narrative review

    Directory of Open Access Journals (Sweden)

    Khadijeh Saket

    2017-05-01

    Full Text Available Foods play an important role in preparing the health of body. Foods and nutrients are effective in increasing health and regulating the immune system as well as in prevention of different diseases such as cardiovascular diseases. In the past few years, the prevalence of cardiovascular disease is progressively increasing. Change in lifestyle and dietary pattern of the societies plays an important role in inducing cardiovascular diseases. Studies have shown that the risk of cardiovascular disease among people consuming more vegetables is lower. Recent findings suggest that foods rich in omega-3, vitamins, antioxidants and fibers are useful for the health of cardiovascular system and such nutrition, in addition to disease prevention, reduces the cost and side effects of chemical treatments. In this article, different clinical trials introducing beneficial dietary approaches in preventing cardiovascular diseases are reviewed

  8. Prevention of cardiovascular disease in rheumatoid arthritis.

    Science.gov (United States)

    Hollan, I; Dessein, P H; Ronda, N; Wasko, M C; Svenungsson, E; Agewall, S; Cohen-Tervaert, J W; Maki-Petaja, K; Grundtvig, M; Karpouzas, G A; Meroni, P L

    2015-10-01

    The increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) has been recognized for many years. However, although the characteristics of CVD and its burden resemble those in diabetes, the focus on cardiovascular (CV) prevention in RA has lagged behind, both in the clinical and research settings. Similar to diabetes, the clinical picture of CVD in RA may be atypical, even asymptomatic. Therefore, a proactive screening for subclinical CVD in RA is warranted. Because of the lack of clinical trials, the ideal CVD prevention (CVP) in RA has not yet been defined. In this article, we focus on challenges and controversies in the CVP in RA (such as thresholds for statin therapy), and propose recommendations based on the current evidence. Due to the significant contribution of non-traditional, RA-related CV risk factors, the CV risk calculators developed for the general population underestimate the true risk in RA. Thus, there is an enormous need to develop adequate CV risk stratification tools and to identify the optimal CVP strategies in RA. While awaiting results from randomized controlled trials in RA, clinicians are largely dependent on the use of common sense, and extrapolation of data from studies on other patient populations. The CVP in RA should be based on an individualized evaluation of a broad spectrum of risk factors, and include: 1) reduction of inflammation, preferably with drugs decreasing CV risk, 2) management of factors associated with increased CV risk (e.g., smoking, hypertension, hyperglycemia, dyslipidemia, kidney disease, depression, periodontitis, hypothyroidism, vitamin D deficiency and sleep apnea), and promotion of healthy life style (smoking cessation, healthy diet, adjusted physical activity, stress management, weight control), 3) aspirin and influenza and pneumococcus vaccines according to current guidelines, and 4) limiting use of drugs that increase CV risk. Rheumatologists should take responsibility for the education of

  9. New approaches to the implementation of cardiovascular disease prevention

    NARCIS (Netherlands)

    Jørstad, H.T.

    2016-01-01

    Cardiovascular disease is one of the biggest contemporary health problems worldwide. To aid preventive measures, risk calculators have been developed to estimate the risk of dying of cardiovascular disease within 10 years, for use in healthy individuals. Decisions to initiate preventive measures are

  10. Preventing Cardiovascular Disease Risk Factors through Aerobic ...

    African Journals Online (AJOL)

    This paper focused on the reduction of cardiovascular disease risk factors, through aerobic exercises. The central argument here is that through exercise there is the tendency for increased strength of the heart muscles. When this is the case, what follows is a reduction in body weight and ultimately less risk on the ...

  11. Nutritional Recommendations for Cardiovascular Disease Prevention

    OpenAIRE

    Eilat-Adar, Sigal; Sinai, Tali; Yosefy, Chaim; Henkin, Yaakov

    2013-01-01

    Lifestyle factors, including nutrition, play an important role in the etiology of Cardiovascular Disease (CVD). This position paper, written by collaboration between the Israel Heart Association and the Israel Dietetic Association, summarizes the current, preferably latest, literature on the association of nutrition and CVD with emphasis on the level of evidence and practical recommendations. The nutritional information is divided into three main sections: dietary patterns, individual food it...

  12. Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy

    NARCIS (Netherlands)

    van Schaik, T. M.; Jørstad, H. T.; Twickler, T. B.; Peters, R. J. G.; Tijssen, J. P. G.; Essink-Bot, M. L.; Fransen, M. P.

    2017-01-01

    Objective To explore the association between health literacy and the risk of cardiovascular disease (CVD), and to assess the differential effects by health literacy level of a nurse-coordinated secondary prevention program (NCPP) in patients with coronary artery disease (CAD). Methods Data were

  13. Nutritional recommendations for cardiovascular disease prevention.

    Science.gov (United States)

    Eilat-Adar, Sigal; Sinai, Tali; Yosefy, Chaim; Henkin, Yaakov

    2013-09-17

    Lifestyle factors, including nutrition, play an important role in the etiology of Cardiovascular Disease (CVD). This position paper, written by collaboration between the Israel Heart Association and the Israel Dietetic Association, summarizes the current, preferably latest, literature on the association of nutrition and CVD with emphasis on the level of evidence and practical recommendations. The nutritional information is divided into three main sections: dietary patterns, individual food items, and nutritional supplements. The dietary patterns reviewed include low carbohydrate diet, low-fat diet, Mediterranean diet, and the DASH diet. Foods reviewed in the second section include: whole grains and dietary fiber, vegetables and fruits, nuts, soy, dairy products, alcoholic drinks, coffee and caffeine, tea, chocolate, garlic, and eggs. Supplements reviewed in the third section include salt and sodium, omega-3 and fish oil, phytosterols, antioxidants, vitamin D, magnesium, homocysteine-reducing agents, and coenzyme Q10.

  14. Nutritional Recommendations for Cardiovascular Disease Prevention

    Directory of Open Access Journals (Sweden)

    Yaakov Henkin

    2013-09-01

    Full Text Available Lifestyle factors, including nutrition, play an important role in the etiology of Cardiovascular Disease (CVD. This position paper, written by collaboration between the Israel Heart Association and the Israel Dietetic Association, summarizes the current, preferably latest, literature on the association of nutrition and CVD with emphasis on the level of evidence and practical recommendations. The nutritional information is divided into three main sections: dietary patterns, individual food items, and nutritional supplements. The dietary patterns reviewed include low carbohydrate diet, low-fat diet, Mediterranean diet, and the DASH diet. Foods reviewed in the second section include: whole grains and dietary fiber, vegetables and fruits, nuts, soy, dairy products, alcoholic drinks, coffee and caffeine, tea, chocolate, garlic, and eggs. Supplements reviewed in the third section include salt and sodium, omega-3 and fish oil, phytosterols, antioxidants, vitamin D, magnesium, homocysteine-reducing agents, and coenzyme Q10.

  15. Nutritional Recommendations for Cardiovascular Disease Prevention

    Science.gov (United States)

    Eilat-Adar, Sigal; Sinai, Tali; Yosefy, Chaim; Henkin, Yaakov

    2013-01-01

    Lifestyle factors, including nutrition, play an important role in the etiology of Cardiovascular Disease (CVD). This position paper, written by collaboration between the Israel Heart Association and the Israel Dietetic Association, summarizes the current, preferably latest, literature on the association of nutrition and CVD with emphasis on the level of evidence and practical recommendations. The nutritional information is divided into three main sections: dietary patterns, individual food items, and nutritional supplements. The dietary patterns reviewed include low carbohydrate diet, low-fat diet, Mediterranean diet, and the DASH diet. Foods reviewed in the second section include: whole grains and dietary fiber, vegetables and fruits, nuts, soy, dairy products, alcoholic drinks, coffee and caffeine, tea, chocolate, garlic, and eggs. Supplements reviewed in the third section include salt and sodium, omega-3 and fish oil, phytosterols, antioxidants, vitamin D, magnesium, homocysteine-reducing agents, and coenzyme Q10. PMID:24067391

  16. The role of aspirin in the prevention of cardiovascular disease.

    Science.gov (United States)

    Ittaman, Sunitha V; VanWormer, Jeffrey J; Rezkalla, Shereif H

    2014-12-01

    Aspirin therapy is well-accepted as an agent for the secondary prevention of cardiovascular events and current guidelines also define a role for aspirin in primary prevention. In this review, we describe the seminal trials of aspirin use in the context of current guidelines, discuss factors that may influence the effectiveness of aspirin therapy for cardiovascular disease prevention, and briefly examine patterns of use. The body of evidence supports a role for aspirin in both secondary and primary prevention of cardiovascular events in selected population groups, but practice patterns may be suboptimal. As a simple and inexpensive prophylactic measure for cardiovascular disease, aspirin use should be carefully considered in all at-risk adult patients, and further measures, including patient education, are necessary to ensure its proper use. © 2013 Marshfield Clinic.

  17. The Role of Aspirin in the Prevention of Cardiovascular Disease

    Science.gov (United States)

    Ittaman, Sunitha V.; VanWormer, Jeffrey J.; Rezkalla, Shereif H.

    2014-01-01

    Aspirin therapy is well-accepted as an agent for the secondary prevention of cardiovascular events and current guidelines also define a role for aspirin in primary prevention. In this review, we describe the seminal trials of aspirin use in the context of current guidelines, discuss factors that may influence the effectiveness of aspirin therapy for cardiovascular disease prevention, and briefly examine patterns of use. The body of evidence supports a role for aspirin in both secondary and primary prevention of cardiovascular events in selected population groups, but practice patterns may be suboptimal. As a simple and inexpensive prophylactic measure for cardiovascular disease, aspirin use should be carefully considered in all at-risk adult patients, and further measures, including patient education, are necessary to ensure its proper use. PMID:24573704

  18. Barriers to lifestyle changes for prevention of cardiovascular disease

    DEFF Research Database (Denmark)

    Nielsen, Jesper Bo; Leppin, Anja; Gyrd-Hansen, Dorte

    2017-01-01

    BACKGROUND: Elimination of modifiable risk factors including unhealthy lifestyle has the potential for prevention of 80% of cardiovascular disease cases. The present study focuses on disclosing barriers for maintaining specific lifestyle changes by exploring associations between perceiving...... inequality even in populations with equal and cost-free access to health care. Our study suggests supplementing traditional public campaigns to counter cardiovascular disease by using individualized and targeted initiatives....... these barriers and various sociodemographic and health-related characteristics. METHODS: Data were collected through a web-based questionnaire survey and included 962 respondents who initially accepted treatment for a hypothetical cardiovascular risk, and who subsequently stated that they preferred lifestyle...

  19. 459 Preventing Cardiovascular Disease Risk Factors through ...

    African Journals Online (AJOL)

    FIRST LADY

    2011-01-18

    Jan 18, 2011 ... heart rate consistently high enough to produce a cardiovascular training effect. Activities that usually meet these criteria are considered to be good aerobic activities. Examples of some good aerobic activities according to. Hockey (1996) include, Aerobic dance, Basketball, “Marksball”, Bicycling,.

  20. Primary prevention of cardiovascular disease with hormone replacement therapy

    DEFF Research Database (Denmark)

    Schierbeck, L

    2015-01-01

    Many peri- and postmenopausal women suffer from a reduced quality of life due to menopausal symptoms and preventable diseases. The importance of cardiovascular disease in women must be emphasized, as it is the leading cause of mortality and morbidity in women. It is well known that female hormones...... contribute to the later onset of cardiovascular disease in women. The effect of estrogens has for decades been understood from observational studies of postmenopausal women treated with hormone replacement therapy (HRT). Later, treatment with HRT was disregarded due to the fear of side...

  1. Risk Assessment in the Prevention of Cardiovascular Disease in ...

    African Journals Online (AJOL)

    Risk Assessment in the Prevention of Cardiovascular Disease in Low-Resource Settings: Lessons for practitioners in Nigeria. Sandra N Ofori, Osaretin James Odia. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African ...

  2. Prevention of cardiovascular disease in a rural general practice

    Directory of Open Access Journals (Sweden)

    Elżbieta Tomiak

    2016-09-01

    The higher number of preventive consultations had an impact on a statistically significant decrease in mean blood pressure and mean SCORE value. The year-long cardiovascular disease prophylaxis programme proved less effective than expected, and neither a decrease in body weight nor an improvement in lipid metabolism was achieved in any of the groups.

  3. Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer

    Science.gov (United States)

    ... and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer The U.S. Preventive Services Task Force ( ... and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer. This final recommendation statement applies to ...

  4. Physician Performance Assessment: Prevention of Cardiovascular Disease

    Science.gov (United States)

    Lipner, Rebecca S.; Weng, Weifeng; Caverzagie, Kelly J.; Hess, Brian J.

    2013-01-01

    Given the rising burden of healthcare costs, both patients and healthcare purchasers are interested in discerning which physicians deliver quality care. We proposed a methodology to assess physician clinical performance in preventive cardiology care, and determined a benchmark for minimally acceptable performance. We used data on eight…

  5. Primary prevention of cardiovascular diseases: a cost study in family practices.

    NARCIS (Netherlands)

    Bekker-Grob, E.W. de; Dulmen, S. van; Berg, M. van den; Verheij, R.A.; Slobbe, L.C.J.

    2011-01-01

    BACKGROUND: Considering the scarcity of health care resources and the high costs associated with cardiovascular diseases, we investigated the spending on cardiovascular primary preventive activities and the prescribing behaviour of primary preventive cardiovascular medication (PPCM) in Dutch family

  6. South American Guidelines for Cardiovascular Disease Prevention and Rehabilitation

    Directory of Open Access Journals (Sweden)

    AH Herdy

    2014-08-01

    Full Text Available In this document, the Inter-American Committee of Cardiovascular Prevention and Rehabilitation, together with the South American Society of Cardiology, aimed to formulate strategies, measures, and actions for cardiovascular disease prevention and rehabilitation (CVDPR. In the context of the implementation of a regional and national health policy in Latin American countries, the goal is to promote cardiovascular health and thereby decrease morbidity and mortality. The study group on Cardiopulmonary and Metabolic Rehabilitation from the Department of Exercise, Ergometry, and Cardiovascular Rehabilitation of the Brazilian Society of Cardiology has created a committee of experts to review the Portuguese version of the guideline and adapt it to the national reality. The mission of this document is to help health professionals to adopt effective measures of CVDPR in the routine clinical practice. The publication of this document and its broad implementation will contribute to the goal of the World Health Organization (WHO, which is the reduction of worldwide cardiovascular mortality by 25% until 2025. The study group's priorities are the following: • Emphasize the important role of CVDPR as an instrument of secondary prevention with significant impact on cardiovascular morbidity and mortality; • Join efforts for the knowledge on CVDPR, its dissemination, and adoption in most cardiovascular centers and institutes in South America, prioritizing the adoption of cardiovascular prevention methods that are comprehensive, practical, simple and which have a good cost/benefit ratio; • Improve the education of health professionals and patients with education programs on the importance of CVDPR services, which are directly targeted at the health system, clinical staff, patients, and community leaders, with the aim of decreasing the barriers to CVDPR implementation.

  7. Diet, Weight Loss, and Cardiovascular Disease Prevention.

    Science.gov (United States)

    Bray, George A.; Ryan, Donna H.; Harsha, David W.

    2003-08-01

    Body weight, like cholesterol and blood pressure, are continuous variables. Overweight results when energy intake as food exceeds energy expenditure from exercise for a considerable period of time. When body weight becomes sufficiently high, it poses a risk to cardiovascular and metabolic health. The types of treatments considered by the physician and discussed with a patient should be based on this risk-benefit assessment. The body mass is the basic measurement for this assessment, and should be part of the "vital signs" when a patient is first evaluated by the medical staff. When the body mass index (BMI) is below 25 kg/m(2), there is little risk from the body weight, but because obesity is a "stigmatized" condition, many patients, particularly women, desire to lose weight even within the normal range. For this purpose, a high-quality diet like the Dietary Approaches to Stopping Hypertension (DASH) diet at a reduced-calorie intake would be our recommendation. When the BMI is above 25 kg/m(2), patients deserve dietary advice, but in addition to a reduced-calorie DASH-like diet, this is a place to consider using "portion-control" strategies, such as the nutrition labels that manufacturers provide on canned and frozen foods to guide patients in reducing calorie intake. In overweight individuals at high risk (ie, those with a BMI above 30 kg/m(2) or impaired glucose tolerance, hypertension, or the metabolic syndrome), the use of orlistat or sibutramine along with diet, exercise, lifestyle changes, and portion control should be considered. When the BMI is above 35 kg/m(2), bariatric surgery should also be discussed as an option for the "at-risk" individual. Evidence reviewed here shows that modest weight losses of 5% to 10% can reduce the risk of conversion from impaired glucose tolerance to diabetes and can maintain lower blood pressure over extended periods. All of the approaches described above can produce weight losses of this magnitude.

  8. Primary prevention of cardiovascular disease with a Mediterranean diet.

    Science.gov (United States)

    Estruch, Ramón; Ros, Emilio; Salas-Salvadó, Jordi; Covas, Maria-Isabel; Corella, Dolores; Arós, Fernando; Gómez-Gracia, Enrique; Ruiz-Gutiérrez, Valentina; Fiol, Miquel; Lapetra, José; Lamuela-Raventos, Rosa Maria; Serra-Majem, Lluís; Pintó, Xavier; Basora, Josep; Muñoz, Miguel Angel; Sorlí, José V; Martínez, José Alfredo; Martínez-González, Miguel Angel

    2013-04-04

    Observational cohort studies and a secondary prevention trial have shown an inverse association between adherence to the Mediterranean diet and cardiovascular risk. We conducted a randomized trial of this diet pattern for the primary prevention of cardiovascular events. In a multicenter trial in Spain, we randomly assigned participants who were at high cardiovascular risk, but with no cardiovascular disease at enrollment, to one of three diets: a Mediterranean diet supplemented with extra-virgin olive oil, a Mediterranean diet supplemented with mixed nuts, or a control diet (advice to reduce dietary fat). Participants received quarterly individual and group educational sessions and, depending on group assignment, free provision of extra-virgin olive oil, mixed nuts, or small nonfood gifts. The primary end point was the rate of major cardiovascular events (myocardial infarction, stroke, or death from cardiovascular causes). On the basis of the results of an interim analysis, the trial was stopped after a median follow-up of 4.8 years. A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events). No diet-related adverse effects were reported. Among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events. (Funded by the Spanish government's Instituto de Salud Carlos III and others; Controlled-Trials.com number, ISRCTN35739639.).

  9. Exercise for prevention of cardiovascular disease: Evidence-based recommendations

    Directory of Open Access Journals (Sweden)

    Geevar Zachariah

    2017-01-01

    Full Text Available Sedentary lifestyle is one of the major risk factors for cardiovascular disease (CVD. In India, a large percentage of the people are physically inactive with fewer than 10% engaging in recreational physical activity. Physical activity has many beneficial effects on the risk factors for CVD. Apart from improving fitness level, it decreases myocardial oxygen demand and improves myocardial perfusion. There is an inverse association between physical activity and all-cause mortality. In primary prevention, physical inactivity is associated with a two-fold increase in the risk for coronary events. In secondary prevention, data confirm the existence of an inverse dose–response relationship between cardiovascular fitness and the all-cause mortality in large populations of cardiovascular patients. Guidelines from the American authorities as well as the European Society of Cardiology provide specific recommendations for exercise depending on the clinical setting (primary or secondary prevention of CVD and the patient-specific factors (the patient's physical activity level and the perceived CVD risk. The present review summarizes the clinical evidence regarding the role of exercise in CVD prevention and the exercise recommendations from the leading Cardiac societies.

  10. Cardiovascular disease risk and secondary prevention of cardiovascular disease among patients with low health literacy.

    Science.gov (United States)

    van Schaik, T M; Jørstad, H T; Twickler, T B; Peters, R J G; Tijssen, J P G; Essink-Bot, M L; Fransen, M P

    2017-07-01

    To explore the association between health literacy and the risk of cardiovascular disease (CVD), and to assess the differential effects by health literacy level of a nurse-coordinated secondary prevention program (NCPP) in patients with coronary artery disease (CAD). Data were collected in two medical centres participating in the RESPONSE trial (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists). CVD risk profiles were assessed at baseline and 12-month follow-up using the Systematic Coronary Risk Evaluation (SCORE). Health literacy was assessed by the short Rapid Estimate of Adult Literacy in Medicine (REALM-D) and the Newest Vital Sign (NVS-D); self-reported health literacy was evaluated by the Set of Brief Screening Questions (SBSQ-D). Among 201 CAD patients, 18% exhibited reading difficulties, 52% had difficulty understanding and applying written information, and 5% scored low on self-reported health literacy. Patients with low NVS-D scores had a higher CVD risk [mean SCORE 5.2 (SD 4.8) versus 3.3 (SD 4.1), p literacy levels without significant differences. Inadequate health literacy is prevalent in CAD patients in the Netherlands, and is associated with less favourable CVD risk profiles. Where many other forms of CVD prevention fail, nurse-coordinated care seems to be effective among patients with inadequate health literacy.

  11. Primary Prevention of Cardiovascular Disease in Diabetes Mellitus.

    Science.gov (United States)

    Newman, Jonathan D; Schwartzbard, Arthur Z; Weintraub, Howard S; Goldberg, Ira J; Berger, Jeffrey S

    2017-08-15

    Type 2 diabetes mellitus (T2D) is a major risk factor for cardiovascular disease (CVD), the most common cause of death in T2D. Yet, exercise, nutrition, and weight management) and CVD risk factor (blood pressure, cholesterol and blood lipids, glycemic control, and the use of aspirin) management for the prevention of CVD among patients with T2D. The authors believe appropriate lifestyle and CVD risk factor management has the potential to significantly reduce the burden of CVD among patients with T2D. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  12. Diet, nutrition and the prevention of hypertension and cardiovascular diseases

    NARCIS (Netherlands)

    Reddy, K.S.; Katan, M.B.

    2004-01-01

    Cardiovascular diseases (CVD) are growing contributors to global disease burdens, with epidemics of CVD advancing across many regions of the world which are experiencing a rapid health transition. Diet and nutrition have been extensively investigated as risk factors for major cardiovascular diseases

  13. Diets for cardiovascular disease prevention: what is the evidence?

    Science.gov (United States)

    Walker, Christopher; Reamy, Brian V

    2009-04-01

    Patients often initiate commercial dietary plans to reduce obesity and prevent cardiovascular disease. Such plans include very low-carbohydrate, low-carbohydrate, very low-fat, and Mediterranean diets. Published evidence on several popular diets has made it easier for physicians to counsel patients about the health benefits and risks of such plans. Although the Atkins, Zone, Sugar Busters!, and South Beach diets have data proving that they are effective for weight loss and do not increase deleterious disease-oriented outcomes, they have little evidence of patient-oriented benefits. In contrast, the Mediterranean diet has extensive patient-oriented outcome data showing a significant risk reduction in mortality rates and in rates of fatal and nonfatal myocardial infarction. The American Heart Association released guidelines in 2006 that integrate recommendations from a variety of diets into a single plan. Physicians should emphasize diets that are rich in fruits, vegetables, and healthful fatty acids and that limit saturated fat intake. A stepwise individualized patient approach, with incorporation of one or two dietary interventions every three to six months, may be a practical way to help reduce a patient's cardiovascular disease risk.

  14. The North Karelia lessons for prevention of cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Tiina Laatikainen

    2007-06-01

    Full Text Available

    Background: As a result of the high cardiovascular disease (CVD rates in Finland in late 1960’s, which became a source of national concern, a major community based programme for CVD prevention called the North Karelia project was established. Aim: The aim of the project was to carry out a programme of comprehensive community based interventions to reduce coronary heart disease (CHD mortality and morbidity.

    Methods: Using lifestyle modification methods and strategies for environmental change the programme aimed to reduce three main risk factors: smoking, elevated blood cholesterol and blood pressure. Several intervention settings and strategies in the community were used.

    Results: Since the 1970’s the CHD mortality in North Karelia has declined by more than 80%. Major reductions have been seen across the main three cardiovascular risk factors. Among both men and women, total serum cholesterol levels within the population declined by almost 20% and systolic blood pressure by about 10%. Smoking among men decreased from 52% to 33%, while among women a slight increase in smoking prevalence was recorded.

    Conclusions: The North Karelia project has shown that a comprehensive, determined, theory-based community program can have a meaningful and positive effect on risk factors and lifestyles. Furthermore, these changes are associated with favorable changes in chronic disease rates and the health of the population.

  15. Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease

    NARCIS (Netherlands)

    Squizzato, Alessandro; Keller, Tymen; Romualdi, Erica; Middeldorp, Saskia

    2011-01-01

    Aspirin is the prophylactic antiplatelet drug of choice for people with cardiovascular disease. Adding a second antiplatelet drug to aspirin may produce additional benefit for those at high risk and those with established cardiovascular disease. To quantify the benefit and harm of adding clopidogrel

  16. Aspirin overutilization for the primary prevention of cardiovascular disease

    Directory of Open Access Journals (Sweden)

    VanWormer JJ

    2014-12-01

    Full Text Available Jeffrey J VanWormer,1 Aaron W Miller,2 Shereif H Rezkalla3 1Center for Clinical Epidemiology and Population Health, 2Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI, USA; 3Department of Cardiology, Marshfield Clinic, Marshfield, WI, USA Background: Aspirin is commonly used for the primary prevention of cardiovascular disease (CVD in the US. Previous research has observed significant levels of inappropriate aspirin use for primary CVD prevention in some European populations, but the degree to which aspirin is overutilized in the US remains unknown. This study examined the association between regular aspirin use and demographic/clinical factors in a population-based sample of adults without a clinical indication for aspirin for primary prevention.Methods: A cross-sectional analysis was performed using 2010–2012 data from individuals aged 30–79 years in the Marshfield Epidemiologic Study Area (WI, USA. Regular aspirin users included those who took aspirin at least every other day.Results: There were 16,922 individuals who were not clinically indicated for aspirin therapy for primary CVD prevention. Of these, 19% were regular aspirin users. In the final adjusted model, participants who were older, male, lived in northern Wisconsin, had more frequent medical visits, and had greater body mass index had significantly higher odds of regular aspirin use (P<0.001 for all. Race/ethnicity, health insurance, smoking, blood pressure, and lipid levels had negligible influence on aspirin use. A sensitivity analysis found a significant interaction between age and number of medical visits, indicating progressively more aspirin use in older age groups who visited their provider frequently.Conclusion: There was evidence of aspirin overutilization in this US population without CVD. Older age and more frequent provider visits were the strongest predictors of inappropriate aspirin use. Obesity was the only significant

  17. [Prevention of cardiovascular diseases - Prophylactic program in a selected enterprise].

    Science.gov (United States)

    Siedlecka, Jadwiga; Gadzicka, Elżbieta; Szyjkowska, Agata; Siedlecki, Patryk; Szymczak, Wiesław; Makowiec-Dąbrowska, Teresa; Bortkiewicz, Alicja

    2017-10-17

    In Poland cardiovascular diseases (CVD), classified as work-related diseases, are responsible for 25% of disability and cause 50% of all deaths, including 26.9% of deaths in people aged under 65 years. The aim of the study was to analyze employee expectations regarding CVD- oriented prophylactic activities in the selected enterprise. A questionnaire, developed for this study, consists of: socio-demographic data, job characteristics, occupational factors, and questions about the respondents' expectations concerning the prevention program. The study group comprised 407 multi-profile company employees aged (mean) 46.7 years (standard deviation (SD) = 9.1), including 330 men (81.1%), mean age = 46.9 (SD = 9.2) and 77 women (18.9%), mean age = 45.9 (SD = 8.2) The study was performed using the method of auditorium survey. Employees declared the need for actions related to physical activity: use of gym, swimming pool, tennis (56.5%), smoking habits - education sessions on quitting smoking (24.6%). A few people were interested in activities related to healthy diet. According to the majority of the study group, the scope of preventive examinations should be expanded. Based on our own findings and literature data CVD- -oriented preventive program, addressed to the analyzed enterprise was prepared. The program will be presented in another paper. The results showed significant quantitative and qualitative differences in the classic and occupational CVD risk factors between men and women, as well as in preferences for participation in prevention programs. Therefore, gender differences should be taken into account when planning prevention programs. Med Pr 2017;68(6):757-769. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  18. Microalgae for the prevention of cardiovascular disease and stroke.

    Science.gov (United States)

    Raposo, Maria Filomena de Jesus; de Morais, Alcina Maria Miranda Bernardo

    2015-03-15

    This review focuses on and discusses the primary phytochemicals present in microalgal biomass - carotenoids, phenolic compounds, antioxidant vitamins, sterols, and polyunsaturated fatty acids - and also on the exopolysaccharides, which are produced by some types of microalgae and may play a significant role in the prevention of cardiovascular diseases (CVD) and strokes. We have listed several preclinical trials and clinical studies supporting the health benefits that most of these compounds may provide. Microalgae are very easy to grow and are not vulnerable to contaminants when grown under controlled conditions. Proper handling and growth conditions may improve the production of phytochemicals. Therefore, they may represent an excellent source of nutraceuticals and food supplements once their safety as a food supplement has been confirmed. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Chronic kidney disease and cardiovascular risk : epidemiology, mechanisms, and prevention

    NARCIS (Netherlands)

    Gansevoort, Ron T.; Correa-Rotter, Ricardo; Hemmelgarn, Brenda R.; Jafar, Tazeen H.; Heerspink, Hiddo J. Lambers; Mann, Johannes F.; Matsushita, Kunihiro; Wen, Chi Pang

    2013-01-01

    Since the first description of the association between chronic kidney disease and heart disease, many epidemiological studies have confirmed and extended this finding. As chronic kidney disease progresses, kidney-specific risk factors for cardiovascular events and disease come into play. As a

  20. Aspirin for Primary Prevention of Cardiovascular Disease and Cancer. A Benefit and Harm Analysis

    NARCIS (Netherlands)

    Stegeman, Inge; Bossuyt, Patrick M.; Yu, Tsung; Boyd, Cynthia; Puhan, Milo A.

    2015-01-01

    Aspirin is widely used for prevention of cardiovascular disease. In recent years randomized trials also suggested a preventive effect for various types of cancer. We aimed to assess, in a quantitative way, benefits and harms of aspirin for primary prevention of both cardiovascular disease and cancer

  1. Statins for the primary prevention of cardiovascular disease

    Science.gov (United States)

    Taylor, Fiona; Ward, Kirsten; Moore, Theresa HM; Burke, Margaret; Smith, George Davey; Casas, Juan P; Ebrahim, Shah

    2014-01-01

    Background Reducing high blood cholesterol, a risk factor for cardiovascular disease (CVD) events in people with and without a past history of coronary heart disease (CHD) is an important goal of pharmacotherapy. Statins are the first-choice agents. Previous reviews of the effects of statins have highlighted their benefits in people with coronary artery disease. The case for primary prevention, however, is less clear. Objectives To assess the effects, both harms and benefits, of statins in people with no history of CVD. Search methods To avoid duplication of effort, we checked reference lists of previous systematic reviews. We searched the Cochrane Central Register of Controlled Trials (Issue 1, 2007), MEDLINE (2001 to March 2007) and EMBASE (2003 to March 2007). There were no language restrictions. Selection criteria Randomised controlled trials of statins with minimum duration of one year and follow-up of six months, in adults with no restrictions on their total low density lipoprotein (LDL) or high density lipoprotein (HDL) cholesterol levels, and where 10% or less had a history of CVD, were included. Data collection and analysis Two authors independently selected studies for inclusion and extracted data. Outcomes included all cause mortality, fatal and non-fatal CHD, CVD and stroke events, combined endpoints (fatal and non-fatal CHD, CVD and stroke events), change in blood total cholesterol concentration, revascularisation, adverse events, quality of life and costs. Relative risk (RR) was calculated for dichotomous data, and for continuous data pooled weighted mean differences (with 95% confidence intervals) were calculated. Main results Fourteen randomised control trials (16 trial arms; 34,272 participants) were included. Eleven trials recruited patients with specific conditions (raised lipids, diabetes, hypertension, microalbuminuria). All-cause mortality was reduced by statins (RR 0.84, 95% CI 0.73 to 0.96) as was combined fatal and non-fatal CVD endpoints

  2. Prevalence and prevention of cardiovascular disease and diabetes mellitus.

    Science.gov (United States)

    Balakumar, Pitchai; Maung-U, Khin; Jagadeesh, Gowraganahalli

    2016-11-01

    Noncommunicable diseases (NCDs) have become important causes of mortality on a global scale. According to the report of World Health Organization (WHO), NCDs killed 38 million people (out of 56 million deaths that occurred worldwide) during 2012. Cardiovascular diseases accounted for most NCD deaths (17.5 million NCD deaths), followed by cancers (8.2 million NCD deaths), respiratory diseases (4.0 million NCD deaths) and diabetes mellitus (1.5 million NCD deaths). Globally, the leading cause of death is cardiovascular diseases; their prevalence is incessantly progressing in both developed and developing nations. Diabetic patients with insulin resistance are even at a greater risk of cardiovascular disease. Obesity, high cholesterol, hypertriglyceridemia and elevated blood pressure are mainly considered as major risk factors for diabetic patients afflicted with cardiovascular disease. The present review sheds light on the global incidence of cardiovascular disease and diabetes mellitus. Additionally, measures to be taken to reduce the global encumbrance of cardiovascular disease and diabetes mellitus are highlighted. Published by Elsevier Ltd.

  3. Childhood obesity and cardiovascular disease: links and prevention strategies

    Science.gov (United States)

    Nadeau, Kristen J.; Maahs, David M.; Daniels, Stephen R.; Eckel, Robert H.

    2015-01-01

    The prevalence and severity of pediatric obesity have dramatically increased since the late 1980s, raising concerns about a subsequent increase in cardiovascular outcomes. Strong evidence, particularly from autopsy studies, supports the concept that precursors of adult cardiovascular disease (CVD) begin in childhood, and that pediatric obesity has an important influence on overall CVD risk. Lifestyle patterns also begin early and impact CVD risk. In addition, obesity and other CVD risk factors tend to persist over time. However, whether childhood obesity causes adult CVD directly, or does so by persisting as adult obesity, or both, is less clear. Regardless, sufficient data exist to warrant early implementation of both obesity prevention and treatment in youth and adults. In this Review, we examine the evidence supporting the impact of childhood obesity on adult obesity, surrogate markers of CVD, components of the metabolic syndrome, and the development of CVD. We also evaluate how obesity treatment strategies can improve risk factors and, ultimately, adverse clinical outcomes. PMID:21670745

  4. Dietetic approaches in prevention and treatment of cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Ines Banjari

    2014-03-01

    Full Text Available Cardiovascular diseases (CVDs are responsible for 30% of all death causes worldwide, and according to the World Health Organization predictions this negative trend will be continued further on. CVDs include diseases related to macro and microvascular system. There are numerous underlying risk factors, but the biggest emphasis is on those that can be modified and therefore lower the incidence of CVD, its complications, and causative morbidity and mortality due to CVDs. This is especially related to hypertension, hyperlipidemias, smoking, increased body mass, diagnosis of type 2 diabetes, and inadequate level of physical activity and unfavourable dietary habits. The last two are the mostly highlighted and all preventive measures and actions go in that direction. From the aspect of diet, high intake of fats in total, and especially saturated and trans fats, high intake of salt, and high intake of simple carbohydrates, i.e. refined carbohydrates present the backbone of unfavourable dietary habits responsible for rising global problem of CVDs. World’s, European’s as well as the national’s guidelines for prevention and treatment of CVDs contain specific guidelines aiming at the abovementioned aspects. Several dietary approaches arise from these guidelines, but the Mediterranean diet positioned itself as the most optimal for its centuries-old reputation. The other thing is that the Mediterranean diet contains all of the principles set by guidelines, and has another important aspects - the aspects of cultural, sociological, and quality-of-life aspect. Mediterranean diet was and has remained the most frequently researched dietary principle, not only across the Mediterranean, but in countries with non-Mediterranean populations. All of these researches have proven its beneficial impact that goes well beyond the impact on CVDs.

  5. Reduced or modified dietary fat for preventing cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Lee Hooper

    Full Text Available ABSTRACT: BACKGROUND: Reduction and modification of dietary fats have differing effects on cardiovascular risk factors (such as serum cholesterol, but their effects on important health outcomes are less clear. OBJECTIVE: To assess the effect of reduction and/or modification of dietary fats on mortality, cardiovascular mortality, cardiovascular morbidity and individual outcomes including myocardial infarction, stroke and cancer diagnoses in randomised clinical trials of at least 6 months duration. METHODS: Search methods: For this review update, the Cochrane Central Register of Controlled Trials (CENTRAL, Medline and Embase, were searched through to June 2010. References of Included studies and reviews were also checked. Selection criteria: Trials fulfilled the following criteria: 1 randomized with appropriate control group, 2 intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions, 3 not multi factorial, 4 adult humans with or without cardiovascular disease, 5 intervention at least six months, 6 mortality or cardiovascular morbidity data available. Data collection and analysis: Participant numbers experiencing health outcomes in each arm were extracted independently in duplicate and random effects meta-analyses, meta-regression, sub-grouping, sensitivity analyses and funnel plots were performed. MAIN RESULTS: This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% (RR 0.86, 95% CI 0.77 to 0.96, 24 comparisons, 65,508 participants of whom 7% had a cardiovascular event, I2 50%. Subgrouping suggested that this reduction in cardiovascular events was seen in studies of fat modification (not reduction - which related directly to the degree of effect on serum total and LDL cholesterol and triglycerides, of at least two years duration and in studies of men (not of women. There were no clear effects of dietary fat

  6. Reduced or modified dietary fat for preventing cardiovascular disease

    Science.gov (United States)

    Hooper, Lee; Summerbell, Carolyn D; Thompson, Rachel; Sills, Deirdre; Roberts, Felicia G; Moore, Helen; Smith, George Davey

    2014-01-01

    Background Reduction and modification of dietary fats have differing effects on cardiovascular risk factors (such as serum cholesterol), but their effects on important health outcomes are less clear. Objectives To assess the effect of reduction and/or modification of dietary fats on mortality, cardiovascular mortality, cardiovascular morbidity and individual outcomes including myocardial infarction, stroke and cancer diagnoses in randomised clinical trials of at least 6 months duration. Search methods For this review update, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE, were searched through to June 2010. References of Included studies and reviews were also checked. Selection criteria Trials fulfilled the following criteria: 1) randomised with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) adult humans with or without cardiovascular disease, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available. Data collection and analysis Participant numbers experiencing health outcomes in each arm were extracted independently in duplicate and random effects meta-analyses, meta-regression, sub-grouping, sensitivity analyses and funnel plots were performed. Main results This updated review suggested that reducing saturated fat by reducing and/or modifying dietary fat reduced the risk of cardiovascular events by 14% (RR 0.86, 95% CI 0.77 to 0.96, 24 comparisons, 65,508 participants of whom 7% had a cardiovascular event, I2 50%). Subgrouping suggested that this reduction in cardiovascular events was seen in studies of fat modification (not reduction - which related directly to the degree of effect on serum total and LDL cholesterol and triglycerides), of at least two years duration and in studies of men (not of women). There were no clear effects of dietary fat changes on total mortality (RR 0

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

    Science.gov (United States)

    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.

  8. New cardiovascular targets to prevent late onset Alzheimer disease.

    Science.gov (United States)

    Claassen, Jurgen A H R

    2015-09-15

    The prevalence of dementia rises to between 20% and 40% with advancing age. The dominant cause of dementia in approximately 70% of these patients is Alzheimer disease. There is no effective disease-modifying pharmaceutical treatment for this neurodegenerative disease. A wide range of Alzheimer drugs that appeared effective in animal models have recently failed to show clinical benefit in patients. However, hopeful news has emerged from recent studies that suggest that therapeutic strategies aimed at reducing cardiovascular disease may also reduce the prevalence of dementia due to Alzheimer disease. This review summarizes the evidence for this link between cardiovascular disease and late onset Alzheimer dementia. Only evidence from human research is considered here. Longitudinal studies show an association between high blood pressure and pathological accumulation of the protein amyloid-beta42, and an even stronger association between vascular stiffness and amyloid accumulation, in elderly subjects. Amyloid-beta42 accumulation is considered to be an early marker of Alzheimer disease, and increases the risk of subsequent cognitive decline and development of dementia. These observations could provide an explanation for recent observations of reduced dementia prevalence associated with improved cardiovascular care. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Dietetic approaches in prevention and treatment of cardiovascular diseases

    OpenAIRE

    Ines Banjari; Snežana Bajraktarović - Labović; Boris Huzjak

    2014-01-01

    Cardiovascular diseases (CVDs) are responsible for 30% of all death causes worldwide, and according to the World Health Organization predictions this negative trend will be continued further on. CVDs include diseases related to macro and microvascular system. There are numerous underlying risk factors, but the biggest emphasis is on those that can be modified and therefore lower the incidence of CVD, its complications, and causative morbidity and mortality due to CVDs. This is especially rela...

  10. Qigong for the primary prevention of cardiovascular disease.

    Science.gov (United States)

    Hartley, Louise; Lee, Myeong Soo; Kwong, Joey S W; Flowers, Nadine; Todkill, Daniel; Ernst, Edzard; Rees, Karen

    2015-06-11

    Two major determinants of cardiovascular disease (CVD) are a sedentary lifestyle and stress. Qigong involves physical exercise, mind regulation and breathing control to restore the flow of Qi (a pivotal life energy). As it is thought to help reduce stress and involves exercise, qigong may be an effective strategy for the primary prevention of CVD. To determine the effectiveness of qigong for the primary prevention of CVD. We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2014, Issue 10 of 12); MEDLINE (Ovid) (1946 to 2014 October week 4); EMBASE Classic + EMBASE (Ovid) (1947 to 2014 November 4); Web of Science Core Collection (1970 to 31 October 2014); Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database and Health Economics Evaluations Database (November 2014, Issue 4 of 4). We searched several Asian databases (inception to July 2013) and the Allied and Complementary Medicine Database (AMED) (inception to December 2013), as well as trial registers and reference lists of reviews and articles; we also approached experts in the field and applied no language restrictions in our search. Randomised controlled trials lasting at least three months involving healthy adults or those at high risk of CVD. Trials examined any type of qigong, and comparison groups provided no intervention or minimal intervention. Outcomes of interest included clinical CVD events and major CVD risk factors. We did not include trials that involved multi-factorial lifestyle interventions or weight loss. Two review authors independently selected trials for inclusion. Two review authors extracted data from included studies and assessed the risk of bias. We identified 11 completed trials (1369 participants) and one ongoing trial. Trials were heterogeneous in participants recruited, qigong duration and length of follow-up periods. We were unable to ascertain the risk of bias in nine trials

  11. Antiplatelet Drugs for Secondary Prevention of Cardiovascular Diseases : Drug Utilization, Effectiveness, and Safety

    NARCIS (Netherlands)

    Noorsyahdy, A.Y.

    2017-01-01

    Antiplatelet drugs are recommended for secondary prevention of recurrent cardiovascular events in patients who experience diseases in which the pathophysiology is associated with platelet aggregation and atherosclerosis, including acute coronary syndrome, transient ischemic attack, ischemic stroke,

  12. Formalized Interconnected Guidelines on Cardiovascular Disease Prevention and Those for Management of Diabetes, Dyslipidemia and Hypertension

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Anger, Z.; Buchtela, David; Tomečková, Marie; Veselý, Arnošt; Zvárová, Jana

    24 Suppl. 4, - (2006), s. 172-172 ISSN 0263-6352. [European Meeting on Hypertension /16./. 12.06.2006-15.06.2006, Madrid] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : computer presentation * interconnected medical guidelines * cardiovascular prevention Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  13. Global cardiovascular disease prevention: a call to action for nursing: community-based and public health prevention initiatives.

    Science.gov (United States)

    Fletcher, Barbara J; Himmelfarb, Cheryl Dennison; Lira, Maria Teresa; Meininger, Janet C; Pradhan, Sala Ray; Sikkema, Joanna

    2011-01-01

    Policy changes are necessary to promote cardiovascular disease prevention. These will involve community-based and public health initiatives for primary and secondary prevention of cardiovascular disease. In this article, we discuss such interventions, community-based participatory research that has been conducted in this area, and implications for capacity building in genetics research. Finally, areas for future research in this area will be identified.

  14. Vitamin C supplementation for the primary prevention of cardiovascular disease.

    Science.gov (United States)

    Al-Khudairy, Lena; Flowers, Nadine; Wheelhouse, Rebecca; Ghannam, Obadah; Hartley, Louise; Stranges, Saverio; Rees, Karen

    2017-03-16

    Vitamin C is an essential micronutrient and powerful antioxidant. Observational studies have shown an inverse relationship between vitamin C intake and major cardiovascular events and cardiovascular disease (CVD) risk factors. Results from clinical trials are less consistent. To determine the effectiveness of vitamin C supplementation as a single supplement for the primary prevention of CVD. We searched the following electronic databases on 11 May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library; MEDLINE (Ovid); Embase Classic and Embase (Ovid); Web of Science Core Collection (Thomson Reuters); Database of Abstracts of Reviews of Effects (DARE); Health Technology Assessment Database and Health Economics Evaluations Database in the Cochrane Library. We searched trial registers on 13 April 2016 and reference lists of reviews for further studies. We applied no language restrictions. Randomised controlled trials of vitamin C supplementation as a single nutrient supplement lasting at least three months and involving healthy adults or adults at moderate and high risk of CVD were included. The comparison group was no intervention or placebo. The outcomes of interest were CVD clinical events and CVD risk factors. Two review authors independently selected trials for inclusion, abstracted the data and assessed the risk of bias. We included eight trials with 15,445 participants randomised. The largest trial with 14,641 participants provided data on our primary outcomes. Seven trials reported on CVD risk factors. Three of the eight trials were regarded at high risk of bias for either reporting or attrition bias, most of the 'Risk of bias' domains for the remaining trials were judged as unclear, with the exception of the largest trial where most domains were judged to be at low risk of bias.The composite endpoint, major CVD events was not different between the vitamin C and placebo group (hazard ratio (HR) 0.99, 95% confidence interval

  15. [Job strain and cardiovascular diseases: epidemiologic evidence and prevention].

    Science.gov (United States)

    Ferrario, M M

    2012-01-01

    The present contribution wishes to draw attention to major evidences from more recent studies on the relationship between job strain (JS) and cardiovascular diseases (CVD). In particular the demand-control model and the effort-reward imbalance models will be reviewed. Different outcomes are considered: first hypertension, second coronary heart disease (CHD), third atherosclerosis progression, and finally stroke. All these results are in favor of the association between JS and CVD, but with relevant discrepancies in different socio-cultural contest, in different gender groups, indifferent socio-occupational strata. A recent meta-analysis considering prospective cohort studies attribute to people with high JS a 50% increment in risk of CHD in men. Evidences are scares per women. Many limitations in study design contributes to explain some of the discrepancies in the results obtained so far. Promising first results have been reported for studies exploring the interaction between JS and genetic connotes on blood pressure values. More researchers are needed. Based on the actually available evidences, it is time anyhow to start promotion activities at the workplace to improve Individual coping as well as improve the work climate, contrasting major stressor related to work organization and relationships.

  16. [USE OF STATINS IN PATIENTS WITH CHRONIC KIDNEY DISEASE TO PREVENT CARDIOVASCULAR DISEASE].

    Science.gov (United States)

    Zavidić, T; Lodeta, B; Lovrinić, Đ

    2016-12-01

    Chronic kidney disease (CKD) is one of the leading public health issues due to frequent and serious complications. Once the function of kidneys is disrupted, regardless of etiology, there are numerous factors that can speed up decrease of glomerular filtration rate, including hypertension, proteinuria and dyslipidemia. Statins are widely used in primary and secondary prevention of cardiovascular diseases in general population. Clinical advantages of statins in CKD patients are not as clear. The aim of this paper is to present lipid status in CKD patients and indications for statin therapy with the aim to reduce cardiovascular risk in this group of patients. CKD is a well-known independent risk factor in cardiovascular events, but professional associations issuing guidelines differ in the approach to treatment of dyslipidemia. The results of some studies indicate that treatment with statins may slow down the rate of kidney function reduction in patients with mild to moderate kidney damage, whereas other studies deny this effect. Furthermore, CKD patients have a higher risk of side effects, in part due to the reduced kidney excretion, polypharmacy, and numerous other comorbidities. Family physician has the role of providing preventive measures, with focus on appropriate treatment of patients with hypertension or diabetes, as the most common cause of CKD, and timely detection of CKD in initial stage.

  17. Personalized nutrition and cardiovascular disease prevention: From Framingham to PREDIMED.

    Science.gov (United States)

    Konstantinidou, Valentini; Daimiel, Lidia; Ruiz, Lidia Angeles Daimiel; Ordovás, Jose M

    2014-05-01

    Diet is considered the cornerstone for the prevention of age-related diseases, and a low-fat diet has been considered for decades as the most suitable alternative to achieve this goal. However, mounting evidence supports the efficacy of other alternatives, such as the Mediterranean diet. Nevertheless, it is well known that people present a dramatic range of responses to similar environmental challenges, and it has been shown that some of this variability is rooted in the genome. In fact, this knowledge is driving the field of nutrigenetics. The finding of interactions between diet and genetic variants has led to intense research and debate about the effectiveness of personalized nutrition as a more suitable tool for the prevention of chronic diseases than the traditional 1-size-fits-all recommendations. Here, we provide some of our own examples that illustrate the progression of nutrigenetics through the years, from the initial studies within the Framingham Heart Study, to the most recent use of large consortia, such as the Cohorts for Heart and Aging Research in Genomic Epidemiology, and ending up with large dietary intervention studies, such as the PREDIMED (Prevención con Dieta Mediterránea) study. These recent approaches are providing more robust and clinically relevant gene-diet interactions. Therefore, although the current evidence level of applying genomic information to tailoring is at its early stages, the prospect of widespread incorporation of nutrigenetics to the clinical practice is encouraging. © 2014 American Society for Nutrition.

  18. Latest evidence of the effects of the Mediterranean diet in prevention of cardiovascular disease.

    Science.gov (United States)

    Chiva-Blanch, G; Badimon, L; Estruch, Ramon

    2014-10-01

    The first step in the prevention of cardiovascular disease is healthy lifestyle and diet. Recent systematic reviews of observational studies ranked Mediterranean diet as the most likely dietary model to provide cardiovascular protection. This review updates the knowledge on the effects of Mediterranean diet from observational and randomized trials published in the last year. The results of the PREDIMED study, a randomized trial providing a higher level of scientific evidence than cohort studies, confirmed that the Mediterranean diet reduces the incidence of cardiovascular events. This effect may be exerted by reducing blood pressure; improving glucose metabolism, lipid profile, and lipoprotein particle characteristics; and decreasing inflammation and oxidative stress. It may also stem from a favorable interaction between diet and gene polymorphisms related to cardiovascular risk factors and events. These recent results allow us to recommend Mediterranean diet to subjects at high risk for cardiovascular disease with the highest level of scientific evidence.

  19. The Tsim Tsoum Approaches for Prevention of Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    R. B. Singh

    2010-01-01

    proinflammatory status of blood vessels, cardiomyocytes, liver cells and neurones; (a and (b are phenotype-related and depend on genetic, environmental and developmental factors. As such, they appear as universal markers for holistic health and these may be important in the pathogenesis of cardiovascular diseases and cancer, which is the main consideration of Tsim Tsoum concept.

  20. Is the high-risk strategy to prevent cardiovascular disease equitable?

    DEFF Research Database (Denmark)

    Wallach Kildemoes, Helle; Diderichsen, Finn; Krasnik, Allan

    2012-01-01

    ABSTRACT: BACKGROUND: Statins are increasingly prescribed to prevent cardiovascular disease (CVD) in asymptomatic individuals. Yet, it is unknown whether those at higher CVD risk - i.e. individuals in lower socio-economic position (SEP) - are adequately reached by this high-risk strategy. Aim......: To examine whether the Danish implementation of the strategy to prevent cardiovascular disease (CVD) by initiating statin (HMG-CoA reductase inhibitor) therapy in high-risk individuals is equitable across socioeconomic groups. METHODS: Design: Cohort study. Setting and participants: Applying individual...

  1. [Research on Prevention and Treatment of Cardiovascular Disease by Translational Medicine Based Chinese Medicine].

    Science.gov (United States)

    Lu, Shi-chao; Zhang, Jun-ping

    2015-05-01

    Translational medicine is inevitable in the development of modern medicine, and the uprising concept of translational medicine provides an opportunity for the development of Chinese medicine (CM). Their ideas are well communicated. There are two patterns of researching on CM based on translational medicine: 'literature to bench to bedside' and 'bench to bedside to bench'. CM has her advantages in preventing and treating cardiovascular disease. Effective methods for preventing and treating cardiovascular disease by CM should be further studied based on translational medicine concepts.

  2. Primary prevention of cardiovascular disease in patients with systemic lupus erythematosus: case series and literature review.

    Science.gov (United States)

    Fasano, S; Margiotta, D P; Navarini, L; Pierro, L; Pantano, I; Riccardi, A; Afeltra, A; Valentini, G

    2017-12-01

    Background Systemic lupus erythematosus is associated with an increased risk of cardiovascular disease. Low-dose aspirin, hydroxychloroquine and statins have been suggested to play a prophylactic role of cardiovascular events. This study is devoted to reviewing the literature on the topic and assessing the effects of these drugs in preventing a first cardiovascular event in a two-centre Italian series. Methods A PubMed search on cardiovascular prevention in systemic lupus erythematosus was performed. Moreover, systemic lupus erythematosus patients admitted to two centres from 2000-2015, who at admission had not experienced any cardiovascular event, were investigated. Aspirin, hydroxychloroquine and statin use, and the occurrence of any cardiovascular event, were recorded at each visit. Kaplan-Meier and Cox regression analyses were performed to evaluate the role of traditional, disease-related cardiovascular risk factors and of each of the three drugs in the occurrence of new cardiovascular events. Results The literature search produced conflicting results. Two hundred and ninety-one systemic lupus erythematosus patients were included in the study and followed for a median of eight years. During follow-up, 16 cardiovascular events occurred. At multivariate analysis, taking aspirin (hazard ratio: 0.24) and hydroxychloroquine for more than five years (hazard ratio: 0.27) reduced, while antiphospholipid antibody positivity (hazard ratio: 4.32) increased, the risk of a first cardiovascular event. No effect of statins emerged. Conclusion Our study confirms an additive role of aspirin and hydroxychloroquine in the primary prophylaxis of cardiovascular events in Italian patients with systemic lupus erythematosus. The lack of any detected effect in previous reports may depend on the design of studies and their short follow-up period.

  3. Consensus document for the use of the Polypill in the secondary prevention of cardiovascular disease.

    Science.gov (United States)

    González-Juanatey, José Ramón; Mostaza, José María; Lobos, José María; Abarca, Benjamín; Llisterri, José Luis; Baron-Esquivias, Gonzalo; Galve, Enrique; Lidón, Rosa María; Garcia-Moll, Francisco Xavier; Sánchez, Pedro Luis; Suárez, Carmen; Millán, Jesús; Pallares, Vicente; Alemán, José Juan; Egocheaga, Isabel

    2017-02-09

    Cardiovascular disease is a chronic disorder which is usually already at an advanced stage when the first symptoms develop. The fact that the initial clinical presentation can be lethal or highly incapacitating emphasizes the need for primary and secondary prevention. It is estimated that the ratio of patients with good adherence to secondary prevention of cardiovascular disease is low and also decreases gradually over time. The Polypill for secondary prevention of cardiovascular disease is the first fixed-dose combination therapy of salicylic acid, atorvastatin and ramipril approved in Spain. The purpose of this consensus document was to define and recommend, through the evidence available in the literature and clinical expert opinion, the impact of treatment adherence in the secondary prevention of cardiovascular disease and the use of the Polypill in daily clinical practice as part of a global strategy including adjustments in patient lifestyle. A RAND/UCLA methodology based on scientific evidence, as well as the collective judgment and clinical expertise of an expert panel was used for this assessment. As a result, a final report of recommendations on the impact of the lack of adherence to treatment of secondary prevention of cardiovascular disease and the effect of using a Polypill in adherence of patients was produced. The recommendations included in this document have been addressed to all those specialists, cardiologists, internists and primary care physicians with competence in prescribing and monitoring patients with high and very high cardiovascular risks. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  4. Reduced dietary salt for the prevention of cardiovascular disease

    Science.gov (United States)

    Taylor, Rod S; Ashton, Kate E; Moxham, Tiffany; Hooper, Lee; Ebrahim, Shah

    2014-01-01

    Background An earlier Cochrane review of dietary advice identified insufficient evidence to assess effects of reduced salt intake on mortality or cardiovascular events. Objectives To assess the long term effects of interventions aimed at reducing dietary salt on mortality and cardiovascular morbidity. To investigate whether blood pressure reduction is an explanatory factor in any effect of such dietary interventions on mortality and cardiovascular outcomes. Search methods The Cochrane Library (CENTRAL, Health Technology Assessment (HTA) and Database of Abstracts of Reviews of Effect (DARE)), MEDLINE, EMBASE, CINAHL and PsycInfo were searched through to October 2008. References of included studies and reviews were also checked. No language restrictions were applied. Selection criteria Trials fulfilled the following criteria: (1) randomised with follow up of at least six-months, (2) intervention was reduced dietary salt (restricted salt dietary intervention or advice to reduce salt intake), (3) adults, (4) mortality or cardiovascular morbidity data was available. Two reviewers independently assessed whether studies met these criteria. Data collection and analysis Data extraction and study validity were compiled by a single reviewer, and checked by a second. Authors were contacted where possible to obtain missing information. Events were extracted and relative risks (RRs) and 95% CIs calculated. Main results Six studies (including 6,489 participants) met the inclusion criteria - three in normotensives (n=3518), two in hypertensives (n=758), and one in a mixed population of normo- and hypertensives (n=1981) with end of trial follow-up of seven to 36 months and longest observational follow up (after trial end) to 12.7 yrs. Relative risks for all cause mortality in normotensives (end of trial RR 0.67, 95% CI: 0.40 to 1.12, 60 deaths; longest follow up RR 0.90, 95% CI: 0.58 to 1.40, 79 deaths) and hypertensives (end of trial RR 0.97, 95% CI: 0.83 to 1.13, 513 deaths

  5. Which interventions offer best value for money in primary prevention of cardiovascular disease?

    Directory of Open Access Journals (Sweden)

    Linda J Cobiac

    Full Text Available BACKGROUND: Despite many decades of declining mortality rates in the Western world, cardiovascular disease remains the leading cause of death worldwide. In this research we evaluate the optimal mix of lifestyle, pharmaceutical and population-wide interventions for primary prevention of cardiovascular disease. METHODS AND FINDINGS: In a discrete time Markov model we simulate the ischaemic heart disease and stroke outcomes and cost impacts of intervention over the lifetime of all Australian men and women, aged 35 to 84 years, who have never experienced a heart disease or stroke event. Best value for money is achieved by mandating moderate limits on salt in the manufacture of bread, margarine and cereal. A combination of diuretic, calcium channel blocker, ACE inhibitor and low-cost statin, for everyone with at least 5% five-year risk of cardiovascular disease, is also cost-effective, but lifestyle interventions aiming to change risky dietary and exercise behaviours are extremely poor value for money and have little population health benefit. CONCLUSIONS: There is huge potential for improving efficiency in cardiovascular disease prevention in Australia. A tougher approach from Government to mandating limits on salt in processed foods and reducing excessive statin prices, and a shift away from lifestyle counselling to more efficient absolute risk-based prescription of preventive drugs, could cut health care costs while improving population health.

  6. Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa

    OpenAIRE

    Ojji, Dike B; Ojji, Dike B Ojji; Lamont, Kim; Sliwa, Karen; Ojji, Olubunmi I; Egenti, Bibiana Nonye; Sliwa, Karen

    2017-01-01

    Summary Cardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemic heart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub- Saharan A...

  7. Primary prevention of cardiovascular diseases in primary care: prove principles and persistent practice

    NARCIS (Netherlands)

    Scheltens, T.

    2009-01-01

    Prevention of cardiovascular diseases in clinical practice includes identification of persons at high risk, assessing the well known risk factors, proper estimation and optimal communication of CVD risk and appropriate allocation of therapies, all with the aim to ultimately improve outcomes for

  8. Fruits and vegetables in the prevention of cancer and cardiovascular disease

    NARCIS (Netherlands)

    Veer, van 't P.; Jansen, M.C.F.; Klerk, M.; Kok, F.J.

    2000-01-01

    Objective: We quantified the public health benefit of fruits and vegetables on the prevention of cancer and cardiovascular disease (CVD), using currently available human data. Design: We reviewed over 250 observational studies on cancer and CVD. Relative risks (RRs) for high versus low intake of

  9. The future of metabolic syndrome and cardiovascular disease prevention: polyhype or polyhope?: tales from the polyera

    NARCIS (Netherlands)

    Franco, O.; Karnik, K.; Bonneux, L.G.A.

    2007-01-01

    Recently society has been witnessing the rise of a new era in the prevention and treatment of the metabolic syndrome and cardiovascular disease: the Polyera. This new era started when a promising concept – the Polypill – was introduced by Wald et al. in 2003. The Polypill is a theoretical

  10. Cardiovascular disease and obesity prevention in Germany: an investigation into a heterogeneous engineering project

    NARCIS (Netherlands)

    Niewöhner, J.; Döring, M.; Kontopodis, M.; Madarász, J.; Heintze, C.

    2011-01-01

    Cardiovascular diseases present the leading cause of death worldwide. Over the last decade, their preventio has become not only a central medical and public health issue but also a matter of political concern as well as a major market for pharma, nutrition, and exercise. A preventive assemblage has

  11. Self-Efficacy and Perceived Control in the Prevention of Cardiovascular Disease

    NARCIS (Netherlands)

    Carpi Ballester, Amparo; Gonzalez Navarro, Pilar; Zurriaga Llorens, Rosario; Marzo Campos, Juan Carlos; Buunk, Abraham P.

    2010-01-01

    From the Theory of Planed Behaviour (TPB), the aim of this study is to analyse the effect of self-efficacy and perceived control on intention and preventive behaviors of cardiovascular disease. To this end, 359 participants were evaluated in an empirical study. Data were analysed using the

  12. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice].

    Science.gov (United States)

    Royo-Bordonada, Miguel Ángel; Armario, Pedro; Lobos Bejarano, José María; Pedro-Botet, Juan; Villar Álvarez, Fernando; Elosua, Roberto; Brotons Cuixart, Carlos; Cortés, Olga; Serrano, Benilde; Camafort Babkowski, Miguel; Gil Núñez, Antonio; Pérez, Antonio; Maiques, Antonio; de Santiago Nocito, Ana; de Castro, Almudena; Alegría, Eduardo; Baeza, Ciro; Herranz, María; Sans, Susana; Campos, Pilar

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than alcohol abuse. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  13. MyHeart: fighting cardiovascular disease by preventive lifestyle and early diagnosis.

    Science.gov (United States)

    Lauter, Josef

    2004-01-01

    MyHeart is an integrated project of the 6th framework programme for research and development of the European Commission under Philips Research Aachen leadership for fighting Cardiovascular Diseases (CVD) by prevention and early diagnosis. The major goal of the project is to create business options using smart electronic systems and appropriate services that empower the users to take control of their own health status. MyHeart addresses a wide variety of applications in the cardiovascular disease space and intends to develop lifelong solutions for healthy people, at risk population as well for chronically ill patients.

  14. Suboptimal primary and secondary cardiovascular disease prevention in HIV-positive individuals on antiretroviral therapy

    NARCIS (Netherlands)

    van Zoest, Rosan A; van der Valk, Marc; Wit, Ferdinand W N M; Vaartjes, Ilonca; Kooij, Katherine W.; Hovius, Joppe W.; Prins, Maria; Reiss, Peter

    Background We aimed to identify the prevalence of cardiovascular risk factors, and investigate preventive cardiovascular medication use and achievement of targets as per Dutch cardiovascular risk management guidelines among human immunodeficiency virus (HIV)-positive and HIV-negative individuals.

  15. Suboptimal primary and secondary cardiovascular disease prevention in HIV-positive individuals on antiretroviral therapy

    NARCIS (Netherlands)

    van Zoest, Rosan A.; van der Valk, Marc; Wit, Ferdinand W.; Vaartjes, Ilonca; Kooij, Katherine W.; Hovius, Joppe W.; Prins, Maria; Reiss, Peter

    2017-01-01

    Background: We aimed to identify the prevalence of cardiovascular risk factors, and investigate preventive cardiovascular medication use and achievement of targets as per Dutch cardiovascular risk management guidelines among human immunodeficiency virus (HIV)-positive and HIV-negative individuals.

  16. Which people should take aspirin for primary prevention of cardiovascular disease?

    Directory of Open Access Journals (Sweden)

    Lozano R

    2015-07-01

    Full Text Available Roberto Lozano,1 Maria-Esther Franco21Pharmacy Department, 2Haematology Department, Hospital Real de Nuestra Señora de Gracia, Zaragoza, SpainDear editorA single trial, ISIS-2,1 in 1988, demonstrated the utility of daily aspirin in the setting of acute myocardial infarction, reducing the risk of vascular death by 23%. In addition, aspirin has also proven effective in the setting of acute ischemic stroke.2 Thus, for a subset of the general population, aspirin may help to prevent heart attacks and strokes. In fact, at low doses, in the range of 75 to 100 mg per day, aspirin prevents the progression of existing cardiovascular disease (CVD, including coronary heart disease, stroke and peripheral arterial disease, and reduces the frequency of cardiovascular events in patients with history of CVD,3,4 referred to as secondary prevention.Although the benefits of aspirin for secondary prevention of CVD are well known, its use in primary prevention of CVD, defined as prevention of the first occurrence of CVD for all patients without clinical CVD, including those with diabetes mellitus and those without clinical evidence of atherosclerotic disease who are at higher CVD risk, is less clear and controversial results have been obtained. In fact, the results of several studies using aspirin for primary prevention of CVD have generally shown more modest reductions of major vascular events compared with secondary prevention (12% vs 23%.3,5

  17. [Eating habits in the prevention of cardiovascular diseases and associated factors in elderly hypertensive individuals].

    Science.gov (United States)

    Gadenz, Sabrina Dalbosco; Benvegnú, Luís Antônio

    2013-12-01

    Cardiovascular diseases are the leading cause of death and disability in the elderly. In this study, healthy eating habits and associated factors in the prevention of cardiovascular disease in elderly hypertensive individuals were identified. It involved a cross-sectional study gathering primary data in a family health unit in a city in the interior of the state of Rio Grande do Sul and 212 elderly hypertensive individuals participated in the study. A higher prevalence among the lower age bracket of elderly individuals, female, with little schooling and low income was revealed. Healthy eating habits among the elderly hypertensive individuals assessed are below those recommended in the prevention of cardiovascular disease. Social and economic factors, health characteristics and the use of health services influenced the adoption of healthy eating habits. The results of this study suggest that elderly hypertensive individuals find it difficult to adopt healthy eating habits. This contributes further to the definition of strategies for routine prevention and control of cardiovascular diseases in the elderly.

  18. Cardiovascular disease

    African Journals Online (AJOL)

    user

    risk factors. These associations involve obesity and. 37 may be modified by improving fitness . Sedentary lifestyle with its associated risk is increasing becoming rampant in Africa due to rural to urban migration. Injury to endothelium causes endothelial dysfunction. Cardiovascular disease: A Global Epidemic extending into.

  19. Antioxidant Vitamins and Their Use in Preventing Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    Andrew P. Levy

    2010-11-01

    Full Text Available Atherosclerosis remains one of the leading causes of death in Western populations. Subsequent to the discovery that oxidative stress plays a pivotal role in the development and progression of atherosclerosis, vitamins C and E, along with other antioxidants, were studied as potential therapies for the disease. However, while in vitro and in vivo studies showed promising antiatherogenic effects for vitamins C and E, clinical trials in which patients were given high doses of vitamin E or C showed no benefit and even possible harm. This review will attempt to summarize the known mechanistic data regarding the biochemical effects of vitamins C and E and their relevance to atherosclerosis, and offer an explanation for the failure of clinical trials to show that supplementation with these vitamins provides any benefit when given indiscriminately. We provide one example of how pharmacogenomics may be used to identify a sub-population which may indeed benefit from antioxidant supplementation.

  20. [Anti-PCSK9 antibodies in type 2 diabetes and secondary prevention of cardiovascular diseases].

    Science.gov (United States)

    López-Miranda, José; Pintó, Xavier

    2016-05-01

    Patients with type 2 diabetes are considered to have the same cardiovascular risk as patients with ischemia. However, the degree of lipid control in diabetic and ischemic patients remains highly deficient. The availability of new agents, such as anti-PCSK9 monoclonal antibodies, could represent a notable advance in meeting this unmet need. Alirocumab and evolucumab, followed by bococizumab, are currently under the advanced phase of research. A growing database has demonstrated a relationship between glucose metabolism, body weight and PCSK9 function, but the clinical implications of this relationship have not been well defined. A broad programme of clinical trials has demonstrated that these agents decrease low-density lipoprotein cholesterol by more than 60% and also decrease apolipoprotein B and lipoprotein (a), showing a good tolerability and safety profile. In addition, post hoc analyses of phase 2 and 3 trials have observed that when these agents are associated with conventional lipid-lowering they reduce cardiovascular risk by more than 50%. Currently, 4 large clinical trials of cardiovascular prevention are underway in patients with ischemia or high cardiovascular risk. The aim of these trials is to define the role of anti-PCSK9 agents in the treatment of dyslipidemia and the prevention of cardiovascular disease in patients with ischemia and high cardiovascular risk. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Arteriosclerosis. All rights reserved.

  1. Health benefits of blue-green algae: prevention of cardiovascular disease and nonalcoholic fatty liver disease.

    Science.gov (United States)

    Ku, Chai Siah; Yang, Yue; Park, Youngki; Lee, Jiyoung

    2013-02-01

    Blue-green algae (BGA) are among the most primitive life forms on earth and have been consumed as food or medicine by humans for centuries. BGA contain various bioactive components, such as phycocyanin, carotenoids, γ-linolenic acid, fibers, and plant sterols, which can promote optimal health in humans. Studies have demonstrated that several BGA species or their active components have plasma total cholesterol and triglyceride-lowering properties due to their modulation of intestinal cholesterol absorption and hepatic lipogenic gene expression. BGA can also reduce inflammation by inhibiting the nuclear factor κ B activity, consequently reducing the production of proinflammatory cytokines. Furthermore, BGA inhibit lipid peroxidation and have free radical scavenging activity, which can be beneficial for the protection against oxidative stress. The aforementioned effects of BGA can contribute to the prevention of metabolic and inflammatory diseases. This review provides an overview of the current knowledge of the health-promoting functions of BGA against cardiovascular disease and nonalcoholic fatty liver disease, which are major health threats in the developed countries.

  2. Role of Garlic Usage in Cardiovascular Disease Prevention: An Evidence-Based Approach

    Science.gov (United States)

    Ashfaq, Tabinda

    2013-01-01

    Introduction. Rapidly growing prevalence of cardiovascular disease is a major threat for the developed as well as developing world warranting urgent need of intervention. Complementary and alternative medicines are gaining popularity among general population because of their safety profile and easy administration. Garlic, in particular, is considered to be one of the best disease-preventive foods because of its potent and widespread effects. This study was done to find out the role of garlic usage in cardiovascular disease prevention. Methodology. Major databases including Google, PubMed, MEDLINE, and Cochrane library view were used for the literature search. Clinical trials conducted on humans assessing role of garlic usage in cardiovascular disease prevention and the possible mechanisms responsible for such therapeutic actions were assessed. Results. Various clinical trials and meta-analyses conducted have shown positive impact of garlic in cardiovascular-disease prevention especially its effects on lipid levels; however, some contradictory results are also reported. Similarly, its effects on hypertension control, and platelet are also mild with limited data availability. The possible reason for these inconsistent results is the difference in preparations with diverse composition, variations in sulphur content present in different garlic preparations used, and methodological variations in subject recruitment, duration of study, dietary control and so forth. Conclusion. Garlic can be used as an adjuvant with lipid-lowering drugs for control of lipids, however, its role as a main therapeutic agent cannot be recommended and it is suggested that more meta-analyses using standardized preparations with a close watch on methodological shortfalls should be conducted to prove its role. PMID:23690831

  3. Adherence to nutrition guidelines in patients with cardiovascular diseases (CVD) as a secondary prevention

    Science.gov (United States)

    Woźniak, Agnieszka; Krótki, Monika; Anyżewska, Anna; Górnicka, Magdalena; Wawrzyniak, Agata

    The appropriate nutrition is an important component of the secondary prevention of cardiovascular diseases (CVD) The aim of the study was to investigate if the patients with cardiovascular disease were informed of the role of appropriate nutrition in prevention or received nutrition guidelines and to assess the dietary intake compared to recommendations for patients with cardiovascular disease who received or not nutrition guidelines The study was conducted among patients with cardiovascular disease (n = 127) of cardiological hospital clinic, aged 62 ± 11. The questionnaire was used to obtain personal and anthropometric details, information if patients had received nutrition guidelines. The method of 3-day food records was used for dietary assessment 20% of subjects had not received nutrition guidelines and almost 40% of subjects did not recognize the nutrition effect on cardiovascular disease development. Compared to the diets of the subjects who had not received nutrition guidelines, the diets of those who had received them were of significantly lower intake of: energy from saturated fatty acids (15%, p = 0.006), cholesterol (21%, p = 0.012) and higher intake (14-26%) of potassium (p = 0,003), sodium (p = 0.013), phosphorus (p = 0.044), magnesium (p = 0.003), iron (p = 0.005), copper (p = 0.001), zinc (p = 0.046). Among the patients who had received nutrition guidelines, percentage of the subjects whose intake of nutrients was consistent with recommendations was higher Not all subjects had received nutrition guidelines. Diets of those who had received them were more balanced, but in neither group nutrition guidelines were complied with

  4. PROBLEMS OF PROGNOSIS, DIAGNOSIS AND PREVENTION OF CARDIOVASCULAR DISEASES IN THE POPULATION EXPOSED TO RADIATION

    OpenAIRE

    LACKLAND D.; GROSCHE B.; PIVINA L.; KERIMKULOVA A.; MARKABAEVA A.

    2013-01-01

    In the paper we have presented the developed algorithm for prognosis, earl diagnostics, treatment and prevention of cardiovascular diseases in the population of East-Kazakhstan area exposed to ionizing radiation in results of nuclear tests. For every group of radiation risk we have developed the list of necessary measures aimed to prognosis, treatment, primary and secondary prophylactics and monitoring of the effectiveness of done measures.

  5. Primary prevention of cardiovascular disease: A review of contemporary guidance and literature

    Directory of Open Access Journals (Sweden)

    Jack Stewart

    2017-01-01

    Full Text Available Cardiovascular disease is a significant and ever-growing problem in the United Kingdom, accounting for nearly one-third of all deaths and leading to significant morbidity. It is also of particular and pressing interest as developing countries experience a change in lifestyle which introduces novel risk factors for cardiovascular disease, leading to a boom in cardiovascular disease risk throughout the developing world. The burden of cardiovascular disease can be ameliorated by careful risk reduction and, as such, primary prevention is an important priority for all developers of health policy. Strong consensus exists between international guidelines regarding the necessity of smoking cessation, weight optimisation and the importance of exercise, whilst guidelines vary slightly in their approach to hypertension and considerably regarding their approach to optimal lipid profile which remains a contentious issue. Previously fashionable ideas such as the polypill appear devoid of in-vivo efficacy, but there remain areas of future interest such as the benefit of serum urate reduction and utility of reduction of homocysteine levels.

  6. Health promotion and cardiovascular disease prevention in sub-Saharan Africa.

    Science.gov (United States)

    Sampson, Uchechukwu K A; Amuyunzu-Nyamongo, Mary; Mensah, George A

    2013-01-01

    Recent population studies demonstrate an increasing burden of cardiovascular disease (CVD) and related risk factors in sub-Saharan Africa (SSA). The mitigation or reversal of this trend calls for effective health promotion and preventive interventions. In this article, we review the core principles, challenges, and progress in promoting cardiovascular health with special emphasis on interventions to address physical inactivity, poor diet, tobacco use, and adverse cardiometabolic risk factor trends in SSA. We focus on the five essential strategies of the Ottawa Charter for Health Promotion. Successes highlighted include community-based interventions in Ghana, Nigeria, South Africa, and Mauritius and school-based programs in Kenya, Namibia, and Swaziland. We address the major challenge of developing integrated interventions, and showcase partnerships opportunities. We conclude by calling for intersectoral partnerships for effective and sustainable intervention strategies to advance cardiovascular health promotion and close the implementation gap in accordance with the 2009 Nairobi Call to Action on Health Promotion. © 2013.

  7. HIV and Cardiovascular Disease

    Science.gov (United States)

    ... Select a Language: Fact Sheet 652 HIV and Cardiovascular Disease HIV AND CARDIOVASCULAR DISEASE WHY SHOULD PEOPLE WITH HIV CARE ABOUT CVD? ... OF CVD? WHAT ABOUT CHANGING MEDICATIONS? HIV AND CARDIOVASCULAR DISEASE Cardiovascular disease (CVD) includes a group of problems ...

  8. Site-Specific Antioxidative Therapy for Prevention of Atherosclerosis and Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    Hajime Otani

    2013-01-01

    Full Text Available Oxidative stress has been implicated in pathophysiology of aging and age-associated disease. Antioxidative medicine has become a practice for prevention of atherosclerosis. However, limited success in preventing cardiovascular disease (CVD in individuals with atherosclerosis using general antioxidants has prompted us to develop a novel antioxidative strategy to prevent atherosclerosis. Reducing visceral adipose tissue by calorie restriction (CR and regular endurance exercise represents a causative therapy for ameliorating oxidative stress. Some of the recently emerging drugs used for the treatment of CVD may be assigned as site-specific antioxidants. CR and exercise mimetic agents are the choice for individuals who are difficult to continue CR and exercise. Better understanding of molecular and cellular biology of redox signaling will pave the way for more effective antioxidative medicine for prevention of CVD and prolongation of healthy life span.

  9. Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa

    Science.gov (United States)

    Ojji, Dike B; Ojji, Dike B Ojji; Lamont, Kim; Sliwa, Karen; Ojji, Olubunmi I; Egenti, Bibiana Nonye; Sliwa, Karen

    2017-01-01

    Summary Cardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemic heart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub- Saharan Africa. One major challenge of such an approach is how to equip primary care to respond promptly and effectively to this burden. We present a practical approach on how primary care in sub-Saharan Africa could effectively address the prevention, treatment and control of CVD on the subcontinent. For effective prevention, control and treatment of CVD in sub-Saharan Africa, there should be strategic plans to equip primary care clinics with well-trained allied healthcare workers who are supervised by physicians. PMID:28752890

  10. Primary care in the prevention, treatment and control of cardiovascular disease in sub-Saharan Africa.

    Science.gov (United States)

    Ojji, Dike B; Lamont, Kim; Ojji, Olubunmi I; Egenti, Bibiana Nonye; Sliwa, Karen

    Cardiovascular disease (CVD) is the frontrunner in the disease spectrum of sub-Saharan Africa, with stroke and ischaemic heart disease ranked seventh and 14th as leading causes of death, respectively, on this sub-continent. Unfortunately, this region is also grappling with many communicable, maternal, neonatal and nutritional disorders. Limited resources and the high cost of CVD treatment necessitate that primary prevention should have a high priority for CVD control in sub-Saharan Africa. One major challenge of such an approach is how to equip primary care to respond promptly and effectively to this burden. We present a practical approach on how primary care in sub-Saharan Africa could effectively address the prevention, treatment and control of CVD on the subcontinent. For effective prevention, control and treatment of CVD in sub-Saharan Africa, there should be strategic plans to equip primary care clinics with well-trained allied healthcare workers who are supervised by physicians.

  11. Prevention and treatment of vascular vagovagal reflexes in patients with cardiovascular disease during intervention

    International Nuclear Information System (INIS)

    Shao Mingfeng; Su Jingrong

    2002-01-01

    Objective: To study the prevention and treatment of vascular vagovagal reflexes (VVRs) in patients with cardiovascular disease during intervention. Methods: The causes and results in 61 patients with VVRs during intervention of 2100 patients were analysed. Results: In 61 patients with VVRs, there were 12 cases having vascular restriction, 7 cases with heart restriction, 42 cases with mixed type. All patients were recovered after treatment, no adverse reaction happened. Conclusions: The major causes of VVRs during interventional treatment were mental tension, pain, low blood volume and expansive stimulation of hollow organs. Preventive measure and prompt treatment are necessary

  12. Improving cardiovascular disease prevention and management in Africa: issues to consider for the 21st century.

    Science.gov (United States)

    Madu, Ernest C; Richardson, Kelly D; Ozigbo, Obinna H; Baugh, Dainia S

    2003-01-01

    There is substantial evidence that cardiovascular diseases, and their associated risk factors, are becoming an increasing threat to the health of a large portion of the populace in many areas of Africa, particularly sub-Saharan Africa. If not adequately addressed, this epidemic will place an even greater burden on the poor economies and weak public health infrastructures of this continent. Important strategies for curtailing this epidemic will include primordial, primary, and secondary prevention, population-based prevention programs, improved research and surveillance, and increased governmental accountability for the adequate appropriation of public health.

  13. ACC/AHA Guidelines for Cardiovascular Disease Prevention and Cholesterol Management: Implications of New Therapeutic Agents

    Directory of Open Access Journals (Sweden)

    Nathan D. Wong, PhD, FACC, FAHA, FNLA

    2016-09-01

    Full Text Available In 2014 the American College of Cardiology/American Heart Association issued four new guidelines for cardiovascular disease prevention that focused on cardiovascular risk assessment, lifestyle management, obesity management, and blood cholesterol management. The development of an atherosclerotic cardiovascular disease risk calculator formed the basis of the risk assessment guideline, and the lifestyle management guideline focused on recommending an evidence-based dietary pattern. The blood cholesterol management guideline specifically identified four groups of patients shown to benefit from moderate-intensity or high-intensity statin therapy from previous clinical trials and abandoned the use of specific low-density lipoprotein (LDL cholesterol (LDL-C goal levels on the basis of the lack of clinical trial evidence. The recommendations for treatment with moderate-intensity or high-intensity statin therapy are based on rigorous evidence from randomized clinical trials. Guidance has since been provided for the use of nonstatin therapies, including cholesterol absorption inhibitor and proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapy when adequate reduction of LDL-C levels is not achieved with maximally tolerated statin therapy. The recent development and application of these therapies have resulted in remarkable reductions in LDL-C levels that are well tolerated, and preliminary outcome data are promising in showing substantial atherosclerotic cardiovascular disease event reductions beyond statin therapy.

  14. Aspirin for the Primary Prevention of Cardiovascular Disease: In Need of Clarity.

    Science.gov (United States)

    Miedema, Michael D; Huguelet, Joseph; Virani, Salim S

    2016-01-01

    Aspirin remains one of the most extensively studied cardiovascular medications in the history of medicine. However, despite multiple, well-designed, large randomized controlled trials evaluating the potential of aspirin to prevent cardiovascular events in individuals without known cardiovascular disease (CVD), the role of aspirin in primary prevention is currently unclear. The initial aspirin trials included largely low-risk individuals with primary outcomes mostly focused on myocardial infarction (MI) and stroke, and showed a significant reduction in these CVD outcomes, especially MI. The more recently conducted trials have focused on older, higher CVD risk populations with high rates of lipid-lowering and antihypertensive medications use. These studies have used broader CVD outcomes as their primary end points and have failed to show a significant benefit of aspirin therapy in primary prevention. The exact reasons for the lack of efficacy in these recent trials are unclear but may be related to low rate of atherothrombotic events relative to other CVD events in the populations studied. Four large randomized controlled trials are currently underway which should provide some clarity in determining the optimal use of aspirin in the primary prevention of CVD.

  15. Prevention and Control of Cardiovascular Disease in the Rapidly Changing Economy of China.

    Science.gov (United States)

    Wu, Yangfeng; Benjamin, Emelia J; MacMahon, Stephen

    2016-06-14

    With one-fifth of the world's total population, China's prevention and control of cardiovascular disease (CVD) may affect the success of worldwide efforts to achieve sustainable CVD reduction. Understanding China's current cardiovascular epidemic requires awareness of the economic development in the past decades. The rapid economic transformations (industrialization, marketization, urbanization, globalization, and informationalization) contributed to the aging demography, unhealthy lifestyles, and environmental changes. The latter have predisposed to increasing cardiovascular risk factors and the CVD pandemic. Rising CVD rates have had a major economic impact, which has challenged the healthcare system and the whole society. With recognition of the importance of health, initial political steps and national actions have been taken to address the CVD epidemic. Looking to the future, we recommend that 4 priorities should be taken: pursue multisectorial government and nongovernment strategies targeting the underlying causes of CVD (the whole-of-government and whole-of-society policy); give priority to prevention; reform the healthcare system to fit the nature of noncommunicable diseases; and conduct research for evidence-based, low-cost, simple, sustainable, and scalable interventions. By pursuing the 4 priorities, the pandemic of CVD and other major noncommunicable diseases in China will be reversed and the global sustainable development goal achieved. © 2016 American Heart Association, Inc.

  16. Analysis of the Cochrane Review: Fibrates for secondary prevention of cardiovascular disease and stroke.

    Science.gov (United States)

    Pires da Rosa, Gilberto; Libânio, Diogo; Filipe Azevedo, Luís

    2017-01-01

    The influence of fibrates on cardiovascular risk has been the focus of several clinical trials. This Cochrane Collaboration Systematic Review evaluated the efficacy of fibrates for secondary prevention of cardiovascular events and stroke, analyzing 13 randomized controlled trials, in a total of 16 112 participants with a history of cardiovascular disease. Fibrates showed a protective effect for the composite outcome of non-fatal stroke, non-fatal myocardial infarction (MI) and vascular death, mainly due to reduction in the risk of non-fatal or fatal MI. Nonetheless, these results largely relied on studies including clofibrate, a drug withdrawn from the market in 2002. No statistically significant differences regarding adverse events were found between fibrates and placebo. Although insufficient to support the routine prescription of fibrates in this setting, this evidence should be taken into account when deciding on lipid-modifying therapy in dyslipidemic patients with a history of cardiovascular disease. Copyright © 2016 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review.

    Science.gov (United States)

    Carroll, Allison J; Labarthe, Darwin R; Huffman, Mark D; Hitsman, Brian

    2016-12-01

    The purpose of this review is to emphasize the role of tobacco prevention and control in cardiovascular health (CVH) promotion and cardiovascular disease (CVD) prevention, including the importance of these endpoints for measuring the full impact of tobacco-related policies, programs, and practices. In this review, we describe an overview of tobacco control interventions that have led to substantial declines in tobacco use and the relationship between these declines with CVH and CVD. We review interventions that have had success in high-income countries (HICs) as well as those that are gaining traction in low- and middle-income countries (LMICs). We emphasize the challenges to comprehensive tobacco prevention and control strategies faced by LMICs, and highlight the special role of cardiovascular health professionals in achieving CVH promotion and CVD prevention endpoints through tobacco control. Tobacco prevention and control strategies have a strong scientific basis, yet a distinct gap remains between this evidence and implementation of tobacco control policies, particularly in LMICs. Health professionals can contribute to tobacco control efforts, especially through patient-level clinical interventions, when supported by a health care system and government that recognize and support tobacco control as a critical strategy for CVH promotion and CVD prevention. Understanding, supporting, and applying current and evolving policies, programs, and practices in tobacco prevention and control is the province of all health professionals, especially those concerned with CVH promotion and CVD prevention. A new tobacco control roadmap from the World Heart Federation provides a strong impetus to the needed interdisciplinary collaboration. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. The role of homocysteine-lowering B-vitamins in the primary prevention of cardiovascular disease.

    Science.gov (United States)

    Debreceni, Balazs; Debreceni, Laszlo

    2014-06-01

    Cardiovascular disease (CVD) is the leading cause of mortality in the Western world. The effort of research should aim at the primary prevention of CVD. Alongside statin therapy, which is maintained to be an effective method of CVD prevention, there are alternative methods such as vitamin B substitution therapy with folic acid (FA), and vitamins B12 and B6 . B-vitamins may inhibit atherogenesis by decreasing the plasma level of homocysteine (Hcy)-a suspected etiological factor for atherosclerosis-and by other mechanisms, primarily through their antioxidant properties. Although Hcy-lowering vitamin trials have failed to demonstrate beneficial effects of B-vitamins in the prevention of CVD, a meta-analysis and stratification of a number of large vitamin trials have suggested their effectiveness in cardiovascular prevention (CVP) in some aspects. Furthermore, interpretation of the results from these large vitamin trials has been troubled by statin/aspirin therapy, which was applied along with the vitamin substitution, and FA fortification, both of which obscured the separate effects of vitamins in CVP. Recent research results have accentuated a new approach to vitamin therapy for CVP. Studies undertaken with the aim of primary prevention have shown that vitamin B substitution may be effective in the primary prevention of CVD and may also be an option in the secondary prevention of disease if statin therapy is accompanied by serious adverse effects. Further investigations are needed to determine the validity of vitamin substitution therapy before its introduction in the protocol of CVD prevention. © 2014 John Wiley & Sons Ltd.

  19. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice].

    Science.gov (United States)

    Royo-Bordonada, M Á; Armario, P; Lobos Bejarano, J M; Pedro-Botet, J; Villar Alvarez, F; Elosua, R; Brotons Cuixart, C; Cortés, O; Serrano, B; Cammafort Babkowski, M; Gil Núñez, A; Pérez, A; Maiques, A; de Santiago Nocito, A; Castro, A; Alegría, E; Baeza, C; Herranz, M; Sans, S; Campos, P

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2016. Publicado por Elsevier España, S.L.U.

  20. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice].

    Science.gov (United States)

    Royo-Bordonada, Miguel Ángel; Armario, Pedro; Lobos Bejarano, José María; Pedro-Botet, Juan; Villar Álvarez, Fernando; Elosua, Roberto; Brotons Cuixart, Carlos; Cortés, Olga; Serrano, Benilde; Camafort Babkowski, Miguel; Gil Núñez, Antonio; Pérez, Antonio; Maiques, Antonio; de Santiago Nocito, Ana; de Castro, Almudena; Alegría, Eduardo; Baeza, Ciro; Herranz, María; Sans, Susana; Campos, Pilar

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  1. Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice.

    Science.gov (United States)

    Royo-Bordonada, M Á; Armario, P; Lobos Bejarano, J M; Pedro-Botet, J; Villar Alvarez, F; Elosua, R; Brotons Cuixart, C; Cortés, O; Serrano, B; Camafort Babkowski, M; Gil Núñez, A; Pérez, A; Maiques, A; de Santiago Nocito, A; Castro, A; Alegría, E; Baeza, C; Herranz, M; Sans, S; Campos, P

    The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  2. Review of Cardiovascular Disease Prevention and Control Programs: International Experience and Challenges in China

    Directory of Open Access Journals (Sweden)

    Seng Chuen Tan

    2016-01-01

    Full Text Available Major cardiovascular risk factors in China, such as hyperlipidemia, hypertension, dietary factors, exposure to tobacco, diabetes, obesity and physical inactivity, have contributed to deteriorating trends in cardiovascular disease (CVD deaths. In past years, a number of CVD prevention programs have been initiated in European and American countries and successfully brought down CVD related death rate by involving various parties such as physicians, patients, government agencies and payers. However, there is rare published literature that systemically reviewed such experience, which would be highly valuable for China and other countries with high CVD burden. In this article, we review the published literature on CVD prevention and control programs and report on interviews of local and foreign experts to provide recommendations for China-specific CVD prevention and control programs. In order to provide practical suggestions, we describe the type of programs as patient, physician, pharmacist, nurse, or payer-focused. Based on this evidence and identified challenges in China, programs focusing on disease management, treatment adherence, physician/health care provider education, financial incentives, and integrated healthcare are recommended for the prevention and control of CVD in China.

  3. Risk assessment in the prevention of cardiovascular disease in low-resource settings.

    Science.gov (United States)

    Ofori, Sandra N; Odia, Osaretin J

    2016-01-01

    Cardiovascular disease (CVD) prevalence is increasing in low- and middle-income countries. Total risk assessment is key to prevention. Studies and guidelines published between 1990 and 2013 were sought using Medline database, PubMed, and World Health Organization report sheets. Search terms included 'risk assessment' and 'cardiovascular disease prevention'. Observational studies and randomized controlled trials were reviewed. The ideal risk prediction tool is one that is derived from the population in which it is to be applied. Without national population-based cohort studies in sub-Saharan African countries like Nigeria, there is no tool that is used consistently. Regardless of which one is adopted by national guidelines, routine consistent use is advocated by various CVD prevention guidelines. In low-resource settings, the consistent use of simple tools like the WHO charts is recommended, as the benefit of a standard approach to screening outweighs the risk of missing an opportunity to prevent CVD. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  4. Prevention and Control of Cardiovascular Disease in the Rapidly Changing Economy of China

    Science.gov (United States)

    Wu, Yangfeng; Benjamin, Emelia J.; MacMahon, Stephen

    2016-01-01

    With one fifth of the world’s total population, China’s prevention and control of cardiovascular disease (CVD) may affect the success of worldwide efforts to achieve sustainable CVD reduction. To understand China’s current cardiovascular epidemic, requires awareness of the economic development in the past decades. The rapid economic transformations (industrialization, marketization, urbanization, globalization, and informationalization) contributed to the aging demography, unhealthy lifestyles, and environmental changes. The later have predisposed to increasing cardiovascular risk factors and the CVD pandemic. Rising CVD rates have had a major economic impact, which has challenged the health care system and the whole society. With recognition of the importance of health, initial political steps and national actions have been taken to address the CVD epidemic. Looking to the future, we recommend that four priorities should be taken: pursue multi-sectorial government and non-government strategies targeting the underlying causes of CVD (the “whole-of-government and whole-of-society” policy); give priority to prevention; reform the health care system to fit the nature of noncommunicable diseases; and conduct research for evidence-based, low-cost, simple, sustainable, and scalable interventions. By pursuing the four priorities, the pandemic of CVD and other major NCDs in China will be reversed and the global sustainable development goal achieved. PMID:27297347

  5. Implementation of a Cardiovascular Disease Prevention Program among School-Aged Children: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Lavon Young

    2006-09-01

    Full Text Available The objective of this study was to test students’ knowledge of cardiovascular disease information and to determine if a carefully structured training program administered to high school students would increase their knowledge about cardiovascular disease and risk factors that are preventable. A pilot study was conducted during which fifty high school students from nine counties in the State of Mississippi were measured for their knowledge of hypertension both at baseline and after the completion of an intervention training activity. There were significant gains in knowledge between the pre-test and the post-test that the students completed. The gains in knowledge indicate that elimination of risk factors is possible if all health care and school-based prevention programs are implemented to positively impact changes in eating and physical activity behaviors. Students’ involvement in such activities could translate into significant changes in risk factors at these ages and throughout their lifetime. It is widely accepted that these behavioral changes, if sustained into adulthood, could have the potential to influence cardiovascular risk reduction.

  6. Marine microalgae used as food supplements and their implication in preventing cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Mimouni Virginie

    2015-07-01

    Full Text Available Marine microalgae are photosynthetic microorganisms producing numerous bioactive molecules of interest for health and disease care such as lipids rich in omega-3 fatty acids -as eicosapentaenoic acid (EPA, 20:5 n-3 and docosahexaenoic acid (DHA, 22:6 n-3- and carotenoids (e.g., β-carotene, fucoxanthin, astaxanthin. It has already been shown that these molecules, individually used, are benefic in the prevention of diseases such as those associated with the cardiovascular risks, but also in some carcinomas. When these molecules are combined, synergistic effects may be observed. Microalgae, as a dietary supplement, can be used to study these synergistic effects in animal models in which dyslipidemia can be induced by a nutrition treatment. Different marine microalgae of interest are studied in this context to determine their potential effect as an alternative source to marine omega-3 rich fish oils, actually widely used for human health. Actually, the pharmaceutical and nutrition industries are developing health research programs involving microalgae, trying to limit the dramatic reduction of fish stocks and the associated pollution in the marine environment. The aim of this review is threefold: (1 to present research on lipids, particularly long chain polyunsaturated fatty acids, as components of marine microalgae used as food supplements; (2 to present the health benefits of some microalgae or their extracts, in particular in the prevention of cardiovascular diseases and (3 to highlight the role of Odontella aurita, a marine microalga rich in EPA used as food supplement with the aim of preventing cardiovascular diseases.

  7. The Mediterranean and other Dietary Patterns in Secondary Cardiovascular Disease Prevention: A Review.

    Science.gov (United States)

    Panagiotakos, Demosthenes B; Notara, Venetia; Kouvari, Matina; Pitsavos, Christos

    2016-01-01

    Cardiovascular Disease (CVD) remains the leading cause of death and disability worldwide, with increased hospital discharge rates, causing a serious public health issue and an economic burden. Recent demographic transitions, including ageing of the population, low fertility, urbanization and shift towards unhealthy behaviours have resulted in an increase in the prevalence of cardiometabolic disorders (i.e. hypertension, obesity, diabetes). According to the reports of international organisations, a substantial number of heart attacks could have been prevented through lifestyle modifications (i.e. diet, physical activity, smoking cessation). Regarding secondary prevention, it is well documented that effective cardiovascular rehabilitation requires a multidisciplinary approach, including medical treatment, as well as lifestyle changes. Diet has been recognised as one of the most important modifiable and preventable factors, being undoubtedly beneficial in primary prevention, as well as among cardiac patients. However, studies among CVD patients are scarce, and with inconclusive results. The most studied dietary pattern is the Mediterranean-type diet, with several observational studies and clinical trials demonstrating its protective role against recurrent cardiac events, whereas evidence regarding other well-known models, including Western-type, Vegetarian, Asian-type and Dietary Approaches to Stop Hypertension (DASH) diet, are more limited. The aim of this review was to present an overview of the most prevalent dietary patterns and their role in the secondary CVD prevention and management.

  8. Impact of functional foods on prevention of cardiovascular disease and diabetes.

    Science.gov (United States)

    Sikand, Geeta; Kris-Etherton, Penny; Boulos, Nancy Mariam

    2015-06-01

    A healthy dietary pattern is a cornerstone for the prevention and treatment of cardiovascular disease (CVD) and type 2 diabetes (T2DM). Compelling scientific evidence has shown many health effects of individual foods (including herbs and spices), beverages, and their constituent nutrients and bioactive components on risk of chronic disease and associated risk factors. The focus of functional foods research that is reviewed herein has been on assessing the health effects and underlying mechanisms of action of fruits and vegetables, whole grains, dairy products including fermented products, legumes, nuts, green tea, spices, olive oil, seafood, red wine, herbs, and spices. The unique health benefits of these functional foods have been the basis for recommending their inclusion in a healthy dietary pattern. A better understanding of strategies for optimally including functional foods in a healthy dietary pattern will confer greater benefits on the prevention and treatment of CVD and T2DM.

  9. Whole grain cereals for the primary or secondary prevention of cardiovascular disease.

    Science.gov (United States)

    Kelly, Sarah Am; Hartley, Louise; Loveman, Emma; Colquitt, Jill L; Jones, Helen M; Al-Khudairy, Lena; Clar, Christine; Germanò, Roberta; Lunn, Hannah R; Frost, Gary; Rees, Karen

    2017-08-24

    reported) to whole grain versus lower whole grain or refined grain control groups. We found no studies that reported the effect of whole grain diets on total cardiovascular mortality or cardiovascular events (total myocardial infarction, unstable angina, coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, total stroke). All included studies reported the effect of whole grain diets on risk factors for cardiovascular disease including blood lipids and blood pressure. All studies were in primary prevention populations and had an unclear or high risk of bias, and no studies had an intervention duration greater than 16 weeks.Overall, we found no difference between whole grain and control groups for total cholesterol (mean difference 0.07, 95% confidence interval -0.07 to 0.21; 6 studies (7 comparisons); 722 participants; low-quality evidence).Using GRADE, we assessed the overall quality of the available evidence on cholesterol as low. Four studies were funded by independent national and government funding bodies, while the remaining studies reported funding or partial funding by organisations with commercial interests in cereals. There is insufficient evidence from RCTs of an effect of whole grain diets on cardiovascular outcomes or on major CVD risk factors such as blood lipids and blood pressure. Trials were at unclear or high risk of bias with small sample sizes and relatively short-term interventions, and the overall quality of the evidence was low. There is a need for well-designed, adequately powered RCTs with longer durations assessing cardiovascular events as well as cardiovascular risk factors.

  10. Secondary Prevention of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus: International Insights From the TECOS Trial (Trial Evaluating Cardiovascular Outcomes With Sitagliptin).

    Science.gov (United States)

    Pagidipati, Neha J; Navar, Ann Marie; Pieper, Karen S; Green, Jennifer B; Bethel, M Angelyn; Armstrong, Paul W; Josse, Robert G; McGuire, Darren K; Lokhnygina, Yuliya; Cornel, Jan H; Halvorsen, Sigrun; Strandberg, Timo E; Delibasi, Tuncay; Holman, Rury R; Peterson, Eric D

    2017-09-26

    Intensive risk factor modification significantly improves outcomes for patients with diabetes mellitus and cardiovascular disease. However, the degree to which secondary prevention treatment goals are achieved in international clinical practice is unknown. Attainment of 5 secondary prevention parameters-aspirin use, lipid control (low-density lipoprotein cholesterol diabetes mellitus and known cardiovascular disease at entry into TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin). Logistic regression was used to evaluate the association between individual and regional factors and secondary prevention achievement at baseline. Cox proportional hazards regression analysis was used to determine the association between baseline secondary prevention achievement and cardiovascular death, myocardial infarction, or stroke. Overall, 29.9% of patients with diabetes mellitus and cardiovascular disease achieved all 5 secondary prevention parameters at baseline, although 71.8% achieved at least 4 parameters. North America had the highest proportion (41.2%), whereas Western Europe, Eastern Europe, and Latin America had proportions of ≈25%. Individually, blood pressure control (57.9%) had the lowest overall attainment, whereas nonsmoking status had the highest (89%). Over a median 3.0 years of follow-up, a higher baseline secondary prevention score was associated with improved outcomes in a step-wise graded relationship (adjusted hazard ratio, 0.60; 95% confidence interval, 0.47-0.77 for those patients achieving all 5 measures versus those achieving ≤2). In an international trial population, significant opportunities exist to improve the quality of cardiovascular secondary prevention care among patients with diabetes mellitus and cardiovascular disease, which in turn could lead to reduced risk of downstream cardiovascular events. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00790205. © 2017 American Heart Association, Inc.

  11. The Cardiovascular Health in Ambulatory Care Research Team performance indicators for the primary prevention of cardiovascular disease: a modified Delphi panel study.

    Science.gov (United States)

    Tu, Jack V; Maclagan, Laura C; Ko, Dennis T; Atzema, Clare L; Booth, Gillian L; Johnston, Sharon; Tu, Karen; Lee, Douglas S; Bierman, Arlene; Hall, Ruth; Bhatia, R Sacha; Gershon, Andrea S; Tobe, Sheldon W; Sanmartin, Claudia; Liu, Peter; Chu, Anna

    2017-04-25

    High-quality ambulatory care can reduce cardiovascular disease risk, but important gaps exist in the provision of cardiovascular preventive care. We sought to develop a set of key performance indicators that can be used to measure and improve cardiovascular care in the primary care setting. As part of the Cardiovascular Health in Ambulatory Care Research Team initiative, we established a 14-member multidisciplinary expert panel to develop a set of indicators for measuring primary prevention performance in ambulatory cardiovascular care. We used a 2-stage modified Delphi panel process to rate potential indicators, which were identified from the literature and national cardiovascular organizations. The top-rated indicators were pilot tested to determine their measurement feasibility with the use of data routinely collected in the Canadian health care system. A set of 28 indicators of primary prevention performance were identified, which were grouped into 5 domains: risk factor prevalence, screening, management, intermediate outcomes and long-term outcomes. The indicators reflect the major cardiovascular risk factors including smoking, obesity, hypertension, diabetes, dyslipidemia and atrial fibrillation. All indicators were determined to be amenable to measurement with the use of population-based administrative (physician claims, hospital admission, laboratory, medication), survey or electronic medical record databases. The Cardiovascular Health in Ambulatory Care Research Team indicators of primary prevention performance provide a framework for the measurement of cardiovascular primary prevention efforts in Canada. The indicators may be used by clinicians, researchers and policy-makers interested in measuring and improving the prevention of cardiovascular disease in ambulatory care settings. Copyright 2017, Joule Inc. or its licensors.

  12. Factors Influencing the Prescription of Cardiovascular Preventive Therapies in Patients with Peripheral Arterial Disease.

    Science.gov (United States)

    Montminy, Myriam L; Gauvin, Valerie; Turcotte, Stephane; Milot, Alain; Douville, Yvan; Bairati, Isabelle

    2016-01-01

    Guidelines recommend that patients with peripheral arterial disease should be medically treated to reduce the occurrence of serious cardiovascular events. Despite these recommendations, studies conducted in the early 2000s reported that medical therapies for secondary cardiovascular prevention are not given systematically to patients with peripheral arterial disease (PAD). We identified factors associated with the prescription of preventive therapies in patients with symptomatic PAD. Consecutive patients with symptomatic peripheral arterial disease (n = 362) treated between 2008 and 2010 in one tertiary care center (CHU de Quebec, Canada) were considered. Data were collected from the medical charts. The main outcome was the combined prescription of three therapies: 1) statins, 2) antiplatelets, 3) angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers. The mean age was 70 years and 43% had a pre-existing coronary artery disease. Antiplatelet therapy was the most prescribed drug (83%). A total of 52% of the patients received the three combined therapies. Less than 10% of patients had a known contraindication to one class of medication. Having at least three cardiovascular risk factors (Odds Ratio (OR) = 4.51; 95% CI: 2.76-7.37) was the factor most strongly associated with the prescription of the combined therapies. Pre-existing coronary artery disease (OR = 2.28; 95% CI: 1.43-3.65) and history of peripheral vascular surgery (OR = 2.30; 95% CI: 1.37-3.86) were two factors independently associated with the prescription of the combined therapies. However, peripheral arterial disease patients with chronic critical limb ischemia were less likely to receive the combined therapies (OR = 0.53; 95% CI: 0.32-0.87) than those with claudication. The retrospective nature of this study, not allowing for an exhaustive report of the contraindication to medication prescription, is the main limitation. About half of the patients with peripheral arterial disease

  13. Cost effective interventions for the prevention of cardiovascular disease in low and middle income countries: a systematic review.

    Science.gov (United States)

    Shroufi, Amir; Chowdhury, Rajiv; Anchala, Raghupathy; Stevens, Sarah; Blanco, Patricia; Han, Tha; Niessen, Louis; Franco, Oscar H

    2013-03-28

    While there is good evidence to show that behavioural and lifestyle interventions can reduce cardiovascular disease risk factors in affluent settings, less evidence exists in lower income settings.This study systematically assesses the evidence on cost-effectiveness for preventive cardiovascular interventions in low and middle-income settings. Systematic review of economic evaluations on interventions for prevention of cardiovascular disease. PubMed, Web of Knowledge, Scopus and Embase, Opensigle, the Cochrane database, Business Source Complete, the NHS Economic Evaluations Database, reference lists and email contact with experts. we included economic evaluations conducted in adults, reporting the effect of interventions to prevent cardiovascular disease in low and middle income countries as defined by the World Bank. The primary outcome was a change in cardiovascular disease occurrence including coronary heart disease, heart failure and stroke. After selection of the studies, data were extracted by two independent investigators using a previously constructed tool and quality was evaluated using Drummond's quality assessment score. From 9731 search results we found 16 studies, which presented economic outcomes for interventions to prevent cardiovascular disease in low and middle income settings, with most of these reporting positive cost effectiveness results.When the same interventions were evaluated across settings, within and between papers, the likelihood of an intervention being judged cost effective was generally lower in regions with lowest gross national income. While population based interventions were in most cases more cost effective, cost effectiveness estimates for individual pharmacological interventions were overall based upon a stronger evidence base. While more studies of cardiovascular preventive interventions are needed in low and mid income settings, the available high-level of evidence supports a wide range of interventions for the prevention

  14. Individualized Statin Benefit for Determining Statin Eligibility in the Primary Prevention of Cardiovascular Disease.

    Science.gov (United States)

    Thanassoulis, George; Williams, Ken; Altobelli, Kathleen Kimler; Pencina, Michael J; Cannon, Christopher P; Sniderman, Allan D

    2016-04-19

    Current guidelines recommend statins in the primary prevention of cardiovascular disease on the basis of predicted cardiovascular risk without directly considering the expected benefits of statin therapy based on the available randomized, controlled trial evidence. We included 2134 participants representing 71.8 million American residents potentially eligible for statins in primary prevention from the National Health and Nutrition Examination Survey for the years 2005 to 2010. We compared statin eligibilities using 2 separate approaches: a 10-year risk-based approach (≥7.5% 10-year risk) and an individualized benefit approach (ie, based on predicted absolute risk reduction over 10 years [ARR10] ≥2.3% from randomized, controlled trial data). A risk-based approach led to the eligibility of 15.0 million (95% confidence interval, 12.7-17.3 million) Americans, whereas a benefit-based approach identified 24.6 million (95% confidence interval, 21.0-28.1 million). The corresponding numbers needed to treat over 10 years were 21 (range, 9-44) and 25 (range, 9-44). The benefit-based approach identified 9.5 million lower-risk (statin treatment who had the same or greater expected benefit from statins (≥2.3% ARR10) compared with higher-risk individuals. This lower-risk/acceptable-benefit group includes younger individuals (mean age, 55.2 versus 62.5 years; PStatin treatment in this group would be expected to prevent an additional 266 508 cardiovascular events over 10 years. An individualized statin benefit approach can identify lower-risk individuals who have equal or greater expected benefit from statins in primary prevention compared with higher-risk individuals. This approach may help develop guideline recommendations that better identify individuals who meaningfully benefit from statin therapy. © 2016 American Heart Association, Inc.

  15. Heart healthy and stroke free: successful business strategies to prevent cardiovascular disease.

    Science.gov (United States)

    Matson Koffman, Dyann M; Goetzel, Ron Z; Anwuri, Victoria V; Shore, Karen K; Orenstein, Diane; LaPier, Timothy

    2005-12-01

    Heart disease and stroke, the principal components of cardiovascular disease (CVD), are the first and third leading causes of death in the United States. In 2002, employers representing 88 companies in the United States paid an average of 18,618 dollars per employee for health and productivity-related costs. A sizable portion of these costs are related to CVD. Employers can yield a 3 dollar to 6 dollar return on investment for each dollar invested over a 2 to 5 year period and improve employee cardiovascular health by investing in comprehensive worksite health-promotion programs, and by choosing health plans that provide adequate coverage and support for essential preventive services. The most effective interventions in worksites are those that provide sustained individual follow-up risk factor education and counseling and other interventions within the context of a comprehensive health-promotion program: (1) screening, health risk assessments, and referrals; (2) environmental supports for behavior change (e.g., access to healthy food choices); (3) financial and other incentives; and (4) corporate policies that support healthy lifestyles (e.g., tobacco-free policies). The most effective practices in healthcare settings include systems that use (1) standardized treatment and prevention protocols consistent with national guidelines, (2) multidisciplinary clinical care teams to deliver quality patient care, (3) clinics that specialize in treating/preventing risk factors, (4) physician and patient reminders, and (5) electronic medical records. Comprehensive worksite health-promotion programs, health plans that cover preventive benefits, and effective healthcare systems will have the greatest impact on heart disease and stroke and are likely to reduce employers' health and productivity-related costs.

  16. Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

    Directory of Open Access Journals (Sweden)

    Hogg William

    2011-10-01

    Full Text Available Abstract Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69% than in fee-for-service (45% practices (Adjusted Odds Ratio (AOR = 2.4 [95% CI 1.4-4.2], p = 0.001. Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006, and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007. Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices

  17. Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study.

    Science.gov (United States)

    Liddy, Clare; Singh, Jatinderpreet; Hogg, William; Dahrouge, Simone; Taljaard, Monica

    2011-10-18

    Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC) through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69%) than in fee-for-service (45%) practices (Adjusted Odds Ratio (AOR) = 2.4 [95% CI 1.4-4.2], p = 0.001). Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006), and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007). Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices had the greatest gaps in care, most noticeably in

  18. The analysis of Lower Silesian adult inhabitants’ lifestyles in the context of cardiovascular diseases (CVDs prevention

    Directory of Open Access Journals (Sweden)

    Janusz Muszyński

    2016-02-01

    Full Text Available Background . CVDs are considered to be the leading cause of demise and disability. The authors established cardiovascular risk factors and divided them into two groups: those subject and those not subject to modification. As prevention of risk factors, a population strategy and high-risk strategy, including secondary prevention were elaborated. The population strategy (recognized as the most effective method of combating CVD consists of modifying lifestyle risk factors. Objectives. The analysis of Lower Silesian adult inhabitants’ lifestyles as well as the attempt to estimate possible differences underlying the lifestyles of healthy individuals and ones who have been treated due to cardiovascular afflictions. Material and methods . 140 adult Lower Silesian inhabitants were divided into two groups: I – 74 healthy people; II – 66 people who have so far been treated due to cardiovascular afflictions. Michałków’s modification of the Personal Fitness Inventory, the questionnaire on physical fitness and lifestyle excogitated by San Lukas Hospital in USA , was used to make a diagnosis of the lifestyles. Results . The distinction between the lifestyles of healthy people and those who have been treated due to cardiovascular diseases was drawn. The lifestyle classified as a very good one was found among 8.11% of healthy individuals when compared to 0% among people treated due to CVDs. The lifestyle classified as a poor one was found among 7.58% (5 subjects of the afflicted patients while the ones unaffected constituted 0%. Conclusions . None of diagnosed with CVDs was evaluated with a good grade which may indicate that people suffering from CVDs don’t lead a healthy lifestyle. Accordingly, these patients do not attempt to maintain or enhance their physical fitness. Obesity and overweight are predominant as far as the BMI results are concerned. The affected don’t follow a sensible diet. Healthy individuals tend to deal with stress more

  19. [Prevention of cardiovascular diseases through sport and physical activity: A question of intensity?].

    Science.gov (United States)

    Wernhart, S; Dinic, M; Pressler, A; Halle, M

    2015-05-01

    Coronary artery disease is the leading cause of death worldwide. A sedentary lifestyle accounts for 9% of premature mortality and creates a substantial health economic burden. Measurement of physical activity in daily practice refers to metabolic equivalent tasks and assessment of cardiopulmonary fitness to measurements of peak oxygen uptake during ergometry, which can be used to classify an individual's physical activity and maximum exercise capacity. Physical activity is a multifunctional intervention tool in prevention, which exerts its effects on multiple biochemical pathways, in contrast to conventional drug therapy. These changes reduce cardiovascular morbidity and mortality. Moderate physical exercise reduces blood pressure, improves insulin sensitivity and dyslipidemia, improves body composition and enhances weight reduction. Exercise of higher intensity seems to have superior effects compared to moderate intensity training; however, the training volume also seems to be important, as negative effects of long-term intensive training have been reported, e.g. atrial fibrillation or coronary sclerosis. Overall, exercise training has a major role in primary prevention of cardiovascular disease but seems to have a maximum threshold for benefit, which may be exceeded by some individuals.

  20. The Role of the Nrf2/ARE Antioxidant System in Preventing Cardiovascular Diseases

    Directory of Open Access Journals (Sweden)

    Robert E. Smith

    2016-11-01

    Full Text Available It is widely believed that consuming foods and beverages that have high concentrations of antioxidants can prevent cardiovascular diseases and many types of cancer. As a result, many articles have been published that give the total antioxidant capacities of foods in vitro. However, many antioxidants behave quite differently in vivo. Some of them, such as resveratrol (in red wine and epigallocatechin gallate or EGCG (in green tea can activate the nuclear erythroid-2 like factor-2 (Nrf2 transcription factor. It is a master regulator of endogenous cellular defense mechanisms. Nrf2 controls the expression of many antioxidant and detoxification genes, by binding to antioxidant response elements (AREs that are commonly found in the promoter region of antioxidant (and other genes, and that control expression of those genes. The mechanisms by which Nrf2 relieves oxidative stress and limits cardiac injury as well as the progression to heart failure are described. Also, the ability of statins to induce Nrf2 in the heart, brain, lung, and liver is mentioned. However, there is a negative side of Nrf2. When over-activated, it can cause (not prevent cardiovascular diseases and multi-drug resistance cancer.

  1. Population Trends in Aspirin Use for Cardiovascular Disease Prevention 1980-2009: The Minnesota Heart Survey.

    Science.gov (United States)

    Luepker, Russell V; Steffen, Lyn M; Duval, Sue; Zantek, Nicole D; Zhou, Xia; Hirsch, Alan T

    2015-12-23

    Daily low-dose aspirin is recommended for primary prevention of myocardial infarction and stroke in higher-risk patients. Population trends in aspirin use for cardiovascular disease (CVD) prevention in an urban population (Minneapolis/St. Paul, 2010 population 2.85 million) from 1980 to 2009 were evaluated. Surveys of randomly selected adults aged 25 to 74 years were collected at 5-year intervals. Self-reports of regular aspirin use for CVD prevention and history of CVD were obtained. Six cross-sectional surveys included 12 281 men and 14 258 women. Age-adjusted aspirin use for primary prevention increased during this period from 1% to 21% among men and 1% to 12% among women. Aspirin use was highest in those aged 65 to 74 years. For secondary prevention, age-adjusted aspirin use increased from 19% to 74% among men and 11% to 64% among women. While data are based on self-report, a substudy using a biochemical indicator of aspirin use (serum thromboxane B2) supports the validity of self-report. Aspirin for CVD prevention is commonly used by a large and growing portion of the general population. It is not known if this is based on professional advice or self-prescribed use. It is also likely that many who would benefit do not use aspirin and others use aspirin inappropriately. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  2. The roles of community pharmacists in cardiovascular disease prevention and management

    Directory of Open Access Journals (Sweden)

    George J

    2011-05-01

    Full Text Available There is ample evidence in the international literature forpharmacist involvement in the prevention and managementof cardiovascular disease (CVD conditions in primary care.Systematic reviews and meta-analyses have confirmed thesignificant clinical benefits of pharmacist interventions for arange of CVD conditions and risk factors. Evidence generatedin research studies of Australian community pharmacistinvolvement in CVD prevention and management issummarised in this article.Commonwealth funding through the Community PharmacyAgreements has facilitated research to establish the feasibilityand effectiveness of new models of primary care involvingcommunity pharmacists. Australian community pharmacistshave been shown to effect positive clinical, humanistic andeconomic outcomes in patients with CVD conditions.Improvements in blood pressure, lipid levels, medicationadherence and CVD risk have been demonstrated usingdifferent study designs. Satisfaction for GPs, pharmacists andconsumers has also been reported. Perceived ‘turf’encroachment, expertise of the pharmacist, space, time andremuneration are challenges to the implementation of diseasemanagement services involving community pharmacists.

  3. Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

    OpenAIRE

    Adrianna Murphy, PhD; Benjamin Palafox, MSc; Owen O'Donnell, ProfPhD; David Stuckler, ProfPhD; Pablo Perel, PhD; Khalid F AlHabib, ProfMBBS; Alvaro Avezum, ProfPhD; Xiulin Bai, BSc; Jephat Chifamba, ProfDPhil; Clara K Chow, ProfPhD; Daniel J Corsi, PhD; Gilles R Dagenais, MD; Antonio L Dans, MD; Rafael Diaz, MD; Ayse N Erbakan, MD

    2018-01-01

    Summary: Background: There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods: We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary p...

  4. Risk stratification in cardiovascular disease primary prevention - scoring systems, novel markers, and imaging techniques.

    LENUS (Irish Health Repository)

    Zannad, Faiez

    2012-04-01

    The aim of this paper is to review and discuss current methods of risk stratification for cardiovascular disease (CVD) prevention, emerging biomarkers, and imaging techniques, and their relative merits and limitations. This report is based on discussions that took place among experts in the area during a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy in September 2009. Classical risk factors such as blood pressure and low-density lipoprotein cholesterol levels remain the cornerstone of risk estimation in primary prevention but their use as a guide to management is limited by several factors: (i) thresholds for drug treatment vary with the available evidence for cost-effectiveness and benefit-to-risk ratios; (ii) assessment may be imprecise; (iii) residual risk may remain, even with effective control of dyslipidemia and hypertension. Novel measures include C-reactive protein, lipoprotein-associated phospholipase A(2) , genetic markers, and markers of subclinical organ damage, for which there are varying levels of evidence. High-resolution ultrasound and magnetic resonance imaging to assess carotid atherosclerotic lesions have potential but require further validation, standardization, and proof of clinical usefulness in the general population. In conclusion, classical risk scoring systems are available and inexpensive but have a number of limitations. Novel risk markers and imaging techniques may have a place in drug development and clinical trial design. However, their additional value above and beyond classical risk factors has yet to be determined for risk-guided therapy in CVD prevention.

  5. Dietary counselling for cardiovascular disease prevention in primary care settings: results from a German physician survey.

    Science.gov (United States)

    Görig, Tatiana; Mayer, Manfred; Bock, Christina; Diehl, Katharina; Hilger, Jennifer; Herr, Raphael M; Schneider, Sven

    2014-06-01

    Primary care physicians (PCPs) play an important role in the promotion of healthy dietary behaviour. However, little is known about the practice of and factors associated with the provision of dietary counselling in primary health care in Germany. To explore the attitudes towards and factors associated with the routine provision of dietary counselling in Germany using data from the nationwide, representative sample of the Physician Survey on Cardiovascular Disease Prevention. A total of 4074 randomly selected PCPs (response rate: 33.9%) provided data on dietary counselling for prevention of cardiovascular disease (CVD) based on the 5 A's (Assess, Advise, Agree, Assist, Arrange), attitudes towards dietary counselling and patients' and practice characteristics. While the majority of PCPs (86%) reported having high levels of competence in providing dietary advice, only 49% felt they had been successful in counselling their patients on nutrition. PCPs routinely asked (68%) and advised patients to change their dietary habits more frequently (77%) compared to other counselling techniques based on the 5 A's. Female physicians and those with a higher percentage of privately insured patients and patients at higher risk of CVD were more likely to use the 5 A's to routinely counsel their patients on nutrition. The data showed high levels of involvement by German PCPs in CVD prevention and dietary counselling. The rather low perceived success of dietary intervention and differences with respect to patients' health insurance status indicate a need to address both communication skills in medical training and appropriate reimbursement of preventive services. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme: QUality Improvement Cardiovascular care Kwara-I (QUICK-I)

    NARCIS (Netherlands)

    Hendriks, M.; Brewster, L.; Wit, F.; Bolarinwa, O.A.; Odusola, A.O.; Redekop, W.; Bindraban, N.; Vollaard, A.; Alli, S.; Adenusi, P.; Agbede, K.; Akande, T.; de Lange, J.; Schultsz, C.

    2011-01-01

    Background: Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A community

  7. Cardiovascular disease prevention in rural Nigeria in the context of a community based health insurance scheme : QUality improvement cardiovascular care Kwara-I (QUICK-I)

    NARCIS (Netherlands)

    M. Hendriks (Maaike); L.M. Brewster (Lizzy); F.W.N.M. Wit (Ferdinand); O.A. Bolarinwa (Oladimeji Akeem); A.O. Odusola (Aina Olufemi); W.K. Redekop (Ken); N. Bindraban (Navin); A. Vollaard (Albert); S. Alli (Shade); P. Adenusi (Peju); K. Agbede (Kayode); T.M. Akande (Tanimola); J. Lange (Joep); C. Schultsz (Constance)

    2011-01-01

    textabstractBackground: Cardiovascular diseases (CVD) are a leading contributor to the burden of disease in low- and middle-income countries. Guidelines for CVD prevention care in low resource settings have been developed but little information is available on strategies to implement this care. A

  8. Cardiovascular disease prevention in low resource settings: lessons from the Heartfile experience in Pakistan.

    Science.gov (United States)

    Nishtar, Sania

    2003-01-01

    This paper outlines activities of the Heartfile Program in Pakistan (http://heartfile.org). The program focuses on cardiovascular disease prevention and health promotion, and includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches. Initiated by the nonprofit private sector, the program now links with major public sector primary healthcare programs, and is currently spearheading formulation of the National Action Plan on Noncommunicable Disease Prevention and Control in Pakistan. In addition, the program is being refined, validated, and packaged as a replicable model for other developing countries and in low resource settings, utilizing appropriate principles of franchising with inbuilt components sensitive to cultural and social adaptations. A review of the planning process, implementation strategy, and fund-raising experience is presented. Strategies unique to low resource settings, such as the development of cost- and time-efficient strategic alliances and partnerships, have also been highlighted. In addition, specific caveats are identified as being helpful to private sector development of chronic disease prevention programs in resource-constrained settings, and a road map to a sustainable public-private sector partnership is provided.

  9. Epigenetics and cardiovascular disease

    Science.gov (United States)

    Despite advances in the prevention and management of cardiovascular disease (CVD), this group of multifactorial disorders remains a leading cause of mortality worldwide. CVD is associated with multiple genetic and modifiable risk factors; however, known environmental and genetic influences can only...

  10. Use of generic and essential medicines for prevention and treatment of cardiovascular diseases in Portugal.

    Science.gov (United States)

    Gama, Helena; Torre, Carla; Guerreiro, José Pedro; Azevedo, Ana; Costa, Suzete; Lunet, Nuno

    2017-06-29

    The successful control of cardiovascular diseases at the lowest possible cost requires the use of the most effective and affordable medicines. We aimed to describe the trends in the ambulatory use of medicines for prevention and treatment of cardiovascular diseases [Anatomic Therapeutic Chemical classification system (ATC): C and B01A] in Portugal, between 2004 and 2012, and to estimate the potential for expenditure reduction through changes in patterns of use. We analysed sell-out data, expressed as defined daily doses (DDD) and pharmacy retail price (€), from a nationwide database. We estimated potential reduction in expenditures through the increase, up to 90% of the volume of DDD, in the use of generic and essential medicines; the latter were defined according to guidelines from Portugal and another European country. Overall consumption increased by approximately 50% from 2004 to 2012, reaching nearly 2400 million DDD, whereas expenditure decreased to 753 million € (-31.3% since 2006). Use of generics and essential medicines increased, representing 43.6 and 39.9% of DDD consumption in 2012, respectively. The 40 most used groups of medicines in 2012 accounted for just over 80% of overall consumption; among these, increase in use of generics and essential medicines would have contributed to a saving of 275 million €. Changes in patterns of consumption of medicines towards a more frequent use of generics, a preferential use of essential medicines and a more rational use of fixed-dose combinations may contribute to a more efficient use of health resources.

  11. Ethical considerations in clinical research on herbal medicine for prevention of cardiovascular disease in the ageing.

    Science.gov (United States)

    Koonrungsesomboon, Nut; Karbwang, Juntra

    2016-10-15

    Cardiovascular disease (CVD) in the ageing is a major public health problem worldwide. The nature of most CVD is subclinical with pathological processes that can span over years. Use of preventive measures could be an appropriate approach to prevailing over CVD in the ageing, and herbal medicine is one of the promising preventive approaches and is currently of interest among medical societies. In the evidence-based era, herbal medicine is, however, often underestimated and approached with skepticism, mainly due to the paucity of scientific evidence. Properly designed clinical trials on herbal medicine for prevention of CVD in a geriatric population are thus of importance and of clinical value. To review ethical issues and discuss considerations when such research is proposed. Four ethical issues, including the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent, are structured and extensively discussed in this article. Ethical core considerations of prevention research of CVD on herbal medicine involve particular attention on the scientific validity of research, risk-benefit assessments, subject selection and vulnerability, and informed consent. These issues and considerations are keys, although they must be adapted to an individual research setting in which a clinical study is proposed. Copyright © 2015 Elsevier GmbH. All rights reserved.

  12. Impact of Theory-Based Education about Cardiovascular Disease on Preventative Nutrition Behavior of Women Aged 30-45 Years

    Directory of Open Access Journals (Sweden)

    2017-06-01

    Full Text Available Introduction: Cardiovascular disease is the leading cause of morbidity and mortality in many countries. Its prevention has been discussed by the World Health Organization. The current study determined the effect of an educational program designed to raise awareness about cardiovascular disease based on the health belief model on the preventative nutrition behavior of women aged 30-45 years. Result: Educational intervention increased the scores for knowledge and health belief model structures except when barriers were perceived (The mean consumption of calories, carbohydrates, fats, fatty acids, salt, milk groups, bread and cereals decreased, but the consumption of milk, dairy products and vegetables increased (p < 0.05. Education based on the health belief model effectively increased knowledge and promoted nutritional behavior for the prevention of cardiovascular disease.

  13. Prevention of cardiovascular diseases – Prophylactic program in a selected enterprise

    Directory of Open Access Journals (Sweden)

    Jadwiga Siedlecka

    2017-12-01

    Full Text Available Background: In Poland cardiovascular diseases (CVD, classified as work-related diseases, are responsible for 25% of disability and cause 50% of all deaths, including 26.9% of deaths in people aged under 65 years. The aim of the study was to analyze employee expectations regarding CVD- oriented prophylactic activities in the selected enterprise. Material and Methods: A questionnaire, developed for this study, consists of: socio-demographic data, job characteristics, occupational factors, and questions about the respondents’ expectations concerning the prevention program. The study group comprised 407 multi-profile company employees aged (mean 46.7 years (standard deviation (SD = 9.1, including 330 men (81.1%, mean age = 46.9 (SD = 9.2 and 77 women (18.9%, mean age = 45.9 (SD = 8.2 The study was performed using the method of auditorium survey. Results: Employees declared the need for actions related to physical activity: use of gym, swimming pool, tennis (56.5%, smoking habits – education sessions on quitting smoking (24.6%. A few people were interested in activities related to healthy diet. According to the majority of the study group, the scope of preventive examinations should be expanded. Based on our own findings and literature data CVD- oriented preventive program, addressed to the analyzed enterprise was prepared. The program will be presented in another paper. Conclusions: The results showed significant quantitative and qualitative differences in the classic and occupational CVD risk factors between men and women, as well as in preferences for participation in prevention programs. Therefore, gender differences should be taken into account when planning prevention programs. Med Pr 2017;68(6:757–769

  14. Screening for Hypertension and Lowering Blood Pressure for Prevention of Cardiovascular Disease Events.

    Science.gov (United States)

    Viera, Anthony J

    2017-07-01

    Hypertension affects 1 in 3 American adults. Blood pressure (BP)-lowering therapy reduces the risk of cardiovascular disease. The United States Preventive Services Task Force recommends all adults be screened for hypertension. Most patients whose office BP is elevated should have out-of-office monitoring to confirm the diagnosis. Ambulatory BP monitoring is preferred for out-of-office measurement, but home BP monitoring is a reasonable alternative. Guidelines for treatment are stratified by age (60 years) and include cutoffs for recommended treatment BPs and target BP goals. Quality of hypertension care is improved by incorporating population health management using registries and medication titration. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. The primary prevention of cardiovascular disease: nurse practitioners using behaviour modification strategies.

    Science.gov (United States)

    Farrell, Todd Charles; Keeping-Burke, Lisa

    2014-01-01

    Cardiovascular disease (CVD) places great financial strain on the health care system and dramatically affects individual quality of life. As primary health care providers, nurse practitioners (NPs) are ideally positioned to advise clients on risk factor and lifestyle modifications that ameliorate the impact of CVD. While the lifestyle targets for CVD prevention are established, the most effective means of achieving these goals remain uncertain. Behaviour modification strategies, including motivational interviewing (MI) and the transtheoretical model (TTM), have been suggested, but neither approach is established as being more efficacious than the other. In this paper, evidence on the effectiveness of the two approaches for modifying smoking, diet, and exercise behaviour are presented, and a recommendation for NP practice is made.

  16. Cardiovascular disease prevention in a health insurance program in rural Nigeria

    NARCIS (Netherlands)

    Hendriks, M.E.

    2014-01-01

    Cardiovascular diseases (CVD) are a leading cause of death and disability in sub-Saharan Africa. Treatment of cardiovascular risk factors, such as hypertension and diabetes, greatly reduces the risk of CVD. However, this treatment is often not available or not accessible for patients in sub-Saharan

  17. Persistence With Statins in Primary Prevention of Cardiovascular Disease: Findings From a Cohort of Spanish Workers.

    Science.gov (United States)

    Malo, Sara; Aguilar-Palacio, Isabel; Feja, Cristina; Menditto, Enrica; Lallana, María Jesús; Andrade, Elena; Casasnovas, José Antonio; Rabanaque, María José

    2018-01-01

    The aim of this study was to assess patterns of treatment persistence in a cohort of male Spanish workers receiving statin therapy for primary prevention of cardiovascular disease. This descriptive study was conducted within the framework of the prospective longitudinal Aragon Workers' Health Study (N = 5400). Incident male statin users were identified based on data collected from the regional government's medication consumption information system. Patterns of treatment persistence with statins prescribed for primary cardiovascular disease prevention were assessed and the relevance of potential predictors explored. Among the 725 new statin users, less than one third remained persistent during the 1 year of follow-up. About 15% of nonpersistent users discontinued statin therapy after dispensation of the first prescription; of these, 42.1% did not recommence treatment within the following year. Factors reducing the likelihood of treatment discontinuation were older age (HR, 0.55; 95%CI, 0.39-0.77) and cotreatment with antihypertensive drugs (HR, 0.68; 95%CI, 0.56-0.82). No association was observed between treatment persistence and cotreatment with antidiabetic or antithrombotic drugs, baseline low-density lipoprotein levels, or total cholesterol levels. However, persistence was influenced by the type of statin first prescribed. Our analysis of a cohort of healthy male workers revealed poor statin persistence. These findings underscore the need for a better understanding of patterns of statin use, especially in apparently healthy individuals, and for the incorporation of patient behavior into prescribing decisions. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  18. Vitamin, mineral, and multivitamin supplements for the primary prevention of cardiovascular disease and cancer: U.S. Preventive services Task Force recommendation statement.

    Science.gov (United States)

    Moyer, Virginia A

    2014-04-15

    Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on vitamin supplementation to prevent cardiovascular disease and cancer. The USPSTF reviewed the evidence on the efficacy of multivitamin or mineral supplements in the general adult population for the prevention of cardiovascular disease and cancer. This recommendation applies to healthy adults without special nutritional needs (typically aged 50 years or older). It does not apply to children, women who are pregnant or may become pregnant, or persons who are chronically ill or hospitalized or have a known nutritional deficiency. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of multivitamins for the prevention of cardiovascular disease or cancer. (I statement). The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of single- or paired-nutrient supplements (except β-carotene and vitamin E) for the prevention of cardiovascular disease or cancer. (I statement). The USPSTF recommends against β-carotene or vitamin E supplements for the prevention of cardiovascular disease or cancer. (D recommendation).

  19. Primary prevention of stroke and cardiovascular disease in the community (PREVENTS): Methodology of a health wellness coaching intervention to reduce stroke and cardiovascular disease risk, a randomized clinical trial.

    Science.gov (United States)

    Mahon, Susan; Krishnamurthi, Rita; Vandal, Alain; Witt, Emma; Barker-Collo, Suzanne; Parmar, Priya; Theadom, Alice; Barber, Alan; Arroll, Bruce; Rush, Elaine; Elder, Hinemoa; Dyer, Jesse; Feigin, Valery

    2018-02-01

    Rationale Stroke is a major cause of death and disability worldwide, yet 80% of strokes can be prevented through modifications of risk factors and lifestyle and by medication. While management strategies for primary stroke prevention in high cardiovascular disease risk individuals are well established, they are underutilized and existing practice of primary stroke prevention are inadequate. Behavioral interventions are emerging as highly promising strategies to improve cardiovascular disease risk factor management. Health Wellness Coaching is an innovative, patient-focused and cost-effective, multidimensional psychological intervention designed to motivate participants to adhere to recommended medication and lifestyle changes and has been shown to improve health and enhance well-being. Aims and/or hypothesis To determine the effectiveness of Health Wellness Coaching for primary stroke prevention in an ethnically diverse sample including Māori, Pacific Island, New Zealand European and Asian participants. Design A parallel, prospective, randomized, open-treatment, single-blinded end-point trial. Participants include 320 adults with absolute five-year cardiovascular disease risk ≥ 10%, calculated using the PREDICT web-based clinical tool. Randomization will be to Health Wellness Coaching or usual care groups. Participants randomized to Health Wellness Coaching will receive 15 coaching sessions over nine months. Study outcomes A substantial relative risk reduction of five-year cardiovascular disease risk at nine months post-randomization, which is defined as 10% relative risk reduction among those at moderate five-year cardiovascular disease risk (10-15%) and 25% among those at high risk (>15%). Discussion This clinical trial will determine whether Health Wellness Coaching is an effective intervention for reducing modifiable risk factors, and hence decrease the risk of stroke and cardiovascular disease.

  20. [New clinical and organizational approaches to preventing cardiovascular diseases in the primary health care system].

    Science.gov (United States)

    Boĭtsov, S A; Kalinina, A M; Ipatov, P V

    2013-01-01

    The paper deals with the justification and description of clinical and organizational approaches to preventing cardiovascular diseases (CVD) in the primary health care system (PHCS) under the present conditions of health care modernization in Russia. It formulates the basic directions of systematic measures in integration strategies for the prevention of noncommunicable diseases (mainly CVD) at a federal level, in which practical measures are presented to improve a system for the early detection of high-risk individuals and to carry out measures for risk factor correction in PHCS, i.e. to implement high-risk strategies, including clinical and organizational approaches to reconstituting the medical prevention infrastructure in PHCS. This is favored by the new normative documents adopted by the Ministry of Health of Russia on the follow-up and prophylactic medical examinations of the adult population. The paper substantiates the objective need for such examinations and characterizes the main clinical and organizational approaches promoted in medical examinations, which is aimed at introducing the current science-based and economically expedient methods in the real practice of PHCS for the early identifications of atherosclerosis-induced major CVDs and, what is particularly important, a risk for their development. Prophylactic counseling as a compulsory component is first being introduced in medical examination procedures. The key clinical and organizational principle of effective CVD prevention in public health is the implementation of the relationship and continuity of preventive measures, which becomes realistic with the adoption of new regulations of clinical examinations, prophylactic medical examinations, and follow-ups. The improvement of CVD prevention is associated not only with the introduction of organizational innovation changes, but also with the need to create a prevention ideology in physicians at all levels. It is emphasized that a comprehensive

  1. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease

    Science.gov (United States)

    Multiple randomized controlled trials (RCTs) have assessed the effects of supplementation with eicosapentaenoic acid plus docosahexaenoic acid (omega-3 polyunsaturated fatty acids, commonly called fish oils) on the occurrence of clinical cardiovascular diseases. Although the effects of supplementati...

  2. Does Supplementation with Omega-3 PUFAs Add to the Prevention of Cardiovascular Disease?

    Science.gov (United States)

    Rizos, Evangelos C; Elisaf, Moses S

    2017-06-01

    Omega-3 fatty acids are increasingly used for the protection of cardiovascular disease. The main but not the sole mechanism of action is the reduction of triglyceride levels. In this review, we summarize the effect of omega-3 supplements on all-cause and cardiovascular mortality, myocardial infarction, and stroke from the relevant randomized controlled trials. Twenty-one randomized controlled trials assessed omega-3 supplementation on mortality and cardiovascular-related outcomes. From these studies, as well as from the relevant meta-analyses, we found that omega-3 supplements do not exert a consistent benefit for cardiovascular protection. There is uncertainty of a clear profit from omega-3 supplementation in cardiovascular disease.

  3. Precision Medicine in Cardiovascular Diseases

    OpenAIRE

    Yan Liu; Jie Du

    2017-01-01

    Since President Obama announced the Precision Medicine Initiative in the United States, more and more attention has been paid to precision medicine. However, clinicians have already used it to treat conditions such as cancer. Many cardiovascular diseases have a familial presentation, and genetic variants are associated with the prevention, diagnosis, and treatment of cardiovascular diseases, which are the basis for providing precise care to patients with cardiovascular diseases. Large-scale c...

  4. Screening for hypertension in children and adolescents to prevent cardiovascular disease.

    Science.gov (United States)

    Thompson, Matthew; Dana, Tracy; Bougatsos, Christina; Blazina, Ian; Norris, Susan L

    2013-03-01

    The prevalence of hypertension is increasing in children, and may persist into adulthood. This systematic review was conducted for the US Preventive Services Task Force recommendation on the effectiveness of screening asymptomatic children and adolescents for hypertension in order to prevent cardiovascular disease. Eligible studies were identified from Medline and the Cochrane Library (through July 2012). We included trials and controlled observational studies in asymptomatic children and adolescents on the effectiveness and harms of screening and treatment, as well as accuracy of blood pressure measurement. One author extracted study characteristics and results, which were checked for accuracy by a second author. No studies evaluated the effects of screening for hypertension on health outcomes. Two studies of screening tests for elevated blood pressure reported moderate sensitivities (0.65, 0.72) and specificities (0.75, 0.92). Sensitivities and specificities of child hypertension for the later presence of adult hypertension (7 studies) were wide ranging (0-0.63 and 0.77-1.0, respectively), and associations between child hypertension and carotid intima media thickening and proteinuria in young adults (3 studies) were inconsistent. Seven studies reported that drug interventions effectively lowered blood pressure in adolescents over short follow-up periods. No serious treatment-related adverse effects were reported. There is no direct evidence that screening for hypertension in children and adolescents reduces adverse cardiovascular outcomes in adults. Additional studies are needed to improve diagnosis and risk stratification of children with elevated blood pressure and to quantify risks and benefits of interventions.

  5. Use of cardiovascular polypills for the secondary prevention of cerebrovascular disease.

    Science.gov (United States)

    Masjuan, J; Gállego, J; Aguilera, J M; Arenillas, J F; Castellanos, M; Díaz, F; Portilla, J C; Purroy, F

    2018-01-08

    There is little control of cardiovascular (CV) risk factors in secondary prevention after an ischaemic stroke, in part due to a lack of adherence to treatment. The CV polypill may contribute to proper treatment adherence, which is necessary for CV disease prevention. This study aimed to establish how and in what cases the CV polypill should be administered. A group of 8 neurologists drafted consensus recommendations using structured brainstorming and based on their experience and a literature review. These recommendations are based on the opinion of the participating experts. The use of the CV polypill is beneficial for patients, healthcare professionals, and the health system. Its use is most appropriate for atherothrombotic stroke, lacunar stroke, stroke associated with cognitive impairment, cryptogenic stroke with CV risk factors, and silent cerebrovascular disease. It is the preferred treatment in cases of suspected poor adherence, polymedicated patients, elderly people, patients with polyvascular disease or severe atherothrombosis, young patients in active work, and patients who express a preference for the CV polypill. Administration options include switching from individual drugs to the CV polypill, starting treatment with the CV polypill in the acute phase in particular cases, use in patients receiving another statin or an angiotensin ii receptor antagonist, or de novo use if there is suspicion of poor adherence. Nevertheless, use of the CV polypill requires follow-up on the achievement of the therapeutic objectives to make dose adjustments. This document is the first to establish recommendations for the use of the CV polypill in cerebrovascular disease, beyond its advantages in terms of treatment adherence. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. DETERMINANTS OF PREVENTIVE BEHAVIOR REGARDING CARDIOVASCULAR DISEASES AND RISK FACTORS IN PATIENTS WITH ESSENTIAL HYPERTENSION AND CHRONIC ISCHEMIC HEART DISEASE

    Directory of Open Access Journals (Sweden)

    D. Yu. Platonov

    2011-01-01

    Full Text Available Aim. To analyze potential determinants of preventive behavior (PB in patients with essential hypertension (HT and chronic ischemic heart disease (CIHD, and to establish their significance and hierarchy. Material and methods. Patients with HT (n=285 and CIHD (n=223 were studied. Questioning of all patients was performed to assess the characteristics of their PB. Differentiated multivariate analysis of activity and efficacy of PB determinants was performed in HT and CIHD patients by the method of step-by-step backward logistic regression. Results. Awareness of the cardiovascular diseases (CVD and its prevention (odds ratio [OR] 6.08 as well as high level of general education (OR=2.29 were the most significant determinants of active PB in HT patients. Sufficient social support (OR=3.77, awareness of CVD and its prevention (OR=3.16 were the most significant determinants of active PB in patients with CIHD. Efficacy of PB in patients with HT and CIHD mostly depends on satisfaction of medical service (OR=10.2 and 6.63, respectively, social support (OR=6.25 and 10.5, respectively, adequate awareness of CVD and its prevention (OR, 6.92 and 6.64, respectively. Conclusion. PB activity and efficacy in patients with HT and CIHD depends on many contributing and impeding factors. Disregarding these factors can result in failure in preventive efforts at both individual and population levels.

  7. Hypertriglyceridemia and omega-3 fatty acids: Their often overlooked role in cardiovascular disease prevention.

    Science.gov (United States)

    Arca, M; Borghi, C; Pontremoli, R; De Ferrari, G M; Colivicchi, F; Desideri, G; Temporelli, P L

    2018-03-01

    This review aims to describe the pathogenic role of triglycerides in cardiometabolic risk, and the potential role of omega-3 fatty acids in the management of hypertriglyceridemia and cardiovascular disease. In epidemiological studies, hypertriglyceridemia correlates with an increased risk of cardiovascular disease, even after adjustment for low density lipoprotein cholesterol (LDL-C) levels. This has been further supported by Mendelian randomization studies where triglyceride-raising common single nucleotide polymorphisms confer an increased risk of developing cardiovascular disease. Although guidelines vary in their definition of hypertriglyceridemia, they consistently define a normal triglyceride level as risk of cardiovascular disease, even in patients with optimally managed LDL-C levels, triglycerides are an important secondary target in both assessment and treatment. Dietary changes are a key element of first-line lifestyle intervention, but pharmacological treatment including omega-3 fatty acids may be indicated in people with persistently high triglyceride levels. Moreover, in patients with pre-existing cardiovascular disease, omega-3 supplements significantly reduce the risk of sudden death, cardiac death and myocardial infarction and are generally well tolerated. Targeting resistant hypertriglyceridemia should be considered as a part of clinical management of cardiovascular risk. Omega-3 fatty acids may represent a valuable resource to this aim. 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.

  8. Rosuvastatin, inflammation, C-reactive protein, JUPITER, and primary prevention of cardiovascular disease--a perspective.

    Science.gov (United States)

    Kones, Richard

    2010-12-09

    The major public health concern worldwide is coronary heart disease, with dyslipidemia as a major risk factor. Statin drugs are recommended by several guidelines for both primary and secondary prevention. Rosuvastatin has been widely accepted because of its efficacy, potency, and superior safety profile. Inflammation is involved in all phases of atherosclerosis, with the process beginning in early youth and advancing relentlessly for decades throughout life. C-reactive protein (CRP) is a well-studied, nonspecific marker of inflammation which may reflect general health risk. Considerable evidence suggests CRP is an independent predictor of future cardiovascular events, but direct involvement in atherosclerosis remains controversial. Rosuvastatin is a synthetic, hydrophilic statin with unique stereochemistry. A large proportion of patients achieve evidence-based lipid targets while using the drug, and it slows progression and induces regression of atherosclerotic coronary lesions. Rosuvastatin lowers CRP levels significantly. The Justification for Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial was designed after the observation that when both low density lipoprotein and CRP were reduced, patients fared better than when only LDL was lowered. Advocates and critics alike acknowledge that the benefits of rosuvastatin in JUPITER were real. After a review, the US Food and Drug Administration extended the indications for rosuvastatin to include asymptomatic JUPITER-eligible individuals with one additional risk factor. The American Heart Association and Centers of Disease Control and Prevention had previously recognized the use of CRP in persons with "intermediate risk" as defined by global risk scores. The Canadian Cardiovascular Society guidelines went further and recommended use of statins in persons with low LDL and high CRP levels at intermediate risk. The JUPITER study focused attention on ostensibly healthy individuals with

  9. Understanding cardiovascular disease

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000759.htm Understanding cardiovascular disease To use the sharing features on this page, ... lead to heart attack or stroke. Types of Cardiovascular Disease Coronary heart disease (CHD) is the most common ...

  10. Cardiovascular Disease and Diabetes

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Cardiovascular Disease & Diabetes Updated:Jan 29,2018 The following statistics ... clear that there is a strong correlation between cardiovascular disease (CVD) and diabetes. At least 68 percent of ...

  11. The importance of continuing surveillance of risk factors for prevention of cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Gaetano Lanza

    2007-06-01

    Full Text Available After peaking in the 1960s’, cardiovascular diseases (CVDs have shown a consistent decline in western countries in recent decades [1].Despite this,CVDs remain the major cause of mortality and morbidity in industrialized populations, with relevant associated socio-economical issues, while their incidence is increasing in developing countries. Several factors have likely contributed to the reduced incidence of CVDs in industrialized societies, including an increase in education and attention to health issues, lifestyle changes and improvement in diagnostic facilities and therapeutic tools. Epidemiologic studies have played an outstanding role in the decline of CVDs. Indeed, they have allowed for the identification of habits and conditions which expose healthy subjects to an increased risk of development of atherosclerosis and its complications They have also led to the implementation of appropriate programs and campaigns aimed at fighting the identified risk factors by means of changes in diet and lifestyle and the use of specific drug treatments. In particular, tight control and prevention of hypertension, smoking and hypercholesterolemia has largely contributed to the reduction of CVDs, accounting for more than 50% of the reduction of mortality from the 1960s’ to the 1990s’ [2].This approach was also crucial in improving the clinical outcomes of secondary prevention for CVDs.

  12. Gender differences in barriers to lifestyle change for cardiovascular disease prevention.

    Science.gov (United States)

    Mosca, L; McGillen, C; Rubenfire, M

    1998-08-01

    Achieving and maintaining a healthy lifestyle are important aspects of a cardiovascular disease prevention program. Few data have evaluated barriers to lifestyle change by gender. We studied self-reported barriers to lifestyle change and evaluated support systems to make positive changes in 293 patients (186 men, 107 women) enrolled in a multidisciplinary preventive cardiology clinic. Subjects were asked to rate barriers and support systems on a scale of 1 to 5, with 1 being very important and 5 not important. Women ranked self-esteem as the most important barrier and rated it significantly higher than did men (p = 0.0003). Women also rated money, knowledge, skills, and stress significantly higher than did men (p genders. Women, compared with men, rated dietitians, exercise physiologists, nurses, counselors, family members, and social/religious groups as more important sources of support. These data suggest that gender differences exist in barriers to lifestyle change. Psychosocial factors should be considered important elements of programs designed to help patients make positive lifestyle changes.

  13. Costs of cardiovascular disease prevention care and scenarios for cost saving: a micro-costing study from rural Nigeria

    NARCIS (Netherlands)

    Hendriks, Marleen E.; Bolarinwa, Oladimeji A.; Nelissen, Heleen E.; Boers, Alexander C.; Gomez, Gabriela B.; Tan, Siok Swan; Redekop, William; Adenusi, Peju; Lange, Joep M. A.; Agbede, Kayode; Akande, Tanimola M.; Schultsz, Constance

    2015-01-01

    To assess the costs of cardiovascular disease (CVD) prevention care according to international guidelines, in a primary healthcare clinic in rural Nigeria, participating in a health insurance programme. A micro-costing study was conducted from a healthcare provider perspective. Activities per

  14. Review of community-based interventions for prevention of cardiovascular diseases in low- and middle-income countries

    NARCIS (Netherlands)

    van de Vijver, Steven; Oti, Samuel; Addo, Juliet; de Graft-Aikins, Ama; Agyemang, Charles

    2012-01-01

    An increasing burden of cardiovascular disease (CVD) is occurring in low- and middle-income countries (LMICs) as a result of urbanisation and globalisation. Low rates of awareness and treatment of risk factors worsen the prognosis in these settings. Prevention of CVD is proven to be cost effective

  15. Being at risk for cardiovascular disease: Perceptions and preventive behavior in people with and without a known genetic predisposition

    NARCIS (Netherlands)

    Claassen, E.A.M.; Henneman, L.; van der Weijden, T.; Marteau, T.M.; Timmermans, D.R.M.

    2012-01-01

    This study compares and explains differences in perceptions of cardiovascular disease (CVD) risk and preventive behaviors in people with and without a known genetic predisposition to CVD. A cross-sectional study using two samples was performed. The first sample (genetic predisposition; n=51)

  16. Precision Medicine in Cardiovascular Diseases

    Directory of Open Access Journals (Sweden)

    Yan Liu

    2017-02-01

    Full Text Available Since President Obama announced the Precision Medicine Initiative in the United States, more and more attention has been paid to precision medicine. However, clinicians have already used it to treat conditions such as cancer. Many cardiovascular diseases have a familial presentation, and genetic variants are associated with the prevention, diagnosis, and treatment of cardiovascular diseases, which are the basis for providing precise care to patients with cardiovascular diseases. Large-scale cohorts and multiomics are critical components of precision medicine. Here we summarize the application of precision medicine to cardiovascular diseases based on cohort and omic studies, and hope to elicit discussion about future health care.

  17. Childhood socioeconomic position, young adult intelligence and fillings of prescribed medicine for prevention of cardiovascular disease in middle-aged men

    DEFF Research Database (Denmark)

    Kriegbaum, Margit; Kildemoes, Helle Wallach; Rasmussen, Jeppe Nørgaard

    2014-01-01

    To explore the relationship between childhood socioeconomic position (SEP) and filling of medicine prescriptions for prevention of cardiovascular diseases (CVDs), with young adult intelligence (IQ) as a potential mediator.......To explore the relationship between childhood socioeconomic position (SEP) and filling of medicine prescriptions for prevention of cardiovascular diseases (CVDs), with young adult intelligence (IQ) as a potential mediator....

  18. The clinical and economic value of lovastatin in the primary prevention of cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Lorenzo Pradelli

    2006-09-01

    Full Text Available HMGCoA-inhibitors (statins lower plasma cholesterol through interference with the rate-limiting enzyme in the endogenous synthesis process. Since their introduction in the early 90’s, the clinical attitude towards cardiovascular (cv risk reduction has evolved from the attention to single risk factors to a more comprehensive global risk evaluation, and thus the indications of statins have broadened from the secondary prevention in hypercholesterolemic patients to include primary prevention in mildly and moderately hypercholesterolemic, or even normocholesterolemic patients, provided their global cv risk is considered high (typically, an estimated major cv event probability greater than 20%. Italian drug utilization data show that a small proportion of patients who could benefit from statins do actually receive them, contributing to the persistence of the clinical and economical burden of cv disease, the leading cause of mortality; since statins have proved effective, and cost-effective, in cv prevention, a more widespread use appears desirable, but requires high investments in pharmaceutical costs. This article defines a clinical profile of lovastatin, a statin with a solid efficacy and safety record only recently introduced into the Italian market despite it has been the first to become clinically available abroad. Among available statin formulations appropriate for target cholesterol reductions up to 30%, which apply to a significant proportion of statin therapy candidates, lovastatin 20 mg is marketed at the lowest price. Although the individual response to the different statins is highly unpredictable, determining a mandatory empirical molecule- and dose-finding strategy on the single patient, from the societal point of view the choice to start with lower cost molecules, among options that on average are equally-effective, may limit initial drug investment and dampen the impact of resource waste secondary to treatment interruptions and

  19. Treatment of asymptomatic hyperuricemia for the prevention of gouty arthritis, renal disease, and cardiovascular events: a systematic literature review.

    Science.gov (United States)

    Vinik, Ophir; Wechalekar, Mihir D; Falzon, Louise; Buchbinder, Rachelle; van der Heijde, Désirée M; Bombardier, Claire

    2014-09-01

    To systematically review available literature on treatment of hyperuricemia (HU) as a measure of preventing gouty arthritis, renal disease, or cardiovascular events in asymptomatic patients. A systematic literature search was conducted in the Cochrane Library, Medline, Embase, clinical trials registries of the World Health Organization and the US National Institutes of Health, and abstracts from American College of Rheumatology/European League Against Rheumatism meetings, for interventional studies involving adults with no history of gouty arthritis, who were treated for HU. Outcomes of interest included gouty arthritis, renal disease (i.e., renal insufficiency, urate nephropathy, nephrolithiasis), and cardiovascular events (i.e., myocardial infarction, heart failure, ischemic stroke). A total of 3 studies met the inclusion criteria, 2 studies assessing the prevention of renal disease and 1 study evaluating the potential for delaying progression of preexisting renal disease. In hyperuricemic patients without renal disease, treatment resulted in increased estimated glomerular filtration rate. In hyperuricemic patients with preexisting renal disease, treatment resulted in no significant elevation of serum creatinine over a 1-year followup. However, differences in renal function between the treatment and no-treatment groups were not statistically significant in any of the identified studies. Very limited data are available on the treatment of HU in asymptomatic patients. There is currently insufficient empiric evidence to suggest that lowering serum uric acid level in asymptomatic patients with HU can prevent gouty arthritis, renal disease, or cardiovascular events.

  20. Metabolic syndrome and cardiovascular disease following hematopoietic cell transplantation: screening and preventive practice recommendations from CIBMTR and EBMT

    Science.gov (United States)

    DeFilipp, Z; Duarte, RF; Snowden, JA; Majhail, NS; Greenfield, DM; Miranda, JL; Arat, M; Baker, KS; Burns, LJ; Duncan, CN; Gilleece, M; Hale, GA; Hamadani, M; Hamilton, BK; Hogan, WJ; Hsu, JW; Inamoto, Y; Kamble, RT; LupoStanghellini, MT; Malone, AK; McCarthy, P; Mohty, M; Norkin, M; Paplham, P; Ramanathan, M; Richart, JM; Salooja, N; Schouten, HC; Schoemans, H; Seber, A; Steinberg, A; Wirk, BM; Wood, WA; Battiwalla, M; Flowers, MED; Savani, BN; Shawon, BE

    2016-01-01

    Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that increases the risk of cardiovascular disease, diabetes mellitus and all cause mortality. Long-term survivors of hematopoietic cell transplantation (HCT) have a substantial risk of developing MetS and cardiovascular disease, with the estimated prevalence of MetS being 31–49% among HCT recipients. Although MetS has not yet been proven to impact cardiovascular risk after HCT, an understanding of the incidence and risk factors for MetS in HCT recipients can provide the foundation to evaluate screening guidelines and develop interventions that may mitigate cardiovascular-related mortality. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal of reviewing literature and recommend practices appropriate to HCT recipients. Here we deliver consensus recommendations to help clinicians provide screening and preventive care for MetS and cardiovascular disease among HCT recipients. All HCT survivors should be advised of the risks of MetS and encouraged to undergo recommended screening based on their predisposition and ongoing risk factors. PMID:27548466

  1. Nattokinase: An Oral Antithrombotic Agent for the Prevention of Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    Yunqi Weng

    2017-02-01

    Full Text Available Natto, a fermented soybean product, has been consumed as a traditional food in Japan for thousands of years. Nattokinase (NK, a potent blood-clot dissolving protein used for the treatment of cardiovascular diseases, is produced by the bacterium Bacillus subtilis during the fermentation of soybeans to produce Natto. NK has been extensively studied in Japan, Korea, and China. Recently, the fibrinolytic (anti-clotting capacity of NK has been recognized by Western medicine. The National Science Foundation in the United States has investigated and evaluated the safety of NK. NK is currently undergoing a clinical trial study (Phase II in the USA for atherothrombotic prevention. Multiple NK genes have been cloned, characterized, and produced in various expression system studies. Recombinant technology represents a promising approach for the production of NK with high purity for its use in antithrombotic applications. This review covers the history, benefit, safety, and production of NK. Opportunities for utilizing plant systems for the large-scale production of NK, or for the production of edible plants that can be used to provide oral delivery of NK without extraction and purification are also discussed.

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

    Science.gov (United States)

    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

  3. [Preventing cardiovascular diseases through a screening modelling applicable to wide population groups: results from the first phase of the project].

    Science.gov (United States)

    Ferro, Antonio; Cinquetti, Sandro; Moro, Alessandro; Siddu, Andrea; Trimarchi, Antonino; Penon, Maria Gabriella; Pavan, Pierpaolo; Camillotto, Raffaella; Rossetto, Luca; Volpe, Valter; Zevrain, Simone; Brusaferro, Silvio

    2014-01-01

    evaluate, through active call, lifestyles of an asymptomatic population in order to identify hyperglycaemic subjects and/or high-blood pressure sufferers to dispatch to their GP to perform suitable checking, and subjects to invite to a cardiovascular disease prevention programme because of their lifestyles. between January 2009 and July 2012, all healthy residents in the Local Health Authority of Este (ULSS 17 Este) aged 45-59 years were invited to join a cardiovascular disease prevention programme. all participants were evaluated through an administered lifestyle questionnaire. Parameters such as blood pressure (BP), glycaemia, waist circumference and body mass index were collected and recorded. Participants also received counseling, informational materials on lifestyle and were invited to individual or group health promotion initiatives in relation to personal risk factors. among the invited, 55.5% (3,922/7,071) adhered. Women (58.8%) responded significantly better than men (51.9%) (p diseases.

  4. Primary prevention of cardiovascular disease in Greece: Greek results of the EURIKA study.

    Science.gov (United States)

    Elisaf, Moses; Tzouvelekis, Emmanouil; Nikas, Nikos

    2014-01-01

    The EURIKA study was designed to describe the control of cardiovascular disease (CVD) risk factors in a real-world primary prevention setting in Europe, to estimate residual CVD risk, and to assess physicians' attitudes to and perceptions of risk factor management. The present manuscript reports the EURIKA results from Greece. EURIKA was a multinational, cross-sectional study conducted in 12 European countries. Randomly selected physicians completed a questionnaire regarding their demographics and CVD prevention beliefs and practices. Consenting patients who were free of CVD, aged 50 years, and with 1 CVD risk factor, were recruited. Risk factor definition and treatment goals were based on the 2007 European guidelines on CVD prevention. Global CVD risk was estimated using the SCORE equation. In addition, each patient provided a fasting blood sample for measurement of serum lipids, and HbA1c. Overall, 620 evaluable patients (male/female 46%/54%) were enrolled by 63 physicians (13 hospital-based, 50 office-based) across Greece. Almost one-third of the patients (27.3%) were classified as highrisk (SCORE5%). Blood pressure, dyslipidaemia and diabetes were controlled in 47.5%, 37.4% and 43.8% of the population who were treated for the respective risk factors, with more than one-fourth of the controlled patients remaining at high risk. The ESC 2007 and ESC/ESH 2007 guidelines were the most popular (44.4% and 38.1% respectively), while the ESC/ESH tool was most frequently reported to be used by physicians for global CVD risk calculation (42%), followed by SCORE (36%), and Framingham (36%). The major barriers to the use of guidelines and risk calculation tools were the plethora of guidelines and time constraints (87.5% and 69.2% respectively). Control of key CVD risk factors appears to be suboptimal in primary prevention patients in Greece, with a remarkable proportion of controlled patients remaining at high risk. Although guidelines and global risk calculation tools are

  5. Formalized Combined 2003 European Guidelines on Cardiovascular Disease Prevention and Hypertension

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Anger, Z.; Buchtela, David; Tomečková, Marie; Veselý, Arnošt; Zvárová, Jana

    23 Suppl. 2, - (2005), s. 196 ISSN 0263-6352. [European Meeting on Hypertension /15./. 17.06.2005-21.06.2005, Milan] R&D Projects: GA AV ČR 1ET200300413 Institutional research plan: CEZ:AV0Z10300504 Keywords : European medical guidelines * formalization of combined guidelines Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  6. PCSK9 monoclonal antibodies for the primary and secondary prevention of cardiovascular disease

    NARCIS (Netherlands)

    Schmidt, Amand F.; Pearce, Lucy S.; Wilkins, John T.; Overington, John P.; Hingorani, Aroon D.; Casas, Juan P.

    2017-01-01

    Background Despite the availability of effective drug therapies that reduce low-density lipoprotein (LDL)-cholesterol (LDL-C), cardiovascular disease (CVD) remains an important cause of mortality and morbidity. Therefore, additional LDL-C reduction may be warranted, especially for patients who are

  7. Role of physical activity in cardiovascular disease prevention in older adults

    NARCIS (Netherlands)

    Lillo, Nicolás; Palomo-Vélez, Gonzalo; Fuentes, Eduardo; Palomo, Iván

    2015-01-01

    According to the World Health Organization, cardiovascular diseases (CVD) will account for around 30 % of deaths worldwide by 2020 with a relative increase over time due to population aging. In addition, the lifestyles of populations today contribute to the development of risk factors for CVD, such

  8. Epidemiological evidence for beta-carotene in prevention of cancer and cardiovascular disease

    NARCIS (Netherlands)

    Poppel, G. van

    1996-01-01

    Objective and conclusions: This article gives an overview of observational and experimental epidemiological studies relating β-carotene to risk of cancer and cardiovascular disease. Observational epidemiological studies have consistently shown that a diet rich in β-carotenerich fruits and vegetables

  9. Aspirin in the prevention of cardiovascular disease in type 2 diabetes

    NARCIS (Netherlands)

    Hovens, Marcel Maria Christiaan

    2010-01-01

    In the first of this thesis, results are summarized of a randomised crossover trial on the effects of aspirin on markers of inflammation, coagulation and number of endothelial progenitor cells in type 2 diabetic patients without cardiovascular disease. In the second part, results of two systematic

  10. Targeting Obesity for the Prevention of Chronic Cardiovascular Disease Through Gut Microbiota-Herb Interactions: An Opportunity for Traditional Herbs.

    Science.gov (United States)

    Chen, Feng; Jiang, Jun; Tian, Dan-Dan; Wen, Qi; Li, Yong-Hui; Zhang, Jun-Qing; Cheng, Chen; Wang, Tengfei

    2017-01-01

    Cardiovascular disease still remains the primary cause of death worldwide and obesity is becoming recognized as one of the most critical contributing risk factors. The increased prevalence of obesity casts a cloud over the global health and the whole societies and will still be burdened in the future. Therefore, prevention and therapy of obesity is a beneficial strategy for the prevention of chronic cardiovascular disease. Numerous studies have demonstrated that gut microbiota takes part in human health and disease including obesity. Traditional herbs hold great potential to improve people's health and wellness, particularly in the area of chronic inflammatory diseases although the mechanisms of action remain poorly understood. Emerging explorations of gut microbiotaherb interactions provide a potential to revolutionize the way we view herbal therapeutics. This review summarizes the experimental studies performed on animals and humans regarding the gut microbiota-herb interactions targeting obesity. This review also discusses the opportunity of herbs with potent activities but low oral bioavailability conundrum for prevention and therapy for obesity and related cardiovascular disease. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  11. Cardiovascular risk factors, burden of disease and preventive strategies in patients with systemic lupus erythematosus: a literature review.

    Science.gov (United States)

    Benvenuti, Francesco; Gatto, Mariele; Larosa, Maddalena; Iaccarino, Luca; Punzi, Leonardo; Doria, Andrea

    2015-01-01

    Risk of developing cardiovascular disease (CVD) is increased in systemic lupus erythematosus (SLE) compared with the general population. Traditional risk factors cannot account for the totality of CV events and adequate prevention may be challenging. This review summarizes traditional and emerging risk factors of CVD in SLE patients and goes over potential pathogenic mechanisms involved in CVD development. Role of commonly used drugs and preventive strategies exploitable in everyday clinical practice are also discussed. SLE-related risk factors involve both disease- and treatment-related features, including disease activity, disease phenotype, corticosteroid misuse and alterations of innate and adaptive immunity. Primary prevention is mandatory in management of lupus patients through appropriate disease control, corticosteroid tapering, use of antimalarials and eventually vitamin D supplementation.

  12. Functional Foods and Nutraceuticals in the Primary Prevention of Cardiovascular Diseases

    OpenAIRE

    Alissa, Eman M.; Ferns, Gordon A.

    2012-01-01

    Cardiovascular disease (CVD) is now the leading cause of death globally and is a growing health concern. Dietary factors are important in the pathogenesis of CVD and may to a large degree determine CVD risk, but have been less extensively investigated. Functional foods are those that are thought to have physiological benefits and/or reduce the risk of chronic disease beyond their basic nutritional functions. The food industry has started to market products labelled as “functional foods.” Alth...

  13. Aspirin and omeprazole for secondary prevention of cardiovascular disease in patients at risk for aspirin-associated gastric ulcers.

    Science.gov (United States)

    García-Rayado, Guillermo; Sostres, Carlos; Lanas, Angel

    2017-08-01

    Cardiovascular disease is the most important cause of morbidity and mortality in the world and low-dose aspirin is considered the cornerstone of the cardiovascular disease prevention. However, low-dose aspirin use is associated with gastrointestinal adverse effects in the whole gastrointestinal tract. In this setting, co-therapy with a proton pump inhibitor is the most accepted strategy to reduce aspirin related upper gastrointestinal damage. In addition, some adverse effects have been described with proton pump inhibitors long term use. Areas covered: Low-dose aspirin related beneficial and adverse effects in cardiovascular system and gastrointestinal tract are reviewed. In addition, this manuscript summarizes current data on upper gastrointestinal damage prevention and adverse events with proton pump inhibition. Finally, we discuss the benefit/risk ratio of proton pump inhibitor use in patients at risk of gastrointestinal damage taking low-dose aspirin. Expert commentary: Nowadays, with the current available evidence, the combination of low-dose aspirin with proton pump inhibitor is the most effective therapy for cardiovascular prevention in patients at high gastrointestinal risk. However, further studies are needed to discover new effective strategies with less related adverse events.

  14. Seaweeds as Preventive Agents for Cardiovascular Diseases: From Nutrients to Functional Foods

    Directory of Open Access Journals (Sweden)

    Susana M. Cardoso

    2015-11-01

    Full Text Available Being naturally enriched in key nutrients and in various health-promoting compounds, seaweeds represent promising candidates for the design of functional foods. Soluble dietary fibers, peptides, phlorotannins, lipids and minerals are macroalgae’s major compounds that can hold potential in high-value food products derived from macroalgae, including those directed to the cardiovascular-health promotion. This manuscript revises available reported data focusing the role of diet supplementation of macroalgae, or extracts enriched in bioactive compounds from macroalgae origin, in targeting modifiable markers of cardiovascular diseases (CVDs, like dyslipidemia, oxidative stress, vascular inflammation, hypertension, hypercoagulability and activation of the sympathetic and renin-angiotensin systems, among others. At last, the review also describes several products that have been formulated with the use of whole macroalgae or extracts, along with their claimed cardiovascular-associated benefits.

  15. Seaweeds as Preventive Agents for Cardiovascular Diseases: From Nutrients to Functional Foods

    Science.gov (United States)

    Cardoso, Susana M.; Pereira, Olívia R.; Seca, Ana M. L.; Pinto, Diana C. G. A.; Silva, Artur M. S.

    2015-01-01

    Being naturally enriched in key nutrients and in various health-promoting compounds, seaweeds represent promising candidates for the design of functional foods. Soluble dietary fibers, peptides, phlorotannins, lipids and minerals are macroalgae’s major compounds that can hold potential in high-value food products derived from macroalgae, including those directed to the cardiovascular-health promotion. This manuscript revises available reported data focusing the role of diet supplementation of macroalgae, or extracts enriched in bioactive compounds from macroalgae origin, in targeting modifiable markers of cardiovascular diseases (CVDs), like dyslipidemia, oxidative stress, vascular inflammation, hypertension, hypercoagulability and activation of the sympathetic and renin-angiotensin systems, among others. At last, the review also describes several products that have been formulated with the use of whole macroalgae or extracts, along with their claimed cardiovascular-associated benefits. PMID:26569268

  16. Mendelian Randomization Analyses for Selection of Therapeutic Targets for Cardiovascular Disease Prevention: a Note of Circumspection.

    Science.gov (United States)

    Rosenson, Robert S; Koenig, Wolfgang

    2016-02-01

    Genetic factors identified from genome-wide association studies have been used to understand causative variants for complex diseases. Studies conducted on large populations of individuals from many geographical regions have provided insights into genetic pathways involved in the causal pathway for atherosclerotic cardiovascular disease. A single genetic trait may ineffectively evaluate the pathway of interest, and it may not account for other complementary genetic pathways that may be activated at various stages of the disease process or evidence-based therapies that alter the molecular and cellular milieu.

  17. Vitamin D for the prevention of cardiovascular disease: Are we ready for that?

    Science.gov (United States)

    Carvalho, Luiz Sergio F; Sposito, Andrei C

    2015-08-01

    A general concept of clinical benefit of vitamin D supplementation has emerged from the evidence in prevention of osteoporosis. From the cardiovascular point of view, clinical benefit of such supplementation remains less clear. Studies in vitro and in animal models demonstrated the expression of vitamin D receptors in endothelial cells, vascular smooth muscle and cardiomyocytes. Vitamin D has been directly implicated in endothelium-mediated vasodilation, anti-coagulant activity and inhibition of the inflammatory response. Indirectly, it may favor the reduction of blood pressure, myocardial hypertrophy and ventricular arrhythmias. In contrast to these mechanistic findings, cross-sectional, longitudinal and small clinical trials have not been consistent in demonstrating association between cardiovascular events and vitamin D. Besides, methodological issues in the tests for serum levels of vitamin D may also contribute to this puzzle. Hence, in the current state of knowledge, it may be too early to consider or to rule out vitamin D as a tool to either estimate or mitigate residual cardiovascular risk. In this review, we discuss recent advances and potential limitations in mechanistic and clinical evidences that are outlining the framework of interaction between vitamin D and cardiovascular risk. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Aspirin prescribing patterns for primary prevention of cardiovascular disease in geriatric patients with diabetes: Survey of prescribers based on experience

    OpenAIRE

    Lianne Kokoska, PharmD; Dana El Masri, BS; Helen Berlie, PharmD, CDE; Candice Garwood, PharmD, FCCP, BCPS

    2016-01-01

    Evidence and guidelines provide conflicting recommendations regarding the use of aspirin for primary prevention of cardiovascular disease, particularly in geriatric patients with diabetes. The objective of this study is to identify aspirin-prescribing patterns and determine if it is consistent with the 2013 American Diabetes Association and American Geriatrics Association guidelines. A survey was distributed to attending physicians, fellow physicians, and mid-level practitioners in internal m...

  19. Inequalities in the use of secondary prevention of cardiovascular disease by socioeconomic status: evidence from the PURE observational study

    Directory of Open Access Journals (Sweden)

    Adrianna Murphy, PhD

    2018-03-01

    Full Text Available Summary: Background: There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development. Methods: We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from −1 (pro-poor to 1 (pro-rich, standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated. Findings: The proportion of patients with cardiovascular disease on three medications ranged from 0% in South Africa (95% CI 0–1·7, Tanzania (0–3·6, and Zimbabwe (0–5·1, to 49·3% in Canada (44·4–54·3. Proportions receiving at least one drug varied from 2·0% (95% CI 0·5–6·9 in Tanzania to 91·4% (86·6–94·6 in Sweden. There was significant (p<0·05 pro-rich inequality in Saudi Arabia, China, Colombia, India, Pakistan, and Zimbabwe. Pro-poor distributions were observed in Sweden, Brazil, Chile, Poland, and the occupied Palestinian territory. The strongest predictors of inequality were public expenditure on health and overall use of secondary prevention medicines. Interpretation: Use of medication for secondary prevention of cardiovascular disease is alarmingly low. In many countries with the lowest use, pro-rich inequality is greatest. Policies associated with an equal or pro-poor distribution include free medications and community health programmes to support adherence to medications. Funding: Full funding sources listed at the end of the paper (see Acknowledgments.

  20. From genome-wide association studies to Mendelian randomization: Novel opportunities for understanding cardiovascular disease causality, pathogenesis, prevention, and treatment.

    Science.gov (United States)

    Benn, Marianne; Nordestgaard, Børge G

    2018-02-19

    The Mendelian randomization approach is an epidemiologic study design incorporating genetic information into traditional epidemiologic studies to infer causality of biomarkers, risk factors, or lifestyle factors on disease risk. Mendelian randomization studies often draw on novel information generated in genome-wide association studies on causal associations between genetic variants and a risk factor or lifestyle factor. Such information can then be used in a largely unconfounded study design free of reverse causation to understand if and how risk factors and lifestyle factors cause cardiovascular disease. If causation is demonstrated, an opportunity for prevention of disease is identified; importantly however, before prevention or treatment can be implemented, randomized intervention trials altering risk factor levels or improving deleterious lifestyle factors needs to document reductions in cardiovascular disease in a safe and side-effect sparse manner. Documentation of causality can also inform on potential drug targets, more likely to be successful than prior approaches often relying on animal or cell studies mainly.The present review summarizes the history and background of Mendelian randomization, the study design, assumptions for using the design, and the most common caveats, followed by a discussion on advantages and disadvantages of different types of Mendelian randomization studies using one or more samples and different levels of information on study participants. The review also provides an overview of results on many of the risk factors and lifestyle factors for cardiovascular disease examined to date using the Mendelian randomization study design.

  1. Mixed methods evaluation of targeted case finding for cardiovascular disease prevention using a stepped wedged cluster RCT

    Directory of Open Access Journals (Sweden)

    Marshall Tom

    2012-10-01

    Full Text Available Abstract Background A pilot project cardiovascular prevention was implemented in Sandwell (West Midlands, UK. This used electronic primary care records to identify untreated patients at high risk of cardiovascular disease then invited these high risk patients for assessment by a nurse in their own general practice. Those found to be eligible for treatment were offered treatment. During the pilot a higher proportion of high risk patients were started on treatment in the intervention practices than in control practices. Following the apparent success of the prevention project, it was intended to extend the service to all practices across the Sandwell area. However the pilot project was not a robust evaluation. There was a need for an efficient evaluation that would not disrupt the planned rollout of the project. Methods/design Project nurses will sequentially implement targeted cardiovascular case finding in a phased way across all general practices, with the sequence of general practices determined randomly. This is a stepped wedge randomised controlled trial design. The target population is patients aged 35 to 74, without diabetes or cardiovascular disease whose ten-year cardiovascular risk, (determined from data in their electronic records is ≥20%. The primary outcome is the number of high risk patients started on treatment, because these data could be efficiently obtained from electronic primary care records. From this we can determine the effects of the case finding programme on the proportion of high risk patients started on treatment in practices before and after implementation of targeted case finding. Cost-effectiveness will be modelled from the predicted effects of treatments on cardiovascular events and associated health service costs. Alongside the implementation it is intended to interview clinical staff and patients who participated in the programme in order to determine acceptability to patients and clinicians. Practical

  2. High-Intensity Interval Training Versus Moderate-Intensity Continuous Training in the Prevention/Management of Cardiovascular Disease.

    Science.gov (United States)

    Hussain, Syed R; Macaluso, Andrea; Pearson, Stephen J

    Moderate-intensity continuous training (MICT) has long been considered the most effective exercise treatment modality for the prevention and management of cardiovascular disease (CVD), but more recently high-intensity interval training (HIIT) has been viewed as a potential alternative to MICT in accruing such benefits. HIIT was initially found to induce significant improvements in numerous physiological and health-related indices, to a similar if not superior extent to MICT. Since then, many studies have attempted to explore the potential clinical utility of HIIT, relative to MICT, with respect to treating numerous cardiovascular conditions, such as coronary artery disease, heart failure, stroke, and hypertension. Despite this, however, the efficacy of HIIT in reversing the specific symptoms and risk factors of these cardiovascular pathologies is not well understood. HIIT is often perceived as very strenuous, which could render it unsafe for those at risk of or afflicted with CVD, but these issues are also yet to be reviewed. Furthermore, the optimal HIIT protocol for each of the CVD cohorts has not been established. Thus, the purpose of this review article is to (1) evaluate the efficacy of HIIT relative to MICT in the prevention and management of cardiovascular conditions, and (2) explore any potential safety issues surrounding the suitability and/or tolerability of HIIT for patients with CVD, and the potential optimal prescriptive variables of HIIT for application in the clinical environment.

  3. [Prevention of cardiovascular diseases by an antihypertensive program in the elderly, a cohort study].

    Science.gov (United States)

    Díaz, J; Achilli, F; Figar, S; Waisman, G; Langlois, E; Galarza, C; Camera, L; González B de Quirós, F

    2005-04-01

    We started on year 2000 a Complex Intervention Program addressed at hypertension control among our patients. To compare the risk of cardiovascular events and of dying in hypertensive patients under Program care. We started follow-up of a cohort of 1922 patients over 65 years in August 2000. Hipertension diagnosis was ascertained if patient reported to be hypertensive, or was under anti hypertensive treatment or if he/she had two blood pressure measurements = 140/90 mm Hg. Cardiovascular events were considered to be admissions due to coronary disease, cardiac insufficiency or stroke. Incidence is reported by 100 person years follow-up. Relative risks between hypertensive and normotensive patients were calculated and Cox regresión was used to adjust for potential confounders. We compared time to first cardiovascular event and to death with Log Rank Test. Fourty eight point three percent of patients were hypertensive and differed from normotensive patients as to age (79 (5) years vs. 77 (5) p dislipemia and diabetes, OR was 1.3 (95% CI 0.86-1.98). Hypertension did not increase the risk in cardiovascular events among our hypertensive patients at 2.3 years follow-up.

  4. Healthy lifestyle in the primordial prevention of cardiovascular disease among young women.

    Science.gov (United States)

    Chomistek, Andrea K; Chiuve, Stephanie E; Eliassen, A Heather; Mukamal, Kenneth J; Willett, Walter C; Rimm, Eric B

    2015-01-06

    Overall mortality rates from coronary heart disease (CHD) in the United States have declined in recent decades, but the rate has plateaued among younger women. The potential for further reductions in mortality rates among young women through changes in lifestyle is unknown. The aim of this study was to estimate the proportion of CHD cases and clinical cardiovascular disease (CVD) risk factors among young women that might be attributable to poor adherence to a healthy lifestyle. A prospective analysis was conducted among 88,940 women ages 27 to 44 years at baseline in the Nurses' Health Study II who were followed from 1991 to 2011. Lifestyle factors were updated repeatedly by questionnaire. A healthy lifestyle was defined as not smoking, a normal body mass index, physical activity ≥ 2.5 h/week, television viewing ≤ 7 h/week, diet in the top 40% of the Alternative Healthy Eating Index-2010, and 0.1 to 14.9 g/day of alcohol. To estimate the proportion of CHD and clinical CVD risk factors (diabetes, hypertension, and hypercholesterolemia) that could be attributed to poor adherence to a healthy lifestyle, we calculated the population-attributable risk percent. During 20 years of follow-up, we documented 456 incident CHD cases. In multivariable-adjusted models, nonsmoking, a healthy body mass index, exercise, and a healthy diet were independently and significantly associated with lower CHD risk. Compared with women with no healthy lifestyle factors, the hazard ratio for CHD for women with 6 lifestyle factors was 0.08 (95% confidence interval: 0.03 to 0.22). Approximately 73% (95% confidence interval: 39% to 89%) of CHD cases were attributable to poor adherence to a healthy lifestyle. Similarly, 46% (95% confidence interval: 43% to 49%) of clinical CVD risk factor cases were attributable to a poor lifestyle. Primordial prevention through maintenance of a healthy lifestyle among young women may substantially lower the burden of CVD. Copyright © 2015 American College

  5. Can oral vitamin D prevent the cardiovascular diseases among migrants in Australia? Provider perspective using Markov modelling.

    Science.gov (United States)

    Ruwanpathirana, Thilanga; Owen, Alice; Renzaho, Andre M N; Zomer, Ella; Gambhir, Manoj; Reid, Christopher M

    2015-06-01

    The study was designed to model the effectiveness and cost effectiveness of oral Vitamin D supplementation as a primary prevention strategy for cardiovascular disease among a migrant population in Australia. It was carried out in the Community Health Service, Kensington, Melbourne. Best-case scenario analysis using a Markov model was employed to look at the health care providers' perspective. Adult migrants who were vitamin D deficient and free from cardiovascular disease visiting the medical centre at least once during the period from 1 January 2010 to 31 December 2012 were included in the study. The blood pressure-lowering effect of vitamin D was taken from a published meta-analysis and applied in the Framingham 10 year cardiovascular risk algorithm (with and without oral vitamin D supplements) to generate the probabilities of cardiovascular events. A Markov decision model was used to estimate the provider costs associated with the events and treatments. Uncertainties were derived by Monte Carlo simulation. Vitamin D oral supplementation (1000 IU/day) for 10 years could potentially prevent 31 (interquartile range (IQR) 26 to 37) non-fatal and 11 (IQR 10 to 15) fatal cardiovascular events in a migrant population of 10,000 assuming 100% compliance. The provider perspective incremental cost effectiveness per year of life saved was AU$3,992 (IQR 583 to 8558). This study suggests subsidised supplementation of oral vitamin D may be a cost effective intervention to reduce non-fatal and fatal cardiovascular outcomes in high-risk migrant populations. © 2015 Wiley Publishing Asia Pty Ltd.

  6. Effectiveness of programmes as part of primary prevention demonstrated on the example of cardiovascular diseases and the metabolic syndrome.

    Science.gov (United States)

    Korczak, Dieter; Dietl, Markus; Steinhauser, Gerlinde

    2011-04-01

    The HTA-report (HTA = Health Technology Assessment) deals with the primary prevention of cardiovascular diseases and diabetes mellitus type 2. In 2009 approximately 356,000 people died in Germany due to cardiovascular diseases. According to estimations about 6.3 million people are suffering from diabetes mellitus type 2. The interventions that are subsidized by the public health insurance are mainly focused on sufficient physical activities, healthy nutrition, stress management and the reduction of the consumption of addictive drugs and luxury food. Which lifestyle-related measures and/or programmes for primary prevention of cardiovascular diseases and of the metabolic syndrome are effective? To what extent will the health status be improved by these offers? To what extent will existing health resources and skills be strengthened by these offers? Are there any differences regarding the effectiveness among the interventions with respect to different settings or subgroups? Which lifestyle-related interventions and/or programmes for primary prevention of cardiovascular diseases and of the metabolic syndrome are sustainable and cost-effective? Which outcome parameters are in the view of the contributors decisive for the evaluation of the effectiveness? In the view of the contributor are there different values between the outcome parameters? In the view of the payers and other actors are there different values between the outcome parameters? Which ethical and juridical factors have to be considered? Which social and/or socio-economic parameters influence the use of the services and effectiveness? A systematic literature research is done in 35 databases. For the period 2005 to 2010, reviews, epidemiological and clinical studies as well as economical evaluations which deal with primary prevention programmes regarding cardiovascular diseases or the metabolic syndrome are included. 44 publications meet the inclusion criteria. These studies confirm the effectiveness of the

  7. Effectiveness of programmes as part of primary prevention demonstrated on the example of cardiovascular diseases and the metabolic syndrome

    Directory of Open Access Journals (Sweden)

    Korczak, Dieter

    2011-01-01

    Full Text Available Background: The HTA-report (HTA = Health Technology Assessment deals with the primary prevention of cardiovascular diseases and diabetes mellitus type 2. In 2009 approximately 356,000 people died in Germany due to cardiovascular diseases. According to estimations about 6.3 million people are suffering from diabetes mellitus type 2. The interventions that are subsidized by the public health insurance are mainly focused on sufficient physical activities, healthy nutrition, stress management and the reduction of the consumption of addictive drugs and luxury food. Objectives: Which lifestyle-related measures and/or programmes for primary prevention of cardiovascular diseases and of the metabolic syndrome are effective? To what extent will the health status be improved by these offers? To what extent will existing health resources and skills be strengthened by these offers? Are there any differences regarding the effectiveness among the interventions with respect to different settings or subgroups? Which lifestyle-related interventions and/or programmes for primary prevention of cardiovascular diseases and of the metabolic syndrome are sustainable and cost-effective? Which outcome parameters are in the view of the contributors decisive for the evaluation of the effectiveness? In the view of the contributor are there different values between the outcome parameters? In the view of the payers and other actors are there different values between the outcome parameters? Which ethical and juridical factors have to be considered? Which social and/or socio-economic parameters influence the use of the services and effectiveness? Methods: A systematic literature research is done in 35 databases. For the period 2005 to 2010, reviews, epidemiological and clinical studies as well as economical evaluations which deal with primary prevention programmes regarding cardiovascular diseases or the metabolic syndrome are included. Results: 44 publications meet the

  8. ECONOMIC EFFICIENCY OF THE IMPLEMENTATION OF THE PROGRAM OF CARDIOVASCULAR DISEASES MULTIFACTORIAL PREVENTION IN THE ORGANIZED COLLECTIVE OF TECHNICAL RESEARCH INSTITUTE

    Directory of Open Access Journals (Sweden)

    A. V. Kontsevaya

    2010-01-01

    Full Text Available Aim. To estimate economic efficiency of a complex of resource-saving activities for cardiovascular diseases prevention at a workplace.Material and methods. The complex of activities including preventive examination and preventive intervention with their efficacy monitoring was performed in 523 people of a technical research institute staff. Preventive examination included evaluation procedures for cardiovascular diseases and their risk factors (89,5% of respondents. Preventive intervention based on risk factors modification was performed in intervention group. Control group included staff not participating in preventive consultation. Costs associated with cardiovascular diseases and risk factors (medical care consumption and temporary disability and cost- efficiency analysis was performed.Results. High prevalence of arterial hypertension, metabolic and psychoemotional risk factors at workplace was found in preventive examination. Significant reduction in blood pressure (BP and total cholesterol (TC plasma level as well as a tendency to cardiovascular risk (CVR decrease was reached due to preventive intervention. Costs associated with cardiovascular diseases and their risk factors in intervention group were lower than these in control group (168 584 and 489 500 rbl per 100 people yearly, respectively. Cost- efficiency analysis shown that costs of BP, TC plasma level and CVR reduction were moderate in intervention group. Costs were not efficient in control group.Conclusion. Implementation of cardiovascular diseases prevention at workplace is economically efficient both for society and for employer.

  9. Cardiovascular Prevention of Cognitive Decline

    Directory of Open Access Journals (Sweden)

    Jean-Jacques Monsuez

    2011-01-01

    Full Text Available Midlife cardiovascular risk factors, including diabetes, hypertension, dyslipemia, and an unhealthy lifestyle, have been linked to subsequent incidence, delay of onset, and progression rate of Alzheimer disease and vascular dementia. Conversely, optimal treatment of cardiovascular risk factors prevents and slows down age-related cognitive disorders. The impact of antihypertensive therapy on cognitive outcome in patients with hypertension was assessed in large trials which demonstrated a reduction in progression of MRI white matter hyperintensities, in cognitive decline and in incidence of dementia. Large-scale database correlated statin use and reduction in the incidence of dementia, mainly in patients with documented atherosclerosis, but clinical trials failed to reach similar conclusions. Whether a multitargeted intervention would substantially improve protection, quality of life, and reduce medical cost expenditures in patients with lower risk profile has not been ascertained. This would require appropriately designed trials targeting large populations and focusing on cognitive decline as a primary outcome endpoint.

  10. The Implication of Coronary Artery Calcium Testing for Cardiovascular Disease Prevention and Diabetes

    Directory of Open Access Journals (Sweden)

    Ron Blankstein

    2017-03-01

    Full Text Available Over the last two decades coronary artery calcium (CAC scanning has emerged as a quick, safe, and inexpensive method to detect the presence of coronary atherosclerosis. Data from multiple studies has shown that compared to individuals who do not have any coronary calcifications, those with severe calcifications (i.e., CAC score >300 have a 10-fold increase in their risk of coronary heart disease events and cardiovascular disease. Conversely, those that have a CAC of 0 have a very low event rate (~0.1%/year, with data that now extends to 15 years in some studies. Thus, the most notable implication of identifying CAC in individuals who do not have known cardiovascular disease is that it allows targeting of more aggressive therapies to those who have the highest risk of having future events. Such identification of risk is especially important for individuals who are not on any therapies for coronary heart disease, or when intensification of treatment is being considered but has an uncertain role. This review will highlight some of the recent data on CAC testing, while focusing on the implications of those findings on patient management. The evolving role of CAC in patients with diabetes will also be highlighted.

  11. Weight management in African-Americans using church-based community interventions to prevent type 2 diabetes and cardiovascular disease.

    Science.gov (United States)

    Thompson, Elizabeth; Berry, Diane; Nasir, Laura

    2009-07-01

    The purpose of this literature review was to examine the utilization of church-based interventions designed for African-Americans in the community for the management of overweight and obesity and prevention of type 2 diabetes and cardiovascular disease. PubMed, CINAHL, and Google scholar were searched using the following key search terms: type 2 diabetes, cardiovascular disease, prevention, management, African-Americans, Blacks, weight loss, weight management, church-based interventions, community interventions, faith-based interventions, and prayer. Sixteen primary studies were located and six met inclusion criteria. The studies were separated into two categories: faith-placed interventions or collaborative interventions. The overall results demonstrated significant weight loss ranging from 2.3 (SD = 4.1) pounds to 10.1 (SD = 10.3) pounds post-intervention. Further research is needed to understand interventions that are church-based and culturally sensitive for African-Americans. Weight management is important in order to decrease the morbidity and mortality related to type 2 diabetes and cardiovascular disease in the African-American population.

  12. Beliefs among black and white adults about causes and prevention of cardiovascular disease: the Minnesota Heart Survey.

    Science.gov (United States)

    Folsom, A R; Sprafka, J M; Luepker, R V; Jacobs, D R

    1988-01-01

    We assessed beliefs about the symptoms, causes, and prevention of cardiovascular disease in population-based surveys of black and white Twin Cities adults in 1985-86. Whites had a generally higher awareness of heart attack symptoms than did blacks; 72% of blacks and 85% of whites mentioned chest pain as a likely symptom. Sixty-five percent of blacks and 76% of whites correctly offered at least one of the three major, modifiable risk factors (smoking, hypertension, and high cholesterol in blood or diet) as likely causes of cardiovascular disease. However, less than 5% of respondents mentioned all three major risk factors. The most frequent response offered as a cause was stress/worry (54% of blacks, 51% of whites). Individuals with higher educational levels generally responded more correctly than those with less education. After accounting for differences in educational level, blacks demonstrated a higher awareness of hypertension as a risk factor, whereas whites were more knowledgeable about smoking and cholesterol. In light of the high percentage of adults still lacking awareness about cardiovascular risk, public education about prevention should continue. Such efforts are broadly desirable but may be most effectively targeted toward minorities and groups with less education, in whom awareness is low and risk of disease is high.

  13. Lipid measures and cardiovascular disease prediction

    NARCIS (Netherlands)

    van Wijk, D.F.; Stroes, E.S.G.; Kastelein, J.J.P.

    2009-01-01

    Traditional lipid measures are the cornerstone of risk assessment and treatment goals in cardiovascular prevention. Whereas the association between total, LDL-, HDL-cholesterol and cardiovascular disease risk has been generally acknowledged, the rather poor capacity to distinguish between patients

  14. Cardiovascular mortality: how can it be prevented?

    Science.gov (United States)

    Estruch, Ramón

    2014-01-01

    The first step in the prevention and treatment of many chronic diseases such as cardiovascular diseases is to follow a healthy diet. Several epidemiological studies have observed that following a traditional Mediterranean diet reduces overall and cardiovascular mortality, as well as the incidence of chronic diseases such as cardiovascular diseases, cancer and neurodegenerative diseases. However, up to now, only one study has analysed the effects of the Mediterranean diet on the primary prevention of cardiovascular disease, the PREDIMED (PREvención con DIeta MEDiterránea) study. This trial included 7447 high vascular risk individuals who were randomly divided into three dietary intervention groups: Mediterranean diet supplemented with extra-virgin olive oil, Mediterranean diet supplemented with nuts, and a control diet (low in all types of fat). Analyses of intermediate markers demonstrated beneficial effects of the Mediterranean diet on blood pressure, lipid profile, lipoprotein particles, oxidative stress and inflammation markers and carotid atherosclerosis. However, the most important finding was the 30% reduction in the relative risk of major cardiovascular complications (heart attack, stroke and cardiovascular mortality) in both Mediterranean diet groups compared to those who followed a low-fat diet. The results of the PREDIMED trial demonstrate that a high unsaturated fat, antioxidant and anti-inflammatory diet plan such as the Mediterranean diet is a useful tool in reducing overall mortality and in preventing cardiovascular disease.

  15. Cardiovascular disease and the potential protective role of ...

    African Journals Online (AJOL)

    STORAGESEVER

    2009-07-20

    Jul 20, 2009 ... paper reports on cardiovascular disease, its associated risk factors and the potential protective role of antioxidants in the ... Key words: antioxidants, cardiovascular disease, risk factors, preventative, epidemiology. INTRODUCTION AND ..... associated with reduced risk of developing cardiovascular disease.

  16. Healthy Ageing Through Internet Counselling in the Elderly: the HATICE randomised controlled trial for the prevention of cardiovascular disease and cognitive impairment

    NARCIS (Netherlands)

    Richard, E.; Jongstra, S.; Soininen, H.; Brayne, C.; Moll van Charante, E.P.; Meiller, Y.; Groep, B. van der; Beishuizen, C.R.; Mangialasche, F.; Barbera, M.; Ngandu, T.; Coley, N.; Guillemont, J.; Savy, S.; Dijkgraaf, M.G.; Peters, R.J.; Gool, W.A. van; Kivipelto, M.; Andrieu, S.

    2016-01-01

    INTRODUCTION: Cardiovascular disease and dementia share a number of risk factors including hypertension, hypercholesterolaemia, smoking, obesity, diabetes and physical inactivity. The rise of eHealth has led to increasing opportunities for large-scale delivery of prevention programmes encouraging

  17. 74. Cardiovascular risk assessment for Saudi university employees and their families: Developing a framework for provision of an evidence-based cardiovascular disease preventative programme

    Directory of Open Access Journals (Sweden)

    R. Alzeidan

    2016-07-01

    Full Text Available In the Kingdom of Saudi Arabia (KSA, cardiovascular diseases (CVDs are the primary cause of death among adults, representing 46% of total mortality in 2014. This study’s objectives were to assess the prevalence of cardiovascular risk factors (CVRFs, and calculate the cardiovascular risk (CVR among King Saud University employees and their families. Moreover, it aimed at assessing the possible effects of living in KSA on the heart health of expatriate employees and their families. A cross-sectional study was conducted on 4500 university employees and their families aged ⩾18 years old, using the World Health Organization STEPwise approach to surveillance of CVRFs. CVR was then calculated for participants using the Framingham Coronary Heart Risk Score calculator. The mean age of participants was 39.3 ± 13.4 years. The prevalence of CVRFs was as follows: low fruit/vegetable consumption of 10% risk to develop CVD within the following 10-years. Furthermore, this study showed that expatriates had significant negative effects on behavioural risk factors after residing in KSA, namely: high rate of physical inactivity, high consumption of fast food, low consumption of fruit and vegetable. However, there was no effect on the pattern of tobacco use. The prevalence of CVRFs is substantially high among the study population. To combat the future expected burden of CVDs, a proposed prevention programme for employees’ cardiovascular wellness is designed and recommended to be implemented and institutionalized within the university.

  18. 26. Cardiovascular risk assessment for Saudi university employees and their families: developing a framework for provision of an evidence-based cardiovascular disease preventative programme.

    Directory of Open Access Journals (Sweden)

    R. Alzeidan

    2016-07-01

    Full Text Available In the Kingdom of Saudi Arabia (KSA, cardiovascular diseases (CVDs are the primary cause of death among adults, representing 46% of total mortality in 2014. This study’s objectives were to assess the prevalence of cardiovascular risk factors (CVRFs, and calculate the cardiovascular risk (CVR among King Saud University employees and their families. Moreover, it aimed at assessing the possible effects of living in KSA on the heart health of expatriate employees and their families.A cross-sectional study was conducted on 4500 university employees and their families aged ⩾18 years old, using the World Health Organization STEPwise approach to surveillance of CVRFs. CVR was then calculated for participants using the Framingham Coronary Heart Risk Score calculator. The mean age of participants was 39.3±13.4 years. The prevalence of CVRFs was as follows: low fruit/vegetable consumption of 10% risk to develop CVD within the following 10-years. Furthermore, this study showed that expatriates had significant negative effects on behavioural risk factors after residing in KSA, namely: high rate of physical inactivity, high consumption of fast food, low consumption of fruit and vegetable. However, there was no effect on the pattern of tobacco use. The prevalence of CVRFs is substantially high among the study population. To combat the future expected burden of CVDs, a proposed prevention programme for employees’ cardiovascular wellness is designed and recommended to be implemented and institutionalized within the university.

  19. Genomics and cardiovascular disease.

    Science.gov (United States)

    Frazier, Lorraine; Johnson, Rolanda L; Sparks, Elizabeth

    2005-01-01

    To describe genetic knowledge and discovery in the area of cardiovascular disease (CVD) and to discuss how these new advances will influence the clinical care of affected people. A selective review of the literature is presented on the disease mechanism of both the Mendelian and multifactorial genetic cardiovascular conditions. A case study approach is used to illustrate how the genetic paradigm affects the healthcare experience of a family affected with familial hypertrophic cardiomyopathy. The current state of CVD treatment remains complex. An understanding of genomic concepts and a genome-based approach is necessary to determine: (a) the risk of CVD susceptibility beyond traditional risk factors; (b) early detection of illness; (c) response to treatment; and (d) molecular taxonomy of the disease. The results of genetic research, education, and teaching will lead to a new understanding of genes and pathways, resulting in powerful new therapeutic approaches to CVD. The challenge is to translate genetic discoveries into clinical practice that ultimately leads to preventing CVD and reducing mortality.

  20. RIA in cardiovascular disease

    International Nuclear Information System (INIS)

    Hourani, M.H.

    1983-01-01

    When one discusses the management of chronic cardiac diseases, and in particular congestive heart failure (CHF), one cannot but think of digitalis and the important role it plays in the management of CHF. One also has to think about digitalis toxicity and the narrow margin between the therapeutic and toxic doses of digitalis and the important role that monitoring the serum level of the drug play in preventing and/or recognizing its toxic effects. Again, RIA has something to offer the clinician in this area. The purpose of this chapter is to discuss the radioassays for CPK-MB and digoxin mainly, as well as touch upon other assays of use in evaluating patients with cardiovascular disease

  1. Cardiovascular disease biomarkers across autoimmune diseases.

    Science.gov (United States)

    Ahearn, Joseph; Shields, Kelly J; Liu, Chau-Ching; Manzi, Susan

    2015-11-01

    Cardiovascular disease is increasingly recognized as a major cause of premature mortality among those with autoimmune disorders. There is an urgent need to identify those patients with autoimmune disease who are at risk for CVD so as to optimize therapeutic intervention and ultimately prevention. Accurate identification, monitoring and stratification of such patients will depend upon a panel of biomarkers of cardiovascular disease. This review will discuss some of the most recent biomarkers of cardiovascular diseases in autoimmune disease, including lipid oxidation, imaging biomarkers to characterize coronary calcium, plaque, and intima media thickness, biomarkers of inflammation and activated complement, genetic markers, endothelial biomarkers, and antiphospholipid antibodies. Clinical implementation of these biomarkers will not only enhance patient care but also likely accelerate the pharmaceutical pipeline for targeted intervention to reduce or eliminate cardiovascular disease in the setting of autoimmunity. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. A 'polypill' aimed at preventing cardiovascular disease could prove highly cost-effective for use in Latin America.

    Science.gov (United States)

    Bautista, Leonelo E; Vera-Cala, Lina M; Ferrante, Daniel; Herrera, Víctor M; Miranda, J Jaime; Pichardo, Rafael; Sánchez Abanto, José R; Ferreccio, Catterina; Silva, Eglé; Oróstegui Arenas, Myriam; Chirinos, Julio A; Medina-Lezama, Josefina; Pérez, Cynthia M; Schapochnik, Norberto; Casas, Juan P

    2013-01-01

    We evaluated the cost-effectiveness of administering a daily "polypill" consisting of three antihypertensive drugs, a statin, and aspirin to prevent cardiovascular disease among high-risk patients in Latin America. We found that the lifetime risk of cardiovascular disease could be reduced by 15 percent in women and by 21 percent in men if the polypill were used by people with a risk of cardiovascular disease equal to or greater than 15 percent over ten years. Attaining this goal would require treating 26 percent of the population at a cost of $34-$36 per quality-adjusted life-year. Offering the polypill to women at high risk and to men age fifty-five or older would be the best approach and would yield acceptable incremental cost-effectiveness ratios. The polypill would be very cost-effective even in the country with the lowest gross national income in our study. However, policy makers must weigh the value of intervention with the polypill against other interventions, as well as their country's willingness and ability to pay for the intervention.

  3. Role development of community health workers for cardiovascular disease prevention in India.

    Science.gov (United States)

    Khetan, Aditya; Patel, Toral; Hejjaji, Vittal; Barbhaya, Dweep; Mohan, Sri Krishna Madan; Josephson, Richard; Webel, Allison

    2018-04-01

    Cardiovascular disease (CVD) is the leading cause of mortality in India. Since community health workers (CHWs) have historically played a pivotal role in improving maternal and child health, it has been hypothesized that they have the potential to mitigate the impact of CVD in countries such as India. Project SEHAT is a cluster RCT to test the hypothesis that CHWs can improve the control of cardiovascular risk factors in a community in West Bengal, India. This study sought to quantitatively assess the training outcomes of CHWs recruited for Project SEHAT, and qualitatively assess their recruitment, training and fieldwork experiences. CHWs were recruited through a 2 step process- a written test and an interview. Upon completion of training, their knowledge and experiences were assessed. All intervention CHWs scored > 80% on the knowledge test, implying a high rate of knowledge retention. Important themes identified during a focus group discussion with CHWs included satisfaction with a 2 step recruitment process, emphasis on communication skills, a preference for audio-visual aids in training and recognition of the importance of a supportive supervisory framework. Respect from society and a positive impact on people was consistently cited as the most satisfying aspects of the job, followed by financial compensation. Recruitment and training processes for CHWs in CVD programs should be more standardized to enable replication, scalability and adequate assessment of their potential to mitigate CVD mortality in countries such as India. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. Triglycerides and cardiovascular disease

    DEFF Research Database (Denmark)

    Nordestgaard, Børge G; Varbo, Anette

    2014-01-01

    cholesterol might not cause cardiovascular disease as originally thought has now generated renewed interest in raised concentrations of triglycerides. This renewed interest has also been driven by epidemiological and genetic evidence supporting raised triglycerides, remnant cholesterol, or triglyceride......-rich lipoproteins as an additional cause of cardiovascular disease and all-cause mortality. Triglycerides can be measured in the non-fasting or fasting states, with concentrations of 2-10 mmol/L conferring increased risk of cardiovascular disease, and concentrations greater than 10 mmol/L conferring increased risk...... of acute pancreatitis and possibly cardiovascular disease. Although randomised trials showing cardiovascular benefit of triglyceride reduction are scarce, new triglyceride-lowering drugs are being developed, and large-scale trials have been initiated that will hopefully provide conclusive evidence...

  5. [Control of major cardiovascular risk factors of ischemic heart disease in secondary prevention in Aragón: COCINA study].

    Science.gov (United States)

    Cucalon Arenal, J M; Buisac Ramón, C; Marin Ibáñez, A; Castan Ruiz, S; Blay Cortes, M G; Barrasa Villar, J I

    2016-01-01

    Ischemic heart disease remains a leading cause of death in Spain. According to the American Heart Association/American College of Cardiology (AHA/ACC) and European national societies, secondary prevention for these patients consists of control of major cardiovascular risk factors (CVRF) and suitable lifestyle habits. To determine the degree of control of CVRF in the Aragonese population in secondary prevention. Cross-sectional study of a sample of 705 patients of Aragon who had suffered a cardiac event, selected opportunistically in consultations of family physicians participating in the 3 provinces of Aragon. The study was conducted in the second half of 2012. To measure the degree of control of different FRVC and lifestyle habits in this population. Anthropometric, different cardiovascular risk factors, treatment and lifestyle. 58% of men and 52% of women met criteria for monitoring of measured variables. The best result was obtained with smoking cessation and the worst with BMI. Hypertension, Dyslipidemia and Diabetes Mellitus achieve poor control results. The results show that the degree of control of CVRF is still low, especially in variables such as dyslipidemia and Diabetes Mellitus. Only 16.5% of control patients met criteria given the pharmacologically-modifiable cardiovascular risk factors. Copyright © 2015 SEHLELHA. Published by Elsevier España, S.L.U. All rights reserved.

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

    Science.gov (United States)

    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

  7. Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease: A Science Advisory From the American Heart Association.

    Science.gov (United States)

    Siscovick, David S; Barringer, Thomas A; Fretts, Amanda M; Wu, Jason H Y; Lichtenstein, Alice H; Costello, Rebecca B; Kris-Etherton, Penny M; Jacobson, Terry A; Engler, Mary B; Alger, Heather M; Appel, Lawrence J; Mozaffarian, Dariush

    2017-04-11

    Multiple randomized controlled trials (RCTs) have assessed the effects of supplementation with eicosapentaenoic acid plus docosahexaenoic acid (omega-3 polyunsaturated fatty acids, commonly called fish oils) on the occurrence of clinical cardiovascular diseases. Although the effects of supplementation for the primary prevention of clinical cardiovascular events in the general population have not been examined, RCTs have assessed the role of supplementation in secondary prevention among patients with diabetes mellitus and prediabetes, patients at high risk of cardiovascular disease, and those with prevalent coronary heart disease. In this scientific advisory, we take a clinical approach and focus on common indications for omega-3 polyunsaturated fatty acid supplements related to the prevention of clinical cardiovascular events. We limited the scope of our review to large RCTs of supplementation with major clinical cardiovascular disease end points; meta-analyses were considered secondarily. We discuss the features of available RCTs and provide the rationale for our recommendations. We then use existing American Heart Association criteria to assess the strength of the recommendation and the level of evidence. On the basis of our review of the cumulative evidence from RCTs designed to assess the effect of omega-3 polyunsaturated fatty acid supplementation on clinical cardiovascular events, we update prior recommendations for patients with prevalent coronary heart disease, and we offer recommendations, when data are available, for patients with other clinical indications, including patients with diabetes mellitus and prediabetes and those with high risk of cardiovascular disease, stroke, heart failure, and atrial fibrillation. © 2017 American Heart Association, Inc.

  8. Lifestyle in Cardiovascular Disease

    NARCIS (Netherlands)

    J.O. Younge (John)

    2015-01-01

    markdownabstract__Abstract__ Globally, the burden of cardiovascular disease (CVD) is still increasing. However, in recent decades, better treatment modalities have led to less cardiovascular related deaths. After years of research, we now generally accept that lifestyle factors are the most

  9. Predicting effective factors on eating behaviors in the prevention of cardiovascular disease based on the PRECEDE model.

    Science.gov (United States)

    Radmerikhi, Samera; Tabatabaei, Seyed Vahid Ahmady; Jahani, Yunes; Mohseni, Mohabbat

    2017-12-01

    Changes in eating behavior can reduce the risk of developing cardiovascular disease. The aim of this study was to predict the effective factors of eating behaviors in the prevention of cardiovascular disease using the PRECEDE model. This cross-sectional study was performed on 400 subjects aged from 20 to 60 years old in Kerman, Iran in 2016. The participants were selected using a multistage random sampling method. A self-administered questionnaire including questions regarding demographic characteristics, eating behavior, and PRECEDE model constructs were completed by the participants. Data were analyzed using SPSS 22 and STATA 12. For data analysis, Spearman correlation coefficient, univariate and multiple median regression were applied. The predictive power of the model constructs was determined by analysis of artificial neural networks. Among participants, the score of knowledge was high (84.15±10.7), and the scores of perceived self-efficacy (59.1±16.57), reinforcing factors (60.66±14.01), enabling factors (56.5±12.91), and eating behavior (62.1±14.7) were intermediate, and the score of attitude was low (47.84±7.67). Attitude, self-perceived efficacy, enabling factors, and knowledge predicted 32%, 30%, 26%, and 0.93% of participants' eating behavior respectively. The relationship between all variables and eating behavior was positive and significant (pfactors the least correlation with eating behavior. According to the results of this study, self-efficacy, attitude, and enabling factors were the main predicting factors for eating behaviors; therefore, to prevent cardiovascular disease and enhance healthy eating behavior, it is recommended to change attitude, and enhance self-efficacy and enabling factors in the community.

  10. Contemporary Reflections on the Safety of Long-Term Aspirin Treatment for the Secondary Prevention of Cardiovascular Disease

    Science.gov (United States)

    Fanaroff, Alexander C.; Roe, Matthew T.

    2018-01-01

    Aspirin has been the cornerstone of therapy for the secondary prevention treatment of patients with cardiovascular disease since landmark trials were completed in the late 1970s and early 1980s that demonstrated the efficacy of aspirin for reducing the risk of ischemic events. Notwithstanding the consistent benefits demonstrated with apirin for both acute and chronic cardiovascular disease, there are a number of toxicities associated with aspirin that have been showcased by recent long-term clinical trials that have included an aspirin monotherapy arm. As an inhibitor of cyclooxygenase, aspirin impairs gastric mucosal protective mechanisms. Prior trials have shown that up to 15–20% of patients developed gastrointestinal symptoms with aspirin monotherapy and roughly 1% of patients per year had a clinically significant bleeding event, including 1 in 1000 patients who suffered an intracranial or fatal bleed. These risks have been shown to be compounded for patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary intervention (PCI), who are also treated with other anti-thrombotic agents during the acute care/procedural period, as well as for an extended time period afterwards. Given observations of substantial increases in bleeding rates from many prior long-term clinical trials that have evaluated aspirin together with other oral platelet inhibitors or oral anti-coagulants, the focus of contemporary research has pivoted towards tailored anti-thrombotic regimens that attempt to either shorten the duration of exposure to aspirin or replace aspirin with an alternative anti-thrombotic agent. While these shifts are occurring, the safety profile of aspirin when used for the secondary prevention treatment of patients with established cardiovascular disease deserves further consideration. PMID:27028617

  11. Genomic Influence in the Prevention of Cardiovascular Diseases with a Sterol-Based Treatment.

    Science.gov (United States)

    San Mauro Martín, Ismael; Blumenfeld Olivares, Javier Andrés; Pérez Arruche, Eva; Arce Delgado, Esperanza; Ciudad Cabañas, María José; Garicano Vilar, Elena; Collado Yurrita, Luis

    2018-04-03

    Raised serum cholesterol concentration is a well-established risk factor in cardiovascular disease. In addition, genetic load may have an indirect influence on cardiovascular risk. Plant-based sterol-supplemented foods are recommended to help reduce the serum low-density lipoprotein cholesterol level. The objective was to analyse the influence of different polymorphisms in hypercholesterolemia patients following a dietary treatment with plant sterols. A randomised double-blind cross-over controlled clinical trial was carried out in 45 people (25 women). Commercial milk, containing 2.24 g of sterols, was ingested daily during a 3-week period, and then the same amount of skim milk, without sterols, was consumed daily during the 3-week placebo phase. Both phases were separated by a washout period of 2 weeks. At the beginning and end of each phase, blood draws were performed. Genes LIPC C-514T and APOA5 C56G are Ser19Trp carriers and greatly benefit from sterol intake in the diet. LIPC C-514T TT homozygous carriers had lower low-density lipoprotein cholesterol (LDL-c) levels than CC homozygote and CT heterozygote carriers after the ingestion of plant sterols ( p = 0.001). These two genes also showed statistically significant changes in total cholesterol levels ( p = 0.025; p = 0.005), and no significant changes in high-density lipoprotein (HDL) cholesterol levels ( p = 0.032; p = 0.003), respectively. No statistically significant differences were observed for other genes. Further studies are needed to establish which genotype combinations would be the most protective against hypercholesterolemia.

  12. Genomic Influence in the Prevention of Cardiovascular Diseases with a Sterol-Based Treatment

    Directory of Open Access Journals (Sweden)

    Ismael San Mauro Martín

    2018-04-01

    Full Text Available Raised serum cholesterol concentration is a well-established risk factor in cardiovascular disease. In addition, genetic load may have an indirect influence on cardiovascular risk. Plant-based sterol-supplemented foods are recommended to help reduce the serum low-density lipoprotein cholesterol level. The objective was to analyse the influence of different polymorphisms in hypercholesterolemia patients following a dietary treatment with plant sterols. A randomised double-blind cross-over controlled clinical trial was carried out in 45 people (25 women. Commercial milk, containing 2.24 g of sterols, was ingested daily during a 3-week period, and then the same amount of skim milk, without sterols, was consumed daily during the 3-week placebo phase. Both phases were separated by a washout period of 2 weeks. At the beginning and end of each phase, blood draws were performed. Genes LIPC C-514T and APOA5 C56G are Ser19Trp carriers and greatly benefit from sterol intake in the diet. LIPC C-514T TT homozygous carriers had lower low-density lipoprotein cholesterol (LDL-c levels than CC homozygote and CT heterozygote carriers after the ingestion of plant sterols (p = 0.001. These two genes also showed statistically significant changes in total cholesterol levels (p = 0.025; p = 0.005, and no significant changes in high-density lipoprotein (HDL cholesterol levels (p = 0.032; p = 0.003, respectively. No statistically significant differences were observed for other genes. Further studies are needed to establish which genotype combinations would be the most protective against hypercholesterolemia.

  13. Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk

    NARCIS (Netherlands)

    Greving, J.P.; Buskens, E.; Koffijberg, H.; Algra, A.

    2008-01-01

    Background-Aspirin is effective for the primary prevention of cardiovascular events, but it remains unclear for which subgroups of individuals aspirin is beneficial. We assessed the cost-effectiveness of aspirin separately for men and women of different ages with various levels of cardiovascular

  14. Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, gender, and varying cardiovascular risk

    NARCIS (Netherlands)

    Greving, Jacoba P.; Buskens, Erik; Koffijberg, Hendrik; Algra, Ale

    2008-01-01

    BACKGROUND - Aspirin is effective for the primary prevention of cardiovascular events, but it remains unclear for which subgroups of individuals aspirin is beneficial. We assessed the cost-effectiveness of aspirin separately for men and women of different ages with various levels of cardiovascular

  15. Reprint of: Marine OMEGA-3 fatty acids in the prevention of cardiovascular disease.

    Science.gov (United States)

    Mori, Trevor A

    2018-04-12

    Omega-6 (ω6) and omega-3 (ω3) fatty acids are two classes of dietary polyunsaturated fatty acids derived from linoleic acid (18:2ω6) and α-linolenic acid (18:3ω3), respectively. Enzymatic metabolism of linoleic and α-linolenic acids generates arachidonic acid (20:4ω6) and eicosapentaenoic acid (20:5ω3; EPA), respectively, both of which are substrates for enzymes that yield eicosanoids with multiple and varying physiological functions. Further elongation and desaturation of EPA yields the 22-carbon fatty acid docosahexaenoic acid (22:6ω3; DHA). The main dietary source of EPA and DHA for human consumption is fish, especially oily fish. There is considerable evidence that EPA and DHA are protective against cardiovascular disease (heart disease and stroke), particularly in individuals with pre-existing disease. ω3 Fatty acids benefit multiple risk factors including blood pressure, blood vessel function, heart function and blood lipids, and they have antithrombotic, anti-inflammatory and anti-oxidative actions. ω3 Fatty acids do not adversely interact with medications. Supplementation with ω3 fatty acids is recommended in individuals with elevated blood triglyceride levels and patients with coronary heart disease. A practical recommendation for the general population is to increase ω3 fatty acid intake by incorporating fish as part of a healthy diet that includes increased fruits and vegetables, and moderation of salt intake. Health authorities recommend the general population should consume at least two oily fish meals per week. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Marine OMEGA-3 fatty acids in the prevention of cardiovascular disease.

    Science.gov (United States)

    Mori, Trevor A

    2017-11-01

    Omega-6 (ω6) and omega-3 (ω3) fatty acids are two classes of dietary polyunsaturated fatty acids derived from linoleic acid (18:2ω6) and α-linolenic acid (18:3ω3), respectively. Enzymatic metabolism of linoleic and α-linolenic acids generates arachidonic acid (20:4ω6) and eicosapentaenoic acid (20:5ω3; EPA), respectively, both of which are substrates for enzymes that yield eicosanoids with multiple and varying physiological functions. Further elongation and desaturation of EPA yields the 22-carbon fatty acid docosahexaenoic acid (22:6ω3; DHA). The main dietary source of EPA and DHA for human consumption is fish, especially oily fish. There is considerable evidence that EPA and DHA are protective against cardiovascular disease (heart disease and stroke), particularly in individuals with pre-existing disease. ω3 Fatty acids benefit multiple risk factors including blood pressure, blood vessel function, heart function and blood lipids, and they have antithrombotic, anti-inflammatory and anti-oxidative actions. ω3 Fatty acids do not adversely interact with medications. Supplementation with ω3 fatty acids is recommended in individuals with elevated blood triglyceride levels and patients with coronary heart disease. A practical recommendation for the general population is to increase ω3 fatty acid intake by incorporating fish as part of a healthy diet that includes increased fruits and vegetables, and moderation of salt intake. Health authorities recommend the general population should consume at least two oily fish meals per week. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. NIGHT HEMODYNAMIC DISORDER RISK FACTORS AND MARKERS FOR PATIENT-SPECIFIC APPROACH TO CARDIOVASCULAR DISEASE PREVENTION IN CHILDREN

    Directory of Open Access Journals (Sweden)

    Olga V. Kozhevnikova

    2017-01-01

    Full Text Available Background:  High mortality rates of cardiovascular disease request research revealing risk factors and early markers of cardiovascular dysfunction in children with chronic pathology.Objective:  to reveal the risk factors and early markers of night hemodynamic disorders for the development of personalized cardiovascular disease prevention in children based on the results of the combined daily monitoring of arterial pressure, ECG examination, and analysis of night sleep. Patients and methods:  Parents filled screeningquestionnaire of night sleep before the study onset. Combined monitoring and examination was performed  in 232  children aged 6–17 with different blood pressure disorders using Astrocard НS E2bp (Russia equipment in the outpatient setting.Results: 24-hour BP monitoring identified arterial hypotension 3.8 times more often than routine ambulance method. 21% of children or every fifth child with hypotension  had night hypertension  associated  with maximum (93% pathology  of ENT organs  with nasal obstruction. Differentiation of investigated groups by night PP and DBP show these marks of hemodynamics to be really important at the early period of pathology development in children. 62% of children had QT interval with bad adaptation to RR-interval at night. In the group with high BMI we found 1.6 times more often children with height more than 85th percentile of the norm. These children had night diastolic hypotension  5 times more often, children with obesity didn’t have normal 24-hour  BP dynamics, children with high BMI had longer QT-interval at night.Conclusions: We demonstrate the necessity of night sleep hemodynamics investigation in children for personalized cardiovascular disorder prevention. Children of early school age suffering from chronic ENT-pathology with nasal obstruction and/or high BMI, with high BMI, and with height ≥85th percentile of gender-age norm have risk of development of cardiovascular

  18. [Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project].

    Science.gov (United States)

    Patel, Pragna; Ordunez, Pedro; DiPette, Donald; Escobar, María Cristina; Hassell, Trevor; Wyss, Fernando; Hennis, Anselm; Asma, Samira; Angell, Sonia

    2017-06-08

    Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality.

  19. A critical evaluation of the clinical evidence for pomegranate preparations in the prevention and treatment of cardiovascular diseases.

    Science.gov (United States)

    Vlachojannis, Christian; Erne, Paul; Schoenenberger, Andreas W; Chrubasik-Hausmann, Sigrun

    2015-04-01

    This study attempts a critical evaluation of the clinical evidence behind the use of dietary pomegranate preparations in the prevention and treatment of cardiovascular diseases. A search of PubMed on August 10, 2014 identified 228 references, which yielded extractable data from 24 clinical studies of pomegranate preparations. Hand searching identified two further studies. The quality of the studies and evidence of effectiveness of pomegranate were assessed by an established set of conventional criteria. Overall, the study quality was poor. Even in the best studies, indications of benefit did not reach the conventional levels of statistical significance. The only study with a definitive design had a biochemical rather than a clinical endpoint: it showed the expected difference in blood concentrations of myeloperoxidase after a single dose of either pomegranate or placebo. Only 10 of the 26 studies provided HPLC data on the amounts of co-active ingredients in the preparations that were consumed by the subjects. If pomegranate has a role in the prevention and treatment of cardiovascular diseases, there is a pressing need for dose-finding and long-term confirmatory studies. The ultimate endpoint for definitive studies would be mortality, but reductions in blood pressure or demonstrable decreases in atherosclerotic plaques would be useful surrogates. Sample sizes for various assumptions are provided. Future studies need to prove the clinical benefit. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Improved Blood Pressure Control to Reduce Cardiovascular Disease Morbidity and Mortality: The Standardized Hypertension Treatment and Prevention Project.

    Science.gov (United States)

    Patel, Pragna; Ordunez, Pedro; DiPette, Donald; Escobar, Maria Cristina; Hassell, Trevor; Wyss, Fernando; Hennis, Anselm; Asma, Samira; Angell, Sonia

    2016-12-01

    Hypertension is the leading remediable risk factor for cardiovascular disease, affecting more than 1 billion people worldwide, and is responsible for more than 10 million preventable deaths globally each year. While hypertension can be successfully diagnosed and treated, only one in seven persons with hypertension have controlled blood pressure. To meet the challenge of improving the control of hypertension, particularly in low- and middle-income countries, the authors developed the Standardized Hypertension Treatment and Prevention Project, which involves a health systems-strengthening approach that advocates for standardized hypertension management using evidence-based interventions. These interventions include the use of standardized treatment protocols, a core set of medications along with improved procurement mechanisms to increase the availability and affordability of these medications, registries for cohort monitoring and evaluation, patient empowerment, team-based care (task shifting), and community engagement. With political will and strong partnerships, this approach provides the groundwork to reduce high blood pressure and cardiovascular disease-related morbidity and mortality. ©2016 Wiley Periodicals, Inc.

  1. Acetylsalicylic acid for primary prevention of cardiovascular diseases in older patients with diabetes: do the benefits overcome the risks?

    Science.gov (United States)

    Couture, Julie; Grégoire, Jean-Pierre

    2012-01-01

    Cardiovascular diseases (CVDs) represent a huge health burden for older patients with diabetes. Acetylsalicylic acid (ASA) has long been used as a cardioprotective agent in primary and secondary prevention of CVD. However, there are important issues regarding the benefits and risks of ASA therapy in primary prevention of CVDs, for the older group in general and for individuals of all ages with diabetes. In this review, we summarize the benefits and risks related to ASA therapy by outlining the evidence for older patients and for patients with diabetes. There appear to be significant gaps in knowledge. The balance of benefits and risks is not well defined but ASA treatment seems to be unfavorable in many older patients. PMID:25083237

  2. Health inequalities associated with neighbourhood deprivation in the Quebec population with hypertension in primary prevention of cardiovascular disease.

    Science.gov (United States)

    Vanasse, A; Courteau, J; Asghari, S; Leroux, D; Cloutier, L

    2014-11-01

    Although a number of studies look at prevalence, incidence, treatment, mortality and morbidity in relation to hypertension, few have taken into account the effect of residential neighbourhood on these health indicators in the population diagnosed with hypertension. The objective of this study was to measure and compare prevalence, mortality, morbidity, use of medical resources and treatments in relation to the level of material and social deprivation of the area of residence, in a population with a diagnosis of hypertension in primary prevention for cardiovascular disease (CVD) in Quebec in 2006-2007. This study is based on a secondary analysis of the medical administrative data of the Quebec health insurance board, the Régie de l'assurance maladie du Québec, for a cohort of 276 793 patients aged 30 years or older who had been diagnosed with hypertension in 2006 or 2007, but who did not have a known diagnosis of CVD. The health indicators adjusted for age and sex are prevalence, death, a cardiovascular event, physician visits, emergency department visits and use of antihypertensives. Twenty-five types of areas of residence were obtained by crossing the material and social deprivation quintiles. Compared with patients living in materially and socially advantaged areas, those living in deprived areas were at 46% higher risk of a cardiovascular event, 47% higher risk of being frequent emergency department visitors and 31% higher risk of being frequent users of a general practitioner's services, but 25% lower risk of being frequent users of medical specialists' services. Little or no variation was observed in the use of antihypertensives. This study reveals the existence, in a CVD primary prevention context, of large variations in a number of health indicators among hypertensive patients owing to the material and social deprivation of residential neighbourhood. It is therefore important to take the socioeconomic context into account when planning interventions to

  3. Preventing cardiovascular disease after hypertensive disorders of pregnancy: Searching for the how and when

    NARCIS (Netherlands)

    Groenhof, T.K.J. (T Katrien J); B.B. van Rijn (Bas); A. Franx (Arie); J.E. Roeters van Lennep (Jeanine); M.L. Bots (Michiel); A.T. Lely (Titia)

    2017-01-01

    textabstractBackground: Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be

  4. Preventing cardiovascular disease after hypertensive disorders of pregnancy : Searching for the how and when

    NARCIS (Netherlands)

    Groenhof, T. Katrien J.|info:eu-repo/dai/nl/413649741; van Rijn, Bas B.|info:eu-repo/dai/nl/304816582; Franx, Arie|info:eu-repo/dai/nl/157009939; Roeters Van Lennep, Jeanine E.; Bots, Michiel L.|info:eu-repo/dai/nl/110610032; Lely, A. Titia|info:eu-repo/dai/nl/30474719X

    2017-01-01

    Background: Women with a history of a hypertensive disorder during pregnancy (HDP) have an increased risk of cardiovascular events. Guidelines recommend assessment of cardiovascular risk factors in these women later in life, but provide limited advice on how this follow-up should be organized.

  5. Stakeholder engagement for the New Zealand Atlas of Healthcare Variation: cardiovascular disease secondary prevention: VIEW-3.

    Science.gov (United States)

    Grey, Corina; Wells, Sue; Exeter, Daniel J; Hanham, Grant; Zhao, Jinfeng; Kerr, Andrew J

    2014-08-15

    As part of the Health Quality and Safety Commission's Atlas of Healthcare Variation in New Zealand, sociodemographic and regional differences in drug management for people with cardiovascular disease (CVD) were mapped. The aim of stakeholder engagement was to obtain feedback regarding interpretation, presentation and use of the Atlas data. Feedback was obtained through surveys, one-on-one interviews and presentations at various meetings of clinicians, managers and researchers with an interest in CVD. Presentation and utility of the Atlas data for frontline quality improvement was explored. 28 stakeholders completed one-on-one feedback and over 100 attended meetings where the Atlas data were presented. Differences in dispensing by medication type, age, gender and ethnicity were thought to be related to diagnostic accuracy or the behaviour of prescribers or patients. Stakeholders found a funnel plot of the variation in triple therapy dispensing among general practices to be the most useful method of presentation, as it enabled practitioners to benchmark against peers, highlight areas for improvement, and monitor their progress over time. Stakeholder engagement has informed the interpretation of findings and the formatting of the Atlas data in a way that would potentially lead to improvements in the quality of patient care.

  6. Gender and Cardiovascular Disease

    NARCIS (Netherlands)

    Den Ruijter, Hester M.; Pasterkamp, Gerard

    2015-01-01

    More women than men die of cardiovascular disease (CVD) each year in every major developed country and most emerging economies. Nonetheless, CVD has often been considered as men’s disease due to the higher rates of coronary artery disease (CAD) of men at younger age. This has led to the

  7. Being at risk for cardiovascular disease: perceptions and preventive behavior in people with and without a known genetic predisposition.

    Science.gov (United States)

    Claassen, L; Henneman, L; van der Weijden, T; Marteau, T M; Timmermans, D R M

    2012-01-01

    This study compares and explains differences in perceptions of cardiovascular disease (CVD) risk and preventive behaviors in people with and without a known genetic predisposition to CVD. A cross-sectional study using two samples was performed. The first sample (genetic predisposition; n = 51) consisted of individuals recently diagnosed with familial hypercholesterolemia (FH) through DNA testing. The second sample (no genetic predisposition; n = 49) was recruited among patients with CVD-risk profiles based on family history of CVD, cholesterol levels, and blood pressure, registered at general practices. Participants filled out a postal questionnaire asking about their perceived risk, causal attributions (i.e. genetic and lifestyle), and about perceived efficacy and adoption of preventive behavior (i.e. medication adherence and adoption of a healthy diet and being sufficiently active). Perceived comparative risk, genetic attributions of CVD, and perceived efficacy of medication were higher in the "genetic predisposition" sample than in the "no genetic predisposition" sample. The samples did not differ on lifestyle attributions, efficacy of a healthy lifestyle, or preventive behavior. Individual differences in perceived risk, genetic attributions, perceived efficacy of medication, and adoption of a healthy lifestyle were best explained by family history of CVD. Our findings suggest that in people diagnosed with a single gene disorder characterized by a family disease history such as FH, family disease history may be more important than DNA information in explaining perceptions of and responses to risk.

  8. Acupuncture and Traditional Herbal Medicine Therapy Prevent Deliriumin Patients with Cardiovascular Disease in Intensive Care Units.

    Science.gov (United States)

    Matsumoto-Miyazaki, Jun; Ushikoshi, Hiroaki; Miyata, Shusaku; Miyazaki, Nagisa; Nawa, Takahide; Okada, Hideshi; Ojio, Shinsuke; Ogura, Shinji; Minatoguchi, Shinya

    2017-01-01

    The aim of this study was to determine the effect of combination therapy consisting of acupuncture and traditional herbal medicine (Kampo medicine) for reducing the incidence rate of delirium in patients with cardiovascular (CV) disease in ICUs. Twenty-nine patients who had been urgently admitted to the ICU in the control period were treated with conventional intensive care. Thirty patients in the treatment period received conventional therapy plus a combination therapy consisting of acupuncture and herbal medicine. Acupuncture treatment was performed once a day, and the herbal formula was administered orally three times a day during the first week of the ICU stay. The standard acupuncture points were GV20, Ex-HN3, HT7, LI4, Liv3, and KI3, and the main herbal preparation was Kamikihito. The incident rates of delirium, assessed using the confusion assessment method for ICU, in the treatment and control period were compared. The incidence rate of delirium was significantly lower in the treatment group than in the control group (6.6% vs. 37.9%, [Formula: see text]). Moreover, sedative drugs and non-pharmacological approaches against aggressive behavior of patients who were delirious were used less in the treatment group than in the control group. No serious adverse events were observed in the treatment group. Combination therapy consisting of acupuncture and herbal medicine was found to be effective in lowering the incidence of delirium in patients with CV disease in ICUs. Further studies with a large sample size and parallel randomized controlled design would be required to establish the effects of this therapy.

  9. Effective interventions for the prevention and management of diabetes mellitus and cardiovascular diseases in primary care: a systematic review.

    NARCIS (Netherlands)

    Snoeijs, S.P.; Boerma, W.G.W.; Baltag, V.; Schellevis, F.G.

    2012-01-01

    Background: Organising effective responses to the growing problem of noncommunicable diseases (NCD) is among the biggest challenges of (primary) health care systems. In particular tackling, cardiovascular diseases (CVDs) and diabetes mellitus type 2 (DM2) requires coordinated approaches close to

  10. An ecological model using promotores de salud to prevent cardiovascular disease on the US-Mexico border: the HEART project.

    Science.gov (United States)

    Balcázar, Hector; Wise, Sherrie; Rosenthal, E Lee; Ochoa, Cecilia; Rodriguez, Jose; Hastings, Diana; Flores, Leticia; Hernandez, Lorraine; Duarte-Gardea, Maria

    2012-01-01

    To address cardiovascular disease risk factors among Hispanics, a community model of prevention requires a comprehensive approach to community engagement. The objectives of our intervention were to reduce cardiovascular disease risk factors in Hispanics living in 2 low-income areas of El Paso, Texas, and to engage the community in a physical activity and nutrition intervention. Drawing on lessons learned in phase 1 (years 2005-2008) of the HEART Project, we used an iterative, community-based process to develop an intervention based on an ecological framework. New community partners were introduced and community health workers delivered several elements of the intervention, including the curriculum entitled "Mi Corazón, Mi Comunidad" ("MiCMiC" [My Heart, My Community]). We received feedback from the project's Community Health Academy and Leadership Council throughout the development process and established a policy agenda that promotes integration of community health workers into the local and state workforce. Collaboration with 2 new community partners, the YWCA and the Department of Parks and Recreation, were instrumental in the process of community-based participatory research. We enrolled 113 participants in the first cohort; 78% were female, and the mean age was 41 years. More than 50% reported having no health insurance coverage. Seventy-two (60%) participants attended 1 or more promotora-led Su Corazón, Su Vida sessions, and 74 (62%) participants attended 1 or more of the 15 exercise classes. HEART phase 2 includes a multilevel ecological model to address cardiovascular disease risk among Hispanics. Future similarly targeted initiatives can benefit from an ecological approach that also embraces the promotora model.

  11. Enriching Diet with n-3 PUFAs to Help Prevent Cardiovascular Diseases in Healthy Adults: Results from Clinical Trials

    Directory of Open Access Journals (Sweden)

    Matteo Manuelli

    2017-07-01

    Full Text Available Omega-3 polyunsaturated fatty acids (n-3 PUFAs are believed to be important for cardiovascular health. Many investigations have been carried out in an attempt to examine the effect of n-3 PUFAs intake, in the form of supplementation or fortified foods, for the management of cardiovascular disease (CVD and risk factors for CVD, whereas less is known about the effect on healthy individuals. The present study reviews the available literature in order to examine the relationship between n-3 PUFAs intake, either via supplementation or enriched food, and the prevention of CVD among healthy adults. Interventional clinical trials on subjects aged >18 years old with none of the established risk factors for CVD have been considered for review. n-3 PUFAs supplementation or enriched food may positively regulate triglycerides and some lipoprotein subsets, as well as several vascular and coagulation parameters, even in healthy patients, presenting no risk factors for CVD, suggesting a protective effect. Diet enrichment with omega-3 is likely to be useful in helping to lower the risk of developing CVD in healthy individuals, but still offers no strong evidence of a tangible benefit on a population level. Additional studies are needed to determine the optimal daily intake, especially to prevent the unfavorable effects of PUFAs over-consumption.

  12. The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease?

    Science.gov (United States)

    Walter, Stefan; Glymour, Maria; Avendano, Mauricio

    2014-01-01

    Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk. Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50-65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk. States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71-0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79-1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models. Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.

  13. Studies on prevention of obesity, metabolic syndrome, diabetes, cardiovascular diseases and cancer by tea

    Directory of Open Access Journals (Sweden)

    Chung Shu Yang

    2018-01-01

    Full Text Available Tea, a popular beverage made from leaves of the plant Camellia sinensis, has been studied extensively in recent decades for its beneficial health effects in the prevention of obesity, metabolic syndrome, diabetes, cancer, and other diseases. Whereas these beneficial effects have been convincingly demonstrated in most laboratory studies, results from human studies have not been consistent. Some studies demonstrated that weight reduction, alleviation of metabolic syndrome and risk reduction in diabetes were only observed in individuals who consume 3–4 cups of tea (600–900 mg tea catechins or more daily. This chapter reviews some of these studies, the possible mechanisms of actions of tea constituents, and the challenges in extrapolating laboratory studies to human situations.

  14. [Cancer and cardiovascular disease].

    Science.gov (United States)

    Lahoz, Carlos; Valdivielso, Pedro; González-Alegre, María Teresa; García-Iglesias, María Francisca; Estirado, Eva; Mostaza, José M

    2015-01-01

    Survivors of cancer have a shorter survival in the long term partly due to the increase in cardiovascular diseases (CVD). Some chemotherapy drugs, thoracic and cranial radiotherapy and above all the transplantation of hematopoietic cells are associated with an increase in the incidence of cardiovascular events compared with general population. Some of these treatments favor the development of a metabolic syndrome that could be the intermediary between these treatments and the development of CVD. It is recommended for cancer survivors to promote healthy lifestyles and the strict control of cardiovascular risk factors. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  15. Vitamin D and the Prevention of Hypertension and Cardiovascular Diseases: A Review of the Currenct Evidence

    NARCIS (Netherlands)

    Geleijnse, J.M.

    2011-01-01

    Vitamin D plays an essential role in bone mineralization and calcium homeostasis. More recently, there has been growing evidence for a role of vitamin D in extraskeletal health, including beneficial effects in the cardiovascular system. Daylight exposure and vitamin D intake in many western

  16. Diet for preventing cardiovascular diseases: light from Ancel Keys, distinguished centenarian scientist.

    Science.gov (United States)

    Mancini, M; Stamler, J

    2004-02-01

    On the great occasion of Professor Ancel Keys' 100th birthday (26 January,2004), it is particularly appropriate--and highly relevant for today and tomorrow--to note the highlights of his professional accomplishments and contributions: the Seven Countries Study (SCS) he initiated and led demonstrated unequivocally in its cross-population analyses that dietary saturated fat intake significantly influences serum cholesterol and the risk of coronary heart disease (CHD), and in turn serum cholesterol relates to CHD risk. In SCS analyses on the several thousand individual participants, it further showed that serum cholesterol, blood pressure, and cigarette smoking all have a continuous, graded, strong, independent, predictive relation to long-term CHD. These data have been critically invaluable for the definition of the major coronary risk factors and low risk status. In scores of metabolic ward feeding trials, Keys and colleagues also demonstrated that dietary saturates and cholesterol relate positively to serum cholesterol, polyunsaturates inversely, and they derived the predictive equation bearing Keys' name. They further showed that increased dietary fiber and weight loss by obese people contribute to reduction of serum cholesterol. All these data served importantly for the development of sound public policy for CHD prevention, and Keys--along with many colleagues all over the world whom he trained and inspired--pioneered in the struggle to achieve and apply that policy in modern public health and medical care.

  17. Statin myopathy: the fly in the ointment for the prevention of cardiovascular disease in the 21st century?

    Science.gov (United States)

    Keen, Helen I; Krishnarajah, Janakan; Bates, Timothy R; Watts, Gerald F

    2014-09-01

    Cardiovascular disease (CVD) remains the leading cause of death in industrialized nations. Despite clear evidence of CVD risk reduction with HMG-CoA reductase inhibitors (statins), the side effects of these medications, particularly myopathy, limit their effectiveness. Studies into the mechanisms, aetiology and management of statin myopathy are limited by lack of an internationally agreed clinical definition and tools for assessing outcomes. Currently there is a paucity of evidence to guide the management of patients affected by statin myopathy; with the exception of dose reduction, there is little evidence that other strategies can improve statin tolerance, and even less evidence to suggest these alternate dosing strategies reduce cardiovascular risk. This review will cover current definitions, clinical presentations, risk factors, pathogenesis and management. PubMed was searched (English language, to 2014) for key articles pertaining to statin myopathy. This review then briefly describes our experience of managing this condition in a tertiary lipid disorders clinic, in the setting of limited guiding evidence. Knowledge gaps in the field of statin myopathy are identified and future research directions are suggested. We urge the need for international attention to address this important, but largely neglected clinical problem, that if unresolved will remain an impediment to the effective prevention and treatment of CVD.

  18. Prevention of cardiovascular disease based on lipid lowering treatment: a challenge for the Mexican health system.

    Science.gov (United States)

    Gómez-Pérez, Francisco J; Rojas, Rosalba; Villalpando, Salvador; Barquera, Simón; Rull, Juan; Aguilar-Salinas, Carlos A

    2010-01-01

    To estimate the percentage of Mexican adults that may require lipid-lowering treatment according to National Cholesterol Education Program-III guidelines, using data from the National Health and Nutrition Survey 2006 (ENSANut 2006). Information was obtained from 4 040 subjects aged 20 to 69 years, studied after a 9 to 12 hours fast. A cardiovascular risk equivalent was found in 13.8% and >or=2 risk factors were present in 31.5% of the population. LDL-C concentrations were above the treatment goal in 70% of the high-risk group and in 38.6% of subjects with >or=2 risk factors. Nearly 12 million Mexicans should be taught how to change their lifestyles and close to 8 million individuals require drug therapy to decrease their cardiovascular risk. Thirty percent of Mexican adults require some form of lipid-lowering treatment (lifestyle modifications in 36.25%, drug therapy in 24.19%).

  19. Complementary Role of Herbal Medicine and Exercise in Cardiovascular Disease Prevention and Management: A Review of Evidence.

    Science.gov (United States)

    Veluswamy, Sundar Kumar; Babu, Abraham Samuel; Sundar, Lakshmi Manickavasagam

    2017-01-01

    Cardiovascular disease (CVD) is the leading cause of death worldwide. Herbal medicine and exercise interventions have individually been shown to be effective in the prevention and management of CVD. However, the complementary roles of herbal medicine and exercise interventions for CVD prevention and management have not been adequately reported. 1. Identify studies analysing complementary roles of herbal medicine and exercise intervention in CVD prevention and management, 2. Identify herbs and exercise strategies that have been reported to exhibit complementary roles in CVD prevention and management, and 3. Summarize evidence of complementary roles of herbal medicine and exercise interventions for CVD prevention and management. PubMed, CINAHL and Web of Science were searched with a customised search strategy in May 2015. Two reviewers screened the search results for inclusion using pre-specified criteria. Data were extracted from full text of selected abstracts in a predetermined template by two reviewers and verified by the third reviewer when needed. A total of 35 titles were identified for full texts review after screening 827 abstracts. Data were extracted from 23 titles, representing 12 human studies and six animal studies. This review identified effects of 14 different herbs and 10 exercise strategies on over 18 CVD risk factors and markers. Complementary roles of herbal medicine and exercise were reported from five studies. Evidence of complementary role of herbal medicine and exercise is emerging from animal studies. More robust clinical studies on proven risk factors are needed before they can be recommended for clinical practice. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  20. Prevention of cardiovascular disease guided by total risk estimations - challenges and opportunities for practical implementation: highlights of a CardioVascular Clinical Trialists (CVCT) Workshop of the ESC Working Group on CardioVascular Pharmacology and Drug Therapy.

    LENUS (Irish Health Repository)

    Zannad, Faiez

    2011-11-03

    This paper presents a summary of the potential practical and economic barriers to implementation of primary prevention of cardiovascular disease guided by total cardiovascular risk estimations in the general population. It also reviews various possible solutions to overcome these barriers. The report is based on discussion among experts in the area at a special CardioVascular Clinical Trialists workshop organized by the European Society of Cardiology Working Group on Cardiovascular Pharmacology and Drug Therapy that took place in September 2009. It includes a review of the evidence in favour of the \\'treat-to-target\\' paradigm, as well as potential difficulties with this approach, including the multiple pathological processes present in high-risk patients that may not be adequately addressed by this strategy. The risk-guided therapy approach requires careful definitions of cardiovascular risk and consideration of clinical endpoints as well as the differences between trial and \\'real-world\\' populations. Cost-effectiveness presents another issue in scenarios of finite healthcare resources, as does the difficulty of documenting guideline uptake and effectiveness in the primary care setting, where early modification of risk factors may be more beneficial than later attempts to manage established disease. The key to guideline implementation is to improve the quality of risk assessment and demonstrate the association between risk factors, intervention, and reduced event rates. In the future, this may be made possible by means of automated data entry and various other measures. In conclusion, opportunities exist to increase guideline implementation in the primary care setting, with potential benefits for both the general population and healthcare resources.

  1. An integrated approach to preventing cardiovascular disease: community-based approaches, health system initiatives, and public health policy

    Directory of Open Access Journals (Sweden)

    Tina Karwalajtys

    2010-09-01

    Full Text Available Tina Karwalajtys1, Janusz Kaczorowski2,31Department of Family Medicine, McMaster University, Hamilton, ON, Canada; 2Primary Care & Community Research, Child & Family Research Institute, Vancouver, BC, Canada; 3Department of Family Practice, University of British Columbia, Vancouver, BC, CanadaAbstract: Cardiovascular disease (CVD is largely the product of interactions among modifiable risk factors that are common in developed nations and increasingly of concern in developing countries. Hypertension is an important precursor to the development of CVD, and although detection and treatment rates have improved in recent years in some jurisdictions, effective strategies and policies supporting a shift in distribution of risk factors at the population level remain paramount. Challenges in managing cardiovascular health more effectively include factors at the patient, provider, and system level. Strategies to reduce hypertension and CVD should be population based, incorporate multilevel, multicomponent, and socioenvironmental approaches, and integrate community resources with public health and clinical care. There is an urgent need to improve monitoring and management of risk factors through community-wide, primary care-linked initiatives, increase the evidence base for community-based prevention strategies, further develop and evaluate promising program components, and develop new approaches to support healthy lifestyle behaviors in diverse age, socioeconomic, and ethnocultural groups. Policy and system changes are critical to reduce risk in populations, including legislation and public education to reduce dietary sodium and trans-fatty acids, food pricing policies, and changes to health care delivery systems to explicitly support prevention and management of CVD.Keywords: risk factors, blood pressure determination, community health services, community health planning, public health practice

  2. Comparative effectiveness of antihypertensive medication for primary prevention of cardiovascular disease: systematic review and multiple treatments meta-analysis

    Directory of Open Access Journals (Sweden)

    Fretheim Atle

    2012-04-01

    -inhibitors (RR 1.43; 1.12 to 1.83 and CCB (RR 1.27; 1.05 to 1.57. Conclusion Based on the available evidence, there seems to be little or no difference between commonly used blood pressure lowering medications for primary prevention of cardiovascular disease. Beta-blockers (atenolol and alpha-blockers may not be first-choice drugs as they were the only drug-classes that were not significantly superior to any other, for any outcomes. Review registration: CRD database ("PROSPERO" CRD42011001066

  3. Engaging the Entire Care Cascade in Western Kenya: A Model to Achieve the Cardiovascular Disease Secondary Prevention Roadmap Goals.

    Science.gov (United States)

    Vedanthan, Rajesh; Kamano, Jemima H; Bloomfield, Gerald S; Manji, Imran; Pastakia, Sonak; Kimaiyo, Sylvester N

    2015-12-01

    Cardiovascular disease (CVD) is the leading cause of death in the world, with a substantial health and economic burden confronted by low- and middle-income countries. In low-income countries such as Kenya, there exists a double burden of communicable and noncommunicable diseases, and the CVD profile includes many nonatherosclerotic entities. Socio-politico-economic realities present challenges to CVD prevention in Kenya, including poverty, low national spending on health, significant out-of-pocket health expenditures, and limited outpatient health insurance. In addition, the health infrastructure is characterized by insufficient human resources for health, medication stock-outs, and lack of facilities and equipment. Within this socio-politico-economic reality, contextually appropriate programs for CVD prevention need to be developed. We describe our experience from western Kenya, where we have engaged the entire care cascade across all levels of the health system, in order to improve access to high-quality, comprehensive, coordinated, and sustainable care for CVD and CVD risk factors. We report on several initiatives: 1) population-wide screening for hypertension and diabetes; 2) engagement of community resources and governance structures; 3) geographic decentralization of care services; 4) task redistribution to more efficiently use of available human resources for health; 5) ensuring a consistent supply of essential medicines; 6) improving physical infrastructure of rural health facilities; 7) developing an integrated health record; and 8) mobile health (mHealth) initiatives to provide clinical decision support and record-keeping functions. Although several challenges remain, there currently exists a critical window of opportunity to establish systems of care and prevention that can alter the trajectory of CVD in low-resource settings. Copyright © 2015 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  4. NKT cells in cardiovascular diseases.

    Science.gov (United States)

    van Puijvelde, Gijs H M; Kuiper, Johan

    2017-12-05

    Despite life-style advice and the prescription of cholesterol-lowering and anti-thrombotic drugs, cardiovascular diseases are still the leading cause of death worldwide. Therefore, there is an urgent need for new therapeutic strategies focussing on atherosclerosis, the major underlying pathology of cardiovascular diseases characterized by an accumulation of lipids in an inflamed arterial/vessel wall. CD1d-restricted lipid-sensing natural killer T (NKT) cells, bridging the innate and adaptive immunity, and CD1d-expressing antigen-presenting cells are detected in atherosclerotic lesions of mice and humans. In this review we will summarize studies that point to a critical role for NKT cells in the pathogenesis of atherosclerosis and other cardiovascular diseases by the secretion of pro-atherogenic cytokines and cytotoxins. These pro-atherogenic NKT cells are potential targets for new therapeutic strategies in the prevention and treatment of cardiovascular diseases. Additionally, proteins transferring lipids during atherosclerosis, which are also important in the loading of lipids onto CD1d and possible endogenous ligands responsible for the activation of NKT cells during atherosclerosis will be discussed. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  5. Risk assessment in the prevention of cardiovascular disease in low-resource settings

    Directory of Open Access Journals (Sweden)

    Sandra N. Ofori

    2016-05-01

    Conclusions: In low-resource settings, the consistent use of simple tools like the WHO charts is recommended, as the benefit of a standard approach to screening outweighs the risk of missing an opportunity to prevent CVD.

  6. Challenges in Sex- and Gender-Centered Prevention and Management of Cardiovascular Disease: Implications of Genetic, Metabolic, and Environmental Paths.

    Science.gov (United States)

    Kouvari, Matina; Yannakoulia, Mary; Souliotis, Kyriakos; Panagiotakos, Demosthenes B

    2018-01-01

    The recognition of cardiovascular disease (CVD) as a "male" privilege has been a commonly held concept. However, emerging data describe another reality. Heterogeneities have been convincingly demonstrated regarding CVD manifestations, risk factor burden, and prognosis between males and females. The aim of the present narrative review was to highlight sex- and gender-related discrepancies in primary and secondary CVD prevention, underscoring plausible underlying mechanisms. Manifestation of CVD in women is characterized by atypical symptoms/signs and inadequately studied pathophysiology features challenging accurate diagnosis and effective treatment. Regarding CVD risk assessment, the burden and effect size of conventional, novel, and female-specific risk factors needs better clarification. Hitherto outcomes are nonconsistent, while most importantly, the interpretation of the attendant metabolic paths remains a challenge; the interactions among genetic, metabolic, and environmental factors are of high complexity regulated by genomic and nongenomic sex hormones effects. To deal with these key points, the National Institutes of Health currently calls upon investigators to provide a sex- and gender-specific reporting in all health research hypotheses. The implementation of high-quality studies addressing these issues is an imperative need to maximize cost-effectiveness in prevention and management strategies.

  7. Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?

    Science.gov (United States)

    Bonner, Carissa; McKinn, Shannon; Lau, Annie; Jansen, Jesse; Doust, Jenny; Trevena, Lyndal; McCaffery, Kirsten

    2017-12-11

    Cardiovascular disease (CVD) prevention guidelines recommend medication based on the probability of a heart attack/stroke in the next 5-10 years. However, heuristics and biases make risk communication challenging for doctors. This study explored how patients interpret personalised CVD risk results presented in varying formats and timeframes. GPs recruited 25 patients with CVD risk factors and varying medication history. Participants were asked to 'think aloud' while using two CVD risk calculators that present probabilistic risk in different ways, within a semi-structured interview. Transcribed audio-recordings were coded using Framework Analysis. Key themes were: 1) numbers lack meaning without a reference point; 2) risk results need to be both credible and novel; 3) selective attention to intervention effects. Risk categories (low/moderate/high) provided meaningful context, but short-term risk results were not credible if they didn't match expectations. Colour-coded icon arrays showing the effect of age and interventions were seen as novel and motivating. Those on medication focused on benefits, while others focused on harms. CVD risk formats need to be tailored to patient expectations and experiences in order to counteract heuristics and biases. Doctors need access to multiple CVD risk formats to communicate effectively about CVD prevention. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Impact evaluation of a community-based intervention for prevention of cardiovascular diseases in the slums of Nairobi: the SCALE-UP study

    NARCIS (Netherlands)

    van de Vijver, Steven; Oti, Samuel Oji; Gomez, Gabriela B.; Agyemang, Charles; Egondi, Thaddaeus; van Charante, Eric Moll; Brewster, Lizzy M.; Hankins, Catherine; Tanovic, Zlata; Ezeh, Alex; Kyobutungi, Catherine; Stronks, Karien

    2016-01-01

    Background A combination of increasing urbanization, behaviour change, and lack of health services in slums put the urban poor specifically at risk of cardiovascular disease (CVD). This study aimed to evaluate the impact of a community-based CVD prevention intervention on blood pressure (BP) and

  9. Impact evaluation of a community-based intervention for prevention of cardiovascular diseases in the slums of Nairobi: the SCALE UP study

    NARCIS (Netherlands)

    van de Vijver, S.; Oti, S.O.; Gomez, G.B.; Agyemang, C.; Egondi, T.; Moll van Charante, E.P.; Brewster, L.M.; Hankins, C.; Tanovic, Z.; Ezeh, A.; Kyobutungi, C.; Stronks, K.

    2016-01-01

    Background: A combination of increasing urbanization, behaviour change, and lack of health services in slums put the urban poor specifically at risk of cardiovascular disease (CVD). This study aimed to evaluate the impact of a community-based CVD prevention intervention on blood pressure (BP) and

  10. Healthy Ageing Through Internet Counselling in the Elderly: the HATICE randomised controlled trial for the prevention of cardiovascular disease and cognitive impairment

    NARCIS (Netherlands)

    Richard, Edo; Jongstra, Susan; Soininen, Hilkka; Brayne, Carol; Moll van Charante, Eric P.; Meiller, Yannick; van der Groep, Bram; Beishuizen, Cathrien R. L.; Mangialasche, Francesca; Barbera, Mariagnese; Ngandu, Tiia; Coley, Nicola; Guillemont, Juliette; Savy, Stéphanie; Dijkgraaf, Marcel G. W.; Peters, Ron J. G.; van Gool, Willem A.; Kivipelto, Miia; Andrieu, Sandrine

    2016-01-01

    Cardiovascular disease and dementia share a number of risk factors including hypertension, hypercholesterolaemia, smoking, obesity, diabetes and physical inactivity. The rise of eHealth has led to increasing opportunities for large-scale delivery of prevention programmes encouraging self-management.

  11. Feasibility and quality of cardiovascular disease prevention within a community-based health insurance program in rural Nigeria: an operational cohort study

    NARCIS (Netherlands)

    Hendriks, Marleen E.; Bolarinwa, Oladimeji A.; Wit, Ferdinand W. N. W.; Brewster, Lizzy M.; Odusola, Aina O.; Rosendaal, Nicole T. A.; Bindraban, Navin R.; Adenusi, Peju; Agbede, Kayode; Lange, Joep M. A.; Akande, Tanimola M.; Schultsz, Constance

    2015-01-01

    To assess the feasibility of providing guideline-based cardiovascular disease (CVD) prevention care within the context of a community-based health insurance program (CBHI) in rural Nigeria. A prospective operational cohort study was conducted in a primary healthcare clinic in rural Nigeria,

  12. Tea and Cardiovascular Disease

    Science.gov (United States)

    Deka, Apranta; Vita, Joseph A.

    2011-01-01

    There is increasing evidence for a protective effect of tea consumption against cardiovascular disease. This review summarizes the available epidemiological data providing evidence for and against such an effect. We also review observational and intervention studies that investigated an effect of tea and tea extracts on cardiovascular risk factors, including blood pressure, serum lipids, diabetes mellitus, and obesity. Finally, we review potential mechanisms of benefit, including anti-inflammatory, anti-oxidant, and anti-proliferative effects, as well as favorable effects on endothelial function. Overall, the observational data suggest a benefit, but results are mixed and likely confounded by lifestyle and background dietary factors. The weight of evidence indicates favorable effects on risk factors and a number of plausible mechanisms have been elucidated in experimental and translational human studies. Despite the growing body evidence, it remains uncertain whether tea consumption should be recommended to the general population or to patients as a strategy to reduce cardiovascular risk. PMID:21477653

  13. Cold Weather and Cardiovascular Disease

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More Cold Weather and Cardiovascular Disease Updated:Sep 16,2015 Th is winter season ... can affect your heart, especially if you have cardiovascular disease . Some people who are outdoors in cold weather ...

  14. Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study.

    Science.gov (United States)

    Halcox, Julian P; Banegas, José R; Roy, Carine; Dallongeville, Jean; De Backer, Guy; Guallar, Eliseo; Perk, Joep; Hajage, David; Henriksson, Karin M; Borghi, Claudio

    2017-06-17

    Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of high-density lipoprotein cholesterol. This cross-sectional observational study assessed the prevalence of two atherogenic dyslipidemia markers, high triglyceride levels and low high-density lipoprotein cholesterol levels, in the study population from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; N = 7641; of whom 51.6% were female and 95.6% were White/Caucasian). The EURIKA population included European patients, aged at least 50 years with at least one cardiovascular risk factor but no history of cardiovascular disease. Over 20% of patients from the EURIKA population have either triglyceride or high-density lipoprotein cholesterol levels characteristic of atherogenic dyslipidemia. Furthermore, the proportions of patients with one of these markers were higher in subpopulations with type 2 diabetes mellitus or those already calculated to be at high risk of cardiovascular disease. Approximately 55% of the EURIKA population who have markers of atherogenic dyslipidemia are not receiving lipid-lowering therapy. A considerable proportion of patients with at least one major cardiovascular risk factor in the primary cardiovascular disease prevention setting have markers of atherogenic dyslipidemia. The majority of these patients are not receiving optimal treatment, as specified in international guidelines, and thus their risk of developing cardiovascular disease is possibly underestimated. The present study is registered with ClinicalTrials.gov (ID: NCT00882336).

  15. Formalized 2003 European Guidelines on Cardiovascular Disease Prevention in Clinical Practice

    Czech Academy of Sciences Publication Activity Database

    Peleška, Jan; Anger, Z.; Buchtela, David; Tomečková, Marie; Veselý, Arnošt

    2004-01-01

    Roč. 25, - (2004), s. 444 ISSN 0195-668X. [ESC Congress 2004. 28.08.2004-01.09.2004, Munich] Institutional research plan: CEZ:AV0Z1030915 Keywords : formalized European guidelines on CVD prevention * computer GLIF model * decision algorithm Subject RIV: BD - Theory of Information

  16. Process evaluation of a lifestyle intervention to prevent diabetes and cardiovascular diseases in primary care

    NARCIS (Netherlands)

    Lakerveld, J.; Bot, S.D.M.; Chin A Paw, M.J.M.; van Tulder, M.W.; Kingo, L.; Nijpels, G.

    2012-01-01

    Effective, cost-effective, safe, and feasible interventions to improve lifestyle behavior in at-risk populations are needed in primary care. In the Hoorn Prevention Study, the authors implemented a theory-based lifestyle intervention in which trained practice nurses used an innovative combination of

  17. Tai Ji Quan as an exercise modality to prevent and manage cardiovascular disease: A review

    Directory of Open Access Journals (Sweden)

    Ruth E. Taylor-Piliae

    2014-03-01

    Conclusion: Collectively, these studies indicate that Tai Ji Quan is a safe form of exercise to prevent and manage CVD. Further research is needed with more rigorous study designs, larger sample sizes, adequate Tai Ji Quan exercise doses, and carefully chosen outcome measures that assess the mechanisms as well as the effects of Tai Ji Quan, before widespread recommendations can be made.

  18. Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease.

    Science.gov (United States)

    Gylling, Helena; Plat, Jogchum; Turley, Stephen; Ginsberg, Henry N; Ellegård, Lars; Jessup, Wendy; Jones, Peter J; Lütjohann, Dieter; Maerz, Winfried; Masana, Luis; Silbernagel, Günther; Staels, Bart; Borén, Jan; Catapano, Alberico L; De Backer, Guy; Deanfield, John; Descamps, Olivier S; Kovanen, Petri T; Riccardi, Gabriele; Tokgözoglu, Lale; Chapman, M John

    2014-02-01

    This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk. Plant sterols/stanols (when taken at 2 g/day) cause significant inhibition of cholesterol absorption and lower LDL-C levels by between 8 and 10%. The relative proportions of cholesterol versus sterol/stanol levels are similar in both plasma and tissue, with levels of sterols/stanols being 500-/10,000-fold lower than those of cholesterol, suggesting they are handled similarly to cholesterol in most cells. Despite possible atherogenicity of marked elevations in circulating levels of plant sterols/stanols, protective effects have been observed in some animal models of atherosclerosis. Higher plasma levels of plant sterols/stanols associated with intakes of 2 g/day in man have not been linked to adverse effects on health in long-term human studies. Importantly, at this dose, plant sterol/stanol-mediated LDL-C lowering is additive to that of statins in dyslipidaemic subjects, equivalent to doubling the dose of statin. The reported 6-9% lowering of plasma triglyceride by 2 g/day in hypertriglyceridaemic patients warrants further evaluation. Based on LDL-C lowering and the absence of adverse signals, this EAS Consensus Panel concludes that functional foods with plant sterols/stanols may be considered 1) in individuals with high cholesterol levels at intermediate or low global cardiovascular risk who do not qualify for pharmacotherapy, 2) as an adjunct to pharmacologic therapy in high and very high risk patients who fail to achieve LDL-C targets on statins or are statin- intolerant, 3) and in adults and children (>6 years) with familial hypercholesterolaemia, in line with current guidance. However, it must be acknowledged that there are no randomised, controlled

  19. Cost and economic benefit of clinical decision support systems for cardiovascular disease prevention: a community guide systematic review.

    Science.gov (United States)

    Jacob, Verughese; Thota, Anilkrishna B; Chattopadhyay, Sajal K; Njie, Gibril J; Proia, Krista K; Hopkins, David P; Ross, Murray N; Pronk, Nicolaas P; Clymer, John M

    2017-05-01

    This review evaluates costs and benefits associated with acquiring, implementing, and operating clinical decision support systems (CDSSs) to prevent cardiovascular disease (CVD). Methods developed for the Community Guide were used to review CDSS literature covering the period from January 1976 to October 2015. Twenty-one studies were identified for inclusion. It was difficult to draw a meaningful estimate for the cost of acquiring and operating CDSSs to prevent CVD from the available studies ( n  = 12) due to considerable heterogeneity. Several studies ( n  = 11) indicated that health care costs were averted by using CDSSs but many were partial assessments that did not consider all components of health care. Four cost-benefit studies reached conflicting conclusions about the net benefit of CDSSs based on incomplete assessments of costs and benefits. Three cost-utility studies indicated inconsistent conclusions regarding cost-effectiveness based on a conservative $50,000 threshold. Intervention costs were not negligible, but specific estimates were not derived because of the heterogeneity of implementation and reporting metrics. Expected economic benefits from averted health care cost could not be determined with confidence because many studies did not fully account for all components of health care. We were unable to conclude whether CDSSs for CVD prevention is either cost-beneficial or cost-effective. Several evidence gaps are identified, most prominently a lack of information about major drivers of cost and benefit, a lack of standard metrics for the cost of CDSSs, and not allowing for useful life of a CDSS that generally extends beyond one accounting period. Published by Oxford University Press on behalf of the American Medical Informatics Association 2017. This work is written by US Government employees and is in the public domain in the US.

  20. Cost-Effectiveness of a Statewide Campaign to Promote Aspirin Use for Primary Prevention of Cardiovascular Disease.

    Science.gov (United States)

    Michaud, Tzeyu L; Abraham, Jean; Jalal, Hawre; Luepker, Russell V; Duval, Sue; Hirsch, Alan T

    2015-12-23

    The U.S. Preventive Services Task Force in 2009 recommended increased aspirin use for primary prevention of cardiovascular disease (CVD) in men ages 45 to 79 years and women ages 55 to 79 years for whom benefit outweighs risk. This study estimated the clinical efficacy and cost-effectiveness of a statewide public and health professional awareness campaign to increase regular aspirin use among the target population in Minnesota to reduce first CVD events. A state-transition Markov model was developed, adopting a payer perspective and lifetime time horizon. The main outcomes of interest were quality-adjusted life years, costs, and the number of CVD events averted among those without a prior CVD history. The model was based on real-world data about campaign effectiveness from representative state-specific aspirin use and event rates, and estimates from the scholarly literature. Implementation of a campaign was predicted to avert 9874 primary myocardial infarctions in men and 1223 primary ischemic strokes in women in the target population. Increased aspirin use was associated with as many as 7222 more major gastrointestinal bleeding episodes. The cost-effectiveness analysis indicated cost-saving results for both the male and female target populations. Using current U.S. Preventive Services Task Force recommendations, a state public and health professional awareness campaign would likely provide clinical benefit and be economically attractive. With clinician adjudication of individual benefit and risk, mechanisms can be made available that would facilitate achievement of aspirin's beneficial impact on lowering risk of primary CVD events, with minimization of adverse outcomes. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  1. Aspirin and the Primary Prevention of Cardiovascular Diseases: An Approach Based on Individualized, Integrated Estimation of Risk.

    Science.gov (United States)

    Volpe, Massimo; Battistoni, Allegra; Gallo, Giovanna; Coluccia, Roberta; De Caterina, Raffaele

    2017-09-01

    While the use of aspirin in the secondary prevention of cardiovascular (CVD) is well established, aspirin in primary prevention is not systematically recommended because the absolute CV event reduction is similar to the absolute excess in major bleedings. Recently, emerging evidence suggests the possibility that the assumption of aspirin, may also be effective in the prevention of cancer. By adding to the CV prevention benefits the potential beneficial effect of aspirin in reducing the incidence of mortality and cancer could tip the balance between risks and benefits of aspirin therapy in the primary prevention in favour of the latter and broaden the indication for treatment with in populations at average risk. While prospective and randomized study are currently investigating the effect of aspirin in prevention of both cancer and CVD, clinical efforts at the individual level to promote the use of aspirin in global (or total) primary prevention could be already based on a balanced evaluation of the benefit/risk ratio.

  2. Is it time to repair a Fairly Fast SAAB Convertible? Testing an evidence-based mnemonic for the secondary prevention of cardiovascular disease.

    Science.gov (United States)

    Chin, Jialiang; Fulcher, Jordan; Jenkins, Alicia; Keech, Anthony

    2015-05-01

    Optimising secondary prevention of cardiovascular disease has the greatest potential to reduce recurrent events, yet despite major guidelines there are ongoing treatment gaps. FFSAABC (Fish oils, Fibrates, Statins, Aspirin, Angiotensin converting enzyme inhibitors or angiotensin 2 receptor antagonists, Beta blockers and Clopidogrel) is one mnemonic previously adopted to assist clinicians in remembering medications for use in secondary prevention. The aim of this narrative review is to examine the current evidence base for medications recommended for patients with established cardiovascular disease and the current applicability of this, or a revised mnemonic for their use. Randomised controlled trials and systematic reviews were sought examining Fish oils, Fibrates, Statins, Aspirin, Angiotensin converting enzyme inhibitors or angiotensin 2 receptor antagonists, Beta blockers or Clopidogrel vs placebo in secondary prevention. The emerging evidence base for other contemporary therapies including the P2Y12 inhibitors (ticagrelor and prasugrel) and aldosterone antagonists was also reviewed. Definitive evidence supports the use of statins, aspirin, angiotensin converting enzyme inhibitors or angiotensin 2 receptor antagonists, and P2Y12 antagonists (clopidogrel, ticagrelor or prasugrel) for the secondary prevention of cardiovascular disease. Aldosterone antagonists have strong evidence in the presence of systolic heart failure. There is a weaker evidence base for the routine use of omega-3 fatty acid supplementation although this therapy carries minimal harms. Fenofibrate reduces cardiovascular events in dyslipidaemic patients, with additional benefits in patients with diabetes. Mnemonic upgrading from a Fairly Fast SAAB Convertible to a Fairly Fast SA(2)A(2)B (Fish oils, Fibrate, Statin, Antiplatelets (Aspirin+Other), ACE/ARB, Aldosterone Antagonist, Beta-blocker) may help to ensure patients receive best practice evidence-based pharmacotherapies for the secondary

  3. Testosterone and Cardiovascular Disease.

    Science.gov (United States)

    Kloner, Robert A; Carson, Culley; Dobs, Adrian; Kopecky, Stephen; Mohler, Emile R

    2016-02-09

    Testosterone (T) is the principal male sex hormone. As men age, T levels typically fall. Symptoms of low T include decreased libido, vasomotor instability, and decreased bone mineral density. Other symptoms may include depression, fatigue, erectile dysfunction, and reduced muscle strength/mass. Epidemiology studies show that low levels of T are associated with more atherosclerosis, coronary artery disease, and cardiovascular events. However, treating hypogonadism in the aging male has resulted in discrepant results in regard to its effect on cardiovascular events. Emerging studies suggest that T may have a future role in treating heart failure, angina, and myocardial ischemia. A large, prospective, long-term study of T replacement, with a primary endpoint of a composite of adverse cardiovascular events including myocardial infarction, stroke, and/or cardiovascular death, is needed. The Food and Drug Administration recently put additional restrictions on T replacement therapy labeling and called for additional studies to determine its cardiac safety. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  4. Vitamin D, cardiovascular disease and risk factors

    DEFF Research Database (Denmark)

    Skaaby, Tea; Thuesen, Betina H.; Linneberg, Allan

    2017-01-01

    of vitamin D effects from a cardiovascular health perspective. It focuses on vitamin D in relation to cardiovascular disease, i.e. ischemic heart disease, and stroke; the traditional cardiovascular risk factors hypertension, abnormal blood lipids, obesity; and the emerging risk factors hyperparathyroidism......, microalbuminuria, chronic obstructive pulmonary diseases, and non-alcoholic fatty liver disease. Meta-analyses of observational studies have largely found vitamin D levels to be inversely associated with cardiovascular risk and disease. However, Mendelian randomization studies and randomized, controlled trials...... (RCTs) have not been able to consistently replicate the observational findings. Several RCTs are ongoing, and the results from these are needed to clarify whether vitamin D deficiency is a causal and reversible factor to prevent cardiovascular disease....

  5. Benefits & risks of statin therapy for primary prevention of cardiovascular disease in Asian Indians – A population with the highest risk of premature coronary artery disease & diabetes

    Science.gov (United States)

    Enas, Enas A.; Kuruvila, Arun; Khanna, Pravien; Pitchumoni, C.S.; Mohan, Viswanathan

    2013-01-01

    Several reviews and meta-analyses have demonstrated the incontrovertible benefits of statin therapy in patients with cardiovascular disease (CVD). But the role for statins in primary prevention remained unclear. The updated 2013 Cochrane review has put to rest all lingering doubts about the overwhelming benefits of long-term statin therapy in primary prevention by conclusively demonstrating highly significant reductions in all-cause mortality, major adverse cardiovascular events (MACE) and the need for coronary artery revascularization procedures (CARPs). More importantly, these benefits of statin therapy are similar at all levels of CVD risk, including subjects at low (statins is also highly effective in delaying and avoiding expensive CARPs such as angioplasties, stents, and bypass surgeries. There is no evidence of any serious harm or threat to life caused by statin therapy, though several adverse effects that affect the quality of life, especially diabetes mellitus (DM) have been reported. Asian Indians have the highest risk of premature coronary artery disease (CAD) and diabetes. When compared with Whites, Asian Indians have double the risk of CAD and triple the risk of DM, when adjusted for traditional risk factors for these diseases. Available evidence supports the use of statin therapy for primary prevention in Asian Indians at a younger age and with lower targets for low-density lipoprotein cholesterol (LDL-C) and non-high density lipoprotein (non-HDL-C), than those currently recommended for Americans and Europeans. Early and aggressive statin therapy offers the greatest potential for reducing the continuing epidemic of CAD among Indians. PMID:24434254

  6. Clinician-patient risk discussion for atherosclerotic cardiovascular disease prevention: importance to implementation of the 2013 ACC/AHA Guidelines.

    Science.gov (United States)

    Martin, Seth S; Sperling, Laurence S; Blaha, Michael J; Wilson, Peter W F; Gluckman, Ty J; Blumenthal, Roger S; Stone, Neil J

    2015-04-07

    Successful implementation of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines hinges on a clear understanding of the clinician-patient risk discussion (CPRD). This is a dialogue between the clinician and patient about potential for atherosclerotic cardiovascular disease risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences. Designed especially for primary prevention patients, this process of shared decision making establishes the appropriateness of a statin for a specific patient. CPRD respects the autonomy of an individual striving to make an informed choice aligned with personal values and preferences. Dedicating sufficient time to high-quality CPRD offers an opportunity to strengthen clinician-patient relationships, patient engagement, and medication adherence. We review the guideline-recommended CPRD, the general concept of shared decision making and decision aids, the American College of Cardiology/American Heart Association Risk Estimator application as an implementation tool, and address potential barriers to implementation. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  7. Healthcare Professional Shortage and Task-Shifting to Prevent Cardiovascular Disease: Implications for Low- and Middle-Income Countries.

    Science.gov (United States)

    Tsolekile, Lungiswa Primrose; Abrahams-Gessel, Shafika; Puoane, Thandi

    2015-12-01

    Cardiovascular diseases (CVD) account for 18 million of annual global deaths with more than three quarters of these deaths occurring in low- and middle-income countries (LMIC). In LMIC, the distribution of risk factors is heterogeneous, with urban areas being the worst affected. Despite the availability of effective CVD interventions in developed countries, many poor countries still struggle to provide care due to lack of resources. In addition, many LMIC suffer from staff shortages which pose additional burden to the healthcare system. Regardless of these challenges, there are potentially effective strategies such as task-shifting which have been used for chronic conditions such as HIV to address the human resource crisis. We propose that through task-shifting, certain tasks related to prevention be shifted to non-physician health workers as well as non-nurse health workers such as community health workers. Such steps will allow better coverage of segments of the underserved population. We recognise that for task-shifting to be effective, issues such as clearly defined roles, evaluation, on-going training, and supervision must be addressed.

  8. Health-promoting properties of artichoke in preventing cardiovascular disease by its lipidic and glycemic-reducing action.

    Science.gov (United States)

    Rondanelli, Mariangela; Monteferrario, Francesca; Perna, Simone; Faliva, Milena Anna; Opizzi, Annalisa

    2013-03-01

    The artichoke, Cynara scolymus, is one of the most ancient plants grown in the world, and its extracts, obtained from different parts of the plant (leaves, fruits and roots), have been used as medicaments from time immemorial. The pharmacological and therapeutic effects of the artichoke on the liver had already been well known in the 17th century. Modern studies started in the last century confirmed the stimulating properties of artichoke extracts on the liver and gallbladder. The ensuing wave of research was initially focused on the patent liver-stimulating, diuretic and choleretic effects exerted by artichoke preparations on both animals and man, then discovering such other therapeutic properties as the hypolipemizing activity, antioxidant activity and hypoglycemizing activity. This review enumerates the most significant studies that have highlighted these therapeutic properties. Complementary medicine information needs to be incorporated into clinical practice and patient and professional education, in addition to adequate education about proper nutrition. Awareness of the widespread use of complementary and alternative medicine by people with metabolic disorders is crucial for healthcare professionals in order to prevent cardiovascular disease.

  9. Nrf2 signaling and redox homeostasis in the aging heart: A potential target to prevent cardiovascular diseases?

    Science.gov (United States)

    Silva-Palacios, Alejandro; Königsberg, Mina; Zazueta, Cecilia

    2016-03-01

    Aging process is often accompanied with a high incidence of cardiovascular diseases (CVD) due to the synergistic effects of age-related changes in heart morphology/function and prolonged exposure to injurious effects of CVD risk factors. Oxidative stress, considered a hallmark of aging, is also an important feature in pathologies that predispose to CVD development, like hypertension, diabetes and obesity. Approaches directed to prevent the occurrence of CVD during aging have been explored both in experimental models and in controlled clinical trials, in order to improve health span, reduce hospitalizations and increase life quality during elderly. In this review we discuss oxidative stress role as a main risk factor that relates CVD with aging. As well as interventions that aim to reduce oxidative stress by supplementing with exogenous antioxidants. In particular, strategies of improving the endogenous antioxidant defenses through activating the nuclear factor related-2 factor (Nrf2) pathway; one of the best studied molecules in cellular redox homeostasis and a master regulator of the antioxidant and phase II detoxification response. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Asian & Pacific Islanders and Cardiovascular Diseases

    Science.gov (United States)

    ... Fact Sheet 2016 Update Asian & Pacific Islanders and Cardiovascular Diseases Cardiovascular Disease (CVD) (ICD 10 codes I00-I99, Q20- ... of na- tive Hawaiians or oth- A indicates cardiovascular disease plus congenital cardiovascular disease (ICD-10 I00- ...

  11. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease

    DEFF Research Database (Denmark)

    Astrup, Arne; Dyerberg, Jørn; Elwood, Peter

    2011-01-01

    Current dietary recommendations advise reducing the intake of saturated fatty acids (SFAs) to reduce coronary heart disease (CHD) risk, but recent findings question the role of SFAs. This expert panel reviewed the evidence and reached the following conclusions: the evidence from epidemiologic...... association between SFA intake relative to refined carbohydrates and the risk of insulin resistance and diabetes has been shown. The effect of diet on a single biomarker is insufficient evidence to assess CHD risk. The combination of multiple biomarkers and the use of clinical endpoints could help...

  12. Nonfasting hyperlipidemia and cardiovascular disease

    DEFF Research Database (Denmark)

    Nordestgaard, B G; Langsted, A; Freiberg, J J

    2009-01-01

    , total cholesterol/HDL cholesterol, and apolipoprotein B/apolipoprotein A1 all associate with increased risk of cardiovascular disease. These new data open the possibility that nonfasting rather than fasting lipid profiles can be used for cardiovascular risk prediction. If implemented, this would...... of cardiovascular disease and early death....

  13. [The role of jogging in the prevention and treatment of cardiovascular disease].

    Science.gov (United States)

    Ziegler, M; Braumann, K-M; Reer, R

    2004-02-19

    Lack of exercise and poor eating habits are considered to be major causes of most diseases of civilization. In consequence, endurance sports, but also an integration of physical activity in everyday life, are gaining in importance. Positive effects of regular physical exercise have been described for CAD, arterial hypertension, lipid metabolic disorders, type 2 diabetes mellitus and the metabolic syndrome. In order to achieve an optimal training effect, exercise intensity should be oriented to the individual anaerobic threshold. As a rule of thumb, 30 minutes of endurance training--ideallyevery day--is considered necessary. Prior testing of a person's ability to undertake such activities should include ECG and blood pressure measurements, spirometry and lactate determination, and contraindications must be taken into account.

  14. Relationship between knowledge of cardiovascular disease risk factors and watching educational television materials. Małopolska CArdiovascular PReventive Intervention Study (M-‑CAPRI).

    Science.gov (United States)

    Waśniowska, Anna; Kopeć, Grzegorz; Podolec, Jakub; Kozela, Magdalena; Sarnecka, Agnieszka; Knap, Klaudia; Szafraniec, Krystyna; Pająk, Andrzej; Podolec, Piotr

    2017-09-29

    INTRODUCTION The current guidelines on cardiovascular disease (CVD) prevention in clinical practice emphasizes the importance of education in the media for population-‑based approaches. OBJECTIVES The aim of the study was to assess the relationship between knowledge of CVD risk factors and watching educational television materials in the adult population. PATIENTS AND METHODS After 22 months of repeated broadcasting of educational television materials, which addressed problems related to CVD, a postal survey was conducted on a random sample of 5000 persons aged 18 years or older. The questionnaire included information on demographics, personal and family history of CVD, educational materials, and knowledge of the risk factors. A multivariate logistic regression was used to assess the relationship between the knowledge of each risk factor and watching educational materials. RESULTS A total of 1129 questionnaires were sent back and used for the analysis. There were 208 participants (18%) who watched the educational materials. The median number of the risk factors listed was 4 (interquartile range, 2-5) for persons who watched the materials and 2 (interquartile range, 0-4) for those who did not watch them. After adjustment for age, sex, education, place of residence, and personal and family history of CVD, the participants who watched the educational materials were 2 to 5 times more likely to have knowledge on particular risk factors, with the exception of hypercholesterolemia for which the relationship was not significant. CONCLUSIONS A strong, plausible relationship revealed by our study supports the idea that in the adult population, better knowledge of CVD risk factors was the effect of watching educational materials.

  15. Smartphones in the secondary prevention of cardiovascular disease: a systematic review.

    Science.gov (United States)

    Hamilton, Sandra J; Mills, Belynda; Birch, Eleanor M; Thompson, Sandra C

    2018-02-07

    Cardiac Rehabilitation (CR) and secondary prevention are effective components of evidence-based management for cardiac patients, resulting in improved clinical and behavioural outcomes. Mobile health (mHealth) is a rapidly growing health delivery method that has the potential to enhance CR and heart failure management. We undertook a systematic review to assess the evidence around mHealth interventions for CR and heart failure management for service and patient outcomes, cost effectiveness with a view to how mHealth could be utilized for rural, remote and Indigenous cardiac patients. A comprehensive search of databases using key terms was conducted for the years 2000 to August 2016 to identify randomised and non-randomised trials utilizing smartphone functionality and a model of care that included CR and heart failure management. Included studies were assessed for quality and risk of bias and data extraction was undertaken by two independent reviewers. Nine studies described a mix of mHealth interventions for CR (5 studies) and heart failure (4 studies) in the following categories: feasibility, utility and uptake studies; and randomised controlled trials. Studies showed that mHealth delivery for CR and heart failure management is feasible with high rates of participant engagement, acceptance, usage, and adherence. Moreover, mHealth delivery of CR was as effective as traditional centre-based CR (TCR) with significant improvement in quality of life. Hospital utilization for heart failure patients showed inconsistent reductions. There was limited inclusion of rural participants. Mobile health delivery has the potential to improve access to CR and heart failure management for patients unable to attend TCR programs. Feasibility testing of culturally appropriate mHealth delivery for CR and heart failure management is required in rural and remote settings with subsequent implementation and evaluation into local health care services.

  16. The gut microbiome in atherosclerotic cardiovascular disease

    DEFF Research Database (Denmark)

    Jie, Zhuye; Xia, Huihua; Zhong, Shi-Long

    2017-01-01

    The gut microbiota has been linked to cardiovascular diseases. However, the composition and functional capacity of the gut microbiome in relation to cardiovascular diseases have not been systematically examined. Here, we perform a metagenome-wide association study on stools from 218 individuals...... with atherosclerotic cardiovascular disease (ACVD) and 187 healthy controls. The ACVD gut microbiome deviates from the healthy status by increased abundance of Enterobacteriaceae and Streptococcus spp. and, functionally, in the potential for metabolism or transport of several molecules important for cardiovascular......), with liver cirrhosis, and rheumatoid arthritis. Our data represent a comprehensive resource for further investigations on the role of the gut microbiome in promoting or preventing ACVD as well as other related diseases.The gut microbiota may play a role in cardiovascular diseases. Here, the authors perform...

  17. Early identification and preventive care for elevated cardiovascular disease risk within a remote Australian Aboriginal primary health care service

    Directory of Open Access Journals (Sweden)

    O'Dea Kerin

    2011-01-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the single greatest contributor to the gap in life expectancy between Indigenous and non-Indigenous Australians. Our objective is to determine if holistic CVD risk assessment, introduced as part of the new Aboriginal and Torres Strait Islander Adult Health Check (AHC, results in better identification of elevated CVD risk, improved delivery of preventive care for CVD and improvements in the CVD risk profile for Aboriginal adults in a remote community. Methods Interrupted time series study over six years in a remote primary health care (PHC service involving Aboriginal adults identified with elevated CVD risk (N = 64. Several process and outcome measures were audited at 6 monthly intervals for three years prior to the AHC (the intervention and three years following: (i the proportion of guideline scheduled CVD preventive care services delivered, (ii mean CVD medications prescribed and dispensed, (iii mean PHC consultations, (iv changes in participants' CVD risk factors and estimated absolute CVD risk and (v mean number of CVD events and iatrogenic events. Results Twenty-five percent of AHC participants were identified as having elevated CVD risk. Of these, 84% had not been previously identified during routine care. Following the intervention, there were significant improvements in the recorded delivery of preventive care services for CVD (30% to 53%, and prescription of CVD related medications (28% to 89% (P P = 0.004 following the intervention. However, there were no significant changes in the mean number of PHC consultations or mean number of CVD events or iatrogenic events. Conclusions Holistic CVD risk assessment during an AHC can lead to better and earlier identification of elevated CVD risk, improvement in the recorded delivery of preventive care services for CVD, intensification of treatment for CVD, and improvements in participants' CVD risk profile. Further research is required on

  18. Cost effective interventions for the prevention of cardiovascular disease in low and middle income countries: A systematic review

    NARCIS (Netherlands)

    A. Shroufi (Amir); R. Chowdhury (Rajiv); R. Anchala (Raghupathy); S. Stevens (Sarah); P. Blanco (Patricia); T. Han (Tha); L.W. Niessen (Louis Wilhelmus); O.H. Franco (Oscar)

    2013-01-01

    textabstractBackground: While there is good evidence to show that behavioural and lifestyle interventions can reduce cardiovascular disease risk factors in affluent settings, less evidence exists in lower income settings.This study systematically assesses the evidence on cost-effectiveness for

  19. A Path Analysis of a Randomized "Promotora de Salud" Cardiovascular Disease-Prevention Trial among At-Risk Hispanic Adults

    Science.gov (United States)

    de Heer, Hendrik Dirk; Balcazar, Hector G.; Castro, Felipe; Schulz, Leslie

    2012-01-01

    This study assessed effectiveness of an educational community intervention taught by "promotoras de salud" in reducing cardiovascular disease (CVD) risk among Hispanics using a structural equation modeling (SEM) approach. Model development was guided by a social ecological framework proposing CVD risk reduction through improvement of…

  20. Utilizing nutritional genomics to tailor diets for the prevention of cardiovascular disease: a guide for upcoming studies and implementations

    Science.gov (United States)

    Introduction: Personalized diets based on an individual's genome to optimize the success of dietary intervention and reduce genetic cardiovascular disease (CVD) risk, is one of the challenges most frequently discussed in the scientific community. Moreover, it has been widely welcomed and demanded by...

  1. Risk of cardiovascular disease

    DEFF Research Database (Denmark)

    Gejl, Michael; Starup-Linde, Jakob; Scheel-Thomsen, Jan

    2014-01-01

    AIMS: Type 2 diabetes (DM) increases the risk of cardiovascular disease. We investigated the effects of antidiabetic drugs on the composite endpoint (CE) of ischemic heart disease, heart failure or stroke in DM patients. METHODS: We conducted a nested case-control study. Cases were DM patients who......% CI: 16.88-24.12), neuropathy (OR=1.39, 95% CI: 1.05-1.85) and peripheral artery disease (OR=1.31, 95% CI: 1.02-1.69) increased the risk of CE. Biguanides (OR=0.62 95% CI; 0.54-0.71) and liraglutide (OR=0.48 95% CI; 0.38-0.62) significantly decreased the risk of CE as did statin treatment (OR=0.63, 95...

  2. Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement.

    Science.gov (United States)

    Bibbins-Domingo, Kirsten

    2016-06-21

    Update of the 2009 USPSTF recommendation on aspirin use to prevent cardiovascular disease (CVD) events and the 2007 recommendation on aspirin and nonsteroidal anti-inflammatory drug use to prevent colorectal cancer (CRC). The USPSTF reviewed 5 additional studies of aspirin for the primary prevention of CVD and several additional analyses of CRC follow-up data. The USPSTF also relied on commissioned systematic reviews of all-cause mortality and total cancer incidence and mortality and a comprehensive review of harms. The USPSTF then used a microsimulation model to systematically estimate the balance of benefits and harms. This recommendation applies to adults aged 40 years or older without known CVD and without increased bleeding risk. The USPSTF recommends initiating low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. (B recommendation) The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin. (C recommendation) The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults younger than 50 years. (I statement) The current evidence is insufficient to assess the balance of benefits and harms of initiating aspirin use for the primary prevention of CVD and CRC in adults aged 70 years or older. (I

  3. Plasma Metabolites From Choline Pathway and Risk of Cardiovascular Disease in the PREDIMED (Prevention With Mediterranean Diet) Study.

    Science.gov (United States)

    Guasch-Ferré, Marta; Hu, Frank B; Ruiz-Canela, Miguel; Bulló, Mònica; Toledo, Estefanía; Wang, Dong D; Corella, Dolores; Gómez-Gracia, Enrique; Fiol, Miquel; Estruch, Ramon; Lapetra, José; Fitó, Montserrat; Arós, Fernando; Serra-Majem, Lluís; Ros, Emilio; Dennis, Courtney; Liang, Liming; Clish, Clary B; Martínez-González, Miguel A; Salas-Salvadó, Jordi

    2017-10-28

    The relationship between plasma concentrations of betaine and choline metabolism and major cardiovascular disease (CVD) end points remains unclear. We have evaluated the association between metabolites from the choline pathway and risk of incident CVD and the potential modifying effect of Mediterranean diet interventions. We designed a case-cohort study nested within the PREDIMED (Prevention With Mediterranean Diet) trial, including 229 incident CVD cases and 751 randomly selected participants at baseline, followed up for 4.8 years. We used liquid chromatography-tandem mass spectrometry to measure, at baseline and at 1 year of follow-up, plasma concentrations of 5 metabolites in the choline pathway: trimethylamine N-oxide, betaine, choline, phosphocholine, and α-glycerophosphocholine. We have calculated a choline metabolite score using a weighted sum of these 5 metabolites. We used weighted Cox regression models to estimate CVD risk. The multivariable hazard ratios (95% confidence intervals) per 1-SD increase in choline and α-glycerophosphocholine metabolites were 1.24 (1.05-1.46) and 1.24 (1.03-1.50), respectively. The baseline betaine/choline ratio was inversely associated with CVD. The baseline choline metabolite score was associated with a 2.21-fold higher risk of CVD across extreme quartiles (95% confidence interval, 1.36-3.59; P <0.001 for trend) and a 2.27-fold higher risk of stroke (95% confidence interval, 1.24-4.16; P <0.001 for trend). Participants in the higher quartiles of the score who were randomly assigned to the control group had a higher risk of CVD compared with participants in the lower quartile and assigned to the Mediterranean diet groups ( P =0.05 for interaction). No significant associations were observed for 1-year changes in individual plasma metabolites and CVD. A metabolite score combining plasma metabolites from the choline pathway was associated with an increased risk of CVD in a Mediterranean population at high cardiovascular risk

  4. Are dietary habits of the Polish population consistent with the recommendations for prevention of cardiovascular disease? - WOBASZ II project.

    Science.gov (United States)

    Waśkiewicz, Anna; Szcześniewska, Danuta; Szostak-Węgierek, Dorota; Kwaśniewska, Magdalena; Pająk, Andrzej; Stepaniak, Urszula; Kozakiewicz, Krystyna; Tykarski, Andrzej; Zdrojewski, Tomasz; Zujko, Małgorzata E; Drygas, Wojciech

    2016-01-01

    Diet is a modifiable risk factor for cardiovascular disease (CVD). To assess diet quality in the adult Polish population, taking into consideration consumption of various nutrients as well as the total diet quality. Within the frame of the National Multicentre Health Survey (WOBASZ II), a random sample of the whole Polish population aged 20 years and above was screened during the years 2013-2014. Dietary habits were assessed in 5690 subjects (2554 men and 3136 women). Nutrient intakes were compared to the Dietary Reference Intakes. Total diet quality was measured using the Healthy Diet Indicator (HDI) score, based on the World Health Organisation recommendations for CVD prevention, that includes 7 nutrients (saturated and polyunsaturated fatty acids, cholesterol, protein, dietary fibre, fruits and vegetables, free sugars) and ranges from 0 (the least healthy diet) to 7 (the healthiest diet). The studied group was characterised by a high prevalence of overweight and obesity (69% in men vs. 59% in women), hypercholesterolaemia (56% vs. 55%, respectively), hypertension (50% vs. 42%), and diabetes (12% vs. 10%). At the same time, a significant percentage of Poles had improper dietary habits. A low fat and low cholesterol diet was reported by only 8% and a low calorie diet by 1% of the respondents. Adding salt to already seasoned dishes was reported by 27% of men and 18% of women, and 56% and 30% of them, respectively, consumed meat products with visible fat. The diet of most adult Polish citizens was found to be not balanced. Vitamins A, C, E, B1, B2, B6, and B12, protein, dietary cholesterol and fruits/vegetables were consumed in recommended doses only by 44-80% of the respondents. The recommended intake of fat, saturated and polyunsaturated fatty acids, which significantly affect lipid levels, was found in 18-37% of the respondents. Dietary intakes of folate and minerals important for the prevention of hypertension were insufficient. The desired level of folate

  5. Aspirin in the primary prevention of cardiovascular disease in the Women’s Health Study: Effect of noncompliance

    Science.gov (United States)

    Cook, Nancy R.; Cole, Stephen R; Buring, Julie E.

    2012-01-01

    Randomized evidence for aspirin in the primary prevention of cardiovascular disease (CVD) among women is limited and suggests at most a modest effect for total CVD. Lack of compliance, however, can null-bias estimated effects. We used marginal structural models (MSMs) to estimate the etiologic effect of continuous aspirin use on CVD events among 39,876 apparently healthy female health professionals aged 45 years and older in the Women’s Health Study, a randomized trial of 100 mg aspirin every other day versus placebo. As-treated analyses and MSMs controlled for time-varying determinants of aspirin use and CVD. Predictors of aspirin use differed by randomized group and prior use and included medical history, CVD risk factors, and intermediate CVD events. Previously reported intent-to-treat analyses found small non-significant effects of aspirin on total CVD (hazard ratio (HR) =0.91, 95% confidence interval (CI) =0.81–1.03) and CVD mortality (HR=0.95, 95% CI=0.74–1.22). As-treated analyses were similar for total CVD with a slight reduction in CVD mortality (HR=0.88, 95%CI=0.67–1.16). MSMs, which adjusted for non-compliance, were similar for total CVD (HR=0.93; 95% CI: 0.81, 1.07) but suggested lower CVD mortality with aspirin use (HR = 0.76; 95% CI: 0.54, 1.08). Adjusting for non-compliance had little impact on the estimated effect of aspirin on total CVD, but strengthened the effect on CVD mortality. These results support a limited effect of low-dose aspirin on total CVD in women, but potential benefit for CVD mortality. PMID:22699516

  6. Cardiovascular diseases in dental practice : Practical considerations

    OpenAIRE

    Margaix Muñoz, María; Jiménez Soriano, Yolanda; Poveda Roda, Rafael; Sarrión Pérez, María Gracia

    2008-01-01

    Coronary heart disease is the principal cause of death in the industrialized world. Its most serious expression, acute myocardial infarction, causes 7.2 million deaths each year worldwide, and it is estimated that 20% of all people will suffer heart failure in the course of their lifetime. The control of risk cardiovascular factors, including arterial hypertension, obesity and diabetes mellitus is the best way to prevent such diseases. The most frequent and serious cardiovascular emergenc...

  7. Association between plasma fatty acids and inflammatory markers in patients with and without insulin resistance and in secondary prevention of cardiovascular disease, a cross-sectional study.

    Science.gov (United States)

    Bersch-Ferreira, Ângela Cristine; Sampaio, Geni Rodrigues; Gehringer, Marcella Omena; Torres, Elizabeth Aparecida Ferraz da Silva; Ross-Fernandes, Maria Beatriz; da Silva, Jacqueline Tereza; Torreglosa, Camila Ragne; Kovacs, Cristiane; Alves, Renata; Magnoni, Carlos Daniel; Weber, Bernardete; Rogero, Marcelo Macedo

    2018-02-21

    Proinflammatory biomarkers levels are increased among patients with cardiovascular disease, and it is known that both the presence of insulin resistance and diet may influence those levels. However, these associations are not well studied among patients with established cardiovascular disease. Our objective is to compare inflammatory biomarker levels among cardiovascular disease secondary prevention patients with and without insulin resistance, and to evaluate if there is any association between plasma fatty acid levels and inflammatory biomarker levels among them. In this cross-sectional sub-study from the BALANCE Program Trial, we collected data from 359 patients with established cardiovascular disease. Plasma fatty acids and inflammatory biomarkers (interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, high sensitive C-reactive protein (hs-CRP), adiponectin, and tumor necrosis factor (TNF)-alpha) were measured. Biomarkers and plasma fatty acid levels of subjects across insulin resistant and not insulin resistant groups were compared, and general linear models were used to examine the association between plasma fatty acids and inflammatory biomarkers. Subjects with insulin resistance had a higher concentration of hs-CRP (p = 0.002) and IL-6 (p = 0.002) than subjects without insulin resistance. Among subjects without insulin resistance there was a positive association between stearic fatty acid and IL-6 (p = 0.032), and a negative association between alpha-linolenic fatty acid and pro-inflammatory biomarkers (p fatty acids and arachidonic fatty acid and adiponectin (p fatty acids and pro-inflammatory biomarkers (p fatty acids and adiponectin (p fatty acids. Subjects in secondary prevention for cardiovascular disease with insulin resistance have a higher concentration of hs-CRP and IL-6 than individuals without insulin resistance, and these inflammatory biomarkers are positively associated with saturated fatty acids and negatively associated with

  8. Are the current recommendations for the use of aspirin in primary prevention of cardiovascular disease applicable in low-income countries?

    Directory of Open Access Journals (Sweden)

    Noubiap JJ

    2015-08-01

    Full Text Available Jean Jacques N Noubiap,1,2 Jobert Richie N Nansseu3,41Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; 2Medical Diagnostic Center, Yaoundé, Cameroon; 3Sickle Cell Disease Unit, Mother and Child Centre, Chantal BIYA Foundation, Yaoundé, Cameroon; 4Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, CameroonAbstract: Although evidence has accumulated that long-term aspirin therapy is beneficial in secondary prevention of cardiovascular disease (CVD, a lot of controversies persist regarding the benefit of aspirin use in primary prevention of CVD. In low-income countries (LIC specifically, the decision to prescribe aspirin for primary CVD prevention is more problematic, as there is a dearth of evidence in this regard. Aspirin has been shown to have relative beneficial effects in preventing a first myocardial infarction, but not stroke. However, as stroke is the prevailing CVD in many LIC, especially in Africa, the benefit of aspirin in these settings is therefore questionable. Indeed, there is no published trial that has evaluated the benefits and risks of continuous aspirin therapy in populations of LIC. Furthermore, though cardiovascular risk assessment is crucial in decision-making for the use of aspirin in primary prevention of CVD, there are no risk assessment tools that have been validated in African populations. Studies are urgently warranted, to determine the usefulness of aspirin in primary prevention of CVD in low-income settings where the drug is highly available and affordable, as CVD is becoming the leading cause of deaths in LIC.Keywords: aspirin, cardiovascular disease, primary prevention, low-income countries

  9. Gut microbial diversity in HIV infection post combined antiretroviral therapy: a key target for prevention of cardiovascular disease

    OpenAIRE

    El-Far, Mohamed; Tremblay, Cécile L.

    2017-01-01

    Purpose of review Although the HIV-infected population is living longer and getting older under current treatment regimens, significant challenges arise for health management as the infection is associated with various premature aging phenotypes, particularly increased incidence of cardiovascular diseases (CVDs). Here we review the current understanding of HIV-related gut dysbiosis in association with CVD and advances in clinical trials aiming to restore gut microbial diversity. Recent findin...

  10. Multiple health behaviour change interventions for primary prevention of cardiovascular disease in primary care: systematic review and meta-analysis.

    Science.gov (United States)

    Alageel, Samah; Gulliford, Martin C; McDermott, Lisa; Wright, Alison J

    2017-06-15

    It is uncertain whether multiple health behaviour change (MHBC) interventions are effective for the primary prevention of cardiovascular disease (CVD) in primary care. A systematic review and a meta-analysis were performed to evaluate the effectiveness of MHBC interventions on CVD risk and CVD risk factors; the study also evaluated associations of theoretical frameworks and intervention components with intervention effectiveness. The search included randomised controlled trials of MHBC interventions aimed at reducing CVD risk in primary prevention population up to 2017. Theoretical frameworks and intervention components were evaluated using standardised methods. Meta-analysis with stratification and meta-regression were used to evaluate intervention effects. We identified 31 trials (36 484 participants) with a minimum duration of 12 months follow-up. Pooled net change in systolic blood pressure (16 trials) was -1.86 (95% CI -3.17 to -0.55; p=0.01) mm Hg; diastolic blood pressure (15 trials), -1.53 (-2.43 to -0.62; p=0.001) mm Hg; body mass index (14 trials), -0.13 (-0.26 to -0.01; p=0.04) kg/m 2 ; serum total cholesterol (14 trials), -0.13 (-0.19 to -0.07; p<0.001) mmol/L. There was no significant association between interventions with a reported theoretical basis and improved intervention outcomes. No association was observed between intervention intensity (number of sessions and intervention duration) and intervention outcomes. There was significant heterogeneity for some risk factor analyses, leading to uncertain validity of some pooled net changes. MHBC interventions delivered to CVD-free participants in primary care did not appear to have quantitatively important effects on CVD risk factors. Better reporting of interventions' rationale, content and delivery is essential to understanding their effectiveness. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted

  11. A community-based intervention for primary prevention of cardiovascular diseases in the slums of Nairobi: the SCALE UP study protocol for a prospective quasi-experimental community-based trial

    NARCIS (Netherlands)

    Oti, Samuel O.; van de Vijver, Steven J. M.; Kyobutungi, Catherine; Gomez, Gabriela B.; Agyemang, Charles; Moll van Charante, Eric P.; Brewster, Lizzy M.; Hendriks, Marleen E.; Schultsz, Constance; Ettarh, Remare; Ezeh, Alex; Lange, Joep

    2013-01-01

    The burden of cardiovascular disease is rising in sub-Saharan Africa with hypertension being the main risk factor. However, context-specific evidence on effective interventions for primary prevention of cardiovascular diseases in resource-poor settings is limited. This study aims to evaluate the

  12. Aspirin for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: A Decision Analysis for the U.S. Preventive Services Task Force.

    Science.gov (United States)

    Dehmer, Steven P; Maciosek, Michael V; Flottemesch, Thomas J; LaFrance, Amy B; Whitlock, Evelyn P

    2016-06-21

    Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) but also increases the risk for gastrointestinal (GI) and cerebral hemorrhages. To assess the net balance of benefits and harms from routine aspirin use across clinically relevant age, sex, and CVD risk groups. Decision analysis using a microsimulation model. 3 systematic evidence reviews. Men and women aged 40 to 79 years with a 10-year CVD risk of 20% or less, and no history of CVD and without elevated risk for GI or cerebral hemorrhages that would contraindicate aspirin use. Lifetime, 20 years, and 10 years. Clinical. Low-dose aspirin (≤100 mg/d). Primary outcomes are length and quality of life measured in net life-years and quality-adjusted life-years. Benefits include reduced nonfatal myocardial infarction, nonfatal ischemic stroke, fatal CVD, CRC incidence, and CRC mortality. Harms include increased fatal and nonfatal GI bleeding and hemorrhagic stroke. Lifetime net quality-adjusted life-years are positive for most adults initiating aspirin at ages 40 to 69 years, and life expectancy gains are expected for most men and women initiating aspirin at ages 40 to 59 years and 60 to 69 years with higher CVD risk. Harms may exceed benefits for persons starting aspirin in their 70s and for many during the first 10 to 20 years of use. Results are most sensitive to the relative risk for hemorrhagic stroke and CVD mortality but are affected by all relative risk estimates, baseline GI bleeding incidence and case-fatality rates, and disutilities associated with aspirin use. Aspirin effects by age are uncertain. Stroke benefits are conservatively estimated. Gastrointestinal bleeding incidence and case-fatality rates account only for age and sex. Lifetime aspirin use for primary prevention initiated at younger ages (40 to 69 years) and in persons with higher CVD risk shows the greatest potential for positive net benefit. Agency for Healthcare

  13. Cardiovascular diseases and diabetes

    DEFF Research Database (Denmark)

    Green, A.; Sortso, C.; Jensen, Peter Bjødstrup

    2016-01-01

    We present an investigation of the occurrence of cardiovascular disease in patients with diabetes in Denmark 2000 through 2011. The Diabetes Impact Study 2013 is based on all registrants in the Danish National Diabetes Register as of July 3rd 2013 (n=497,232). Record linkage with the Danish...... of diabetes has been rather constant at higher level in males (around 16-18%) than in females (around 12-14%) during 2000-2011 (incl.). In contrast, the incidence rate of CVD after having diabetes diagnosis has declined from about 4.5 to less than 3 during the same period, with higher declining level...... for males than for females. Efforts to detect diabetes at an earlier stage have not resulted in a reduced occurrence of CVD at the diagnosis of diabetes in Denmark. However, the risk of developing CVD after the diagnosis of diabetes has been declining, possibly reflecting benefits of intensified treatment...

  14. A Systematic Review of Evidence-Based Community Pharmacy Services Aimed at the Prevention of Cardiovascular Disease.

    Science.gov (United States)

    Sabater-Hernández, Daniel; Sabater-Galindo, Marta; Fernandez-Llimos, Fernando; Rotta, Inajara; Hossain, Lutfun N; Durks, Desire; Franco-Trigo, Lucia; Lopes, Livia A; Correr, Cassyano J; Benrimoj, Shalom I

    2016-06-01

    Cardiovascular disease (CVD) is the leading cause of death worldwide and has a substantial impact on people's health and quality of life. CVD also causes an increased use of health care resources and services, representing a significant proportion of health care expenditure. Integrating evidence-based community pharmacy services is seen as an asset to reduce the burden of CVD on individuals and the health care system. To (a) identify community pharmacy evidence-based services designed to help prevent CVD and (b) provide fundamental information that is needed to assess their potential adaptation to other community pharmacy settings. This review used the DEPICT database, which includes 488 randomized controlled trials (RCT) that address the evaluation of pharmacy services. Articles reviewing these RCTs were identified for the DEPICT database through a systematic search of the following databases: MEDLINE, Scopus, SciELO (Scientific Electronic Library Online), and DOAJ (Directory of Open Access Journals). The DEPICT database was reviewed to identify evidence-based services delivered in the community pharmacy setting with the purpose of preventing CVD. An evidence-based service was defined as a service that has been shown to have a positive effect (compared with usual care) in a high-quality RCT. From each evidence-based service, fundamental information was retrieved to facilitate adaptation to other community pharmacy settings. From the DEPICT database, 14 evidence-based community pharmacy services that addressed the prevention of CVD were identified. All services, except 1, targeted populations with a mean age above 60 years. Pharmacy services encompassed a wide range of practical applications or techniques that can be classified into 3 groups: activities directed at patients, activities directed at health care professionals, and assessments to gather patient-related information in order to support the previous activities. This review provides pharmacy service

  15. Prevention and Control Program for Cardiovascular Diseases in Turkish Population: PRE-CONTROL Study Group.

    Science.gov (United States)

    Kozan, Ömer; Zoghi, Mehdi; Ergene, Oktay; Arıcı, Mustafa; Derici, Ülver; Bakaç, Göksel; Güllü, Sevim; Sain Güven, Gülay

    2013-06-01

    Cardiovascular disease (CVD) is the leading cause of death throughout the world. Despite its high prevalence, the atherosclerotic process can be slowed and its consequences markedly reduced by preventive measures. The lack of risk factor awareness is a major barrier. We aimed to assess total CV risk, determine the knowledge and awareness regarding CVD, and evaluate the effectiveness of education program in urban population of Turkey. A 24-item questionnaire was used to detect CV risk factors and the awareness of participants about CVD. The feedback data for the education program were collected by either questionnaires or individual interviews with participants. For comparison of total CVD risk in men and women in different age groups, a sample t test was used. The level of statistical significance was set at p < 0.05. The prevalence of hyperlipidemia was established to be 41.3%. Nearly one-quarter of the women and one-third of the men were smokers (p < 0.001). One-quarter of the responders had a history of hypertension (men: 21.5%, women: 18.6%), and one-tenth were diabetic. The high CV risk rate was more pronounced among men (p < 0.01) and those with low socioeconomic level (p < 0.01). Awareness regarding CV risk factors following the educational program increased from 6.6% to 12.7% for high blood pressure, from 3.9% to 9.2% for diabetes mellitus, and from 10.2% to 15.1% for elevated cholesterol levels. All the increases were statistically significant. The educational program significantly increased the awareness of CVD and risk factors. The prevalence of CV risk factors was higher in low socioeconomic level groups. The knowledge and awareness of the risk factors for CVD before the education program was very low in our study group. The awareness of CVD and risk factors significantly increased following our education programs. Copyright © 2013 World Heart Federation (Geneva). Published by Elsevier B.V. All rights reserved.

  16. Application of infrared thermal imaging in the study of preventing cardiovascular and cerebrovascular diseases with Chinese medicine health food

    Science.gov (United States)

    Li, Ziru; Zhang, Xusheng

    2009-08-01

    To explore the assessing technique which could objectively reflect the characteristics of Chinese medicine in the prevention of cardiovascular and cerebrovascular diseases, four balance features of infrared thermal images (ITI) corresponding to the up and down, left and right, proximal and distal balance of blood circulation of human body were studied. First, the ITI features of the middle-aged and elderly people with lipid abnormality history were compared with those of the healthy youth. It was found that the balance state of the youth was significantly better than that of the middle-aged and elderly, Plipid, on the balance features. The subjects were middle-aged and elderly people with lipid abnormality history. Shengyi capsule was taken by the trial group while Xuezhikang capsule (with lovastatin as the main effective component) by the control group for 108 days. The balance features of ITI showed that Shengyi was significantly better than Xuezhikang in improving the whole body balance of blood circulation (including the up and down, left and right, proximal and distal balance). The relative efficacy rate was 81.0% for the trial group and 33.3% for the control group, there was significant difference between the two groups (P=0.002). Shengyi could effectively decrease the low density lipoprotein cholesterol (LDL-C) but the effect of Xuezhikang in decreasing total cholesterol (TC) and LDL-C was better than Shengyi. Though the lipid-lowering effect of Shengyi was not as good as Xuezhikang, ITI reflected the obvious advantage of Shengyi in improving the whole body balance of blood circulation which indicated that helping to decrease serum lipid is only part of the health function of Shengyi. The physiology and pathology basis of the influences of Shengyi on the four balance features and its relationship with the clinical outcome deserves further study. So the prospect of infrared thermal imaging is indicated as the suitable evaluation technique which could

  17. Electronic health record-based patient identification and individualized mailed outreach for primary cardiovascular disease prevention: a cluster randomized trial.

    Science.gov (United States)

    Persell, Stephen D; Lloyd-Jones, Donald M; Friesema, Elisha M; Cooper, Andrew J; Baker, David W

    2013-04-01

    Many individuals at higher risk for cardiovascular disease (CVD) do not receive recommended treatments. Prior interventions using personalized risk information to promote prevention did not test clinic-wide effectiveness. To perform a 9-month cluster-randomized trial, comparing a strategy of electronic health record-based identification of patients with increased CVD risk and individualized mailed outreach to usual care. Patients of participating physicians with a Framingham Risk Score of at least 5 %, low-density lipoprotein (LDL)-cholesterol level above guideline threshold for drug treatment, and not prescribed a lipid-lowering medication were included in the intention-to-treat analysis. Patients of physicians randomized to the intervention group were mailed individualized CVD risk messages that described benefits of using a statin (and controlling hypertension or quitting smoking when relevant). The primary outcome was occurrence of a LDL-cholesterol level, repeated in routine practice, that was at least 30 mg/dl lower than prior. A secondary outcome was lipid-lowering drug prescribing. Clinicaltrials.gov identifier: NCT01286311. Fourteen physicians with 218 patients were randomized to intervention, and 15 physicians with 217 patients to control. The mean patient age was 60.7 years and 77% were male. There was no difference in the primary outcome (11.0 % vs. 11.1 %, OR 0.99, 95 % CI 0.56-1.74, P = 0.96), but intervention group patients were twice as likely to receive a prescription for lipid-lowering medication (11.9 %, vs. 6.0 %, OR 2.13, 95 % CI 1.05-4.32, p = 0.038). In post hoc analysis with extended follow-up to 18 months, the primary outcome occurred more often in the intervention group (22.5 % vs. 16.1 %, OR 1.59, 95 % CI 1.05-2.41, P = 0.029). In this effectiveness trial, individualized mailed CVD risk messages increased the frequency of new lipid-lowering drug prescriptions, but we observed no difference in proportions lowering LDL

  18. Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community.

    Science.gov (United States)

    Oli, Natalia; Vaidya, Abhinav; Subedi, Madhusudan; Krettek, Alexandra

    2014-01-01

    Nepal currently faces an increasing burden of cardiovascular disease (CVD). Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice. This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients' viewpoint. We conducted in-depth interviews (IDIs) with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories. Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness. This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with their disease, interventions should be tailored to improve the community

  19. Experiences and perceptions about cause and prevention of cardiovascular disease among people with cardiometabolic conditions: findings of in-depth interviews from a peri-urban Nepalese community

    Directory of Open Access Journals (Sweden)

    Natalia Oli

    2014-04-01

    Full Text Available Background: Nepal currently faces an increasing burden of cardiovascular disease (CVD. Earlier studies on health literacy and the behavior dimension of cardiovascular health reported a substantial gap between knowledge and practice. Objective: This qualitative study aimed to deepen understanding of the community perspective on cardiovascular health from the patients’ viewpoint. Design: We conducted in-depth interviews (IDIs with 13 individuals with confirmed heart disease, hypertension, or diabetes mellitus. All participants provided verbal consent. We used an IDI guide to ask respondents about their perception and experiences with CVD, particularly regarding causation and preventability. We manually applied qualitative content analysis to evaluate the data and grouped similar content into categories and subcategories. Results: Respondents perceived dietary factors, particularly consumption of salty, fatty, and oily food, as the main determinants of CVD. Similarly, our respondents unanimously linked smoking, alcohol intake, and high blood pressure with cardiac ailments but reported mixed opinion regarding the causal role of body weight and physical inactivity. Although depressed and stressed at the time of diagnosis, respondents learned to handle their situation better over time. Despite good family support for health care, the financial burden of disease was a major issue. All respondents understood the importance of lifestyle modification and relied upon health professionals for information and motivation. Respondents remarked that community awareness of CVD was inadequate and that medical doctors or trained local people should help increase awareness. Conclusions: This study provided insight into the perceptions of patients regarding CVD. Respondents embraced the importance of lifestyle modification only after receiving their diagnosis. Although better health care is important in terms of aiding patients to better understand and cope with

  20. Adrenomedullin and cardiovascular diseases

    OpenAIRE

    Wong, Hoi Kin; Cheung, Tommy Tsang; Cheung, Bernard M Y

    2012-01-01

    Summary The cardiovascular system is regulated by the autonomic nervous system, the renin–angiotensin–aldosterone system, nitric oxide (NO) and other factors including neuropeptides. Research in neurohumoral factors has led to the development of many cardiovascular drugs. Adrenomedullin (ADM), initially isolated from the adrenal gland, has diverse physiological and pathophysiological functions in the cardiovascular system. It is produced in many organs and tissues including the vasculature. A...

  1. Neuroprotection and Neurodegeneration in Alzheimer’s Disease: Role of Cardiovascular Disease Risk Factors, Implications for Dementia Rates, and Prevention with Aerobic Exercise in African Americans

    Directory of Open Access Journals (Sweden)

    Thomas O. Obisesan

    2012-01-01

    Full Text Available Prevalence of Alzheimer’s disease (AD will reach epidemic proportions in the United States and worldwide in the coming decades, and with substantially higher rates in African Americans (AAs than in Whites. Older age, family history, low levels of education, and ɛ4 allele of the apolipoprotein E (APOE gene are recognized risk factors for the neurodegeneration in AD and related disorders. In AAs, the contributions of APOE gene to AD risk continue to engender a considerable debate. In addition to the established role of cardiovascular disease (CVD risk in vascular dementia, it is now believed that CVD risk and its endophenotype may directly comediate AD phenotype. Given the pleiotropic effects of APOE on CVD and AD risks, the higher rates of CVD risks in AAs than in Whites, it is likely that CVD risks contribute to the disproportionately higher rates of AD in AAs. Though the advantageous effects of aerobic exercise on cognition is increasingly recognized, this evidence is hardly definitive, and data on AAs is lacking. In this paper, we will discuss the roles of CVD risk factors in the development of AD and related dementias, the susceptibility of these risk factors to physiologic adaptation, and fitness-related improvements in cognitive function. Its relevance to AD prevention in AAs is emphasized.

  2. Environmental Determinants of Cardiovascular Disease.

    Science.gov (United States)

    Bhatnagar, Aruni

    2017-07-07

    Many features of the environment have been found to exert an important influence on cardiovascular disease (CVD) risk, progression, and severity. Changes in the environment because of migration to different geographic locations, modifications in lifestyle choices, and shifts in social policies and cultural practices alter CVD risk, even in the absence of genetic changes. Nevertheless, the cumulative impact of the environment on CVD risk has been difficult to assess and the mechanisms by which some environment factors influence CVD remain obscure. Human environments are complex, and their natural, social, and personal domains are highly variable because of diversity in human ecosystems, evolutionary histories, social structures, and individual choices. Accumulating evidence supports the notion that ecological features such as the diurnal cycles of light and day, sunlight exposure, seasons, and geographic characteristics of the natural environment such as altitude, latitude, and greenspaces are important determinants of cardiovascular health and CVD risk. In highly developed societies, the influence of the natural environment is moderated by the physical characteristics of the social environments such as the built environment and pollution, as well as by socioeconomic status and social networks. These attributes of the social environment shape lifestyle choices that significantly modify CVD risk. An understanding of how different domains of the environment, individually and collectively, affect CVD risk could lead to a better appraisal of CVD and aid in the development of new preventive and therapeutic strategies to limit the increasingly high global burden of heart disease and stroke. © 2017 American Heart Association, Inc.

  3. Statin treatment prevents increased cardiovascular and all-cause mortality associated with clarithromycin in patients with stable coronary heart disease

    DEFF Research Database (Denmark)

    Jensen, Gorm B; Hilden, Jørgen; Als-Nielsen, Bodil

    2010-01-01

    In the CLARICOR trial, significantly increased cardiovascular (CV) and all-cause mortality in stable patients with coronary heart disease were observed after a short course of clarithromycin. We report on the impact of statin treatment at entry on the CV and all-cause mortality. The multicenter...... CLARICOR trial randomized patients to oral clarithromycin (500 mg daily; n = 2172) versus matching placebo (daily; n = 2201) for 2 weeks. Patients were followed through public databases. In the 41% patients on statin treatment at entry, no significant effect of clarithromycin was observed on CV (hazard.......0003; statin-clarithromycin interaction P = 0.0029) and all-cause mortality (HR, 1.33; 95% CI, 1.05-1.67; P = 0.016; statin-clarithromycin interaction P = 0.41). Multivariate analysis and 6-year follow up confirmed these results. Concomitant statin treatment in stable patients with coronary heart disease...

  4. Increased Prevalence of Cardiovascular and Autoimmune Diseases in Periodontitis Patients: A Cross-Sectional Study

    NARCIS (Netherlands)

    Nesse, Willem; Dijkstra, P.U.; Abbas, Frank; Spijkervet, F.K.L.; Stijger, A.; Tromp, J.A.H.; van Dijk, J.L.; Vissink, A.

    2010-01-01

    Background: Associations between periodontitis and cardiovascular and autoimmune diseases are most often assessed in patients with a particular cardiovascular or autoimmune disease. To prevent selection bias, this study assesses the existence of associations between periodontitis and cardiovascular

  5. Increased Prevalence of Cardiovascular and Autoimmune Diseases in Periodontitis Patients : A Cross-Sectional Study

    NARCIS (Netherlands)

    Nesse, Willem; Dijkstra, Pieter U.; Abbas, Frank; Spijkervet, Fred K. L.; Stijger, Astrid; Tromp, Jan A. H.; van Dijk, Johan L.; Vissink, Arjan

    2010-01-01

    Background: Associations between periodontitis and cardiovascular and autoimmune diseases are most often assessed in patients with a particular cardiovascular or autoimmune disease. To prevent selection bias, this study assesses the existence of associations between periodontitis and cardiovascular

  6. Cheese and cardiovascular disease risk

    DEFF Research Database (Denmark)

    Hjerpsted, Julie Bousgaard; Tholstrup, Tine

    2016-01-01

    Abstract Currently, the effect of dairy products on cardiovascular risk is a topic with much debate and conflicting results. The purpose of this review is to give an overview of the existing literature regarding the effect of cheese intake and risk of cardiovascular disease (CVD). Studies included...

  7. APOE Genotyping, Cardiovascular Disease

    Science.gov (United States)

    ... it ordered? As a test to evaluate lipid metabolism or cardiovascular risk, APOE genotyping is ordered when someone has: Significantly elevated cholesterol and triglyceride levels that do not respond to dietary and ...

  8. Ceruloplasmin and cardiovascular disease

    Science.gov (United States)

    Fox, P. L.; Mazumder, B.; Ehrenwald, E.; Mukhopadhyay, C. K.

    2000-01-01

    Transition metal ion-mediated oxidation is a commonly used model system for studies of the chemical, structural, and functional modifications of low-density lipoprotein (LDL). The physiological relevance of studies using free metal ions is unclear and has led to an exploration of free metal ion-independent mechanisms of oxidation. We and others have investigated the role of human ceruloplasmin (Cp) in oxidative processes because it the principal copper-containing protein in serum. There is an abundance of epidemiological data that suggests that serum Cp may be an important risk factor predicting myocardial infarction and cardiovascular disease. Biochemical studies have shown that Cp is a potent catalyst of LDL oxidation in vitro. The pro-oxidant activity of Cp requires an intact structure, and a single copper atom at the surface of the protein, near His(426), is required for LDL oxidation. Under conditions where inhibitory protein (such as albumin) is present, LDL oxidation by Cp is optimal in the presence of superoxide, which reduces the surface copper atom of Cp. Cultured vascular endothelial and smooth muscle cells also oxidize LDL in the presence of Cp. Superoxide release by these cells is a critical factor regulating the rate of oxidation. Cultured monocytic cells, when activated by zymosan, can oxidize LDL, but these cells are unique in their secretion of Cp. Inhibitor studies using Cp-specific antibodies and antisense oligonucleotides show that Cp is a major contributor to LDL oxidation by these cells. The role of Cp in lipoprotein oxidation and atherosclerotic lesion progression in vivo has not been directly assessed and is an important area for future studies.

  9. Differences in Lifestyle Improvements With the Intention to Prevent Cardiovascular Diseases by Socioeconomic Status in a Representative Japanese Population: NIPPON DATA2010.

    Science.gov (United States)

    Goryoda, Sayuri; Nishi, Nobuo; Hozawa, Atsushi; Yoshita, Katsushi; Arai, Yusuke; Kondo, Keiko; Miyagawa, Naoko; Hayakawa, Takehito; Fujiyoshi, Akira; Kadota, Aya; Ohkubo, Takayoshi; Okamura, Tomonori; Okuda, Nagako; Ueshima, Hirotsugu; Okayama, Akira; Miura, Katsuyuki

    2018-01-01

    The relationships among socioeconomic status and lifestyle improvements have not yet been examined in a representative Japanese population. We analyzed data from 2,647 participants (1,087 men and 1,560 women) who participated in NIPPON DATA2010. This survey inquired about lifestyle improvements and socioeconomic status. Education was categorized as low (≤9 years), middle (10-12 years), and high (≥13 years). Marital status was categorized as married, divorced, widowed, and never married/other. A multivariable logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of lifestyle improvements with the intention of preventing cardiovascular diseases for educational attainment and marital status, with adjustments for age and awareness of cardiovascular disease risk factors. Overall, 1,507 (56.9%) participants practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome, and the OR of lifestyle improvements was significantly higher with a high education than with a low education in men (OR 2.86; 95% CI, 1.96-4.17) and women (OR 2.36; 95% CI, 1.67-3.33). The number of participants who practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome was significantly lower in divorced than in married men (OR 0.46; 95% CI, 0.22-0.95) and women (OR 0.53; 95% CI, 0.33-0.86). Specific differences caused by educational attainment and marital status may exist in lifestyle improvements.

  10. Ageing, metabolism and cardiovascular disease.

    Science.gov (United States)

    Costantino, Sarah; Paneni, Francesco; Cosentino, Francesco

    2016-04-15

    Age is one of the major risk factors associated with cardiovascular disease (CVD). About one-fifth of the world population will be aged 65 or older by 2030, with an exponential increase in CVD prevalence. It is well established that environmental factors (overnutrition, smoking, pollution, sedentary lifestyles) may lead to premature defects in mitochondrial functionality, insulin signalling, endothelial homeostasis and redox balance, fostering early senescent features. Over the last few years, molecular investigations have unveiled common signalling networks which may link the ageing process with deterioration of cardiovascular homeostasis and metabolic disturbances, namely insulin resistance. These different processes seem to be highly interconnected and their interplay may favour adverse vascular and cardiac phenotypes responsible for myocardial infarction, stroke and heart failure. In the present review, we carefully describe novel molecular cues underpinning ageing, metabolism and CVD. In particular, we describe a dynamic interplay between emerging pathways such as FOXOs, AMPK, SIRT1, p66(Shc) , JunD and NF-kB. This overview will provide the background for attractive molecular targets to prevent age-driven pathology in the vasculature and the heart. © 2015 The Authors. The Journal of Physiology © 2015 The Physiological Society.

  11. Total cardiovascular disease risk assessment: a review.

    LENUS (Irish Health Repository)

    Cooney, Marie Therese

    2011-09-01

    The high risk strategy for the prevention of cardiovascular disease (CVD) requires an assessment of an individual\\'s total CVD risk so that the most intensive risk factor management can be directed towards those at highest risk. Here we review developments in the assessment and estimation of total CVD risk.

  12. MACD - an imaging marker for cardiovascular disease

    DEFF Research Database (Denmark)

    Ganz, Melanie; de Bruijne, Marleen; Nielsen, Mads

    2010-01-01

    Despite general acceptance that a healthy lifestyle and the treatment of risk factors can prevent the development of cardiovascular diseases (CVD), CVD are the most common cause of death in Europe and the United States. It has been shown that abdominal aortic calcifications (AAC) correlate strong...

  13. Preventive use of Bach flower Rescue Remedy in the control of risk factors for cardiovascular disease in rats.

    Science.gov (United States)

    Resende, Margarida Maria de Carvalho; Costa, Francisco Eduardo de Carvalho; Gardona, Rodrigo Galvão Bueno; Araújo, Rochilan Godinho; Mundim, Fiorita Gonzales Lopes; Costa, Maria José de Carvalho

    2014-08-01

    To evaluate the effect of Bach flower Rescue Remedy on the control of risk factors for cardiovascular disease in rats. A randomized longitudinal experimental study. Eighteen Wistar rats were randomly divided into three groups of six animals each and orogastrically dosed with either 200 μl of water (group A, control), or 100 μl of water and 100 μl of Bach flower remedy (group B), or 200 μl of Bach flower remedy (group C) every 2 days, for 20 days. All animals were fed standard rat chow and water ad libitum. Urine volume, body weight, feces weight, and food intake were measured every 2 days. On day 20, tests of glycemia, hyperuricemia, triglycerides, high-density lipoprotein (HDL) cholesterol, and total cholesterol were performed, and the anatomy and histopathology of the heart, liver and kidneys were evaluated. Data were analyzed using Tukey's test at a significance level of 5%. No significant differences were found in food intake, feces weight, urine volume and uric acid levels between groups. Group C had a significantly lower body weight gain than group A and lower glycemia compared with groups A and B. Groups B and C had significantly higher HDL-cholesterol and lower triglycerides than controls. Animals had mild hepatic steatosis, but no cardiac or renal damage was observed in the three groups. Bach flower Rescue Remedy was effective in controlling glycemia, triglycerides, and HDL-cholesterol and may serve as a strategy for reducing risk factors for cardiovascular disease in rats. This study provides some preliminary "proof of concept" data that Bach Rescue Remedy may exert some biological effects. Copyright © 2014 Elsevier Ltd. All rights reserved.

  14. Nutrição e exercício na prevenção e controle das doenças cardiovasculares Nutrition and exercise on cardiovascular disease prevention and control

    Directory of Open Access Journals (Sweden)

    Ana Beatriz Ribeiro Rique

    2002-12-01

    Full Text Available As doenças cardiovasculares constituem a principal causa de mortalidade no mundo e o seu crescimento significativo nos países em desenvolvimento alerta para o potencial impacto nas classes menos favorecidas. São influenciadas por um conjunto de fatores de risco, alguns modificáveis mediante alterações no estilo de vida, como a dieta adequada e o exercício regular. O objetivo da presente revisão é abordar esses aspectos a fim de prevenir e controlar as doenças cardiovasculares. O consumo de vegetais, frutas, grãos integrais, soja, azeite e peixes deve ser aumentado, ainda que limitando a quantidade de gordura. Os alimentos ricos em ácidos graxos saturados e trans devem ser evitados, assim como o uso excessivo de sal e bebidas alcoólicas. Além do exercício aeróbio, as atividades contra resistência vêm aumentando sua importância na reabilitação cardíaca. Essas mudanças de estilo de vida deveriam ser prioridades na Saúde Pública a fim de deter o avanço das doenças cardiovasculares em nosso país.Cardiovascular diseases represent the major worldwide cause of death, and their significant growth in developing countries alerts against their impact on underprivileged classes. Cardiovascular diseases are subject to a set of risk factors, some of which can be altered through changes in lifestyle, such as balanced diet and regular exercising. The purpose of this review is to approach these factors in order to prevent and control cardiovascular diseases. The consumption of vegetables, fruit, whole grains, soybeans, olive oil, and fish must be increased, although limiting the amount of fat. Saturated and trans fatty acids must be avoided, as well as excessive use of salt and alcoholic beverages. Besides aerobics, resistance training activities are increasing their importance in cardiac rehabilitation. Such lifestyle changes should be prioritized by Public Health authorities in order to hold back cardiovascular disease occurrence in

  15. Healthy Ageing Through Internet Counselling in the Elderly: the HATICE randomised controlled trial for the prevention of cardiovascular disease and cognitive impairment.

    Science.gov (United States)

    Richard, Edo; Jongstra, Susan; Soininen, Hilkka; Brayne, Carol; Moll van Charante, Eric P; Meiller, Yannick; van der Groep, Bram; Beishuizen, Cathrien R L; Mangialasche, Francesca; Barbera, Mariagnese; Ngandu, Tiia; Coley, Nicola; Guillemont, Juliette; Savy, Stéphanie; Dijkgraaf, Marcel G W; Peters, Ron J G; van Gool, Willem A; Kivipelto, Miia; Andrieu, Sandrine

    2016-06-10

    Cardiovascular disease and dementia share a number of risk factors including hypertension, hypercholesterolaemia, smoking, obesity, diabetes and physical inactivity. The rise of eHealth has led to increasing opportunities for large-scale delivery of prevention programmes encouraging self-management. The aim of this study is to investigate whether a multidomain intervention to optimise self-management of cardiovascular risk factors in older individuals, delivered through an coach-supported interactive internet platform, can improve the cardiovascular risk profile and reduce the risk of cardiovascular disease and cognitive decline. HATICE is a multinational, multicentre, prospective, randomised, open-label blinded end point (PROBE) trial with 18 months intervention. Recruitment of 2600 older people (≥65 years) at increased risk of cardiovascular disease will take place in the Netherlands, Finland and France. Participants randomised to the intervention condition will have access to an interactive internet platform, stimulating self-management of vascular risk factors, with remote support by a coach. Participants in the control group will have access to a static internet platform with basic health information.The primary outcome is a composite score based on the average z-score of the difference between baseline and 18 months follow-up values of systolic blood pressure, low-density-lipoprotein and body mass index. Main secondary outcomes include the effect on the individual components of the primary outcome, the effect on lifestyle-related risk factors, incident cardiovascular disease, mortality, cognitive functioning, mood and cost-effectiveness. The study was approved by the medical ethics committee of the Academic Medical Center in Amsterdam, the Comité de Protection des Personnes Sud Ouest et Outre Mer in France and the Northern Savo Hospital District Research Ethics Committee in Finland.We expect that data from this study will result in a manuscript

  16. Effect of cardiovascular prevention strategies on incident coronary disease hospitalisation rates in Spain; an ecological time series analysis.

    Science.gov (United States)

    Medrano, María José; Alcalde-Cabero, Enrique; Ortíz, Cristina; Galán, Iñaki

    2014-02-17

    To assess the overall population impact of primary prevention strategies (promotion of healthy lifestyles, prevention of smoking and use of vascular risk drug therapy) of coronary disease in Spain. Ecological time series analysis, 1982-2009. All public and private hospitals in Spain. General population. Incident coronary disease hospitalisation as derived from official hospital discharge data. Annual hospitalisation rates were modelled according to nationwide use of statins, antihypertensive, antidiabetic and antiplatelet drugs, and prevalences of smoking, obesity and overweight. Additive generalised models and mixed Poisson regression models were used for the purpose, taking year as the random-effect variable and adjusting for age, sex, prevalence of vascular risk factors and the number of hospital beds in intensive and coronary care units. Across 28 years and 671.5 million person-years of observation, there were 2 986 834 hospitalisations due to coronary disease; of these, 1 441 980 (48.28%) were classified as incident. Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009. Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (pstress on excessive body weight prevention.

  17. Educational inequality in cardiovascular diseases

    DEFF Research Database (Denmark)

    Søndergaard, Grethe; Dalton, Susanne Oksbjerg; Mortensen, Laust Hvas

    2018-01-01

    AIMS: Educational inequality in diseases in the circulatory system (here termed cardiovascular disease) is well documented but may be confounded by early life factors. The aim of this observational study was to examine whether the associations between education and all cardiovascular diseases...... in conventional cohort and within-sibship analyses in which the association was examined within siblings discordant on education. Assuming that attenuation of associations in the within-sibship as compared with the cohort analyses would indicate confounding from factors shared within families. RESULTS: A lower...... educational status was associated with a higher risk of cardiovascular disease, ischaemic heart disease and stroke. All associations attenuated in the within-sibship analyses, in particular in the analyses on ischaemic heart disease before age 45 years. For instance, in the cohort analyses, the hazard rate...

  18. Psychosocial perspectives in cardiovascular disease

    NARCIS (Netherlands)

    Pedersen, S.S.; von Kaenel, R.; Tully, P.J.; Denollet, J.

    Adaptation to living with cardiovascular disease may differ from patient to patient and is influenced not only by disease severity and limitations incurred by the disease but also by socioeconomic factors (e.g. health literacy), the patients’ psychological make-up and susceptibility to distress.

  19. [Cacoa and dark chocolate in cardiovascular prevention?].

    Science.gov (United States)

    Belz, G G; Mohr-Kahaly, S

    2011-12-01

    It has been shown that the consumption of cocoa has a positive influence on a number of cardiovascular surrogate parameters such as arterial vasodilatation and a moderate decrease in blood pressure in humans. In the blood, a decrease in platelet aggregation and an increase in angiogenetic progenitor cells was noted. Furthermore, anti-inflammatory effects, an amelioration of the lipid profile and glucose metabolism was described. An increase of endothelial NO production following the ingestion of the antioxidant cocoa flavanols catechin and epicatechin seems to be the leading mechanism causing these effects. In animal studies of myocardial reperfusion, a decrease in infarct size was noted. In several prospective cohort studies from Europe and the United States, a 50 % reduction of mortality mostly due to a reduction of myocardial infarction was published. Consumption up to about 25 g daily of a flavanol rich dark chocolate (ca. 85 % cocoa content) can be recommended for cardiovascular prevention. In this moderate dosage, the potentially harmful effects due to weight gain and cadmium intake will be minimal. However, controlled randomized trials with well defined clinical endpoints are needed to prove the positive effects described so far. At this point, in time based on the information described in this article, a moderate consumption of flavanol rich cocoa products seems to be effective in the prevention of coronary artery disease and myocardial infarction. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Pharmacogenomics and cardiovascular disease

    DEFF Research Database (Denmark)

    Weeke, Peter; Roden, Dan M

    2013-01-01

    Variability in drug responsiveness is a sine qua non of modern therapeutics, and the contribution of genomic variation is increasingly recognized. Investigating the genomic basis for variable responses to cardiovascular therapies has been a model for pharmacogenomics in general and has established...... resulted in changes to the product labels but also have led to development of initial clinical guidelines that consider how to facilitate incorporating genetic information to the bedside. This review summarizes the state of knowledge in cardiovascular pharmacogenomics and considers how variants described...

  1. Anxiety Disorders and Cardiovascular Disease.

    Science.gov (United States)

    Celano, Christopher M; Daunis, Daniel J; Lokko, Hermioni N; Campbell, Kirsti A; Huffman, Jeff C

    2016-11-01

    Anxiety and its associated disorders are common in patients with cardiovascular disease and may significantly influence cardiac health. Anxiety disorders are associated with the onset and progression of cardiac disease, and in many instances have been linked to adverse cardiovascular outcomes, including mortality. Both physiologic (autonomic dysfunction, inflammation, endothelial dysfunction, changes in platelet aggregation) and health behavior mechanisms may help to explain the relationships between anxiety disorders and cardiovascular disease. Given the associations between anxiety disorders and poor cardiac health, the timely and accurate identification and treatment of these conditions is of the utmost importance. Fortunately, pharmacologic and psychotherapeutic interventions for the management of anxiety disorders are generally safe and effective. Further study is needed to determine whether interventions to treat anxiety disorders ultimately impact both psychiatric and cardiovascular health.

  2. Consumption of polyphenol-rich peach and plum juice prevents risk factors for obesity-related metabolic disorders and cardiovascular disease in Zucker rats.

    Science.gov (United States)

    Noratto, Giuliana; Martino, Hercia S D; Simbo, Sunday; Byrne, David; Mertens-Talcott, Susanne U

    2015-06-01

    Polyphenols from fruits have been implied in the prevention of risk factors for cardiometabolic disorders and cardiovascular disease. The purpose of this study was to investigate if the consumption of peach and plum juice has a protective effect against obesity and metabolic disorders that promote the development of cardiovascular diseases. Obese Zucker and lean rats were fed with peach, plum juice ad libitum or placebo. Body weight gain, biochemical markers and molecular markers for inflammation and cardiovascular disease in heart tissue were quantified. Results show that peach and plum juice consumption protected against a combination of obesity-induced metabolic disorders including hyperglycemia, insulin and leptin resistance, dyslipidemia and low-density lipoprotein oxidation. This was accompanied by a decreased expression of pro-atherogenic and pro-inflammatory biomarkers in plasma and heart tissues including intercellular cell adhesion molecule-1, monocyte chemotactic protein-1, NF-κB and foam cell adherence to aortic arches. In addition, peach and plum juice consumption decreased the levels of angiotensin II in plasma and its receptor Agtr1 in heart tissues, suggesting a role of peach and plum polyphenols as peroxisome proliferator-activated receptor-γ agonists. Furthermore, only plum juice significantly prevented body weight gain and increased the ratio high-density lipoprotein cholesterol/total cholesterol in plasma. This effect is most likely attributed to the plum's higher content of polyphenols (three times that of peach). Altogether, these results imply that cardioprotective effects can be achieved by replacing drinks high in sugar content with fruit juice rich in polyphenols in a diet. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Impact of obesity on cardiovascular disease.

    LENUS (Irish Health Repository)

    Zalesin, Kerstyn C

    2012-02-01

    Obesity promotes a cascade of secondary pathologies including diabetes, insulin resistance, dyslipidemia, inflammation, thrombosis, hypertension, the metabolic syndrome, and OSA, which collectively heighten the risk for cardiovascular disease. Obesity may also be an independent moderator of cardiac risk apart from these comorbid conditions. Rates of obesity and cardiac disease continue to rise in a parallel and exponential manner. Because obesity is potentially one of the most modifiable mediators of cardiovascular morbidity and mortality, effective treatment and prevention interventions should have a profound and favorable impact on public health.

  4. Psychosocial perspectives in cardiovascular disease

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; von Känel, Roland; Tully, Phillip J

    2017-01-01

    Adaptation to living with cardiovascular disease may differ from patient to patient and is influenced not only by disease severity and limitations incurred by the disease but also by socioeconomic factors (e.g. health literacy), the patients' psychological make-up and susceptibility to distress. Co......-morbid depression and/or anxiety is prevalent in 20% of patients with cardiovascular disease, which may be either transient or chronic. Distress, such as depression, reduces adherence, serves as a barrier to behaviour change and the adoption of a healthy lifestyle, and increases the risk that patients drop out...

  5. Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases.

    Science.gov (United States)

    Ose, Dominik; Rochon, Justine; Campbell, Stephen M; Wensing, Michel; Freund, Tobias; van Lieshout, Jan; Längst, Gerda; Szecsenyi, Joachim; Ludt, Sabine

    2014-08-01

    This study aimed to describe and to analyse the importance of educational level for controlled risk factors and health-related quality of life (HRQoL). This observational study was conducted in nine European countries (5632 patients in 249 practices). We compared patients with a low level of education (up to 9 years) with patients with a high level of education (>9 years), with regard to controlled cardiovascular disease risk factors and HRQoL. A multilevel approach was used for statistical analysis. Patients with a low level of education were older (P controlled risk factors were revealed for blood pressure (RR) ≤ 140/90 mmHg (P = 0.039) and the sum of controlled risk factors (P = 0.027). Higher age, lower education, female gender, living as single, patient group (coronary heart disease patients) and the number of other conditions were negatively associated with HRQoL. A higher sum of controlled risk factors were positively associated with higher HRQoL in the whole sample (r = 0.0086, P risk factors and a lower HRQoL. However, the higher the control of risk factors was, the higher the HRQoL was overall as well as in both educational-level groups. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  6. Reducing the risk of cardiovascular disease in older women

    African Journals Online (AJOL)

    2005-09-12

    Sep 12, 2005 ... as regards the younger woman in early menopause. Until more data is available in this regard, the main focus of prevention should be on interventions to decrease risk factors for cardiovascular disease. Introduction. Cardiovascular disease (CVD) includes hypertension, coronary heart disease. (CHD) ...

  7. Microparticles as Potential Biomarkers of Cardiovascular Disease

    Energy Technology Data Exchange (ETDEWEB)

    França, Carolina Nunes, E-mail: carolufscar24@gmail.com [Universidade Federal de São Paulo - UNIFESP - UNISA, SP, São Paulo (Brazil); Universidade de Santo Amaro - UNISA, SP, São Paulo (Brazil); Izar, Maria Cristina de Oliveira; Amaral, Jônatas Bussador do; Tegani, Daniela Melo; Fonseca, Francisco Antonio Helfenstein [Universidade Federal de São Paulo - UNIFESP - UNISA, SP, São Paulo (Brazil)

    2015-02-15

    Primary prevention of cardiovascular disease is a choice of great relevance because of its impact on health. Some biomarkers, such as microparticles derived from different cell populations, have been considered useful in the assessment of cardiovascular disease. Microparticles are released by the membrane structures of different cell types upon activation or apoptosis, and are present in the plasma of healthy individuals (in levels considered physiological) and in patients with different pathologies. Many studies have suggested an association between microparticles and different pathological conditions, mainly the relationship with the development of cardiovascular diseases. Moreover, the effects of different lipid-lowering therapies have been described in regard to measurement of microparticles. The studies are still controversial regarding the levels of microparticles that can be considered pathological. In addition, the methodologies used still vary, suggesting the need for standardization of the different protocols applied, aiming at using microparticles as biomarkers in clinical practice.

  8. Dairy products and cardiovascular disease.

    Science.gov (United States)

    Tholstrup, Tine

    2006-02-01

    Although it has often been postulated that the consumption of dairy products is associated with a high risk of coronary heart disease, study results have been conflicting. This review summarizes recent observational and human intervention trial findings on dairy products and cardiovascular disease. Results from more recent observational studies on dairy products and milk disagree. This may be because of the very different methods used combined with several methodological problems. A somewhat surprising beneficial association between the intake of dairy products and the metabolic syndrome was observed in some studies, although not in a single study of elderly women. Milk may have the same cholesterol-raising properties as butter, whereas cheese does not seem to increase plasma cholesterol. Some milk products fermented by specific bacterial strains have been shown to have rather moderate cholesterol-reducing properties. There is also good evidence that certain fermented products (especially by Lactobacillus helveticus) have a mildly decreasing effect on hypertension, probably because of bioactive peptides. When guiding principles such as balance, variety and moderation are stressed, there is no strong evidence that dairy products increase the risk of coronary heart disease in healthy men of all ages or young and middle-aged healthy women. Human studies should investigate the role of dairy products with respect to sex and age by including classic and novel risk markers of coronary heart disease. Specific fermented milks may be beneficial in the future prevention of hypertension. The beneficially neutral effect of cheese on coronary heart disease risk factors should be elucidated further.

  9. Effects of Vegetables on Cardiovascular Diseases and Related Mechanisms

    Directory of Open Access Journals (Sweden)

    Guo-Yi Tang

    2017-08-01

    Full Text Available Epidemiological studies have shown that vegetable consumption is inversely related to the risk of cardiovascular diseases. Moreover, research has indicated that many vegetables like potatoes, soybeans, sesame, tomatoes, dioscorea, onions, celery, broccoli, lettuce and asparagus showed great potential in preventing and treating cardiovascular diseases, and vitamins, essential elements, dietary fibers, botanic proteins and phytochemicals were bioactive components. The cardioprotective effects of vegetables might involve antioxidation; anti-inflammation; anti-platelet; regulating blood pressure, blood glucose, and lipid profile; attenuating myocardial damage; and modulating relevant enzyme activities, gene expression, and signaling pathways as well as some other biomarkers associated to cardiovascular diseases. In addition, several vegetables and their bioactive components have been proven to protect against cardiovascular diseases in clinical trials. In this review, we analyze and summarize the effects of vegetables on cardiovascular diseases based on epidemiological studies, experimental research, and clinical trials, which are significant to the application of vegetables in prevention and treatment of cardiovascular diseases.

  10. Leptin, obesity and cardiovascular disease.

    Science.gov (United States)

    Correia, Marcelo Lima de Gusmao; Haynes, William Geoffrey

    2004-03-01

    Obesity is a risk factor for cardiovascular diseases. Leptin levels are increased in obesity and leptin exhibits cardiovascular actions that may contribute to increased cardiovascular risk. We review the sympathetic, renal and vascular actions of leptin and their relevance to cardiovascular disease. Leptin possesses cardio-renal actions potentially contributing to obesity-related hypertension including generalized sympathoactivation. However, given that leptin resistance occurs in obesity, it has been difficult to link hyperleptinemia with hypertension. One possibility is that leptin resistance is confined to the metabolic effects of leptin, with preservation of its sympathoexcitatory actions. Other mechanisms may contribute to the pressor effects of leptin. For instance, angiotensin II induces leptin generation. Leptin also potentiates the pressor effect of insulin. Therefore, interactions between angiotensin II and insulin with leptin could have deleterious cardiovascular effects in obesity. Additionally, leptin appears to stimulate vascular inflammation, oxidative stress and hypertophy. These actions may contribute to the pathogenesis of hypertension, atherosclerosis, and left ventricular hypertrophy. The potential actions of leptin in the pathophysiology of cardiovascular complications of obesity are diverse, despite evidence of leptin resistance to its metabolic actions. However, most information about cardiovascular actions of leptin derives from in-vitro and animal studies. Future research in humans is widely awaited.

  11. A path analysis of a randomized promotora de salud cardiovascular disease-prevention trial among at-risk Hispanic adults.

    Science.gov (United States)

    de Heer, Hendrik Dirk; Balcazar, Hector G; Castro, Felipe; Schulz, Leslie

    2012-02-01

    This study assessed effectiveness of an educational community intervention taught by promotoras de salud in reducing cardiovascular disease (CVD) risk among Hispanics using a structural equation modeling (SEM) approach. Model development was guided by a social ecological framework proposing CVD risk reduction through improvement of protective health behaviors, health beliefs, contextual and social factors. Participants were 328 Hispanic adults with at least one CVD risk factor. SEM analyses assessed direct and indirect effects of intervention participation on CVD risk (Framingham score) and latent variables nutrition intake and health beliefs. The model fit was adequate (root mean square error of approximation = .056 [90% confidence interval = .040, .072], comparative fit index = .967, normed fit index = .938, nonnormed fit index = .947). Intervention participation was associated with improved nutritional consumption, but not lower CVD risk. Stronger health beliefs predicted healthier nutritional habits. This project provided evidence for the adequacy of a conceptual framework that can be used to elicit new pathways toward CVD risk reduction among at-risk Hispanic populations.

  12. Biomarkers and degree of atherosclerosis are independently associated with incident atherosclerotic cardiovascular disease in a primary prevention cohort: The ARIC study.

    Science.gov (United States)

    Agarwala, Anandita; Virani, Salim; Couper, David; Chambless, Lloyd; Boerwinkle, Eric; Astor, Brad C; Hoogeveen, Ron C; Coresh, Joe; Sharrett, A Richey; Folsom, Aaron R; Mosley, Tom; Ballantyne, Christie M; Nambi, Vijay

    2016-10-01

    Biomarkers and atherosclerosis imaging have been studied individually for association with incident cardiovascular disease (CVD); however, limited data exist on whether the biomarkers are associated with events with a similar magnitude in the presence of atherosclerosis. In this study, we assessed whether the presence of atherosclerosis as measured by carotid intima media thickness (cIMT) affects the association between biomarkers known to be associated with coronary heart disease (CHD) and incident cardiovascular disease (CVD) in a primary prevention cohort. 8127 participants from the ARIC study (4th visit, 1996-1998) were stratified as having minimal, mild, or substantial atherosclerosis by cIMT. Levels of C-reactive protein, lipoprotein-associated phospholipase A2, cardiac troponin T, N-terminal pro-brain natriuretic peptide, lipoprotein(a), cystatin C, and urine albumin to creatinine ratio were measured in each participant. Hazard ratios were used to determine the relationship between the biomarkers and incident CHD, stroke, and CVD in each category of atherosclerosis. While each of the biomarkers was significantly associated with risk of events overall, we found no significant differences noted in the strength of association of biomarkers with CHD, stroke, and CVD when analyzed by degree of atherosclerosis. These findings suggest that the level of atherosclerosis does not significantly influence the association between biomarkers and CVD. Published by Elsevier Ireland Ltd.

  13. Cardiovascular disease incidence and survival

    DEFF Research Database (Denmark)

    Byberg, Stine; Agyemang, Charles; Zwisler, Ann-Dorthe

    2016-01-01

    Studies on cardiovascular disease (CVD) incidence and survival show varying results between different ethnic groups. Our aim was to add a new dimension by exploring the role of migrant status in combination with ethnic background on incidence of-and survival from-CVD and more specifically acute...... of some types of cardiovascular disease compared to Danish-born. Family-reunified migrants on the other hand had lower rates of CVD. All migrants had better survival than Danish-born indicating that migrants may not always be disadvantaged in health....

  14. Vitamin D and Cardiovascular Disease

    Directory of Open Access Journals (Sweden)

    Martin R. Grübler

    2013-07-01

    Full Text Available Vitamin D deficiency, as well as cardiovascular diseases (CVD and related risk factors are highly prevalent worldwide and frequently co-occur. Vitamin D has long been known to be an essential part of bone metabolism, although recent evidence suggests that vitamin D plays a key role in the pathophysiology of other diseases, including CVD, as well. In this review, we aim to summarize the most recent data on the involvement of vitamin D deficiency in the development of major cardiovascular risk factors: hypertension, obesity and dyslipidemia, type 2 diabetes, chronic kidney disease and endothelial dysfunction. In addition, we outline the most recent observational, as well as interventional data on the influence of vitamin D on CVD. Since it is still an unresolved issue whether vitamin D deficiency is causally involved in the pathogenesis of CVD, data from randomized controlled trials (RCTs designed to assess the impact of vitamin D supplementation on cardiovascular outcomes are awaited with anticipation. At present, we can only conclude that vitamin D deficiency is an independent cardiovascular risk factor, but whether vitamin D supplementation can significantly improve cardiovascular outcomes is still largely unknown.

  15. Dietary sodium and cardiovascular disease.

    Science.gov (United States)

    Smyth, Andrew; O'Donnell, Martin; Mente, Andrew; Yusuf, Salim

    2015-06-01

    Although an essential nutrient, higher sodium intake is associated with increasing blood pressure (BP), forming the basis for current population-wide sodium restriction guidelines. While short-term clinical trials have achieved low intake (6 months). Guidelines assume that low sodium intake will reduce BP and reduce cardiovascular disease (CVD), compared to moderate intake. However, current observational evidence suggests a J-shaped association between sodium intake and CVD; the lowest risks observed with 3-5 g/day but higher risk with 5 g/day) and increased risk of CVD. Although lower intake may reduce BP, this may be offset by marked increases in neurohormones and other adverse effects which may paradoxically be adverse. Large randomised clinical trials with sufficient follow-up are required to provide robust data on the long-term effects of sodium reduction on CVD incidence. Until such trials are completed, current evidence suggests that moderate sodium intake for the general population (3-5 g/day) is likely the optimum range for CVD prevention.

  16. Globalization, Work, and Cardiovascular Disease.

    Science.gov (United States)

    Schnall, Peter L; Dobson, Marnie; Landsbergis, Paul

    2016-10-01

    Cardiovascular disease (CVD), a global epidemic, is responsible for about 30% of all deaths worldwide. While mortality rates from CVD have been mostly declining in the advanced industrialized nations, CVD risk factors, including hypertension, obesity, and diabetes, have been on the increase everywhere. Researchers investigating the social causes of CVD have produced a robust body of evidence documenting the relationships between the work environment and CVD, including through the mechanisms of psychosocial work stressors. We review the empirical evidence linking work, psychosocial stressors, and CVD. These work stressors can produce chronic biologic arousal and promote unhealthy behaviors and thus, increased CVD risk. We offer a theoretical model that illustrates how economic globalization influences the labor market and work organization in high-income countries, which, in turn, exacerbates job characteristics, such as demands, low job control, effort-reward imbalance, job insecurity, and long work hours. There is also a growing interest in "upstream" factors among work stress researchers, including precarious employment, downsizing/restructuring, privatization, and lean production. We conclude with suggestions for future epidemiologic research on the role of work in the development of CVD, as well as policy recommendations for prevention of work-related CVD. © The Author(s) 2016.

  17. Cardiovascular calcification. An inflammatory disease

    International Nuclear Information System (INIS)

    New, S.E.P.; Aikawa, E.

    2011-01-01

    Cardiovascular calcification is an independent risk factor for cardiovascular morbidity and mortality. This disease of dysregulated metabolism is no longer viewed as a passive degenerative disease, but instead as an active process triggered by pro-inflammatory cues. Furthermore, a positive feedback loop of calcification and inflammation is hypothesized to drive disease progression in arterial calcification. Both calcific aortic valve disease and atherosclerotic arterial calcification may possess similar underlying mechanisms. Early histopathological studies first highlighted the contribution of inflammation to cardiovascular calcification by demonstrating the accumulation of macrophages and T lymphocytes in 'early' lesions within the aortic valves and arteries. A series of in vitro work followed, which gave a mechanistic insight into the stimulation of smooth muscle cells to undergo osteogenic differentiation and mineralization. The emergence of novel technology, in the form of animal models and more recently molecular imaging, has enabled accelerated progression of this field, by providing strong evidence regarding the concept of this disorder as an inflammatory disease. Although there are still gaps in our knowledge of the mechanisms behind this disorder, this review discusses the various studies that have helped form the concept of the inflammation-dependent cardiovascular calcification paradigm. (author)

  18. Laser therapy in cardiovascular disease

    Science.gov (United States)

    Rindge, David

    2009-02-01

    Cardiovascular disease is the number one cause of death worldwide. It is broadly defined to include anything which adversely affects the heart or blood vessels. One-third of Americans have one or more forms of it. By one estimate, average human life expectancy would increase by seven years if it were eliminated. The mainstream medical model seeks mostly to "manage" cardiovascular disease with pharmaceuticals or to surgically bypass or reopen blocked vessels via angioplasty. These methods have proven highly useful and saved countless lives. Yet drug therapy may be costly and ongoing, and it carries the risk of side effects while often doing little or nothing to improve underlying health concerns. Similarly, angioplasty or surgery are invasive methods which entail risk. Laser therapy1 regenerates tissue, stimulates biological function, reduces inflammation and alleviates pain. Its efficacy and safety have been increasingly well documented in cardiovascular disease of many kinds. In this article we will explore the effects of laser therapy in angina, atherosclerosis, coronary artery disease, hypertension, hyperlipidemia, myocardial infarction, stroke and other conditions. The clinical application of various methods of laser therapy, including laserpuncture and transcutaneous, supravascular and intravenous irradiation of blood will be discussed. Implementing laser therapy in the treatment of cardiovascular disease offers the possibility of increasing the health and wellbeing of patients while reducing the costs and enhancing safety of medical care.

  19. Use of drug treatment for secondary prevention of cardiovascular disease in urban and rural communities of China: China Kadoorie Biobank Study of 0.5 million people.

    Science.gov (United States)

    Chen, Yiping; Li, Liming; Zhang, Qiuli; Clarke, Robert; Chen, Junshi; Guo, Yu; Bian, Zheng; Pan, Xianhai; Peto, Richard; Tao, Ran; Shi, Kunxiang; Collins, Rory; Ma, Liangcai; Sun, Huarong; Chen, Zhengming

    2014-03-01

    Relatively little is known about the use of medication for the secondary prevention of cardiovascular disease (CVD) events in China, and the relevance to it of socioeconomic, lifestyle and health-related factors. We analysed cross-sectional data from the China Kadoorie Biobank (CKB) of 512,891 adults aged 30-79 years recruited from 1737 rural and urban communities in China. Information about doctor-diagnosed ischaemic heart disease (IHD) and stroke, and the use of medication for the secondary prevention of CVD events, were recorded by interview. Multivariate logistic regression was used to estimate odds ratios (ORs) for use of secondary preventive treatment, adjusting simultaneously for age, sex, area and education. Overall, 23,129 (4.5%) participants reported a history of CVD (3.0% IHD, 1.7% stroke). Among them, 35% reported current use of any of 6 classes of drug (anti-platelet, statins, diuretics, ACE-I, β-blockers or calcium-channel blockers) for the prevention of CVD events, with the rate of usage greater in those with older age, higher levels of income, education, BMI or blood pressure. The use of these agents was associated positively with history of diagnosed hypertension (OR 7.5; 95% confidence intervals: 7.08-8.06) and diabetes (1.40; 1.28-1.52) and inversely with self-rated health status, but there was no association with years since diagnosis. Despite recent improvements in hospital care in China, only one in three individuals with prior CVD was routinely treated with any proven secondary preventive drugs. The treatment rates were correlated with the existence of other risk factors, in particular evidence of hypertension. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  20. Vitamin E and cardiovascular disease

    NARCIS (Netherlands)

    Kleijnen, J.; Knipschild, P.; ter Riet, G.

    1989-01-01

    Randomized clinical trials of the effects of Vitamin E on complaints of intermittent claudication and angina pectoris are reviewed, and their methodological shortcomings are considered. Mechanisms by which Vitamin E might act in cardiovascular disease are discussed. The evidence about the possible

  1. Peritoneal dialysis and cardiovascular disease

    NARCIS (Netherlands)

    Balafa, O.; Krediet, R. T.

    2012-01-01

    Cardiovascular (CV) death is the most frequent cause of dying in peritoneal dialysis (PD) patients. Risk factors include not only those that can be present in the general population, but also those related to the presence of end-stage renal disease (ESRD) and factors that are specific for PD

  2. NKT cells in cardiovascular diseases

    NARCIS (Netherlands)

    Puijvelde, van G.H.M.; Kuiper, J.

    2017-01-01

    Despite life-style advice and the prescription of cholesterol-lowering and anti-thrombotic drugs, cardiovascular diseases are still the leading cause of death worldwide. Therefore, there is an urgent need for new therapeutic strategies focussing on atherosclerosis, the major underlying pathology of

  3. The global epidemic of atherosclerotic cardiovascular disease.

    Science.gov (United States)

    Yusuf, Salim; Ounpuu, Stephanie; Anand, Sonia

    2002-01-01

    Of the 50 million deaths that occur in the world, 40 million occur in developing countries. Already a substantial proportion of these deaths are due to cardiovascular diseases. It is projected that by the year 2025 well over 80-90% of all the cardiovascular diseases in the world will be occurring in low income and middle income countries. This increase in cardiovascular disease is due to a number of causes which include the following: (1) conquest of deaths in childhood and infancy from nutritional deficiencies and infection; (2) urbanization with increasing levels of obesity; (3) increasing longevity of the population so that a higher proportion of individuals reach the age when they are subject to chronic diseases, and (4) increasing use of tobacco worldwide. In most countries in the world other than those in the West, the burden of disease is still due to a combination of infections and nutritional disorders as well as those due to chronic diseases. This double burden of disease poses a challenge that is not only medical and epidemiological, but also social and political. Tackling this projected global epidemic of cardiovascular disease therefore needs policies that combine sound knowledge of prevention, good clinical care, but also deals with the allocation of resources for both individual level and community level preventive strategies. The former involves dealing with high-risk individuals through appropriate medical and therapeutic interventions. The latter involves societal level changes including laws that curb the use of tobacco, and strategies that promote physical activities, and appropriate nutrition. Copyright 2002 S. Karger AG, Basel

  4. Cardiovascular Disease Burden: Evolving Knowledge of Risk Factors in Myocardial Infarction and Stroke through Population-Based Research and Perspectives in Global Prevention.

    Science.gov (United States)

    Oliveira, Gustavo B F; Avezum, Alvaro; Roever, Leonardo

    2015-01-01

    Current knowledge and research perspectives on the top ranking causes of mortality worldwide, i.e., ischemic heart disease and cerebrovascular diseases have developed rapidly. In fact, until recently, the evidence describing the incidence of acute myocardial infarction, the underlying risk factors, and the clinical outcomes of those who have this acute ischemic coronary event has largely been based on studies conducted in developed countries, with limited data for women and usually of low-ethnic diversity. Recent reports by the WHO have provided striking public health information, i.e., the global burden of cardiovascular mortality for the next decades is expected to predominantly occur among developing countries. Therefore, multiethnic population-based research including prospective cohorts and, when appropriate, case-control studies, is warranted. These studies should be specifically designed to ascertain key public health measures, such as geographic variations in non-communicable diseases, diagnosis of traditional and potential newly discovered risk factors, causes of death and disability, and gaps for improvement in healthcare prevention (both primary and secondary) and specific treatments. As an example, a multinational, multiethnic population-based cohort study is the Prospective Urban and Rural Epidemiology study, which is the largest global initiative of nearly 200,000 adults aged 35-70 years, looking at environmental, societal, and biological influences on obesity and chronic health conditions, such as ischemic heart disease, stroke, and cancer among urban and rural communities in low-, middle-, and high-income countries, with national, community, household, and individual-level data. Implementation of population-based strategies is crucial to optimizing limited health system resources while improving care and cardiovascular morbidity and mortality.

  5. Nanomedical Theranostics in Cardiovascular Disease

    OpenAIRE

    Tang, Jun; Lobatto, Mark E.; Read, Joanna C.; Mieszawska, Aneta J.; Fayad, Zahi A.; Mulder, Willem J. M.

    2011-01-01

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. New diagnostic and therapeutic strategies are needed to mitigate this public health issue. Advances in nanotechnology have generated innovative strategies for diagnosis and therapy in a variety of diseases, foremost in cancer. Based on these studies, a novel concept referred to as nanomedical theranostics, or the combinatory application of nanoparticulate agents to allow diagnostic therapy, is being explor...

  6. Contraception and cardiovascular disease

    NARCIS (Netherlands)

    Roos-Hesselink, JolienW.; Cornette, Jerome; Sliwa, Karen; Pieper, Petronella G.; Veldtman, Gruschen R.; Johnson, Mark R.

    2015-01-01

    Contraceptive counselling should begin early in females with heart disease, preferably directly after the start of menstruation. In coming to a decision about the method of contraception, the following issues should be considered: (i) the risk of pregnancy for the mother and the consequences of an

  7. Cardiovascular disease after cancer therapy

    DEFF Research Database (Denmark)

    Aleman, Berthe M P; Moser, Elizabeth C; Nuver, Janine

    2014-01-01

    Improvements in treatment and earlier diagnosis have both contributed to increased survival for many cancer patients. Unfortunately, many treatments carry a risk of late effects including cardiovascular diseases (CVDs), possibly leading to significant morbidity and mortality. In this paper we......, and the mechanisms involved, as well as the extent to which treatments may increase CVD indirectly by increasing cardiovascular risk factors is also important. Systematic collection of data relating treatment details to late effects is needed, and great care is needed to obtain valid and generalisable results...

  8. [New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases].

    Science.gov (United States)

    Godoy-Gijón, Elena; Meseguer-Yebra, Carmen; Palacio-Aller, Lucía; Godoy-Rocati, Diego Vicente; Lahoz-Rallo, Carlos

    2016-01-01

    The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  9. Top 10 Myths about Cardiovascular Disease

    Science.gov (United States)

    ... Thromboembolism Aortic Aneurysm More Top 10 Myths about Cardiovascular Disease Updated:Mar 16,2018 How much do you ... false assumptions can be dangerous to your heart. Cardiovascular disease kills more Americans each year than any other ...

  10. Sex steroids and cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Bu Beng Yeap

    2014-04-01

    Full Text Available As men grow older, testosterone (T levels decline and the significance of this change is debated. The evidence supporting a causal role for lower circulating T, or its metabolites dihydrotestosterone (DHT and estradiol, in the genesis of atherosclerosis and cardiovascular disease (CVD in men is limited. Observational studies associate low baseline T levels with carotid atherosclerosis, aortic and peripheral vascular disease, and with the incidence of cardiovascular events and mortality. Studies using mass spectrometry suggest that when total T is assayed optimally, calculation of free T might not necessarily improve risk stratification. There is limited evidence to support an association of estradiol with CVD. Interventional studies of T therapy in men with coronary artery disease have shown beneficial effects on exercise-induced myocardial ischemia. However, placebo-controlled, randomized clinical trials (RCTs of T therapy in men with the prespecified outcomes of cardiovascular events or deaths are lacking. Meta-analyses of randomized controlled trials of T published up to 2010 found no increase in cardiovascular events, mortality, or prostate cancer with therapy. Recently, in a trial of older men with mobility limitations, men randomized to receive a substantial dose of T reported cardiovascular adverse effects. This phenomenon was not reported from a comparable trial where men received a more conservative dose of T, suggesting a prudent approach should be adopted when considering therapy in frail older men with existing CVD. Adequately powered RCTs of T in middle-aged and older men are needed to clarify whether or not hormonal intervention would reduce the incidence of CVD.

  11. Heart Disease, Stroke, or Other Cardiovascular Disease and Adult Vaccination

    Science.gov (United States)

    ... Adult Diseases Resources Heart Disease, Stroke, or Other Cardiovascular Disease and Adult Vaccination Language: English (US) Español (Spanish) ... important step in staying healthy. If you have cardiovascular disease, talk with your doctor about getting your vaccinations ...

  12. Pregnancy disorders and cardiovascular disease risk

    NARCIS (Netherlands)

    Heida, KY

    2016-01-01

    Cardiovascular disease is the most important cause of death in women in the Netherlands. Early identification of women at increased risk of cardiovascular disease and subsequent detection and treatment of risk factors contributes to the reduction of cardiovascular disease morbidity and mortality. A

  13. Exploring the Barriers to and Facilitators of Using Evidence-Based Drugs in the Secondary Prevention of Cardiovascular Diseases: Findings From a Multistakeholder, Qualitative Analysis.

    Science.gov (United States)

    Miller, Victoria; Nambiar, Lavanya; Saxena, Malvika; Leong, Darryl; Banerjee, Amitava; Werba, José Pablo; Faria Neto, Jose Rocha; Quinto, Katherine Curi; Moniruzzaman, Mohammed; Khandelwal, Shweta

    2018-03-01

    Health-system barriers and facilitators associated with cardiovascular medication adherence have seldom been studied, particularly in low- and middle-income countries where uptake rates are poorest. This study sought to explore the major obstacles and facilitators to the use of evidence-supported medications for secondary prevention of cardiovascular disease using qualitative analysis in 2 diverse countries across multiple levels of their health care systems. A qualitative descriptive study approach was implemented in Hamilton, Ontario, Canada, and Delhi, India. A purposeful sample (n = 69) of 23 patients, 10 physicians, 2 nurse practitioners, 5 Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy physicians, 11 pharmacists, 3 nurses, 4 hospital administrators, 1 social worker, 3 nongovernmental organization workers, 2 pharmaceutical company representatives, and 5 policy makers participated in interviews in Hamilton, Ontario, Canada (n = 21), and Delhi, India (n = 48). All interviews were digitally recorded and transcribed followed by directed content analysis to summarize and categorize the interviews. Themes that emerged across the stakeholder groups included: medication counseling; monitoring adherence; medication availability; medication affordability and drug coverage; time restrictions; and task shifting. The depth of verbal medication counseling provided varied substantially between countries, with prescribers in India unable to convey relevant information about drug treatments due to time constraint and high patient load. Canadian patients reported drug affordability as a common issue and very few patients were familiar with government subsidized drug programs. In India, patients purchased medications out-of-pocket from private, community pharmacies to avoid long commutes, lost wages, and unavailability of medications from hospitals formularies. Task shifting medication-refilling and titration to nonphysician health workers was

  14. Physicians' attitudes and adherence to use of risk scores for primary prevention of cardiovascular disease: cross-sectional survey in three world regions.

    Science.gov (United States)

    Sposito, Andrei C; Ramires, Jose A F; Jukema, J Wouter; Molina, Juan Carlos; da Silva, Pedro Marques; Ghadanfar, Mathieu M; Wilson, Peter W F

    2009-05-01

    To evaluate physicians' attitudes and adherence to the use of risk scores in the primary prevention of cardiovascular disease (CVD). A cross-sectional survey of 2056 physicians involved in the primary prevention of CVD. Participants included cardiologists (47%), general practitioners (42%), and endocrinologists (11%) from several geographical regions: Brazil (n = 968), USA (n = 381), Greece (n = 275), Chile (n = 157), Venezuela (n = 128), Portugal (n = 42), The Netherlands (n = 41), and Central America (Costa Rica, Panama, El Salvador and Guatemala; n = 64). The main outcome measure was the percentage of responses on a multiple-choice questionnaire describing a hypothetical asymptomatic patient at intermediate risk for CVD according to the Framingham Risk Score. Only 48% of respondents reported regular use of CVD risk scores to tailor preventive treatment in the case scenario. Of non-users, nearly three-quarters indicated that 'It takes up too much of my time' (52%) or 'I don't believe they add value to the clinical evaluation' (21%). Only 56% of respondents indicated that they would prescribe lipid-lowering therapy for the hypothetical intermediate-risk patient. A significantly greater proportion of regular users than non-users of CVD risk scores identified the need for lipid-lowering therapy in the hypothetical patient (59 vs. 41%; p < 0.0001). Based on a survey conducted in a 'real-world' setting, risk scores are generally not used by a majority of physicians to guide primary prevention in asymptomatic persons at intermediate risk for CVD. Appropriate prescribing of lipid-lowering therapy in such patients is equally neglected. Changing physicians' attitudes towards the use of CVD risk scores is one of several challenges that need to be addressed to reduce the world-wide burden of CVD.

  15. Cocoa, chocolate, and cardiovascular disease.

    Science.gov (United States)

    Galleano, Monica; Oteiza, Patricia I; Fraga, Cesar G

    2009-12-01

    A significant body of evidence demonstrates that diets rich in fruits and vegetables promote health and attenuate, or delay, the onset of various diseases, including cardiovascular disease, diabetes, certain cancers, and several other age-related degenerative disorders. The concept that moderate chocolate consumption could be part of a healthy diet has gained acceptance in past years based on the health benefits ascribed to selected cocoa components. Specifically, cocoa as a plant and chocolate as food contain a series of chemicals that can interact with cell and tissue components, providing protection against the development and amelioration of pathological conditions. The most relevant effects of cocoa and chocolate have been related to cardiovascular disease. The mechanisms behind these effects are still under investigation. However, the maintenance or restoration of vascular NO production and bioavailability and the antioxidant effects are the mechanisms most consistently supported by experimental data. This review will summarize the most recent research on the cardiovascular effects of cocoa flavanols and related compounds.

  16. The experience and influence of social support and social dynamics on cardiovascular disease prevention in migrant Pakistani communities: A qualitative synthesis.

    Science.gov (United States)

    Kokab, Farina; Greenfield, Sheila; Lindenmeyer, Antje; Sidhu, Manbinder; Tait, Lynda; Gill, Paramjit

    2017-10-04

    The objective of this research was to synthesise qualitative literature about the perceived influence and experience of social support, in relation to cardiovascular disease (CVD) prevention in migrant Pakistani communities. Articles were systematically reviewed, critically appraised, and analysed using an adapted meta-ethnography approach. Sixteen qualitative studies on health behaviours related to CVD prevention were included. include four sub-themes under two substantive thematic areas that focus on: 1) family dynamics and 2) community dynamics influenced by discrimination. For members of the Pakistani community, gendered family dynamics and discrimination from outside and within community networks influenced behaviour change. The authors of the synthesis developed multi-layered, contextualised interpretations of the care needs of an established multi-generational community. Future qualitative studies taking an intersectional approach to interpreting the role of social networks in migrant communities should take into account gender, identity, culture and faith. Health care providers should focus on cultural awareness and sensitivity during consultations. In particular, general practitioners can benefit from the insight they gain from patient experiences, allowing for more appropriate recommendations. Crown Copyright © 2017. Published by Elsevier B.V. All rights reserved.

  17. Cardiovascular Disease in Women: Clinical Perspectives

    Science.gov (United States)

    Garcia, Mariana; Mulvagh, Sharon L.; Merz, C. Noel Bairey; Buring, Julie E.; Manson, JoAnn E.

    2016-01-01

    Cardiovascular disease (CVD) continues to be the leading cause of death among women in the United States, accounting for approximately one of every three female deaths. Sex-specific data focused on CVD has been increasing steadily, yet is not routinely collected nor translated into practice. This comprehensive review focuses on novel and unique aspects of cardiovascular health in women and sex-differences as they relate to clinical practice in the prevention, diagnosis, and treatment of CVD. This review also provides current approaches to the evaluation and treatment of acute coronary syndromes that are more prevalent in women, including: myocardial infarction associated with non-obstructive coronary arteries, spontaneous coronary artery dissection, and stress-induced cardiomyopathy (Takotsubo Syndrome). Other CVD entities with higher prevalence or unique considerations in women, such as heart failure with preserved ejection fraction, peripheral arterial disease and abdominal aortic aneurysms, are also briefly reviewed. Lastly, recommendations for cardiac rehabilitation are addressed. PMID:27081110

  18. Grapes and Cardiovascular Disease1–3

    Science.gov (United States)

    Dohadwala, Mustali M.; Vita, Joseph A.

    2009-01-01

    Epidemiological studies suggest that consumption of wine, grape products, and other foods containing polyphenols is associated with decreased risk for cardiovascular disease. The benefits of wine consumption appear to be greater than other alcoholic beverages. Experimental studies indicate that grape polyphenols could reduce atherosclerosis by a number of mechanisms, including inhibition of oxidation of LDL and other favorable effects on cellular redox state, improvement of endothelial function, lowering blood pressure, inhibition of platelet aggregation, reducing inflammation, and activating novel proteins that prevent cell senescence, e.g. Sirtuin 1. Translational studies in humans support these beneficial effects. More clinical studies are needed to confirm these effects and formulate dietary guidelines. The available data, however, strongly support the recommendation that a diet rich in fruits and vegetables, including grapes, can decrease the risk for cardiovascular disease. PMID:19625699

  19. Genetic testing in cardiovascular diseases.

    Science.gov (United States)

    Arndt, Anne-Karin; MacRae, Calum A

    2014-05-01

    The review is designed to outline the major developments in genetic testing in the cardiovascular arena in the past year or so. This is an exciting time in genetic testing as whole exome and whole genome approaches finally reach the clinic. These new approaches offer insight into disease causation in families in which this might previously have been inaccessible, and also bring a wide range of interpretative challenges. Among the most significant recent findings has been the extent of physiologic rare coding variation in the human genome. New disease genes have been identified through whole exome studies in neonatal arrhythmia, congenital heart disease and coronary artery disease that were simply inaccessible with other techniques. This has not only shed light on the challenges of genetic testing at this scale, but has also sharply defined the limits of prior gene-panel focused testing. As novel therapies targeting specific genetic subsets of disease become available, genetic testing will become a part of routine clinical care. The pace of change in sequencing technologies has begun to transform clinical medicine, and cardiovascular disease is no exception. The complexity of such studies emphasizes the importance of real-time communication between the genetics laboratory and genetically informed clinicians. New efforts in data and knowledge management will be central to the continued advancement of genetic testing.

  20. Genome editing in cardiovascular diseases.

    Science.gov (United States)

    Strong, Alanna; Musunuru, Kiran

    2017-01-01

    Genome-editing tools, which include zinc finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9) systems, have emerged as an invaluable technology to achieve somatic and germline genomic manipulation in cells and model organisms for multiple applications, including the creation of knockout alleles, introducing desired mutations into genomic DNA, and inserting novel transgenes. Genome editing is being rapidly adopted into all fields of biomedical research, including the cardiovascular field, where it has facilitated a greater understanding of lipid metabolism, electrophysiology, cardiomyopathies, and other cardiovascular disorders, has helped to create a wider variety of cellular and animal models, and has opened the door to a new class of therapies. In this Review, we discuss the applications of genome-editing technology throughout cardiovascular disease research and the prospect of in vivo genome-editing therapies in the future. We also describe some of the existing limitations of genome-editing tools that will need to be addressed if cardiovascular genome editing is to achieve its full scientific and therapeutic potential.

  1. Cystatin C and Cardiovascular Disease

    Science.gov (United States)

    van der Laan, Sander W.; Fall, Tove; Soumaré, Aicha; Teumer, Alexander; Sedaghat, Sanaz; Baumert, Jens; Zabaneh, Delilah; van Setten, Jessica; Isgum, Ivana; Galesloot, Tessel E.; Arpegård, Johannes; Amouyel, Philippe; Trompet, Stella; Waldenberger, Melanie; Dörr, Marcus; Magnusson, Patrik K.; Giedraitis, Vilmantas; Larsson, Anders; Morris, Andrew P.; Felix, Janine F.; Morrison, Alanna C.; Franceschini, Nora; Bis, Joshua C.; Kavousi, Maryam; O’Donnell, Christopher; Drenos, Fotios; Tragante, Vinicius; Munroe, Patricia B.; Malik, Rainer; Dichgans, Martin; Worrall, Bradford B.; Erdmann, Jeanette; Nelson, Christopher P.; Samani, Nilesh J.; Schunkert, Heribert; Marchini, Jonathan; Patel, Riyaz S.; Hingorani, Aroon D.; Lind, Lars; Pedersen, Nancy L.; de Graaf, Jacqueline; Kiemeney, Lambertus A.L.M.; Baumeister, Sebastian E.; Franco, Oscar H.; Hofman, Albert; Uitterlinden, André G.; Koenig, Wolfgang; Meisinger, Christa; Peters, Annette; Thorand, Barbara; Jukema, J. Wouter; Eriksen, Bjørn Odvar; Toft, Ingrid; Wilsgaard, Tom; Onland-Moret, N. Charlotte; van der Schouw, Yvonne T.; Debette, Stéphanie; Kumari, Meena; Svensson, Per; van der Harst, Pim; Kivimaki, Mika; Keating, Brendan J.; Sattar, Naveed; Dehghan, Abbas; Reiner, Alex P.; Ingelsson, Erik; den Ruijter, Hester M.; de Bakker, Paul I.W.; Pasterkamp, Gerard; Ärnlöv, Johan; Holmes, Michael V.; Asselbergs, Folkert W.

    2017-01-01

    BACKGROUND Epidemiological studies show that high circulating cystatin C is associated with risk of cardiovascular disease (CVD), independent of creatinine-based renal function measurements. It is unclear whether this relationship is causal, arises from residual confounding, and/or is a consequence of reverse causation. OBJECTIVES The aim of this study was to use Mendelian randomization to investigate whether cystatin C is causally related to CVD in the general population. METHODS We incorporated participant data from 16 prospective cohorts (n = 76,481) with 37,126 measures of cystatin C and added genetic data from 43 studies (n = 252,216) with 63,292 CVD events. We used the common variant rs911119 in CST3 as an instrumental variable to investigate the causal role of cystatin C in CVD, including coronary heart disease, ischemic stroke, and heart failure. RESULTS Cystatin C concentrations were associated with CVD risk after adjusting for age, sex, and traditional risk factors (relative risk: 1.82 per doubling of cystatin C; 95% confidence interval [CI]: 1.56 to 2.13; p = 2.12 × 10−14). The minor allele of rs911119 was associated with decreased serum cystatin C (6.13% per allele; 95% CI: 5.75 to 6.50; p = 5.95 × 10−211), explaining 2.8% of the observed variation in cystatin C. Mendelian randomization analysis did not provide evidence for a causal role of cystatin C, with a causal relative risk for CVD of 1.00 per doubling cystatin C (95% CI: 0.82 to 1.22; p = 0.994), which was statistically different from the observational estimate (p = 1.6 × 10−5). A causal effect of cystatin C was not detected for any individual component of CVD. CONCLUSIONS Mendelian randomization analyses did not support a causal role of cystatin C in the etiology of CVD. As such, therapeutics targeted at lowering circulating cystatin C are unlikely to be effective in preventing CVD. PMID:27561768

  2. Cell Therapy in Cardiovascular Disease

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    Hoda Madani

    2014-05-01

    Full Text Available   Recently, cell therapy has sparked a revolution in ischemic heart disease that will in the future help clinicians to cure patients. Earlier investigations in animal models and clinical trials have suggested that positive paracrine effects such as neoangiogenesis and anti-apoptotic can improve myocardial function. In this regard the Royan cell therapy center designed a few trials in collaboration with multi hospitals such as Baqiyatallah, Shahid Lavasani, Tehran Heart Center, Shahid rajaee, Masih daneshvari, Imam Reza, Razavi and Sasan from 2006. Their results were interesting. However, cardiac stem cell therapy still faces great challenges in optimizing the treatment of patients. Keyword: Cardiovascular disease, Cell therapy.  

  3. Cardiovascular involvement in celiac disease.

    Science.gov (United States)

    Ciaccio, Edward J; Lewis, Suzanne K; Biviano, Angelo B; Iyer, Vivek; Garan, Hasan; Green, Peter H

    2017-08-26

    Celiac disease (CD) is an autoimmune response to ingestion of gluten protein, which is found in wheat, rye, and barley grains, and results in both small intestinal manifestations, including villous atrophy, as well as systemic manifestations. The main treatment for the disease is a gluten-free diet (GFD), which typically results in the restoration of the small intestinal villi, and restoration of other affected organ systems, to their normal functioning. In an increasing number of recently published studies, there has been great interest in the occurrence of alterations in the cardiovascular system in untreated CD. Herein, published studies in which CD and cardiovascular terms appear in the title of the study were reviewed. The publications were categorized into one of several types: (1) articles (including cohort and case-control studies); (2) reviews and meta-analyses; (3) case studies (one to three patient reports); (4) letters; (5) editorials; and (6) abstracts (used when no full-length work had been published). The studies were subdivided as either heart or vascular studies, and were further characterized by the particular condition that was evident in conjunction with CD. Publication information was determined using the Google Scholar search tool. For each publication, its type and year of publication were tabulated. Salient information from each article was then compiled. It was determined that there has been a sharp increase in the number of CD - cardiovascular studies since 2000. Most of the publications are either of the type "article" or "case study". The largest number of documents published concerned CD in conjunction with cardiomyopathy (33 studies), and there have also been substantial numbers of studies published on CD and thrombosis (27), cardiovascular risk (17), atherosclerosis (13), stroke (12), arterial function (11), and ischemic heart disease (11). Based on the published research, it can be concluded that many types of cardiovascular issues

  4. [Promoting development of new traditional Chinese medicine by combination disease-syndrome and multi-objective optimization research in prevention and treatment of cardiovascular disease].

    Science.gov (United States)

    Wang, Jie; Guo, Li-li

    2015-09-01

    Differences in theories, application forms and evaluation standards about curative effect between traditional Chinese medicine and modern medicine lead to not only question safty and effectiveness but also hinder development and internationalization of traditional Chinese medicine. Combination of common problems in traditional Chinese new drug registration with experiences in research on traditional Chinese new drugs of prevention and treatment of coronary heart disease elucidate application value about theory of disease-syndrome combination and multi-objective optimization in several ways such as the indications positioning, preparation process optimization, preclinical efficacy evaluating and clinical assessmenting of efficacy and analysis development prospect.

  5. Reducing salt intake to prevent hypertension and cardiovascular disease Reducción del consumo de sal para prevenir la hipertensión y las enfermedades cardiovasculares

    Directory of Open Access Journals (Sweden)

    Feng J. He

    2012-10-01

    Full Text Available There is compelling evidence that dietary salt intake is the major cause of raised blood pressure (BP and that a reduction in salt intake from the current level of ≈ 9 - 12 g/day in most countries to the recommended level of 9 g/day is highly prevalent. Sources of salt in the diet vary hugely among countries; in developed countries, 75% of salt comes from processed foods, whereas in developing countries such as parts of Brazil, 70% comes from salt added during cooking or at the table. To reduce population salt intake, the food industry needs to implement a gradual and sustained reduction in the amount of salt added to foods in developed countries. In developing countries, a public health campaign plays a more important role in encouraging consumers to use less salt coupled with widespread replacement of salt with substitutes that are low in sodium and high in potassium. Numerous countries in the Americas have started salt reduction programs. The challenge now is to engage other countries. A reduction in population salt intake will result in a major improvement in public health along with major health-related cost savings.Hay datos probatorios irrefutables de que la ingesta de sal alimentaria es la principal causa de hipertensión y de que una reducción del consumo de sal, del nivel actual de aproximadamente 9 a 12 g/d en la mayor parte de los países al nivel recomendado de menos de 5 g/d, disminuye la presión arterial. Una reducción adicional hasta 3 a 4 g/d tiene un mayor efecto y es necesario seguir teniendo en cuenta la posibilidad de metas de consumo de sal inferiores en la población. Los estudios de cohortes y los ensayos clínicos han demostrado que el menor consumo de sal se asocia con una reducción del riesgo de padecer enfermedades cardiovasculares. La reducción de sal es una de las medidas más rentables para mejorar la salud pública a escala mundial. En la Región de las Américas, hay una alta prevalencia de un consumo de

  6. [Cardiovascular disease and systemic inflammatory diseases].

    Science.gov (United States)

    Cuende, José I; Pérez de Diego, Ignacio J; Godoy, Diego

    2016-01-01

    More than a century of research has shown that atherosclerosis is an inflammatory process more than an infiltrative or thrombogenic process. It has been demonstrated epidemiologically and by imaging techniques, that systemic inflammatory diseases (in particular, but not exclusively, rheumatoid arthritis and systemic lupus erythematosus) increase the atherosclerotic process, and has a demonstrated pathophysiological basis. Furthermore, treatments to control inflammatory diseases can modify the course of the atherosclerotic process. Although there are no specific scales for assessing cardiovascular risk in patients with these diseases, cardiovascular risk is high. A number of specific risk scales are being developed, that take into account specific factors such as the degree of inflammatory activity. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  7. Oral buflomedil in the prevention of cardiovascular events in patients with peripheral arterial obstructive disease: a randomized, placebo-controlled, 4-year study.

    Science.gov (United States)

    Leizorovicz, A; Becker, F

    2008-02-12

    Cardiovascular-related morbidity and mortality in patients with peripheral arterial obstructive disease remain high. We performed an international, multicenter, randomized, double-blind, placebo-controlled trial to investigate whether long-term administration of oral buflomedil could reduce the rate of cardiovascular events in patients with intermittent claudication. Patients >40 years of age with documented peripheral arterial obstructive disease, intermittent claudication, and an ankle-brachial index between 0.30 and 0.80 were eligible for inclusion and were randomized to receive orally either buflomedil or placebo for 2 to 4 years. Aspirin was recommended for all patients (unless they were receiving other antithrombotic treatments at inclusion). The primary efficacy outcome was critical cardiovascular events, defined as the composite of cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, symptomatic deterioration of peripheral arterial obstructive disease, or leg amputation. A total of 2078 patients were recruited. Mean treatment duration was 33 months. The rate of critical cardiovascular events was significantly lower in buflomedil-randomized patients than in placebo-randomized patients (9.1% versus 12.4%; hazard ratio, 0.742; 95% confidence interval, 0.603 to 0.915; P=0.0163). Ankle-brachial index increased by 9.2% in buflomedil-randomized patients and decreased by 3.6% in placebo-randomized patients (Pperipheral arterial disease. The use of buflomedil should be considered in addition to an antiplatelet agent in patients with peripheral arterial obstructive disease and intermittent claudication.

  8. Apolipoprotein E and cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Adriana Moreno Valladares

    2006-01-01

    Full Text Available Apolipoprotein E is a polymorphic glycoprotein who interacts with the lipoprotein receptors (LRP-Receptor Related Protein and the receptors for low density lipoproteins of (LDL receptors. When lipoproteins bring up the receptors begins lipids captation and degradation which allows cholesterol utilization, taking place an intracellular auto regulation. The three isoforms of greater importance: Apo E2, E3 and E4 are product of three alleles e2, e3, e4 of one only gene. This factor is related with the amount of lipoproteins that contains ApoE for E/B receptors. A low concentration of lipoproteins with ApoE can increase the activity of LDL receptors and consequently downward the circulating LDL. In the other hand particles with Apo E3 or Apo E4, can cause a downward regulation of LDL and in this way produces a LDL plasma elevation. Many studies in human populations have concluded that this polymorphism of apoE and the plasma variation of lipoproteins are associated with cardiovascular risk. Cardiovascular disease is the result of different interaction between factors which are genetic factor specially ApoE polymorphism e4 allelic of ApoE can explain, in some degree, the greater frequency of cardiovascular disease in those who carries it.

  9. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association.

    Science.gov (United States)

    Fox, Caroline S; Golden, Sherita Hill; Anderson, Cheryl; Bray, George A; Burke, Lora E; de Boer, Ian H; Deedwania, Prakash; Eckel, Robert H; Ershow, Abby G; Fradkin, Judith; Inzucchi, Silvio E; Kosiborod, Mikhail; Nelson, Robert G; Patel, Mahesh J; Pignone, Michael; Quinn, Laurie; Schauer, Philip R; Selvin, Elizabeth; Vafiadis, Dorothea K

    2015-08-25

    Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus. © 2015 American Heart Association, Inc.

  10. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence: A Scientific Statement From the American Heart Association and the American Diabetes Association

    Science.gov (United States)

    Golden, Sherita Hill; Anderson, Cheryl; Bray, George A.; Burke, Lora E.; de Boer, Ian H.; Deedwania, Prakash; Eckel, Robert H.; Ershow, Abby G.; Fradkin, Judith; Inzucchi, Silvio E.; Kosiborod, Mikhail; Nelson, Robert G.; Patel, Mahesh J.; Pignone, Michael; Quinn, Laurie; Schauer, Philip R.; Selvin, Elizabeth; Vafiadis, Dorothea K.

    2015-01-01

    Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus. PMID:26246459

  11. Lipoprotein Apheresis for Lipoprotein(a)-Associated Cardiovascular Disease

    DEFF Research Database (Denmark)

    Roeseler, Eberhard; Julius, Ulrich; Heigl, Franz

    2016-01-01

    OBJECTIVE: Lipoprotein(a)-hyperlipoproteinemia (Lp(a)-HLP) along with progressive cardiovascular disease has been approved as indication for regular lipoprotein apheresis (LA) in Germany since 2008. We aimed to study the long-term preventive effect of LA and to assess hypothetical clinical...... correlations of apolipoprotein(a) (apo(a)) by analyzing genotypes and phenotypes. APPROACH AND RESULTS: This prospective observational multicenter study included 170 patients with Lp(a)-HLP and progressive cardiovascular disease (48.9 years median age at diagnosis) despite other cardiovascular risk factors......-nucleotide polymorphisms rs10455872 or rs3798220. CONCLUSIONS: Results of 5 years of prospective follow-up confirm that LA has a lasting effect on prevention of cardiovascular events in patients with Lp(a)-HLP. Patients clinically selected by progressive cardiovascular disease were characterized by a highly frequent...

  12. Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Jianhua Wu

    Full Text Available Guidelines indicate eligibility for lipid lowering drugs, but it is not known to what extent GPs' follow guidelines in routine clinical practice or whether additional clinical factors systematically influence their prescribing decisions.A retrospective cohort analysis was undertaken using electronic primary care records from 421 UK general practices. At baseline (May 2008 patients were aged 30 to 74 years, free from cardiovascular disease and not taking lipid lowering drugs. The outcome was prescription of a lipid lowering drug within the next two years. The proportions of eligible and ineligible patients prescribed lipid lowering drugs were reported and multivariable logistic regression models were used to investigate associations between age, sex, cardiovascular risk factors and prescribing.Of 365,718 patients with complete data, 13.8% (50,558 were prescribed lipid lowering drugs: 28.5% (21,101/74,137 of those eligible and 10.1% (29,457/291,581 of those ineligible. Only 41.7% (21,101/50,558 of those prescribed lipid lowering drugs were eligible. In multivariable analysis prescribing was most strongly associated with increasing age (OR for age ≥ 65 years 4.21; 95% CI 4.05-4.39; diabetes (OR 4.49; 95% CI 4.35-4.64; total cholesterol level ≥ 7 mmol/L (OR 2.20; 95% CI 2.12-2.29; and ≥ 4 blood pressure measurements in the past year (OR 4.24; 95% CI 4.06-4.42. The predictors were similar in eligible and ineligible patients.Most lipid lowering drugs for primary prevention are prescribed to ineligible patients. There is underuse of lipid lowering drugs in eligible patients.

  13. Similarity between generic and brand-name antihypertensive drugs for primary prevention of cardiovascular disease: evidence from a large population-based study.

    Science.gov (United States)

    Corrao, Giovanni; Soranna, Davide; Merlino, Luca; Mancia, Giuseppe

    2014-10-01

    Although generic and earlier brand-name counterparts are bioequivalent, their equivalence in preventing relevant clinical outcomes is of concern. To compare effectiveness of generic and brand-name antihypertensive drugs for preventing the onset of cardiovascular (CV) outcomes. A population-based, nested case-control study was carried out by including the cohort of 78 520 patients from Lombardy (Italy) aged 18 years or older who were newly treated with antihypertensive drugs during 2005. Cases were the 2206 patients who experienced a hospitalization for CV disease from initial prescription until 2011. One control for each case was randomly selected from the same cohort that generated cases. Logistic regression was used to model the CV risk associated with starting on and/or continuing with generic or brand-name agents. There was no evidence that patients who started on generics experienced different CV risk than those on brand-name product (OR 0·86; 95% CI 0·63-1·17). Patients at whom generics were main dispensed had not significantly difference in CV outcomes than those mainly on brand-name agents (OR 1·19; 95% CI 0·86-1·63). Compared with patients who kept initial brand-name therapy, those who experienced brand-to-generic or generic-to-brand switches, and those always on generics, did not show differential CV risks, being the corresponding ORs (and 95% CIs), 1·18 (0·96-1·47), 0·87 (0·63-1·21) and 1·08 (0·80-1·46). Our findings do not support the notion that brand-name antihypertensive agents are superior to generics for preventing CV outcomes in the real-world clinical practice. © 2014 Stichting European Society for Clinical Investigation Journal Foundation.

  14. Oxidative stress in cardiovascular diseases

    Directory of Open Access Journals (Sweden)

    Shyamal K Goswami

    2015-01-01

    Full Text Available Oxidative stress caused by various oxygen containing free radicals and reactive species (collectively called "Reactive Oxygen Species" or ROS has long been attributed to cardiovascular diseases. In human body, major oxidizing species are super oxide, hydrogen peroxide, hydroxyl radical, peroxy nitrite etc. ROS are produced from distinct cellular sources, enzymatic and non-enzymatic; have specific physicochemical properties and often have specific cellular targets. Although early studies in nineteen sixties and seventies highlighted the deleterious effects of these species, later it was established that they also act as physiological modulators of cellular functions and diseases occur only when ROS production is deregulated. One of the major sources of cellular ROS is Nicotinamide adenine dinucleotide phosphate oxidases (Noxes that are expressed in almost all cell types. Superoxide and hydrogen peroxide generated from them under various conditions act as signal transducers. Due to their immense importance in cellular physiology, various Nox inhibitors are now being developed as therapeutics. Another free radical of importance in cardiovascular system is nitric oxide (a reactive nitrogen species generated from nitric oxide synthase(s. It plays a critical role in cardiac function and its dysregulated generation along with superoxide leads to the formation of peroxynitrite a highly deleterious agent. Despite overwhelming evidences of association between increased level of ROS and cardiovascular diseases, antioxidant therapies using vitamins and omega 3 fatty acids have largely been unsuccessful till date. Also, there are major discrepancies between studies with laboratory animals and human trials. It thus appears that the biology of ROS is far complex than anticipated before. A comprehensive understanding of the redox biology of diseases is thus needed for developing targeted therapeutics.

  15. Summer Savory: From the Selection of Traditional Applications to the Novel Effect in Relief, Prevention, and Treatment of a Number of Serious Illnesses such as Diabetes, Cardiovascular Disease, Alzheimer’s Disease, and Cancer

    Directory of Open Access Journals (Sweden)

    Rafie Hamidpour

    2014-07-01

    Full Text Available Savory (Satureja L. plant species have been used for centuries as culinary herbs and spices, as well as traditional remedies for the treatment or relief of various common health symptoms in many parts of the world. Recent studies suggest that the use of some Satureja species is effective in protecting the body against oxidative stress, free radical damage, inflammation, microbial infections, etc., A review of many studies suggests that savory species, in addition to treating minor ordinary ailments, can potentially provide a novel natural prevention or treatment for some chronic and serious illnesses such as diabetes, cardiovascular diseases, cancer, and Alzheimer’s.

  16. Mercury exposure and risk of cardiovascular disease: a nested case-control study in the PREDIMED (PREvention with MEDiterranean Diet) study.

    Science.gov (United States)

    Downer, Mary K; Martínez-González, Miguel A; Gea, Alfredo; Stampfer, Meir; Warnberg, Julia; Ruiz-Canela, Miguel; Salas-Salvadó, Jordi; Corella, Dolores; Ros, Emilio; Fitó, Montse; Estruch, Ramon; Arós, Fernando; Fiol, Miquel; Lapetra, José; Serra-Majem, Lluís; Bullo, Monica; Sorli, Jose V; Muñoz, Miguel A; García-Rodriguez, Antonio; Gutierrez-Bedmar, Mario; Gómez-Gracia, Enrique

    2017-01-05

    Substantial evidence suggests that consuming 1-2 servings of fish per week, particularly oily fish (e.g., salmon, herring, sardines) is beneficial for cardiovascular health due to its high n-3 polyunsaturated fatty acid content. However, there is some concern that the mercury content in fish may increase cardiovascular disease risk, but this relationship remains unclear. The PREDIMED trial included 7477 participants who were at high risk for cardiovascular disease at baseline. In this study, we evaluated associations between mercury exposure, fish consumption and cardiovascular disease. We randomly selected 147 of the 288 cases diagnosed with cardiovascular disease during follow-up and matched them on age and sex to 267 controls. Instrumental neutron activation analysis was used to assess toenail mercury concentration. In-person interviews, medical record reviews and validated questionnaires were used to assess fish consumption and other covariates. Information was collected at baseline and updated yearly during follow-up. We used conditional logistic regression to evaluate associations in the total nested case-control study, and unconditional logistic regression for population subsets. Mean (±SD) toenail mercury concentrations (μg per gram) did not significantly differ between cases (0.63 (±0.53)) and controls (0.67 (±0.49)). Mercury concentration was not associated with cardiovascular disease in any analysis, and neither was fish consumption or n-3 fatty acids. The fully-adjusted relative risks for the highest versus lowest quartile of mercury concentration were 0.71 (95% Confidence Interval [CI], 0.34, 1.14; p trend  = 0.37) for the nested case-control study, 0.74 (95% CI, 0.32, 1.76; p trend  = 0.43) within the Mediterranean diet intervention group, and 0.50 (95% CI, 0.13, 1.96; p trend  = 0.41) within the control arm of the trial. Associations remained null when mercury was jointly assessed with fish consumption at baseline and during follow

  17. Association between periodontal disease and cardiovascular disease

    International Nuclear Information System (INIS)

    Rehman, M.M.; Salama, R.P.

    2004-01-01

    Studies have supported the notion that subjects with periodontitis and patients with multiple tooth extractions as a result of chronic advanced periodontal disease (PDD) have a greater risk of developing Cardiovascular disease (CVD) than those who had little or no periodontal infection. Periodontitis may predispose affected patients to CVD by elevating systemic C-reactive protein level and pro-inflammatory activity in atherosclerotic lesions and accelerate development of cardiovascular diseases, Oral health variables including loss of teeth, positive plaque Benzoyl-D-L-Arginine- Naphthyl Amide test (BANA) scores, and compliant of xerostomia may by considered as risk indicators for CVD. Exact mechanism which links PDD and CVD has not been firmly established. The link between PDD and CVD may be attributed to bacteria entering blood stream and attaching to the fatty plaque in coronary artery and contributing to clot formation which can lead to heart attack. Inflammation caused by PDD increases the plaque build up. The association between the two disease entities is cause for concern. However, dental and medical practitioners should be aware of these findings to move intelligently to interact with inquiring patients with periodontitis. They should be urged to maintain medical surveillance of their cardiovascular status, and work on controlling or reducing all known risk factors associated with CVD, including periodontal infection. (author)

  18. Cost-effectiveness of a cardiovascular disease primary prevention programme in a primary health care setting. Results of the Polish part of the EUROACTION project.

    Science.gov (United States)

    Sović, Nevena; Pająk, Andrzej; Jankowski, Piotr; Duenas, Alejandra; Kawecka-Jaszcz, Kalina; Wolfshaut-Wolak, Renata; Stepaniak, Urszula; Kawalec, Paweł

    2013-01-01

    Well designed cardiovascular disease (CVD) prevention programmes appear to be generally applicable and effective in reducing exposure to risk factors and the incidence of disease. However, introducing them broadly into clinical practice would have a significant impact on the healthcare budget, and requires careful consideration. The purpose of this health economic analysis was to assess the potential cost-effectiveness of the model nurse-led, comprehensive CVD primary prevention programme which was prepared and introduced in the EUROACTION project, in high-risk patients in Poland. A Markov model was developed to assess the long-term costs of preventive intervention. The health states modelled were: event-free (all patients at the beginning of observation), stable angina first year, acute myocardial infarction, stable angina subsequent year, myocardial infarction subsequent year, CVD death, and other causes of death. Health benefits from the reduction in risk factors were estimated based on Framingham risk function assuming the probability of defined health states according to British registers. The time horizon of the analysis was ten years, and one Markov cycle length was one year. The analysis was prepared from the healthcare payer's perspective. A willingness to pay threshold of three gross domestic product (GDP) per capita / quality-adjusted life years (QALY) was used. Univariate sensitivity analysis was conducted. Results were presented as an incremental cost-effectiveness ratio (ICER) expressed as an incremental cost per QALY. In Poland, EUROACTION intervention resulted mainly in reductions in the prevalence of smoking (by 14%) and high blood pressure (by 7%). Intervention on other risk factors, including blood lipids, was found to be less effective. Estimated ICERs were 19,524 PLN for men and 82,262 PLN for women. The programme was even more cost-effective in smokers i.e. estimated ICERs were 12,377 PLN in men and 53,471 PLN in women. The results were most

  19. THE ROLE OF GENE IN CARDIOVASCULAR DISEASES

    OpenAIRE

    Rafiya Begum1 , Syeda Zeba Hyder Zaidi2 , Nuha Rasheed3 and Abdul Saleem Mohammad 4

    2017-01-01

    Interleukin (IL)-18 plays a key role in atherosclerosis and its complications. Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. Cardiovascular disease includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, heart failure, hypertensive heart disease, rheumatic heart disease, cardiomyopathy, heart arrhythmia, congenital heart disease, valvular heart disease, cardit...

  20. Plausible mechanisms explaining the association of periodontitis with cardiovascular diseases

    NARCIS (Netherlands)

    Loos, B.G.; Teeuw, W.J.; Nicu, E.A.; Lynge Petersen, A.M.

    2016-01-01

    The association between periodontitis and cardiovascular diseases is now well established. Cardiovascular diseases include atherosclerosis, coronary heart (artery) disease, cerebrovascular disease, and peripheral artery disease. Atherosclerosis is the underlying pathology of cardiovascular diseases.

  1. Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events

    Science.gov (United States)

    Neal, Bruce; Perkovic, Vlado; de Zeeuw, Dick; Fulcher, Greg; Erondu, Ngozi; Shaw, Wayne; Fabbrini, Elisa; Sun, Tao; Li, Qiang; Desai, Mehul; Matthews, David R.

    2018-01-01

    Background: Canagliflozin is a sodium glucose cotransporter 2 inhibitor that significantly reduces the composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke in patients with type 2 diabetes mellitus and elevated cardiovascular risk. The comparative effects among participants with and without a history of cardiovascular disease (secondary versus primary prevention) were prespecified for evaluation. Methods: The CANVAS Program (Canagliflozin Cardiovascular Assessment Study) randomly assigned 10 142 participants with type 2 diabetes mellitus to canagliflozin or placebo. The primary prevention cohort comprised individuals ≥50 years of age with ≥2 risk factors for cardiovascular events but with no prior cardiovascular event, and the secondary prevention cohort comprised individuals ≥30 years of age with a prior cardiovascular event. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. Secondary outcomes included heart failure hospitalization and a renal composite (40% reduction in estimated glomerular filtration rate, renal replacement therapy, or renal death). Results: Primary prevention participants (N=3486; 34%) were younger (63 versus 64 years of age), were more often female (45% versus 31%), and had a longer duration of diabetes mellitus (14 versus 13 years) compared with secondary prevention participants (N=6656; 66%). The primary end point event rate was higher in the secondary prevention group compared with the primary prevention group (36.9 versus 15.7/1000 patient-years, P<0.001). In the total cohort, the primary end point was reduced with canagliflozin compared with placebo (26.9 versus 31.5/1000 patient-years; hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.75–0.97; P<0.001 for noninferiority, P=0.02 for superiority) with no statistical evidence of heterogeneity (interaction P value=0.18) between the primary (HR, 0.98; 95% CI, 0.74–1.30) and

  2. Self-Care for the Prevention and Management of Cardiovascular Disease and Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association.

    Science.gov (United States)

    Riegel, Barbara; Moser, Debra K; Buck, Harleah G; Dickson, Victoria Vaughan; Dunbar, Sandra B; Lee, Christopher S; Lennie, Terry A; Lindenfeld, JoAnn; Mitchell, Judith E; Treat-Jacobson, Diane J; Webber, David E

    2017-08-31

    Self-care is defined as a naturalistic decision-making process addressing both the prevention and management of chronic illness, with core elements of self-care maintenance, self-care monitoring, and self-care management. In this scientific statement, we describe the importance of self-care in the American Heart Association mission and vision of building healthier lives, free of cardiovascular diseases and stroke. The evidence supporting specific self-care behaviors such as diet and exercise, barriers to self-care, and the effectiveness of self-care in improving outcomes is reviewed, as is the evidence supporting various individual, family-based, and community-based approaches to improving self-care. Although there are many nuances to the relationships between self-care and outcomes, there is strong evidence that self-care is effective in achieving the goals of the treatment plan and cannot be ignored. As such, greater emphasis should be placed on self-care in evidence-based guidelines. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  3. Where and how to search for information on the effectiveness of public health interventions--a case study for prevention of cardiovascular disease.

    Science.gov (United States)

    Bayliss, Susan E; Davenport, Clare F; Pennant, Mary E

    2014-12-01

    This case study documents the experience of searching for information on the effectiveness of population-level multi-factor interventions for the prevention of cardiovascular disease (CVD) to inform guidance from NICE (National Institute for Health and Care Excellence). To compare suitability of different databases for searches on a medical public health topic and performance of sensitive versus specific strategies. A sensitive search strategy identified 34 CVD programmes (reference standard) and sensitivity, precision and number needed to read (NNTR) were compared across seven databases. Two alternative strategies were developed to improve precision while minimising the impact on sensitivity. MEDLINE alone retrieved 91% (31/34) relevant programme citations. Four databases (MEDLINE, CENTRAL, ASSIA and PsycINFO) were required to identify all 34 programmes. In the alternative strategies, greater use of MeSH rather than text and focus on terms directed at population-level interventions resulted in a more precise search on MEDLINE. MEDLINE alone provided a better yield than anticipated. Additional databases improved sensitivity by 9% but to the detriment of precision. Retrospective searching would provide additional insight into the performance of both databases and strategies. How the medical nature of this public health topic affected yield across databases also requires further investigation. © 2014 The authors. Health Information and Libraries Journal © 2014 Health Libraries Journal.

  4. The Use of Behavior Change Techniques and Theory in Technologies for Cardiovascular Disease Prevention and Treatment in Adults: A Comprehensive Review.

    Science.gov (United States)

    Winter, Sandra J; Sheats, Jylana L; King, Abby C

    2016-01-01

    This review examined the use of health behavior change techniques and theory in technology-enabled interventions targeting risk factors and indicators for cardiovascular disease (CVD) prevention and treatment. Articles targeting physical activity, weight loss, smoking cessation and management of hypertension, lipids and blood glucose were sourced from PubMed (November 2010-2015) and coded for use of 1) technology, 2) health behavior change techniques (using the CALO-RE taxonomy), and 3) health behavior theories. Of the 984 articles reviewed, 304 were relevant (240=intervention, 64=review). Twenty-two different technologies were used (M=1.45, SD=+/-0.719). The most frequently used behavior change techniques were self-monitoring and feedback on performance (M=5.4, SD=+/-2.9). Half (52%) of the intervention studies named a theory/model - most frequently Social Cognitive Theory, the Trans-theoretical Model, and the Theory of Planned Behavior/Reasoned Action. To optimize technology-enabled interventions targeting CVD risk factors, integrated behavior change theories that incorporate a variety of evidence-based health behavior change techniques are needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Treatment-resistant hypertension and the incidence of cardiovascular disease and end-stage renal disease: results from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).

    Science.gov (United States)

    Muntner, Paul; Davis, Barry R; Cushman, William C; Bangalore, Sripal; Calhoun, David A; Pressel, Sara L; Black, Henry R; Kostis, John B; Probstfield, Jeffrey L; Whelton, Paul K; Rahman, Mahboob

    2014-11-01

    Apparent treatment-resistant hypertension (aTRH) is defined as uncontrolled hypertension despite the use of ≥3 antihypertensive medication classes or controlled hypertension while treated with ≥4 antihypertensive medication classes. Although a high prevalence of aTRH has been reported, few data are available on its association with cardiovascular and renal outcomes. We analyzed data on 14 684 Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) participants to determine the association between aTRH (n=1870) with coronary heart disease, stroke, all-cause mortality, heart failure, peripheral artery disease, and end-stage renal disease. We defined aTRH as blood pressure not at goal (systolic/diastolic blood pressure ≥140/90 mm Hg) while taking ≥3 classes of antihypertensive medication or taking ≥4 classes of antihypertensive medication with blood pressure at goal during the year 2 ALLHAT study visit (1996-2000). Use of a diuretic was not required to meet the definition of aTRH. Follow-up occurred through 2002. The multivariable adjusted hazard ratios (95% confidence intervals) comparing participants with versus without aTRH were as follows: coronary heart disease (1.44 [1.18-1.76]), stroke (1.57 [1.18-2.08]), all-cause mortality (1.30 [1.11-1.52]), heart failure (1.88 [1.52-2.34]), peripheral artery disease (1.23 [0.85-1.79]), and end-stage renal disease (1.95 [1.11-3.41]). aTRH was also associated with the pooled outcomes of combined coronary heart disease (hazard ratio, 1.47; 95% confidence interval, 1.26-1.71) and combined cardiovascular disease (hazard ratio, 1.46; 95% confidence interval, 1.29-1.64). These results demonstrate that aTRH increases the risk for cardiovascular disease and end-stage renal disease. Studies are needed to identify approaches to prevent aTRH and reduce risk for adverse outcomes among individuals with aTRH. © 2014 American Heart Association, Inc.

  6. The Mediterranean diet, its components, and cardiovascular disease.

    Science.gov (United States)

    Widmer, R Jay; Flammer, Andreas J; Lerman, Lilach O; Lerman, Amir

    2015-03-01

    One of the best-studied diets for cardiovascular health is the Mediterranean diet. This consists of fish, monounsaturated fats from olive oil, fruits, vegetables, whole grains, legumes/nuts, and moderate alcohol consumption. The Mediterranean diet has been shown to reduce the burden, or even prevent the development, of cardiovascular disease, breast cancer, depression, colorectal cancer, diabetes, obesity, asthma, erectile dysfunction, and cognitive decline. This diet is also known to improve surrogates of cardiovascular disease, such as waist-to-hip ratio, lipids, and markers of inflammation, as well as primary cardiovascular disease outcomes such as death and events in both observational and randomized controlled trial data. These enhancements easily rival those seen with more established tools used to fight cardiovascular disease such as aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and exercise. However, it is unclear if the Mediterranean diet offers cardiovascular disease benefit from its individual constituents or in aggregate. Furthermore, the potential benefit of the Mediterranean diet or its components is not yet validated by concrete cardiovascular disease endpoints in randomized trials or observational studies. This review will focus on the effects of the whole and parts of the Mediterranean diet with regard to both population-based and experimental data highlighting cardiovascular disease morbidity or mortality and cardiovascular disease surrogates when hard outcomes are not available. Our synthesis will highlight the potential for the Mediterranean diet to act as a key player in cardiovascular disease prevention, and attempt to identify certain aspects of the diet that are particularly beneficial for cardioprotection. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. The Impact of Autophagy on Cardiovascular Senescence and Diseases.

    Science.gov (United States)

    Sasaki, Yuichi; Ikeda, Yoshiyuki; Iwabayashi, Masaaki; Akasaki, Yuichi; Ohishi, Mitsuru

    2017-10-21

    The risk of cardiovascular disease increases with age, causing chronic disability, morbidity, and mortality in the elderly. Cardiovascular aging and disease are characterized by heart failure, cardiac ischemia-reperfusion injury, cardiomyopathy, hypertension, arterial stiffness, and atherosclerosis. As a cell ages, damaged organelles and abnormal proteins accumulate. A system for removing these cytoplasmic substrates is essential for maintaining homeostasis. Autophagy assists tissue homeostasis by forming a pathway by which these substances are degraded. Growing evidence suggests that autophagy plays a role in age-related and disease states of the cardiovascular system, and it may even be effective in preventing or treating cardiovascular disease. On the other hand, overexpression of autophagy in the heart and arteries can produce detrimental effects. We summarize the current understanding of the close relationship between autophagy and cardiovascular senescence.

  8. A cluster randomised school-based lifestyle intervention programme for the prevention of childhood obesity and related early cardiovascular disease (JuvenTUM 3

    Directory of Open Access Journals (Sweden)

    Haller Bernhard

    2011-04-01

    Full Text Available Abstract Background Childhood obesity is not only associated with adult obesity but also with increased risk of adult onset of type 2 diabetes and subsequent coronary heart disease. The potential effects of school-based health intervention programmes on cardiovascular risk and surrogate markers are unclear, as only few studies have attempted to investigate a complete risk profile including a detailed laboratory analysis or micro- and macrovascular function. In this study a comprehensive school-based randomized intervention programme will be investigated in 10-14-year old children addressing the influence of lifestyle intervention on inactivity, cardiometabolic risk factors and early signs of vascular disease. Methods/Design 15 secondary schools in Southern Germany are randomly assigned to intervention or control schools. Children in the fifth grade (10-11 years will be observed over four years. The study combines a school-based with a home-based approach, aiming at children, teachers and parents. The main components are weekly lifestyle-lessons for children, taught by regular classroom teachers to increase physical activity in- and outside of school, to improve eating patterns at school and at home, to reduce media consumption and to amplify well-being. In 4-6 annual meetings, teachers receive information about health-related topics with worksheets for children and supporting equipment, accounting for school-specific needs and strategies. Parents' trainings are provided on a regular basis. All examinations are performed at the beginning and at the end of every school year. Anthropometry includes measurements of BMI, waist and upper arm circumferences, skinfold thickness as well as peripheral blood pressure. Blood sampling includes lipid parameters, insulin, glucose, hsCRP, adiponectin, and IL-6 as well as testosteron and estrogen to determine maturation status. Vascular function is non-invasively assessed by measuring arterial stiffness in large

  9. Aspirin desensitization for cardiovascular disease.

    Science.gov (United States)

    Woessner, Katharine M

    2015-08-01

    The use of aspirin in coronary artery disease and address the unmet need of aspirin therapy in patients with history of hypersensitivity reactions to aspirin (acetylsalicylic acid; ASA) or other nonsteroidal inflammatory drugs (NSAIDs). Aspirin hypersensitivity is reported in 1.5% of patients with cardiovascular disease. However, many of those labeled as allergic to aspirin had experienced side-effects and could be safely treated with aspirin. Those with true hypersensitivity reactions were often not placed on appropriate antiplatelet therapy. A number of protocols of varying complexity exist in the literature for aspirin desensitization. The focus of this review is to identify the types of aspirin reactions that can occur and provide a rational approach to oral aspirin challenge and desensitization. In summary, with rare exceptions, patients with a history of 'aspirin/NSAID allergy' who need ASA for cardiovascular issues will be able to safely take aspirin either after a graded challenge or desensitization providing a central role of the allergist in the management of these patients.

  10. Marijuana Use and Cardiovascular Disease.

    Science.gov (United States)

    Franz, Christopher A; Frishman, William H

    2016-01-01

    Marijuana is currently the most used illicit substance in the world. With the current trend of decriminalization and legalization of marijuana in the US, physicians in the US will encounter more patients using marijuana recreationally over a diverse range of ages and health states. Therefore, it is relevant to review marijuana's effects on human cardiovascular physiology and disease. Compared with placebo, marijuana cigarettes cause increases in heart rate, supine systolic and diastolic blood pressures, and forearm blood flow via increased sympathetic nervous system activity. These actions increase myocardial oxygen demand to a degree that they can decrease the time to exercise-induced angina in patients with a history of stable angina. In addition, marijuana has been associated with triggering myocardial infarctions (MIs) in young male patients. Smoking marijuana has been shown to increase the risk of MI onset by a factor of 4.8 for the 60 minutes after marijuana consumption, and to increase the annual risk of MI in the daily cannabis user from 1.5% to 3% per year. Human and animal models suggest that this effect may be due to coronary arterial vasospasm. However, longitudinal studies have indicated that marijuana use may not have a significant effect on long-term mortality. While further research is required to definitively determine the impact of marijuana on cardiovascular disease, it is reasonable to recommend against recreational marijuana use, especially in individuals with a history of coronary artery disorders.

  11. The Efficacy and Safety of 3 Types of Interventions for Stroke Prevention in Patients With Cardiovascular and Cerebrovascular Diseases: A Network Meta-analysis.

    Science.gov (United States)

    Sun, Qian; Chang, Shumei; Lu, Songtao; Zhang, Yajing; Chang, Yajun

    2017-07-01

    The goal of this study was to compare the relative efficacy and safety of different types of interventions for stroke prevention in patients with cardiovascular and cerebrovascular diseases. This network meta-analysis (NMA) was conducted with a random effects model of Bayesian framework using Stata version 12.0. Odds ratios (ORs) and their credible intervals (CrIs) were applied for the efficacy and safety evaluation of various medical interventions, including aspirin, dipyridamole, ticlopidine, warfarin, and apixaban. In addition, the ranking of probability of every clinical outcome was estimated by comparing the surface under the cumulative ranking curve. Compared with dabigatran, both edoxaban and aspirin + warfarin exhibited a higher rate of all-cause stroke (OR, 2.84 [95% CrI, 1.17-6.97]; OR, 3.42 [95% CrI, 1.20-9.84]). With respect to intracranial hemorrhage, aspirin + clopidogrel yielded worse outcomes than 7 treatments, including placebo, apixaban, aspirin, aspirin + dipyridamole, cilostazol, clopidogrel, and dabigatran (OR, 2.21 [95% CrI, 1.45-3.40]; OR, 2.11 [95% CrI, 1.05-4.17]; OR, 1.53 [95% CrI, 1.11-2.15]; OR, 1.78 [95% CrI, 1.01-3.03]; OR, 4.17 [95% CrI, 1.37-14.28]; OR, 1.85 [95% CrI, 1.22-2.86]; and OR, 2.56 [95% CrI, 1.37-4.76]). In terms of ischemic stroke, dabigatran provided better efficacy than placebo, aspirin, and aspirin + dipyridamole (OR, 0.36 [95% CrI, 0.18-0.72]; OR, 0.43 [95% CrI, 0.21-0.84]; and OR, 0.41 [95% CrI, 0.17-0.94]). As for mortality, dabigatran resulted in a lower mortality compared with aspirin, aspirin + clopidogrel, edoxaban, and warfarin (OR, 0.48 [95% CrI, 0.23-0.97]; OR, 0.40 [95% CrI, 0.17-0.92]; OR, 0.27 [95% CrI, 0.10-0.72]; and OR, 0.52 [95% CrI, 0.28-0.92]). There are still some limitations to our NMA research. For instance, the lack of direct evidence for some therapies resulted in inconsistencies, particularly for warfarin compared with placebo and clopidogrel under different end points. Moreover, the included

  12. Genetic risk factors and Mendelian randomization in cardiovascular disease.

    Science.gov (United States)

    Swerdlow, Daniel I; Hingorani, Aroon D; Humphries, Steve E

    2015-05-01

    Cardiovascular disease encompasses several diverse pathological states that place a heavy burden on individual and population health. The aetiological basis of many cardiovascular disorders is not fully understood. Growing knowledge of the genetic architecture underlying coronary heart disease, stroke, cardiac arrhythmias and peripheral vascular disease has confirmed some suspected causal pathways in these conditions but also uncovered many previously unknown mechanisms. Here, we consider the contribution of genetics to the understanding of cardiovascular disease risk. We evaluate the utility and relevance of findings from genome-wide association studies and explore the role that Mendelian randomisation has to play in exploiting these. Mendelian randomisation permits robust causal inference in an area of research where this has been hampered by bias and confounding in observational studies. In doing so, it provides evidence for causal processes in cardiovascular disease that could represent novel targets for much-needed new drugs for disease prevention and treatment.

  13. Platelets, aspirin, and cardiovascular disease.

    Science.gov (United States)

    Elwood, P C; Hughes, C; O'Brien, J R

    1998-10-01

    Aspirin was first synthesised 100 years ago and its preparation and marketing is generally reckoned to have been the foundation of the pharmaceutical industry. For most of the time since then it has been used for the relief of pain and fever. The modern phase of aspirin use commenced with the reporting in 1974 of a randomised controlled trial in the secondary prevention of death by low-dose aspirin given to patients who had suffered a myocardial infarct. Reports of other trials followed and an overview of the first six trials was presented to the inaugural meeting of the Society for Clinical Trials in Philadelphia in 1980. There have been two further major overviews and the most recent, based on 145 trials, established that low-dose aspirin reduces vascular events by around one third. It has been estimated that, used appropriately, aspirin could prevent 100,000 premature deaths each year worldwide, at a cost of about 250 Pounds ($400) per life saved, and about 80 Pounds ($130) per cardiovascular event prevented. The evidence indicates that it is seriously underused at present. The aspirin story continues and trials are in progress to test other possible uses of aspirin, in vascular dementia, colorectal cancer, and cataract.

  14. Cardiovascular disease in immune-mediated inflammatory diseases

    Science.gov (United States)

    Fernández-Gutiérrez, Benjamín; Perrotti, Pedro P.; Gisbert, Javier P.; Domènech, Eugeni; Fernández-Nebro, Antonio; Cañete, Juan D.; Ferrándiz, Carlos; Tornero, Jesús; García-Sánchez, Valle; Panés, Julián; Fonseca, Eduardo; Blanco, Francisco; Rodríguez-Moreno, Jesús; Carreira, Patricia; Julià, Antonio; Marsal, Sara; Rodriguez-Rodriguez, Luis

    2017-01-01

    Abstract To analyze in several immune-mediated inflammatory diseases (IMIDs) the influence of demographic and clinical-related variables on the prevalence of cardiovascular disease (CVD), and compare their standardized prevalences. Cross-sectional study, including consecutive patients diagnosed with rheumatoid arthritis, psoriatic arthritis, psoriasis, systemic lupus erythematosus, Crohn disease, or ulcerative colitis, from rheumatology, gastroenterology, and dermatology tertiary care outpatient clinics located throughout Spain, between 2007 and 2010. Our main outcome was defined as previous diagnosis of angina, myocardial infarction, peripheral vascular disease, and/or stroke. Bivariate and multivariate logistic and mixed-effects logistic regression models were performed for each condition and the overall cohort, respectively. Standardized prevalences (in subjects per 100 patients, with 95% confidence intervals) were calculated using marginal analysis. We included 9951 patients. For each IMID, traditional cardiovascular risk factors had a different contribution to CVD. Overall, older age, longer disease duration, presence of traditional cardiovascular risk factors, and male sex were independently associated with a higher CVD prevalence. After adjusting for demographic and traditional cardiovascular risk factors, systemic lupus erythematosus exhibited the highest CVD standardized prevalence, followed by rheumatoid arthritis, psoriasis, Crohn disease, psoriatic arthritis, and ulcerative colitis (4.5 [95% confidence interval (CI): 2.2, 6.8], 1.3 [95% CI: 0.8, 1.8], 0.9 [95% CI: 0.5, 1.2], 0.8 [95% CI: 0.2, 1.3], 0.6 [95% CI: 0.2, 1.0], and 0.5 [95% CI: 0.1, 0.8], respectively). Systemic lupus erythematosus, rheumatoid arthritis, and psoriasis are associated with higher prevalence of CVD compared with other IMIDs. Specific prevention programs should be established in subjects affected with these conditions to prevent CVD. PMID:28658137

  15. Prevention of periodontal diseases.

    Science.gov (United States)

    Dentino, Andrew R; Kassab, Moawia M; Renner, Erica J

    2005-07-01

    The ultimate goal of periodontal disease prevention is to maintain the dentition over a lifetime in a state of health, comfort, and function in an aesthetically pleasing presentation. This article focuses on primary and secondary periodontal disease prevention as they relate to gingivitis and periodontitis. Risk assessment, mechanical plaque control, chemical plaque control, current clinical recommendations for optimal prevention, and future preventive strategies are discussed.

  16. Prevention of diseases after menopause.

    Science.gov (United States)

    Lobo, R A; Davis, S R; De Villiers, T J; Gompel, A; Henderson, V W; Hodis, H N; Lumsden, M A; Mack, W J; Shapiro, S; Baber, R J

    2014-10-01

    Women may expect to spend more than a third of their lives after menopause. Beginning in the sixth decade, many chronic diseases will begin to emerge, which will affect both the quality and quantity of a woman's life. Thus, the onset of menopause heralds an opportunity for prevention strategies to improve the quality of life and enhance longevity. Obesity, metabolic syndrome and diabetes, cardiovascular disease, osteoporosis and osteoarthritis, cognitive decline, dementia and depression, and cancer are the major diseases of concern. Prevention strategies at menopause have to begin with screening and careful assessment for risk factors, which should also include molecular and genetic diagnostics, as these become available. Identification of certain risks will then allow directed therapy. Evidence-based prevention for the diseases noted above include lifestyle management, cessation of smoking, curtailing excessive alcohol consumption, a healthy diet and moderate exercise, as well as mentally stimulating activities. Although the most recent publications from the follow-up studies of the Women's Health Initiative do not recommend menopause hormonal therapy as a prevention strategy, these conclusions may not be fully valid for midlife women, on the basis of the existing data. For healthy women aged 50-59 years, estrogen therapy decreases coronary heart disease and all-cause mortality; this interpretation is entirely consistent with results from other randomized, controlled trials and observational studies. Thus. as part of a comprehensive strategy to prevent chronic disease after menopause, menopausal hormone therapy, particularly estrogen therapy may be considered as part of the armamentarium.

  17. [Cardiovascular prevention in diabetes mellitus: A multifactorial challenge].

    Science.gov (United States)

    Pedro-Botet, Juan; Chillarón, Juan J; Benaiges, David; Flores-Le Roux, Juana A

    2016-01-01

    Patients with type2 diabetes mellitus have a high to very high cardiovascular risk, and often have other associated risk factors, such as hypertension, obesity and dyslipidaemia. Cardiovascular disease is the leading cause of morbidity and mortality in this population. An integrated control of all risk factors in patients with diabetes is essential for minimising the risk of macrovascular complications. Given the benefits of the multifactorial intervention strategies for cardiovascular prevention in diabetic patients, a review is presented on the therapeutic goals established for each risk factor in diabetes and the benefits of their control. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  18. The Brazilian Cardioprotective Nutritional Program to reduce events and risk factors in secondary prevention for cardiovascular disease: study protocol (The BALANCE Program Trial).

    Science.gov (United States)

    Weber, Bernardete; Bersch-Ferreira, Ângela Cristine; Torreglosa, Camila Ragne; Ross-Fernandes, Maria Beatriz; da Silva, Jacqueline Tereza; Galante, Andrea Polo; Lara, Enilda de Sousa; Costa, Rosana Perim; Soares, Rafael Marques; Cavalcanti, Alexandre Biasi; Moriguchi, Emilio H; Bruscato, Neide M; Kesties; Vivian, Lilian; Schumacher, Marina; de Carli, Waldemar; Backes, Luciano M; Reolão, Bruna R; Rodrigues, Milena P; Baldissera, Dúnnia M B; Tres, Glaucia S; Lisbôa, Hugo R K; Bem, João B J; Reolão, Jose B C; Deucher, Keyla L A L; Cantarelli, Maiara; Lucion, Aline; Rampazzo, Daniela; Bertoni, Vanessa; Torres, Rosileide S; Verríssimo, Adriana O L; Guterres, Aldair S; Cardos, Andrea F R; Coutinho, Dalva B S; Negrão, Mayara G; Alencar, Mônica F A; Pinho, Priscila M; Barbosa, Socorro N A A; Carvalho, Ana P P F; Taboada, Maria I S; Pereira, Sheila A; Heyde, Raul V; Nagano, Francisca E Z; Baumgartner, Rebecca; Resende, Fernanda P; Tabalipa, Ranata; Zanini, Ana C; Machado, Michael J R; Araujo, Hevila; Teixeira, Maria L V; Souza, Gabriela C; Zuchinali, Priccila; Fracasso, Bianca M; Ulliam, Karen; Schumacher, Marina; Pierotto, Moara; Hilário, Thamires; Carlos, Daniele M O; Cordeiro, Cintia G N C; Carvalho, Daniele A; Gonçalves, Marília S; Vasconcelos, Valdiana B; Bosquetti, Rosa; Pagano, Raira; Romano, Marcelo L P; Jardim, César A; de Abreu, Bernardo N A; Marcadenti, Aline; Schmitt, Alessandra R; Tavares, Angela M V; Faria, Christiane C; Silva, Flávia M; Fink, Jaqueline S; El Kik, Raquel M; Prates, Clarice F; Vieira, Cristiane S; Adorne, Elaine F; Magedanz, Ellen H; Chieza, Fernanda L; Silva, Ingrid S; Teixeira, Joise M; Trescastro, Eduardo P; Pellegrini, Lívia A; Pinto, Jéssika C; Telles, Cristina T; Sousa, Antonio C S; Almeida, Andreza S; Costa, Ariane A; Carmo, José A C; Silva, Juliana T; Alves, Luciana V S; Sales, Saulo O C; Ramos, Maria E M; Lucas, Marilia C S; Damiani, Monica; Cardoso, Patricia C; Ramos, Salvador S; Dantas, Clenise F; Lopes, Amanda G; Cabral, Ana M P; Lucena, Ana C A; Medeiros, Auriene L; Terceiro, Bernardino B; Leda, Neuma M F S; Baía, Sandra R D; Pinheiro, Josilene M F; Cassiano, Alexandra N; Melo, Andressa N L; Cavalcanti, Anny K O; Souza, Camila V S; Queiroz, Dayanna J M; Farias, Hercilla N C F; Souza, Larissa C F; Santos, Letícia S; Lima, Luana R M; Hoffmann, Meg S; Ribeiro, Átala S Silva; Vasconcelos, Daniel F; Dutra, Eliane S; Ito, Marina K; Neto, José A F; Santos, Alexsandro F; Sousa, Rosângela M L; Dias, Luciana Pereira P; Lima, Maria T M A; Modanesi, Victor G; Teixeira, Adriana F; Estrada, Luciana C N C D; Modanesi, Paulo V G; Gomes, Adriana B L; Rocha, Bárbara R S; Teti, Cristina; David, Marta M; Palácio, Bruna M; Junior, Délcio G S; Faria, Érica H S; Oliveira, Michelle C F; Uehara, Rose M; Sasso, Sandramara; Moreira, Annie S B; Cadinha, Ana C A H; Pinto, Carla W M; Castilhos, Mariana P; Costa, Mariana; Kovacs, Cristiane; Magnoni, Daniel; Silva, Quênia; Germini, Michele F C A; da Silva, Renata A; Monteiro, Aline S; dos Santos, Karina G; Moreira, Priscila; Amparo, Fernanda C; Paiva, Catharina C J; Poloni, Soraia; Russo, Diana S; Silveira, Izabele V; Moraes, Maria A; Boklis, Mirena; Cardoso, Quinto I; Moreira, Annie S B; Damaceno, Aline M S; Santos, Elisa M; Dias, Glauber M; Pinho, Cláudia P S; Cavalcanti, Adrilene C; Bezerra, Amanda S; Queiroga, Andrey V; Rodrigues, Isa G; Leal, Tallita V; Sahade, Viviane; Amaral, Daniele A; Souza, Diana S; Araújo, Givaldo A; Curvello, Karine; Heine, Manuella; Barretto, Marília M S; Reis, Nailson A; Vasconcelos, Sandra M L; Vieira, Danielly C; Costa, Francisco A; Fontes, Jessica M S; Neto, Juvenal G C; Navarro, Laís N P; Ferreira, Raphaela C; Marinho, Patrícia M; Abib, Renata Torres; Longo, Aline; Bertoldi, Eduardo G; Ferreira, Lauren S; Borges, Lúcia R; Azevedo, Norlai A; Martins, Celma M; Kato, Juliana T; Izar, Maria C O; Asoo, Marina T; de Capitani, Mariana D; Machado, Valéria A; Fonzar, Waléria T; Pinto, Sônia L; Silva, Kellen C; Gratão, Lúcia H A; Machado, Sheila D; de Oliveira, Susane R U; Bressan, Josefina; Caldas, Ana P S; Lima, Hatanne C F M; Hermsdorff, Helen H M; Saldanha, Tânia M; Priore, Sílvia E; Feres, Naoel H; Neves, Adila de Queiroz; Cheim, Loanda M G; Silva, Nilma F; Reis, Silvia R L; Penafort, Andreza M; de Queirós, Ana Paula O; Farias, Geysa M N; de los Santos, Mônica L P; Ambrozio, Cíntia L; Camejo, Cirília N; dos Santos, Cristiano P; Schirmann, Gabriela S; Boemo, Jorge L; Oliveira, Rosane E C; Lima, Súsi M B; Bortolini, Vera M S; Matos, Cristina H; Barretta, Claiza; Specht, Clarice M; de Souza, Simone R; Arruda, Cristina S; Rodrigues, Priscila A; Berwanger, Otávio

    2016-01-01

    This article reports the rationale for the Brazilian Cardioprotective Nutritional Program (BALANCE Program) Trial. This pragmatic, multicenter, nationwide, randomized, concealed, controlled trial was designed to investigate the effects of the BALANCE Program in reducing cardiovascular events. The BALANCE Program consists of a prescribed diet guided by nutritional content recommendations from Brazilian national guidelines using a unique nutritional education strategy, which includes suggestions of affordable foods. In addition, the Program focuses on intensive follow-up through one-on-one visits, group sessions, and phone calls. In this trial, participants 45 years or older with any evidence of established cardiovascular disease will be randomized to the BALANCE or control groups. Those in the BALANCE group will receive the afore mentioned program interventions, while controls will be given generic advice on how to follow a low-fat, low-energy, low-sodium, and low-cholesterol diet, with a view to achieving Brazilian nutritional guideline recommendations. The primary outcome is a composite of death (any cause), cardiac arrest, acute myocardial infarction, stroke, myocardial revascularization, amputation for peripheral arterial disease, or hospitalization for unstable angina. A total of 2468 patients will be enrolled in 34 sites and followed up for up to 48 months. If the BALANCE Program is found to decrease cardiovascular events and reduce risk factors, this may represent an advance in the care of patients with cardiovascular disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Vitamin D, cardiovascular disease and risk factors

    DEFF Research Database (Denmark)

    Skaaby, Tea; Thuesen, Betina H.; Linneberg, Allan

    2017-01-01

    Observational studies have suggested a possible protective role of vitamin D on the cardiovascular system. The available evidence does not support either cardiovascular benefits or harms of vitamin D supplementation. This chapter provides an overview and discussion of the current knowledge...... of vitamin D effects from a cardiovascular health perspective. It focuses on vitamin D in relation to cardiovascular disease, i.e. ischemic heart disease, and stroke; the traditional cardiovascular risk factors hypertension, abnormal blood lipids, obesity; and the emerging risk factors hyperparathyroidism......, microalbuminuria, chronic obstructive pulmonary diseases, and non-alcoholic fatty liver disease. Meta-analyses of observational studies have largely found vitamin D levels to be inversely associated with cardiovascular risk and disease. However, Mendelian randomization studies and randomized, controlled trials...

  20. Factors of health in the protection against death and cardiovascular disease among adults with subclinical atherosclerosis

    Science.gov (United States)

    While cardiovascular disease (CVD) prevention traditionally emphasizes risk-factor control, recent evidence also supports the promotion of "health-factors" associated with cardiovascular wellness. However, whether such health-factors exist among adults with advanced subclinical atherosclerosis is un...

  1. Colchicine for prevention of cardiovascular events.

    Science.gov (United States)

    Hemkens, Lars G; Ewald, Hannah; Gloy, Viktoria L; Arpagaus, Armon; Olu, Kelechi K; Nidorf, Mark; Glinz, Dominik; Nordmann, Alain J; Briel, Matthias

    2016-01-27

    Colchicine is an anti-inflammatory drug that is used for a wide range of inflammatory diseases. Cardiovascular disease also has an inflammatory component but the effects of colchicine on cardiovascular outcomes remain unclear. Previous safety analyses were restricted to specific patient populations. To evaluate potential cardiovascular benefits and harms of a continuous long-term treatment with colchicine in any population, and specifically in people with high cardiovascular risk. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, ClinicalTrials.gov, WHO International Clinical Trials Registry, citations of key papers, and study references in January 2015. We also contacted investigators to gain unpublished data. Randomised controlled trials (parallel-group or cluster design or first phases of cross-over studies) comparing colchicine over at least six months versus any control in any adult population. Primary outcomes were all-cause mortality, myocardial infarction, and adverse events. Secondary outcomes were cardiovascular mortality, stroke, heart failure, non-scheduled hospitalisations, and non-scheduled cardiovascular interventions. We conducted predefined subgroup analyses, in particular for participants with high cardiovascular risk. . We included 39 randomised parallel-group trials with 4992 participants. Colchicine had no effect on all-cause mortality (RR 0.94, 95% CI 0.82 to 1.09; participants = 4174; studies = 30; I² = 27%; moderate quality of evidence). There is uncertainty surrounding the effect of colchicine in reducing cardiovascular mortality (RR 0.34, 95% CI 0.09 to 1.21, I² = 9%; participants = 1132; studies = 7; moderate quality of evidence). Colchicine reduced the risk for total myocardial infarction (RR 0.20, 95% CI 0.07 to 0.57; participants = 652; studies = 2; moderate quality of evidence). There was no effect on total adverse events (RR 1.52, 95% CI 0.93 to 2.46; participants = 1313; studies = 11; I

  2. Diabetic Cardiovascular Disease Induced by Oxidative Stress

    Directory of Open Access Journals (Sweden)

    Yosuke Kayama

    2015-10-01

    Full Text Available Cardiovascular disease (CVD is the leading cause of morbidity and mortality among patients with diabetes mellitus (DM. DM can lead to multiple cardiovascular complications, including coronary artery disease (CAD, cardiac hypertrophy, and heart failure (HF. HF represents one of the most common causes of death in patients with DM and results from DM-induced CAD and diabetic cardiomyopathy. Oxidative stress is closely associated with the pathogenesis of DM and results from overproduction of reactive oxygen species (ROS. ROS overproduction is associated with hyperglycemia and metabolic disorders, such as impaired antioxidant function in conjunction with impaired antioxidant activity. Long-term exposure to oxidative stress in DM induces chronic inflammation and fibrosis in a range of tissues, leading to formation and progression of disease states in these tissues. Indeed, markers for oxidative stress are overexpressed in patients with DM, suggesting that increased ROS may be primarily responsible for the development of diabetic complications. Therefore, an understanding of the pathophysiological mechanisms mediated by oxidative stress is crucial to the prevention and treatment of diabetes-induced CVD. The current review focuses on the relationship between diabetes-induced CVD and oxidative stress, while highlighting the latest insights into this relationship from findings on diabetic heart and vascular disease.

  3. Cost-effectiveness of medical primary prevention strategies to reduce absolute risk of cardiovascular disease in Tanzania: a Markov modelling study.

    Science.gov (United States)

    Ngalesoni, Frida N; Ruhago, George M; Mori, Amani T; Robberstad, Bjarne; Norheim, Ole F

    2016-05-17

    Cardiovascular disease (CVD) is a growing cause of mortality and morbidity in Tanzania, but contextualized evidence on cost-effective medical strategies to prevent it is scarce. We aim to perform a cost-effectiveness analysis of medical interventions for primary prevention of CVD using the World Health Organization's (WHO) absolute risk approach for four risk levels. The cost-effectiveness analysis was performed from a societal perspective using two Markov decision models: CVD risk without diabetes and CVD risk with diabetes. Primary provider and patient costs were estimated using the ingredients approach and step-down methodologies. Epidemiological data and efficacy inputs were derived from systematic reviews and meta-analyses. We used disability- adjusted life years (DALYs) averted as the outcome measure. Sensitivity analyses were conducted to evaluate the robustness of the model results. For CVD low-risk patients without diabetes, medical management is not cost-effective unless willingness to pay (WTP) is higher than US$1327 per DALY averted. For moderate-risk patients, WTP must exceed US$164 per DALY before a combination of angiotensin converting enzyme inhibitor (ACEI) and diuretic (Diu) becomes cost-effective, while for high-risk and very high-risk patients the thresholds are US$349 (ACEI, calcium channel blocker (CCB) and Diu) and US$498 per DALY (ACEI, CCB, Diu and Aspirin (ASA)) respectively. For patients with CVD risk with diabetes, a combination of sulfonylureas (Sulf), ACEI and CCB for low and moderate risk (incremental cost-effectiveness ratio (ICER) US$608 and US$115 per DALY respectively), is the most cost-effective, while adding biguanide (Big) to this combination yielded the most favourable ICERs of US$309 and US$350 per DALY for high and very high risk respectively. For the latter, ASA is also part of the combination. Medical preventive cardiology is very cost-effective for all risk levels except low CVD risk. Budget impact analyses and

  4. Aspirin in primary prevention of cardiovascular disease and cancer: a systematic review of the balance of evidence from reviews of randomized trials.

    Directory of Open Access Journals (Sweden)

    Paul Sutcliffe

    Full Text Available Aspirin has been recommended for primary prevention of cardiovascular disease (CVD and cancer, but overall benefits are unclear. We aimed to use novel methods to re-evaluate the balance of benefits and harms of aspirin using evidence from randomised controlled trials, systematic reviews and meta-analyses.Data sources included ten electronic bibliographic databases, contact with experts, and scrutiny of reference lists of included studies. Searches were undertaken in September 2012 and restricted to publications since 2008. Of 2,572 potentially relevant papers 27 met the inclusion criteria. Meta-analysis of control arms to estimate event rates, modelling of all-cause mortality and L'Abbé plots to estimate heterogeneity were undertaken. Absolute benefits and harms were low: 60-84 major CVD events and 34-36 colorectal cancer deaths per 100,000 person-years were averted, whereas 46-49 major bleeds and 68-117 gastrointestinal bleeds were incurred. Reductions in all-cause mortality were minor and uncertain (Hazard Ratio 0.96; 95% CI: 0.90-1.02 at 20 years, Relative Risk [RR] 0.94, 95% CI: 0.88-1.00 at 8 years; there was a non-significant change in total CVD (RR 0.85, 95% CI: 0.69-1.06 and change in total cancer mortality ranged from 0.76 (95% CI: 0.66-0.88 to 0.93 (95% CI: 0.84-1.03 depending on follow-up time and studies included. Risks were increased by 37% for gastrointestinal bleeds (RR 1.37, 95% CI: 1.15-1.62, 54%-66% for major bleeds (Rate Ratio from IPD analysis 1.54, 95% CI: 1.30-1.82, and RR 1.62, 95% CI: 1.31-2.00, and 32%-38% for haemorrhagic stroke (Rate Ratio from IPD analysis 1.32; 95% CI: 1.00-1.74; RR 1.38; 95% CI: 1.01-1.82.Findings indicate small absolute effects of aspirin relative to the burden of these diseases. When aspirin is used for primary prevention of CVD the absolute harms exceed the benefits. Estimates of cancer benefit rely on selective retrospective re-analysis of RCTs and more information is needed.

  5. The current and potential health benefits of the National Health Service Health Check cardiovascular disease prevention programme in England: A microsimulation study.

    Science.gov (United States)

    Mytton, Oliver T; Jackson, Christopher; Steinacher, Arno; Goodman, Anna; Langenberg, Claudia; Griffin, Simon; Wareham, Nick; Woodcock, James

    2018-03-01

    The National Health Service (NHS) Health Check programme was introduced in 2009 in England to systematically assess all adults in midlife for cardiovascular disease risk factors. However, its current benefit and impact on health inequalities are unknown. It is also unclear whether feasible changes in how it is delivered could result in increased benefits. It is one of the first such programmes in the world. We sought to estimate the health benefits and effect on inequalities of the current NHS Health Check programme and the impact of making feasible changes to its implementation. We developed a microsimulation model to estimate the health benefits (incident ischaemic heart disease, stroke, dementia, and lung cancer) of the NHS Health Check programme in England. We simulated a population of adults in England aged 40-45 years and followed until age 100 years, using data from the Health Survey of England (2009-2012) and the English Longitudinal Study of Aging (1998-2012), to simulate changes in risk factors for simulated individuals over time. We used recent programme data to describe uptake of NHS Health Checks and of 4 associated interventions (statin medication, antihypertensive medication, smoking cessation, and weight management). Estimates of treatment efficacy and adherence were based on trial data. We estimated the benefits of the current NHS Health Check programme compared to a healthcare system without systematic health checks. This counterfactual scenario models the detection and treatment of risk factors that occur within 'routine' primary care. We also explored the impact of making feasible changes to implementation of the programme concerning eligibility, uptake of NHS Health Checks, and uptake of treatments offered through the programme. We estimate that the NHS Health Check programme prevents 390 (95% credible interval 290 to 500) premature deaths before 80 years of age and results in an additional 1,370 (95% credible interval 1,100 to 1,690) people

  6. [Importance of dyslipidaemia in cardiovascular disease: a point of view].

    Science.gov (United States)

    Ascaso, Juan F; Carmena, Rafael

    2015-01-01

    The authors present their view on the prevention of cardiovascular diseases, accepting the European ESC/EAS guidelines. They consider that the aim of the lipid control, based on LDL-C goals, is essential for the prevention and treatment of cardiovascular diseases. In subjects with metabolic syndrome (mainly, abdominal obesity, pre-diabetes and diabetes), the primary objective should be apoB or Non-HDL-C, which are better associated with cardiovascular risk. The treatment must be lifestyle changes and control of other risk factors. After calculating cardiovascular risk, statins are the first therapeutic step, with the strength and dose needed to achieve LDL-C goals. If targets are not achieved, ezetimibe or resins should be added. A new group of potent cholesterol-lowering agents, the PCSK-9 monoclonal antibodies, have recently been approved in Spain. Subjects at very high cardiovascular risk that have achieved LDL-C goals, or other objectives (apoB, Non-HDL-C), other drugs (fibrates, omega-3) capable of modifying triglycerides and HDL-C could be added, if necessary. Treatment to reduce cardiovascular risk and prevent cardiovascular disease has proven effective in all populations and at all age groups. Subjects older than 80years should be individually assessed, taking into consideration possible comorbidities. Copyright © 2015 Sociedad Española de Arteriosclerosis. Published by Elsevier España. All rights reserved.

  7. Management of Measurable Variable Cardiovascular Disease' Risk Factors.

    Science.gov (United States)

    Zaninovic, Sonja Francula; Nola, Iskra A

    2018-02-21

    To summarize the main findings on variable cardiovascular risk factors and their management in everyday practice. A narrative review of the relevant literature known to the authors and incorporation of healthy changes tips in defined variable cardiovascular risk factors. There are known variable cardiovascular risk factors to be claimed as those that should be changed in order to achieve a better prevention of cardiovascular disease development. But, most papers are informative and they didn't incorporate exact measures for each variable risk factor. Our paper shows exact measures for each variable cardiovascular risk factor that should be incorporate in everyday practice of family practitioners and cardiologists as well. The best cardiovascular disease' prevention should include a multidisciplinary team of experts and the entire community with the support of governmental and non-governmental organizations that will contribute to improving the lifestyle of individuals and the entire community through their activities and legal provisions. The most important factors in cardiovascular disease management are: recognizing individual risk factors, monitoring them, and assisting in changes in life-style habits that directly affect the defined risk factors of a patient. The simplest and most practicable guidelines for CV prevention in accordance with the national, cultural and socioeconomic aspects of their country of work are needed. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  8. The use of Aspirin in Primary Prevention of cardiovascular disease: new updates El uso de la Aspirina en la Prevención Primaria de la enfermedad cardiovascular: nuevas actualizaciones O uso da Aspirina na Prevenção Primária da doença cardiovascular: novas atualizações

    OpenAIRE

    Luís Filipe Cavadas

    2011-01-01

    Many times the Family Physicians need to make the decision of start to use or not aspirin in their patients. Although the benefits of treatment with aspirin in reducing the risk of myocardial infarction (MI), stroke or vascular cause of death among men and women with pre-existing cardiovascular disease (CVD) are well established, the role of aspirin in primary prevention is less clear. So, the objective of this work is to determine the indications of aspirin use for the primary preve...

  9. Patients' perceptions and experiences of cardiovascular disease and diabetes prevention programmes: A systematic review and framework synthesis using the Theoretical Domains Framework.

    Science.gov (United States)

    Shaw, Rachel L; Holland, Carol; Pattison, Helen M; Cooke, Richard

    2016-05-01

    This review provides a worked example of 'best fit' framework synthesis using the Theoretical Domains Framework (TDF) of health psychology theories as an a priori framework in the synthesis of qualitative evidence. Framework synthesis works best with 'policy urgent' questions. The review question selected was: what are patients' experiences of prevention programmes for cardiovascular disease (CVD) and diabetes? The significance of these conditions is clear: CVD claims more deaths worldwide than any other; diabetes is a risk factor for CVD and leading cause of death. A systematic review and framework synthesis were conducted. This novel method for synthesizing qualitative evidence aims to make health psychology theory accessible to implementation science and advance the application of qualitative research findings in evidence-based healthcare. Findings from 14 original studies were coded deductively into the TDF and subsequently an inductive thematic analysis was conducted. Synthesized findings produced six themes relating to: knowledge, beliefs, cues to (in)action, social influences, role and identity, and context. A conceptual model was generated illustrating combinations of factors that produce cues to (in)action. This model demonstrated interrelationships between individual (beliefs and knowledge) and societal (social influences, role and identity, context) factors. Several intervention points were highlighted where factors could be manipulated to produce favourable cues to action. However, a lack of transparency of behavioural components of published interventions needs to be corrected and further evaluations of acceptability in relation to patient experience are required. Further work is needed to test the comprehensiveness of the TDF as an a priori framework for 'policy urgent' questions using 'best fit' framework synthesis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Cardiovascular Involvement in Autoimmune Diseases

    Science.gov (United States)

    Amaya-Amaya, Jenny

    2014-01-01

    Autoimmune diseases (AD) represent a broad spectrum of chronic conditions that may afflict specific target organs or multiple systems with a significant burden on quality of life. These conditions have common mechanisms including genetic and epigenetics factors, gender disparity, environmental triggers, pathophysiological abnormalities, and certain subphenotypes. Atherosclerosis (AT) was once considered to be a degenerative disease that was an inevitable consequence of aging. However, research in the last three decades has shown that AT is not degenerative or inevitable. It is an autoimmune-inflammatory disease associated with infectious and inflammatory factors characterized by lipoprotein metabolism alteration that leads to immune system activation with the consequent proliferation of smooth muscle cells, narrowing arteries, and atheroma formation. Both humoral and cellular immune mechanisms have been proposed to participate in the onset and progression of AT. Several risk factors, known as classic risk factors, have been described. Interestingly, the excessive cardiovascular events observed in patients with ADs are not fully explained by these factors. Several novel risk factors contribute to the development of premature vascular damage. In this review, we discuss our current understanding of how traditional and nontraditional risk factors contribute to pathogenesis of CVD in AD. PMID:25177690

  11. An integrated general practice and pharmacy-based intervention to promote the use of appropriate preventive medications among individuals at high cardiovascular disease risk: protocol for a cluster randomized controlled trial

    OpenAIRE

    Hayek, Adina; Joshi, Rohina; Usherwood, Tim; Webster, Ruth; Kaur, Baldeep; Saini, Bandana; Armour, Carol; Krass, Ines; Laba, Tracey-Lea; Reid, Christopher; Shiel, Louise; Hespe, Charlotte; Hersch, Fred; Jan, Stephen; Lo, Serigne

    2016-01-01

    Background Cardiovascular diseases (CVD) are responsible for significant morbidity, premature mortality, and economic burden. Despite established evidence that supports the use of preventive medications among patients at high CVD risk, treatment gaps remain. Building on prior evidence and a theoretical framework, a complex intervention has been designed to address these gaps among high-risk, under-treated patients in the Australian primary care setting. This intervention comprises a general p...

  12. Relevance of genetics and genomics for prevention and treatment of cardiovascular disease: a scientific statement from the American Heart Association Council on Epidemiology and Prevention, the Stroke Council, and the Functional Genomics and Translational Biology Interdisciplinary Working Group.

    Science.gov (United States)

    Arnett, Donna K; Baird, Alison E; Barkley, Ruth A; Basson, Craig T; Boerwinkle, Eric; Ganesh, Santhi K; Herrington, David M; Hong, Yuling; Jaquish, Cashell; McDermott, Deborah A; O'Donnell, Christopher J

    2007-06-05

    Atherosclerotic cardiovascular disease (CVD) is a major health problem in the United States and around the world. Evidence accumulated over decades convincingly demonstrates that family history in a parent or a sibling is associated with atherosclerotic CVD, manifested as coronary heart disease, stroke, and/or peripheral arterial disease. Although there are several mendelian disorders that contribute to CVD, most common forms of CVD are believed to be multifactorial and to result from many genes, each with a relatively small effect working alone or in combination with modifier genes and/or environmental factors. The identification and the characterization of these genes and their modifiers would enhance prediction of CVD risk and improve prevention, treatment, and quality of care. This scientific statement describes the approaches researchers are using to advance understanding of the genetic basis of CVD and details the current state of knowledge regarding the genetics of myocardial infarction, atherosclerotic CVD, hypercholesterolemia, and hypertension. Current areas of interest and investigation--including gene-environment interaction, pharmacogenetics, and genetic counseling--are also discussed. The statement concludes with a list of specific recommendations intended to help incorporate usable knowledge into current clinical and public health practice, foster and guide future research, and prepare both researchers and practitioners for the changes likely to occur as molecular genetics moves from the laboratory to clinic.

  13. Depression: risk factor for cardiovascular disease

    NARCIS (Netherlands)

    Kuehl, L.K.; Penninx, B.W.J.H.; Otte, C.

    2012-01-01

    Major depression is an independent risk factor for the development of cardiovascular disease. In patients with existing cardiovascular disease, major depression has a large impact on the quality of life and is associated with a poor course and prognosis. Potential mechanisms responsible for this

  14. [The condition of the cardiovascular prevention in Spain].

    Science.gov (United States)

    Royo-Bordonada, Miguel Ángel; Lobos, José Maria; Brotons, Carlos; Villar, Fernando; de Pablo, Carmen; Armario, Pedro; Cortés, Olga; Gil Nuñez, Antonio; Lizcano, Angel; de Santiago, Ana; Sans, Susana

    2014-01-07

    In Spain, where cardiovascular diseases are the leading cause of death, control of their risk factors is low. This study analyzes the implementation of cardiovascular risk (CVR) assessment in clinical practice and the existence of control objectives amongst quality care indicators and professional incentive systems. Between 2010 and 2011, data from each autonomous community were collected, by means of a specific questionnaire concerning prevalence and control of major CVR factors, CVR assessment, and implementation of control objectives amongst quality care indicators and primary care incentive systems. Fifteen out of 17 autonomous communities filled in the questionnaire. CVR was calculated through SCORE in 9 autonomous communities, REGICOR in 3 and Framingham in 3, covering 3.4 to 77.6% of target population. The resulting control of the main CVR factors was low and variable: hypertension (22.7-61.3%), dyslipidemia (11-45.1%), diabetes (18.5-84%) and smoking (20-50.5%). Most autonomous communities did not consider CVR assessment and control amongst quality care indicators or incentive systems, highlighting the lack of initiatives on lifestyles. Variability exists in cardiovascular prevention policies among autonomous communities. It is necessary to implement a common agreed cardiovascular prevention guide, to encourage physicians to implement CVR in electronic clinical history, and to promote CVR assessment and control inclusion amongst quality care indicators and professional incentive systems, focusing on lifestyles management. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  15. Impact of nutrition since early life on cardiovascular prevention

    Directory of Open Access Journals (Sweden)

    Guardamagna Ornella

    2012-12-01

    Full Text Available Abstract The cardiovascular disease represents the leading cause of morbidity and mortality in Western countries and it is related to the atherosclerotic process. Cardiovascular disease risk factors, such as dyslipidemia, hypertension, insulin resistance, obesity, accelerate the atherosclerotic process which begins in childhood and progresses throughout the life span. The cardiovascular disease risk factor detection and management through prevention delays the atherosclerotic progression towards clinical cardiovascular disease. Dietary habits, from prenatal nutrition, breastfeeding, complementary feeding to childhood and adolescence nutrition play a basic role for this topic. The metabolic and neuroendocrine environment of the fetus is fundamental in the body’s “metabolic programming”. Further several studies have demonstrated the beneficial effects of breastfeeding on cardiovascular risk factors reduction. Moreover the introduction of complementary foods represents another important step, with particular regard to protein intake. An adequate distribution between macronutrients (lipids, proteins and carbohydrates is required for correct growth development from infancy throughout adolescence and for prevention of several cardiovascular disease risk determinants in adulthood. The purpose of this review is to examine the impact of nutrition since early life on disease. La malattia cardiovascolare rappresenta la principale causa di morbilità e mortalità dei paesi occidentali ed è correlata a degenerazione vascolare aterosclerotica. I fattori di rischio cardiovascolari quali dislipidemia, ipertensione, insulino resistenza e obesità accelerano tale processo il cui esordio è noto sin dell’età pediatrica ed evolve nel corso della vita. L’individuazione e la cura dei fattori di rischio cardiovascolari mediante la prevenzione dei fattori causali ritardano la progressione dell’aterosclerosi e l’insorgenza dei sintomi cardiovascolari. La

  16. Absolute risk representation in cardiovascular disease prevention: comprehension and preferences of health care consumers and general practitioners involved in a focus group study

    Directory of Open Access Journals (Sweden)

    Ryan Rebecca

    2010-03-01

    Full Text Available Abstract Background Communicating risk is part of primary prevention of coronary heart disease and stroke, collectively referred to as cardiovascular disease (CVD. In Australia, health organisations have promoted an absolute risk approach, thereby raising the question of suitable standardised formats for risk communication. Methods Sixteen formats of risk representation were prepared including statements, icons, graphical formats, alone or in combination, and with variable use of colours. All presented the same risk, i.e., the absolute risk for a 55 year old woman, 16% risk of CVD in five years. Preferences for a five or ten-year timeframe were explored. Australian GPs and consumers were recruited for participation in focus groups, with the data analysed thematically and preferred formats tallied. Results Three focus groups with health consumers and three with GPs were held, involving 19 consumers and 18 GPs. Consumers and GPs had similar views on which formats were more easily comprehended and which conveyed 16% risk as a high risk. A simple summation of preferences resulted in three graphical formats (thermometers, vertical bar chart and one statement format as the top choices. The use of colour to distinguish risk (red, yellow, green and comparative information (age, sex, smoking status were important ingredients. Consumers found formats which combined information helpful, such as colour, effect of changing behaviour on risk, or comparison with a healthy older person. GPs preferred formats that helped them relate the information about risk of CVD to their patients, and could be used to motivate patients to change behaviour. Several formats were reported as confusing, such as a percentage risk with no contextual information, line graphs, and icons, particularly those with larger numbers. Whilst consumers and GPs shared preferences, the use of one format for all situations was not recommended. Overall, people across groups felt that risk

  17. Estimation of the burden of cardiovascular disease attributable to modifiable risk factors and cost-effectiveness analysis of preventative interventions to reduce this burden in Argentina

    Directory of Open Access Journals (Sweden)

    Martí Sebastián

    2010-10-01

    Full Text Available Abstract Background Cardiovascular disease (CVD is the primary cause of mortality and morbidity in Argentina representing 34.2% of deaths and 12.6% of potential years of life lost (PYLL. The aim of the study was to estimate the burden of acute coronary heart disease (CHD and stroke and the cost-effectiveness of preventative population-based and clinical interventions. Methods An epidemiological model was built incorporating prevalence and distribution of high blood pressure, high cholesterol, hyperglycemia, overweight and obesity, smoking, and physical inactivity, obtained from the Argentine Survey of Risk Factors dataset. Population Attributable Fraction (PAF of each risk factor was estimated using relative risks from international sources. Total fatal and non-fatal events, PYLL and Disability Adjusted Life Years (DALY were estimated. Costs of event were calculated from local utilization databases and expressed in international dollars (I$. Incremental cost-effectiveness ratios (ICER were estimated for six interventions: reducing salt in bread, mass media campaign to promote tobacco cessation, pharmacological therapy of high blood pressure, pharmacological therapy of high cholesterol, tobacco cessation therapy with bupropion, and a multidrug strategy for people with an estimated absolute risk > 20% in 10 years. Results An estimated total of 611,635 DALY was lost due to acute CHD and stroke for 2005. Modifiable risk factors explained 71.1% of DALY and more than 80% of events. Two interventions were cost-saving: lowering salt intake in the population through reducing salt in bread and multidrug therapy targeted to persons with an absolute risk above 20% in 10 years; three interventions had very acceptable ICERs: drug therapy for high blood pressure in hypertensive patients not yet undergoing treatment (I$ 2,908 per DALY saved, mass media campaign to promote tobacco cessation amongst smokers (I$ 3,186 per DALY saved, and lowering cholesterol with

  18. Unravelling cardiovascular disease using four dimensional flow cardiovascular magnetic resonance.

    Science.gov (United States)

    Kamphuis, Vivian P; Westenberg, Jos J M; van der Palen, Roel L F; Blom, Nico A; de Roos, Albert; van der Geest, Rob; Elbaz, Mohammed S M; Roest, Arno A W

    2017-07-01

    Knowledge of normal and abnormal flow patterns in the human cardiovascular system increases our understanding of normal physiology and may help unravel the complex pathophysiological mechanisms leading to cardiovascular disease. Four-dimensional (4D) flow cardiovascular magnetic resonance (CMR) has emerged as a suitable technique that enables visualization of in vivo blood flow patterns and quantification of parameters that could potentially be of prognostic value in the disease process. In this review, current image processing tools that are used for comprehensive visualization and quantification of blood flow and energy distribution in the heart and great vessels will be discussed. Also, imaging biomarkers extracted from 4D flow CMR will be reviewed that have been shown to distinguish between normal and abnormal flow patterns. Furthermore, current applications of 4D flow CMR in the heart and great vessels will be discussed, showing its potential as an additional diagnostic modality which could aid in disease management and timing of surgical intervention.

  19. ASPIRE-2-PREVENT: a survey of lifestyle, risk factor management and cardioprotective medication in patients with coronary heart disease and people at high risk of developing cardiovascular disease in the UK.

    Science.gov (United States)

    Kotseva, Kornelia; Jennings, Catriona S; Turner, Elizabeth L; Mead, Alison; Connolly, Susan; Jones, Jennifer; Bowker, Timothy J; Wood, David A

    2012-06-01

    To determine in patients with coronary heart disease (CHD) and people at high risk of developing cardiovascular disease (CVD) whether the Joint British Societies' guidelines on CVD prevention (JBS2) are followed in everyday clinical practice. A cross-sectional survey was undertaken of medical records and patient interviews and examinations at least 6 months after the recruiting event or diagnosis using standardised instruments and a central laboratory for measurement of lipids and glucose. The ASPIRE-2-PREVENT survey was undertaken in 19 randomly selected hospitals and 19 randomly selected general practices in 12 geographical regions in England, Northern Ireland, Wales and Scotland. In hospitals, 1474 consecutive patients with CHD were identified and 676 (25.6% women) were interviewed. In general practice, 943 people at high CVD risk were identified and 446 (46.5% women) were interviewed. The prevalence of risk factors in patients with CHD and high-risk individuals was, respectively: smoking 14.1%, 13.3%; obesity 38%, 50.2%; not reaching physical activity target 83.3%, 85.4%; blood pressure ≥130/80 mm Hg (patients with CHD and self-reported diabetes) or ≥140/85 mm Hg (high-risk individuals) 46.9%, 51.3%; total cholesterol ≥4 mmol/l 52.6%, 78.7%; and diabetes 17.8%, 43.8%. The potential among patients with CHD and individuals at high risk of developing CVD in the UK to achieve the JBS2 lifestyle and risk factor targets is considerable. CVD prevention needs a comprehensive multidisciplinary approach, addressing all aspects of lifestyle and risk factor management. The challenge is to engage and motivate cardiologists, physicians and other health professionals to routinely practice high quality preventive cardiology in a healthcare system which must invest in prevention.

  20. Prevention and management of work-related cardiovascular disorders

    Directory of Open Access Journals (Sweden)

    Akizumi Tsutsumi

    2015-02-01

    Full Text Available Cardiovascular disorders (CVDs constitute a major burden for health of working populations throughout the world with as much as 50% of all causes of death and at least 25% of work disability. There are some changes in CVD risk factors among occupational classes. This is mainly due to the new types of work-related causes of morbidity associated with the recent developments in global work life, particularly in the industrialized countries. Meanwhile, in the developing countries or those in transition (e.g., in Eastern Europe, CVD mortality is increasing due to major socioeconomic changes, the demographic transition and rapid industrialisation and urbanisation, all leading to growing challenges to cardiovascular health. Better control of known risk factors (i.e., smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose is effective to prevent CVD incidence. But the expected improvement has not been achieved. The obstacles of achieving such impact are due to lack of awareness, lack of policies and their implementation into practice and shortage of infrastructures and human resources. These are needed for wide-scale and long-term programme implementation. Considering the WHO Global Strategy on Occupational Health for All, the WHO Global Action Plan on Workers’ Health, the WHO Programme on Prevention of Non-communicable Diseases and the ILO Decent Work agenda, the 6th ICOH International Conference on Work Environment and Cardiovascular Diseases adopted the Tokyo Declaration.

  1. Cardiovascular Disease, Mitochondria, and Traditional Chinese Medicine

    Directory of Open Access Journals (Sweden)

    Jie Wang

    2015-01-01

    Full Text Available Recent studies demonstrated that mitochondria play an important role in the cardiovascular system and mutations of mitochondrial DNA affect coronary artery disease, resulting in hypertension, atherosclerosis, and cardiomyopathy. Traditional Chinese medicine (TCM has been used for thousands of years to treat cardiovascular disease, but it is not yet clear how TCM affects mitochondrial function. By reviewing the interactions between the cardiovascular system, mitochondrial DNA, and TCM, we show that cardiovascular disease is negatively affected by mutations in mitochondrial DNA and that TCM can be used to treat cardiovascular disease by regulating the structure and function of mitochondria via increases in mitochondrial electron transport and oxidative phosphorylation, modulation of mitochondrial-mediated apoptosis, and decreases in mitochondrial ROS. However further research is still required to identify the mechanism by which TCM affects CVD and modifies mitochondrial DNA.

  2. Childhood antecedents to adult cardiovascular disease.

    Science.gov (United States)

    Halfon, Neal; Verhoef, Philip A; Kuo, Alice A

    2012-02-01

    Through research in the prevention and treatment of adult diseases, it has become clear that many adult diseases have their origins in childhood. As illustrated in this review, these antecedents are largely a function of the nutrition, physical activity, and habits of developing children. There is also increasing evidence that chronic and toxic levels of stress can play a significant role not only in the development of mental and behavioral conditions but in the developmental pathways that lead to a number of chronic physical health conditions. Internists, family medicine physicians, and medicine-pediatrics physicians generally are comfortable managing patients with a number of cardiovascular risk factors or conditions. Although pediatric clinical guidelines have recommended universal screening for hypertension since 1977 and targeted screening for dyslipidemia since 1992 and type 2 DM since 2000, this screening is not yet common practice in general pediatrics. As the population of children and youth with risk factors for metabolic syndrome--hypertension, dyslipidemia, and type 2 DM--increases as a result of the obesity epidemic, pediatricians will have to screen routinely, and diagnose and treat these conditions in the primary care setting. Pediatric residency programs and continuing medical education programs will have to provide knowledge and clinical training in the management of these conditions before primary care pediatricians are comfortable treating children and youth with multiple cardiovascular conditions.

  3. Physical activity in the prevention and rehabilitation of cardiovascular risk

    Directory of Open Access Journals (Sweden)

    Jovović Veselin

    2015-01-01

    Full Text Available Cardiovascular diseases (CVD are more widespread today, whereby they take dimensions of global epidemic. They are the leading cause of diseases in the world, of inability to work, of absenteeism and premature mortality up to 65 years of age. Modern lifestyle in which there is not enough physical activity is recognized as one of the major risk factors for health and emergence of CVD. Physical inactivity is responsible for poor health quality, unnecessary illnesses and premature death. The aim of this work is to point out the basic risk factors and importance and the role of physical exercise in the prevention and rehabilitation of CVD. In the analysis of the data, the methods of speculation and introspection are used. Numerous studies have shown that properly practiced physical activity is a powerful and beneficial effect in the prevention, treatment and rehabilitation of cardiovascular diseases (Scrutino et al. 2005; Secco et al. 2000; Jovović, 2008; Šuščević et al. 2011. Physical activity belongs to the concept of numerous factors, which along with the reduction of risk factors, lifestyle changes and medical therapy leads to the reduction of risk for cardiovascular diseases. To achieve the desired effect, a combination of aerobic, interval and isotonic muscle activity of moderate intensity at least four times a week for 45 minutes is recommended. During the secondary prevention and rehabilitation, physical activity adapts to health status, level of individual risk and the estimated functional abilities of patients. Transformational processes can only be achieved through regular exercise. The risk of emergence of complications during physical exercise is negligible, especially if the walking is practiced as a form of physical exercise.

  4. Cardiovascular diseases among patients with schizophrenia.

    Science.gov (United States)

    Azad, Muhammad Chanchal; Shoesmith, Wendy Diana; Al Mamun, Mohammad; Abdullah, Ahmad Faris; Naing, Daw Khin Saw; Phanindranath, Mahadasa; Turin, Tanvir Chowdhury

    2016-02-01

    The presence of comorbid physical illnesses especially, cardiovascular diseases (CVD) in schizophrenia is a growing area of concern in recent years. In order to reduce disease burden, to improve quality of life and to provide holistic care, it is important to know about the relationship between schizophrenia and CVD. The objective of this review is to explore the extent of CVD problems, relevant risk factors and potential measures for early diagnosis and prevention of CVD among patients with schizophrenia. Worldwide studies show that patients with schizophrenia have a higher mortality and lower life expectancy than the general population. CVD is the leading cause of increased mortality in schizophrenia. Common CVD risk factors in schizophrenia include metabolic syndrome, sedentary behaviour, tobacco smoking, effects of antipsychotics, long chain omega-3 fatty acid deficiency and shared genetics between CVD and schizophrenia. The potential methods for early detection and prevention of CVD in schizophrenia are also discussed. Though the patients with schizophrenia form a high risk group for CVD, consensus guidelines for early detection and prevention of CVD in schizophrenia are lacking. Comorbidity of CVD in schizophrenia needs more serious attention by clinicians and researchers. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Air Pollution and Cardiovascular Disease: A Review.

    Science.gov (United States)

    Patel, Vivek; Kantipudi, Neha; Jones, Graham; Upton, Adrian; Kamath, Markad V

    2016-01-01

    , location of exercise, smoking, pregnancy, diabetes, preexisting cardiovascular or pulmonary diseases, and other factors. Considering the number of individuals affected by pollution on a daily basis and the burden that this places on society through the health-care system, immediate preventive measures are needed to address these problems. Increased knowledge about the widespread effects of pollution on human physiological systems should aid in remediating the problem across the globe. Biomedical engineers can have a great positive impact in developing better instrumentation to measure discrete pollutants and characterizing their harmful effects on physiological systems.

  6. Cardiovascular Risk in Malaysia: causes, consequences and prevention

    NARCIS (Netherlands)

    Selvarajah, S.

    2012-01-01

    Cardiovascular disease forms the highest morbidity and mortality worldwide and disproportionately affects low and middle-income developing countries. In developing countries, cardiovascular morbidity and mortality tend to affect the (younger) working adults. This poses a significant burden to the

  7. Endocannabinoids and cardiovascular prevention: real progress?

    Directory of Open Access Journals (Sweden)

    Livio Dei Cas

    2007-06-01

    Full Text Available ABSTRACT: The prevalence of obesity continues to increase and represents one of the principal causes of cardiovascular morbidity and mortality. After the discovery of a specific receptor of the psychoactive principle of marijuana, the cannabinoid receptors and their endogenous ligands, several studies have demonstrated the role of this system in the control of food intake and energy balance and its overactivity in obesity. Recent studies with the CB1 receptor antagonist rimonabant have demonstrated favorable effects such as a reduction in body weight and waist circumference and an improvement in metabolic factors (cholesterol, triglycerides, glycemia etc. Therefore, the antagonism of the endocannabinoid (EC system, if recent data can be confirmed, could be a new treatment target for high risk overweight or obese patients. Obesity is a growing problem that has epidemic proportions worldwide and is associated with an increased risk of premature death (1-3. Individuals with a central deposition of fats have elevated cardiovascular morbidity and mortality (including stroke, heart failure and myocardial infarction and, because of a growing prevalence not only in adults but also in adolescents, it was reclassified in AHA guidelines as a “major modifiable risk factor” for coronary heart disease (4, 5. Although first choice therapy in obesity is based on correcting lifestyle (diet and physical activity in patients with abdominal obesity and high cardiovascular risk and diabetes, often it is necessary to use drugs which reduce the risks. The EC system represents a new target for weight control and the improvement of lipid and glycemic metabolism (6, 7. (Heart International 2007; 3: 27-34

  8. Impact evaluation of a community-based intervention for prevention of cardiovascular diseases in the slums of Nairobi: the SCALE-UP study

    Directory of Open Access Journals (Sweden)

    Steven van de Vijver

    2016-03-01

    Full Text Available Background: A combination of increasing urbanization, behaviour change, and lack of health services in slums put the urban poor specifically at risk of cardiovascular disease (CVD. This study aimed to evaluate the impact of a community-based CVD prevention intervention on blood pressure (BP and other CVD risk factors in a slum setting in Nairobi, Kenya. Design: Prospective intervention study includes awareness campaigns, household visits for screening, and referral and treatment of people with hypertension. The primary outcome was overall change in mean systolic blood pressure (SBP, while secondary outcomes were changes in awareness of hypertension and other CVD risk factors. We evaluated the intervention's impact through consecutive cross-sectional surveys at baseline and after 18 months, comparing outcomes of intervention and control group, through a difference-in-difference method. Results: We screened 1,531 and 1,233 participants in the intervention and control sites. We observed a significant reduction in mean SBP when comparing before and after measurements in both intervention and control groups, −2.75 mmHg (95% CI −4.33 to −1.18, p=0.001 and −1.67 mmHg (95% CI −3.17 to −0.17, p=0.029, respectively. Among people with hypertension at baseline, SBP was reduced by −14.82 mmHg (95% CI −18.04 to −11.61, p<0.001 in the intervention and −14.05 (95% CI −17.71 to −10.38, p<0.001 at the control site. However, comparing these two groups, we found no difference in changes in mean SBP or hypertension prevalence. Conclusions: We found significant declines in SBP over time in both intervention and control groups. However, we found no additional effect of a community-based intervention involving awareness campaigns, screening, referral, and treatment. Possible explanations include the beneficial effect of baseline measurements in the control group on behaviour and related BP levels, and the limited success of treatment and

  9. Impact evaluation of a community-based intervention for prevention of cardiovascular diseases in the slums of Nairobi: the SCALE-UP study.

    Science.gov (United States)

    van de Vijver, Steven; Oti, Samuel Oji; Gomez, Gabriela B; Agyemang, Charles; Egondi, Thaddaeus; Moll van Charante, Eric; Brewster, Lizzy M; Hankins, Catherine; Tanovic, Zlata; Ezeh, Alex; Kyobutungi, Catherine; Stronks, Karien

    2016-01-01

    A combination of increasing urbanization, behaviour change, and lack of health services in slums put the urban poor specifically at risk of cardiovascular disease (CVD). This study aimed to evaluate the impact of a community-based CVD prevention intervention on blood pressure (BP) and other CVD risk factors in a slum setting in Nairobi, Kenya. Prospective intervention study includes awareness campaigns, household visits for screening, and referral and treatment of people with hypertension. The primary outcome was overall change in mean systolic blood pressure (SBP), while secondary outcomes were changes in awareness of hypertension and other CVD risk factors. We evaluated the intervention's impact through consecutive cross-sectional surveys at baseline and after 18 months, comparing outcomes of intervention and control group, through a difference-in-difference method. We screened 1,531 and 1,233 participants in the intervention and control sites. We observed a significant reduction in mean SBP when comparing before and after measurements in both intervention and control groups, -2.75 mmHg (95% CI -4.33 to -1.18, p=0.001) and -1.67 mmHg (95% CI -3.17 to -0.17, p=0.029), respectively. Among people with hypertension at baseline, SBP was reduced by -14.82 mmHg (95% CI -18.04 to -11.61, p<0.001) in the intervention and -14.05 (95% CI -17.71 to -10.38, p<0.001) at the control site. However, comparing these two groups, we found no difference in changes in mean SBP or hypertension prevalence. We found significant declines in SBP over time in both intervention and control groups. However, we found no additional effect of a community-based intervention involving awareness campaigns, screening, referral, and treatment. Possible explanations include the beneficial effect of baseline measurements in the control group on behaviour and related BP levels, and the limited success of treatment and suboptimal adherence in the intervention group.

  10. Estimated burden of cardiovascular disease and value-based price range for evolocumab in a high-risk, secondary-prevention population in the US payer context.

    Science.gov (United States)

    Toth, Peter P; Danese, Mark; Villa, Guillermo; Qian, Yi; Beaubrun, Anne; Lira, Armando; Jansen, Jeroen P

    2017-06-01

    To estimate real-world cardiovascular disease (CVD) burden and value-based price range of evolocumab for a US-context, high-risk, secondary-prevention population. Burden of CVD was assessed using the UK-based Clinical Practice Research Datalink (CPRD) in order to capture complete CV burden including CV mortality. Patients on standard of care (SOC; high-intensity statins) in CPRD were selected based on eligibility criteria of FOURIER, a phase 3 CV outcomes trial of evolocumab, and categorized into four cohorts: high-risk prevalent atherosclerotic CVD (ASCVD) cohort (n = 1448), acute coronary syndrome (ACS) (n = 602), ischemic stroke (IS) (n = 151), and heart failure (HF) (n = 291) incident cohorts. The value-based price range for evolocumab was assessed using a previously published economic model. The model incorporated CPRD CV event rates and considered CV event reduction rate ratios per 1 mmol/L reduction in low-density lipoprotein-cholesterol (LDL-C) from a meta-analysis of statin trials by the Cholesterol Treatment Trialists Collaboration (CTTC), i.e. CTTC relationship. Multiple-event rates of composite CV events (ACS, IS, or coronary revascularization) per 100 patient-years were 12.3 for the high-risk prevalent ASCVD cohort, and 25.7, 13.3, and 23.3, respectively, for incident ACS, IS, and HF cohorts. Approximately one-half (42%) of the high-risk ASCVD patients with a new CV event during follow-up had a subsequent CV event. Combining these real-world event rates and the CTTC relationship in the economic model, the value-based price range (credible interval) under a willingness-to-pay threshold of $150,000/quality-adjusted life-year gained for evolocumab was $11,990 ($9,341-$14,833) to $16,856 ($12,903-$20,678) in ASCVD patients with baseline LDL-C levels ≥70 mg/dL and ≥100 mg/dL, respectively. Real-world CVD burden is substantial. Using the observed CVD burden in CPRD and the CTTC relationship, the cost-effectiveness analysis showed

  11. Cardiovascular magnetic resonance in congenital heart disease

    International Nuclear Information System (INIS)

    Cazacu, A.; Ciubotaru, A.

    2010-01-01

    The increasing prevalence of congenital heart disease can be attributed to major improvements in diagnosis and treatment. Cardiovascular magnetic resonance imaging plays an important role in the clinical management strategy of patients with congenital heart disease. The development of new cardiovascular magnetic resonance (CMR) techniques allows comprehensive assessment of complex cardiac anatomy and function and provides information about the long-term residual post-operative lesions and complications of surgery. It overcomes many of the limitations of echocardiography and cardiac catheterization. This review evaluates the role of cardiovascular magnetic resonance imaging modality in the management of subject with congenital heart disease (CHD). (authors)

  12. Thyroid disease and the cardiovascular system.

    Science.gov (United States)

    Danzi, Sara; Klein, Irwin

    2014-06-01

    Thyroid hormones, specifically triiodothyronine (T3), have significant effects on the heart and cardiovascular system. Hypothyroidism, hyperthyroidism, subclinical thyroid disease, and low T3 syndrome each cause cardiac and cardiovascular abnormalities through both genomic and nongenomic effects on cardiac myocytes and vascular smooth muscle cells. In compromised health, such as occurs in heart disease, alterations in thyroid hormone metabolism may further impair cardiac and cardiovascular function. Diagnosis and treatment of cardiac disease may benefit from including analysis of thyroid hormone status, including serum total T3 levels. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Medication effectiveness may not be the major reason for accepting cardiovascular preventive medication

    DEFF Research Database (Denmark)

    Harmsen, Charlotte Gry; Støvring, Henrik; Jarbøl, Dorte Ejg

    2012-01-01

    of cardiovascular diseases (CVD) is prevalent. A better understanding of patients' medication-taking behavior is needed and may be reached by studying the reasons why people accept or decline medication recommendations. The aim of this paper was to identify factors that may influence people's decisions...... and reasoning for accepting or declining a cardiovascular preventive medication offer....

  14. ABO Blood Groups and Cardiovascular Diseases

    Science.gov (United States)

    Zhang, Hanrui; Mooney, Ciarán J.; Reilly, Muredach P.

    2012-01-01

    ABO blood groups have been associated with various disease phenotypes, particularly cardiovascular diseases. Cardiovascular diseases are the most common causes of death in developed countries and their prevalence rate is rapidly growing in developing countries. There have been substantial historical associations between non-O blood group status and an increase in some cardiovascular disorders. Recent GWASs have identified ABO as a locus for thrombosis, myocardial infarction, and multiple cardiovascular risk biomarkers, refocusing attention on mechanisms and potential for clinical advances. As we highlight in this paper, more recent work is beginning to probe the molecular basis of the disease associations observed in these observational studies. Advances in our understanding of the physiologic importance of various endothelial and platelet-derived circulating glycoproteins are elucidating the mechanisms through which the ABO blood group may determine overall cardiovascular disease risk. The role of blood group antigens in the pathogenesis of various cardiovascular disorders remains a fascinating subject with potential to lead to novel therapeutics and prognostics and to reduce the global burden of cardiovascular diseases. PMID:23133757

  15. Preeclampsia : At risk for remote cardiovascular disease

    NARCIS (Netherlands)

    Harskamp, Ralf E.; Zeeman, Gerda G.

    2007-01-01

    Epidemiological data indicate that women with preeclampsia are more likely to develop cardiovascular disease (CVD) later in life. Population-based studies relate preeclampsia to an increased risk of later chronic hypertension (RR, 2.00 to 8.00) and cardiovascular morbidity/mortality (RR, 1.3 to

  16. Diabetes propels the risk for cardiovascular disease

    NARCIS (Netherlands)

    Diepen, van Janna A.; Thiem, Kathrin; Stienstra, Rinke; Riksen, Niels P.; Tack, Cees J.; Netea, Mihai G.

    2016-01-01

    Diabetes strongly predisposes to cardiovascular disease (CVD), the leading cause of mortality in these patients, as well as in the entire population. Hyperglycemia is an important cardiovascular risk factor as shown by the observation that even transient periods of hyperglycemia, despite return

  17. Natriuretic peptides and integrated risk assessment for cardiovascular disease

    DEFF Research Database (Denmark)

    Willeit, Peter; Kaptoge, Stephen; Welsh, Paul

    2016-01-01

    BACKGROUND: Guidelines for primary prevention of cardiovascular diseases focus on prediction of coronary heart disease and stroke. We assessed whether or not measurement of N-terminal-pro-B-type natriuretic peptide (NT-proBNP) concentration could enable a more integrated approach than at present......, and 2212 heart failure outcomes among 95 617 participants without a history of cardiovascular disease in 40 prospective studies. Risk ratios (for a comparison of the top third vs bottom third of NT-proBNP concentrations, adjusted for conventional risk factors) were 1·76 (95% CI 1....... INTERPRETATION: In people without baseline cardiovascular disease, NT-proBNP concentration assessment strongly predicted first-onset heart failure and augmented coronary heart disease and stroke prediction, suggesting that NT-proBNP concentration assessment could be used to integrate heart failure...

  18. Coffee intake, cardiovascular disease and allcause mortality

    DEFF Research Database (Denmark)

    Nordestgaard, Ask Tybjærg; Nordestgaard, Børge Grønne

    2016-01-01

    Background: Coffee has been associated with modestly lower risk of cardiovascular disease and all-cause mortality in meta-analyses; however, it is unclear whether these are causal associations. We tested first whether coffee intake is associated with cardiovascular disease and all-cause mortality...... observationally; second, whether genetic variations previously associated with caffeine intake are associated with coffee intake; and third, whether the genetic variations are associated with cardiovascular disease and all-cause mortality. Methods: First, we used multivariable adjusted Cox proportional hazard......- and age adjusted Cox proportional hazard regression models to examine genetic associations with cardiovascular disease and all-cause mortality in 112 509 Danes. Finally, we used sex and age-adjusted logistic regression models to examine genetic associations with ischaemic heart disease including...

  19. Randomised clinical trial of an intensive intervention in the primary care setting of patients with high plasma fibrinogen in the primary prevention of cardiovascular disease

    Directory of Open Access Journals (Sweden)

    José Rodríguez Cristóbal Juan

    2012-03-01

    Full Text Available Abstract Background We have studied the possible effects of an intensive lifestyle change program on plasma fibrinogen levels, in patients with no cardiovascular disease, with elevated levels of fibrinogen, normal cholesterol levels, and a moderate estimated risk of coronary heart disease (CHD and we have also analysed whether the effect on fibrinogen is independent of the effect on lipids. Results This clinical trial was controlled, unblinded and randomized, with parallel groups, done in 13 Basic Health Areas (BHA in l'Hospitalet de Llobregat (Barcelona and Barcelona city. The study included 436 patients, aged between 35 and 75 years, with no cardiovascular disease, elevated levels of fibrinogen (> 300 mg/dl, cholesterol The evaluation of the baseline characteristics of the patients showed that both groups were homogenous. Obesity and hypertension were the most prevalent risk factors. After 24 months of the study, statistically significant changes were seen between the adjusted means of the two groups, for the following parameters: fibrinogen, plasma cholesterol, systolic and diastolic blood pressure and body mass index. Conclusion Intensive intervention to achieve lifestyle changes has shown to be effective in reducing some of the estimated CHD factors. However, the effect of intensive intervention on plasma fibrinogen levels did not correlate with the variations in cholesterol. Trial Registration ClinicalTrials.gov: NCT01089530

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

    DEFF Research Database (Denmark)

    Muntendam, Pieter; McCall, Carol; Sanz, Javier

    2010-01-01

    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...... 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...

  1. Cardiovascular risk reduction in high-risk pediatric patients: a scientific statement from the American Heart Association Expert Panel on Population and Prevention Science; the Councils on Cardiovascular Disease in the Young, Epidemiology and Prevention, Nutrition, Physical Activity and Metabolism, High Blood Pressure Research, Cardiovascular Nursing, and the Kidney in Heart Disease; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics.

    Science.gov (United States)

    Kavey, Rae-Ellen W; Allada, Vivek; Daniels, Stephen R; Hayman, Laura L; McCrindle, Brian W; Newburger, Jane W; Parekh, Rulan S; Steinberger, Julia

    2006-12-12

    Although for most children the process of atherosclerosis is subclinical, dramatically accelerated atherosclerosis occurs in some pediatric disease states, with clinical coronary events occurring in childhood and very early adult life. As with most scientific statements about children and the future risk for cardiovascular disease, there are no randomized trials documenting the effects of risk reduction on hard clinical outcomes. A growing body of literature, however, identifies the importance of premature cardiovascular disease in the course of certain pediatric diagnoses and addresses the response to risk factor reduction. For this scientific statement, a panel of experts reviewed what is known about very premature cardiovascular disease in 8 high-risk pediatric diagnoses and, from the science base, developed practical recommendations for management of cardiovascular risk.

  2. Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above: Analyses From the WOSCOPS (West of Scotland Coronary Prevention Study) 5-Year Randomized Trial and 20-Year Observational Follow-Up.

    Science.gov (United States)

    Vallejo-Vaz, Antonio J; Robertson, Michele; Catapano, Alberico L; Watts, Gerald F; Kastelein, John J; Packard, Chris J; Ford, Ian; Ray, Kausik K

    2017-11-14

    Patients with primary elevations of low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL are at a higher risk of atherosclerotic cardiovascular disease as a result of long-term exposure to markedly elevated LDL-C levels. Therefore, initiation of statin therapy is recommended for these individuals. However, there is a lack of randomized trial evidence supporting these recommendations in primary prevention. In the present analysis, we provide hitherto unpublished data on the cardiovascular effects of LDL-C lowering among a primary prevention population with LDL-C ≥190 mg/dL. We aimed to assess the benefits of LDL-C lowering on cardiovascular outcomes among individuals with primary elevations of LDL-C ≥190 mg/dL without preexisting vascular disease at baseline. We performed post hoc analyses from the WOSCOPS (West of Scotland Coronary Prevention Study) randomized, placebo-controlled trial, and observational posttrial long-term follow-up, after excluding individuals with evidence of vascular disease at baseline. WOSCOPS enrolled 6595 men aged 45 to 64 years, who were randomly assigned to pravastatin 40 mg/d or placebo. In the present analyses, 5529 participants without evidence of vascular disease were included, stratified by LDL-C levels into those with LDL-C coronary heart disease and major adverse cardiovascular events were assessed over the 4.9-year randomized controlled trial phase and on mortality outcomes over a total of 20 years of follow-up. Among 5529 individuals without vascular disease, pravastatin reduced the risk of coronary heart disease by 27% ( P =0.002) and major adverse cardiovascular events by 25% ( P =0.004) consistently among those with and without LDL-C ≥190 mg/dL ( P -interaction >0.9). Among individuals with LDL-C ≥190 mg/dL, pravastatin reduced the risk of coronary heart disease by 27% ( P =0.033) and major adverse cardiovascular events by 25% ( P =0.037) during the initial trial phase and the risk of coronary heart disease death

  3. Screen-detected gallstone disease and cardiovascular disease

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel Mønsted; Skaaby, Tea; Sørensen, Lars Tue

    2017-01-01

    Knowledge about temporal associations for screen-detected gallstone disease and cardiovascular disease is limited. The objective of this study was to determine if screen-detected gallstones or cholecystectomy was associated with development of cardiovascular disease. A cohort study of three...... of cardiovascular disease through nationwide registers until December 2014. Multivariable Cox regression analyses were performed including traditional cardiovascular disease risk factors and apolipoprotein E genotype. Gallstone disease was identified in 10% (591/5928) of participants at baseline of whom 6.8% had...... gallstones and 3.2% had cholecystectomy. The study population was followed for a period of 32 years with only 1% lost to follow-up. Gallstone disease was associated with all cardiovascular disease (hazard ratio (HR) 1.36, 95% confidence interval (CI) [1.17;1.59]) and to the subgroups coronary artery (HR 1...

  4. Prevalence of cardiovascular disease risk factors in Tallinn, Estonia

    Directory of Open Access Journals (Sweden)

    Margit Kaldmäe

    2017-01-01

    Conclusions: The study established a high prevalence of cardiovascular disease risk factors in Estonian adults (20–65 years of age. Younger portion of the population and some extent ethnic considerations should be taken into account when designing future studies, health prevention activities and interventions.

  5. Phytosterols and blood lipid risk factors for cardiovascular disease

    NARCIS (Netherlands)

    Ras, R.T.

    2014-01-01

    Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Lifestyle improvements including dietary changes are important for CVD prevention. This thesis aimed to advance insights in the role of phytosterols, lipid-like compounds present in foods or plant origin, in

  6. Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease

    NARCIS (Netherlands)

    Eikelboom, John W.; Connolly, Stuart J.; Bosch, Jackie; Dagenais, Gilles R.; Hart, Robert G.; Shestakovska, Olga; Diaz, Rafael; Alings, Marco; Lonn, Eva M.; Anand, Sonia S.; Widimsky, Petr; Hori, Masatsugu; Avezum, Alvaro; Piegas, Leopoldo S.; Branch, Kelley R. H.; Probstfield, Jeffrey; Bhatt, Deepak L.; Zhu, Jun; Liang, Yan; Maggioni, Aldo P.; Lopez-Jaramillo, Patricio; O'Donnell, Martin; Kakkar, Ajay K.; Fox, Keith A. A.; Parkhomenko, Alexander N.; Ertl, Georg; Störk, Stefan; Keltai, Matyas; Ryden, Lars; Pogosova, Nana; Dans, Antonio L.; Lanas, Fernando; Commerford, Patrick J.; Torp-Pedersen, Christian; Guzik, Tomek J.; Verhamme, Peter B.; Vinereanu, Dragos; Kim, Jae-Hyung; Tonkin, Andrew M.; Lewis, Basil S.; Felix, Camilo; Yusoff, Khalid; Steg, P. Gabriel; Metsarinne, Kaj P.; Cook Bruns, Nancy; Misselwitz, Frank; Chen, Edmond; Leong, Darryl; Yusuf, Salim; Aboyans, V.; Ha, J.; Keltai, K.; Lamy, A.; Liu, L.; Moayyedi, P.; Sharma, M.; Stoerk, S.; Varigos, J.; Bhagirath, V.; Bogaty, P.; Botto, F.; Catanese, L.; Donato Magno, J.; Fabbri, G.; Gabizon, I.; Gosselin, G.; Halon, D.; Heldmann, M.; Lamelas, P.; Lauw, M.; Leong, Y.; Liang, D.; Lutay, Y.; Maly, M.; Mikulik, R.; Nayar, S.; Ng, K.; Perera, K.; Pirvu, O.; Ronner, E.; Sato, S.; Smyth, A.; Sokolova, E.; Wiendl, M.; Winkelmann, B.; Yang, X.; Yufereva, Y.; Cairns, J.; Sleight, P.; deMets, D.; Momomura, S. I.; Prins, M. [=Martin H.; Ramsay, T.; Goto, S.; Rouleau, J. L.; Schumi, J.; Thabane, L.; Casanova, A.; Bangdiwala, S.; Deng, E.; Dyal, L.; Khatun, R.; Marsden, T.; Pogue, J.; Tang, C.; Wong, G.; Yuan, F.; Aman, S.; Ariz, A.; Ashton, H.; Belanger, J.; Belanger, M.; Brettell, K.; Chandra, J.; Choppick, C.; Cisternino, D.; Cuncins-Hearn, A.; Di Marino, M.; Diao, L.; Dwomoh, S.; Dykstra, A.; Galatsis, E.; Gasic, T.; Gutierrez, J.; Hamilton, L.; Irwin, L.; Lapensee, C.; Li, A.; Lu, X.; MacRae, L.; Malik, S.; Malvestiti, A.; Mastrangelo, J.; Maystrenko, A.; O'Donnell, L.; Reeh, K.; Szymkow, P.; Thomas, S.; Thrasher, D.; Tyrwhitt, J.; White, L.; Bastone, R.; Berkowitz, S.; Dias, A.; Ho, K.; Keller, L.; Lanius, V.; Lister, K.; Merten, C.; Muehlhofer, E.; Schmidt, K.; Tasto, C.; Tsihlias, E.; Woroniecka-Osio, A.; Orlandini, A.; Niemann, G.; Pascual, A.; Toscanelli, S.; Cabezón, M.; Debaveye, B.; Meeusen, K.; Luys, C.; Broos, K.; Vandenberghe, K.; Luyten, A.; Oliveira, G. B. F.; Vila Nova, D. C.; Konishi, M. Y. N.; Lonn, A.; Turbide, G.; Cayer, M.; Rovito, C.; Standen, D.; Li, J.; Lopez Pico, M.; Dusek, R.; Buzalka, V.; Larsen, J.; Paucar, M. J.; Saarinen, M.; Simon, T.; Bezault, M.; Le Lay, M.; Epstein, L.; Fajardo-Moser, M.; Röser, C.; Putz-Todd, G.; Scheidemantel, F.; Poehler, D.; Renner, J.; Hargitai, A.; Doherty, A. O.; Duffy, N.; Roarty, C.; Nolan, A.; Power, A.; Yuval, R.; Ben Ari, M.; Greenblatt, S.; Marmor, Y.; Lucci, D.; Ceseri, M.; Baldini, E.; Cipressa, L.; Miccoli, M.; Goto, M.; Yamasowa, H.; Kajiwara, M.; Takase, D.; Ikeguchi, K.; Matsumoto, M.; Ishii, M.; Asai, J.; Nozaki, D.; Akatsuka, T.; Yoshida, T.; Shahadan, S.; Md Nasir, N.; Schut, Astrid; Vinck, Leonie; van Leeuwen, Marjelle; Sanchez, J.; Aquino, M. R.; Mararac, T.; Benedyk, K.; Iordache, A.; Ciobanu, A.; Rimbas, R.; Dragoi Galrinho, R.; Magda, S.; Mihaila, S.; Mincu, R.; Suran, B.; Cotoban, A.; Matei, L.; Kursakov, A.; Rusnak, P.; Zakharova, A.; Demidova, E.; Commerford, A.; Lee, S.; Ju, I.; Gunolf, M.; Lorimer, A.; Parkhomenko, L.; Johnson, J.; Anderson, J.; Norby-Slycord., C.; Sala, J.; Sicer, M.; Rasmussen, M.; Luciani, C.; Cartasegna, L.; Beltrano, C.; Medek, G.; Vico, M.; Lanchiotti, P.; Martella, C.; Hominal, M.; Castoldi, M.; Casali, W.; Raimondi, S.; Hasbani, E.; Prado, A.; Paterlini, G.; Waisman, F.; Leonard, M.; Caccavo, A.; Alarcon, V.; Zaidman, C.; Guerlloy, F.; Vogel, D.; Imposti, H.; Dominguez, A.; Hrabar, A.; Fernandez, A.; Schygiel, P.; Sokn, F.; Cuneo, C.; Gutierrez Carrillo, N.; Martinez, G.; Luquez, H.; Costantino, M.; Ruiz, M.; Beccetti, N.; Mackinnon, I.; Cluigt, N.; Ahuad Guerrero, R.; Fanuele, M.; Campisi, V.; Costabel, J.; Romanelli, M.; Bartolacci, I.; Echeverria, M.; Pedrotti, M.; Montaña, O.; Camino, A.; Crespo, C.; Barbieri, M.; Lopez Santi, R.; Tonin, H.; Heffes, R.; Gomez Vilamajo, O.; Vanesio, F.; Allegrini, E.; Garcia Duran, R.; Garcia, C.; Garcia Duran, L.; Schiavi, L.; Mana, M.; Bordonava, A.; Rodriguez, M.; Gutierrez, M.; Garrido, M.; Rodriguez, C.; Ingaramo, A.; Costamagna, O.; Almagro, S.; Gerbaudo, C.; Pelagagge, M.; Bustamante Labarta, M.; Novaretto, L.; Maldini, A.; Lopez, L.; Albisu Di Gennero, J.; Ibanez Saggia, L.; Garcia Vilkas, A.; Alvarez, M.; Stoermann, W.; Vita, N.; Vottero, E.; Macin, S.; Cocco, M.; Onocko, M.; Dran, R.; Gimenez, C.; Cardona, M.; Guzman, L.; Guzman, P.; Martinez, D.; Sarjanovich, R.; Huerta, C.; Scaro, G.; Cuadrado, J.; Rodriguez, G.; Nani, S.; Guardiani, F.; Litvak Bruno, M.; Ceconi, G.; Chacon, C.; Casado, M.; Fernandez Moutin, M.; Maffei, L.; Sassone, S.; Yantorno, M.; Grinfeld, D.; Vensentini, N.; Rolandi, F.; Fallabrino, L.; Majul, C.; Paez, O.; Visser, M.; Luciardi, H.; Mansilla, V.; Gonzalez Colaso, P.; Ferre Pacora, F.; Jure, H.; Parody, M.; Espeche, E.; Whelan, A.; Boyle, A.; Collins, N.; Roberts-Thomson, P.; Rogers, J.; Caroll, P.; Colquhoun, D.; Williams, L.; Shaw, J.; Blombery, P.; Amerena, J.; Lee, C.; Hii, C.; Royse, A.; Royse, C.; Singh, B.; Selvanayagam, J.; Jansen, S.; Thompson, P.; Lo, W.; Hammett, C.; Poulter, R.; Graves, S.; Narasimhan, S.; van den Heuvel, P.; Wollaert, B.; Sinnaeve, P.; Fourneau, I.; Meuris, B.; Vanassche, T.; Ector, B.; Janssens, L.; Debonnaire, P.; Vandekerckhove, Y.; van de Borne, P.; Wautrecht, J.; Motte, S.; Leroy, J.; Schroë, H.; Vrolix, M.; Ferdinande, B.; Vranckx, P.; Benit, E.; Elegeert, I.; Lerut, P.; Wallaert, P.; Hoffer, E.; Borgoens, P.; Dujardin, K.; Brasil, C. 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Humaloja, K.; Lindberg, L.; Tuomilehto, H.; Tuominen, M.-L.; Kantola, I.; Juliard, J.; Feldman, L.; Ducrocq, G.; Boulogne, C.; Petitalot, V.; Leclercq, F.; Roubille, F.; Agullo, A.; Ferrari, E.; Chiche, O.; Moceri, P.; Boccara, F.; Charbonnier, M.; Azeddine, B.; Ederhy, S.; Soulat Dufour, L.; Cohen, A.; Etienney, A.; Messas, E.; Calvalido, A.; Galloula, A.; Zarka, S.; Courtois, M.-C.; Mismetti, P.; Accassat, S.; Buchmuller, A.; Moulin, N.; Bertoletti, L.; Seffert, B.; Sevestre, M.; Samy Modeliar Remond, S.; Dupas, S.; Mardyla, J.; Le Gloan, S.; Cayla, G.; Cornillet, L.; Schmutz, L.; Motreff, P.; Souteyrand, G.; Amonchot, A.; Barber-Charmoux, N.; Combaret, N.; Malcles, G.; Brenner, S.; Christa, M.; Duengen, H.; Krackhardt, F.; Bobenko, A.; Hashemi, D.; Stellbrink, C.; Stellbrink, E.; Köster, C.; Guerocak, O.; Bourhaial, H.; Oumbe Tiam, S.; Kemala, E.; Froemke, J.; Kadel, C.; Moellinger, H.; Friedrich, K.; Rafoud, K.; Braun-Dullaeus, R.; Herold, J.; Ganzer, M.; Jeserich, M.; Kimmel, S.; 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M.; Mahon, N.; Khan, I.; Hassan, S.; Curtin, R.; McFadden, E.; MacNeill, B.; Kyvelou, S.; Canavan, M.; Veerasingam, D.; Dinneen, S.; Halabi, M.; Rosenfeld, I.; Levinas, T.; Goldberg, A.; Khateeb, A.; Zimlichman, R.; Ben-Aharon, J.; Beniashvili, A.; Betsalel, A.; Zeltser, D.; Rogowski, O.; Mardi, T.; Rozenbaum, Z.; Turgeman, Y.; Or, T.; Rabkin, Y.; Klainman, E.; Halabi, S.; Halon, D. A.; Katz, A.; Plaev, T.; Drogenikov, T.; Atar, S.; Kilimnik, M.; Wishniak, A.; Merei, M.; Zvi, Y.; Nikolsky, E.; Zukermann, R.; Petcherski, S.; Bosi, S.; Gaitani, S.; Naldi, M.; Barbieri, A.; Faggiano, P.; Guidetti, F.; Adamo, M.; D’Aloia, A.; Magatelli, M.; Robba, D.; Mos, L.; Vriz, O.; Sinagra, G.; Maras, P.; Doimo, S.; Cosmi, F.; D'Orazio, S.; Oltrona Visconti, L.; Leonardi, S.; Vullo, E.; Sbaffi, A.; Azzara, G.; Mauri, S.; Gianni, U.; de Matteis, C.; Campidonico, U.; Di Pasquale, G.; Di Niro, M.; Riva, L.; Filippini, E.; Di Biase, M.; Ieva, R.; Martone, A.; Mandorla, S.; Regni, O.; Capponi, E. A.; Martinelli, S.; Bernardinangeli, M.; Proietti, G.; Piccinni, G. C.; Gualtieri, M. R.; Gulizia, M. M.; Francese, G. M.; Portale, A.; Galvani, M.; Ottani, F.; Capatano, O. G.; Conficoni, E.; Longhi, S.; Bachetti, C.; Venturi, F.; Capati, E.; Morocutti, G.; Bisceglia, T.; Fresco, C.; Baldin, M. G.; Gamba, C.; Olivieri, C.; Perna, G. P.; Battistoni, I.; Marini, M.; Cirrincione, V.; Ingrilli, F.; Kanno, T.; Ishii, Y.; Kohmura, C.; Igawa, T.; Izawa, K.; Daida, H.; Miyauchi, K.; Shimada, K.; Ohmura, H.; Ito, S.; Okazaki, S.; Konishi, H.; Miyazaki, T.; Hiki, M.; Kurata, T.; Suzuki, H.; Morimoto, R.; Yokoyama, M.; Yamamoto, T.; Okai, I.; Isoda, K.; Fujimoto, S.; Dohi, T.; Shimada, A.; Ozaki, Y.; Watanabe, E.; Kawai, H.; Naruse, H.; Takada, K.; Okuda, K.; Okumura, M.; Ishikawa, M.; Ohtsuki, M.; Ohta, M.; Sarai, M.; Koshikawa, M.; Kawai, M.; Miyagi, M.; Motoyama, S.; Matsui, S.; Ichikawa, T.; Kato, Y.; Nagahara, Y.; Muramatsu, T.; Hashimoto, Y.; Hoshino, N.; Harada, M.; Yamada, A.; Yoshiki, Y.; Motoike, Y.; Nomura, Y.; Miyajima, K.; Takatsu, H.; Nishimura, H.; Nagasaka, R.; Kawada, Y.; Miyamoto, N.; Seki, K.; Inoue, A.; Higashiue, S.; Kojima, S.; Kuroyanagi, S.; Furuya, O.; Komooka, M.; Yamamoto, S.; Wakabayashi, N.; Domae, H.; Ata, T.; Hashidomi, H.; Kawahara, R.; Hosokawa, S.; Hiasa, Y.; Otani, R.; Kishi, K.; Takahashi, T.; Yuba, K.; Miyajima, H.; Tobetto, Y.; Yoneda, K.; Ogura, R.; Kobayashi, H.; Takamura, T.; Enkou, K.; Ochi, Y.; Yamada, D.; Kuramochi, T.; Misumi, K.; Iiduka, D.; Hirose, M.; Tone, K.; Taniguchi, Y.; Ebihara, T.; Makino, M.; Yokota, M.; Nitta, M.; Udo, A.; Shimizu, S.; Fujii, K.; Iwakura, K.; Okamura, A.; Inoue, K.; Nagai, H.; Hirao, Y.; Tanaka, K.; Tanaka, N.; Yamasaki, T.; Oka, T.; Iwamoto, M.; Tanaka, T.; Nakamaru, R.; Okada, M.; Takayasu, K.; Sumiyoshi, A.; Inoue, H.; Kitagaki, R.; Ninomiya, Y.; Mizutomi, K.; Koizumi, I.; Funada, A.; Tagawa, S.; Kamide, S.; Saku, K.; Ideishi, M.; Ogawa, M.; Uehara, Y.; Iwata, A.; Nishikawa, H.; Ike, A.; Sugihara, M.; Imaizumi, S.; Fujimi, K.; Kawamura, A.; Sako, H.; Morito, N.; Morii, J.; Fukuda, Y.; Yahiro, E.; Matsunaga, A.; Matsumoto, N.; Noda, K.; Shiga, Y.; Nagata, Y.; Kimura, K.; Ebina, T.; Hibi, K.; Iwahashi, N.; Maejima, N.; Konishi, M.; Matsushita, K.; Minamimoto, Y.; Kawashima, C.; Nakahashi, H.; Kimura, Y.; Takahashi, H.; Matsuzawa, Y.; Kirigaya, J.; Sato, R.; Kikuchi, S.; Ogino, Y.; Kirigaya, H.; Kashiwase, K.; Hirata, A.; Takeda, Y.; Amiya, R.; Higuchi, Y.; Sakaguchi, T.; Nakano, T.; Matsusaki, N.; Suzuki, S.; Hayashi, T.; Nakatani, S.; Koide, M.; Kobayashi, T.; Hamanaka, Y.; Makino, N.; Sotomi, Y.; Abe, M.; Fujieda, H.; Hashimoto, K.; Teratani, Y.; Abe, Y.; Yokoyama, Y.; Higashino, H.; Okuda, H.; Yamazato, M.; Noda, T.; Arai, M.; Ono, K.; Hirose, T.; Iwama, M.; Warita, S.; Goto, Y.; Abe, S.; Kojima, T.; Yoshizane, T.; Tanihata, S.; Fujii, T.; Yagasaki, H.; Miwa, H.; Ishiguro, M.; Kato, T.; Watanabe, R.; Horio, S.; Mita, T.; Hirayama, A.; Watanabe, I.; Hiro, T.; Nakai, T.; Takayama, T.; Yoda, S.; Yajima, Y.; Okubo, K.; Okumura, Y.; Kato, M.; Fukamachi, D.; Aizawa, Y.; Sonoda, K.; Iida, K.; Sasaki, N.; Iso, K.; Takahashi, K.; Kougo, T.; Haruta, H.; Kurokawa, S.; Mano, H.; Nagashima, K.; Onaka, H.; Doi, H.; Hirano, N.; Okamoto, F.; Mori, K.; Ri, G.; Zushi, R.; Otsuka, K.; Inoko, M.; Haruna, T.; Nakane, E.; Miyamoto, S.; Izumi, T.; Honjo, S.; Ikeda, H.; Wada, Y.; Funasako, M.; Hayashi, H.; Hamasaki, A.; Sasaki, K.; Seko, Y.; Nakasone, K.; Hanyu, M.; Iwasaki, Y.; Iwasaki, K.; Ayano, S.; Hirokami, M.; Omoto, Y.; Sasaki, H.; Sato, H.; Yuda, S.; Okubo, M.; Matsuo, H.; Tsuchiya, K.; Kawase, Y.; Miyake, T.; Kondo, H.; Hattori, A.; Kikuchi, J.; Okamoto, S.; Hirata, T.; Kawamura, I.; Ota, H.; Omori, H.; Tanigaki, T.; Kamiya, H.; Sobue, Y.; Komoda, T.; Akatsuka, Y.; Yamamoto, M.; Isegawa, K.; Takanezawa, M.; Kataoka, C.; Imamaki, M.; Shibata, Y.; Yasuda, K.; Shimano, M.; Ozaki, R.; Morishita, Y.; Okabe, K.; Kondo, K.; Miura, A.; Manita, M.; Tabata, K.; Asahi, T.; Mashidori, T.; Higa, N.; Nakata, M.; Himi, T.; Matsudo, Y.; Sekine, T.; Hou, K.; Tonoike, N.; Hama, Y.; Tanaka, S.; Ge, B.; Takahara, M.; Ishimura, M.; Shikada, T.; Ueno, H.; Amemiya, H.; Hisamatsu, Y.; Sada, K.; Sato, T.; Harada, K.; Nakamura, T.; Ako, J.; Tojo, T.; Shimohama, T.; Kishihara, J.; Ishii, S.; Fukaya, H.; Meguro, K.; Nishino, Y.; Inoue, M.; Matsui, Y.; Omura, Y.; Kawakami, H.; Matsuoka, H.; Oshita, A.; Seike, F.; Kondo, N.; Miyoshi, T.; Yamada, Y.; Uchiya, T.; Kikuchi, Y.; Koretsune, Y.; Abe, H.; Shinouchi, K.; Nishida, H.; Yasumura, K.; Date, M.; Ueda, Y.; Iida, Y.; Idemoto, A.; Toriyama, C.; Yokoi, K.; Mishima, T.; Yamada, T.; Fukunami, M.; Morita, T.; Furukawa, Y.; Kawasaki, M.; Kikuchi, A.; Tamaki, S.; Seo, M.; Shirakawa, Y.; Ikeda, I.; Fukuhara, E.; Kawai, T.; Kayama, K.; Kawahira, M.; Tanabe, K.; Nakamura, J.; Shimomura, H.; Kudo, T.; Morisaki, S.; Ogura, Y.; Chazono, N.; Onoue, Y.; Matsumuro, Y.; Shirakawa, T.; Nishi, M.; Kinoshita, N.; Nakamura, R.; Miyai, N.; Ohta, K.; Sawanishi, T.; Takahashi, A.; Hada, T.; Nakajima, S.; Taniguchi, N.; Mizuguchi, Y.; Takahashi, Y.; Hashimoto, S.; Machida, M.; Hirabayashi, K.; Morimoto, S.; Higashino, Y.; Otsuji, S.; Takiuchi, S.; Yabuki, M.; Hasegawa, K.; Shishikura, D.; Ibuki, M.; Ishibuchi, K.; Nagayama, S.; Ishii, R.; Tamaru, H.; Yamamoto, W.; Utsu, N.; Miyakoshi, K.; Nakashima, D.; Tsukuda, K.; Ueda, K.; Nakano, A.; Fukuda, T.; Ikeda, S.; Tsuchiya, H.; Toshima, S.; Tateno, R.; Ishikubo, T.; Suguta, M.; Nakamura, S.; Funatsu, A.; Mizobuchi, M.; Tanaka, M.; Nagai, T.; Hirano, S.; Hashimoto, T.; Doi, T.; Shirasaka, A.; Takeda, S.; Sasaki, Y.; Ohya, H.; Hosokawa, A.; Nishina, N.; Koki, B.; Ando, K.; Hiramori, S.; Soga, Y.; Tomoi, Y.; Tohoku, S.; Shirai, S.; Hyodo, M.; Isotani, A.; Domei, T.; Kuramitsu, S.; Morinaga, T.; Hayashi, M.; Hiromasa, T.; Nagae, A.; Yamaji, Y.; Nakao, K.; Sakamoto, T.; Taguchi, E.; Tsurugi, T.; Tanaka, Y.; Suzuyama, H.; Koyama, J.; Nagano, M.; Okamatsu, H.; Kodama, K.; Nakamura, M.; Horibata, Y.; Sone, M.; Tsunemori, M.; Bando, M.; Nakayama, T.; Tanigaito, Y.; Nomoto, M.; Sawamura, T.; Unoki, T.; Lim, C. W.; Zainal Rashid, R.; Najme Khir, R.; Ibrahim, K. S.; Wan Azman, W. A.; Sridhar, G. S.; Watson, T.; Abu Kassim, Z.; Mahmood Zuhdi, A. S.; Abdul Hafidz, M. I.; Abu Hassan, M. R.; Wan Rahimi Shah, W. F.; Karthikesan, D.; Mohd Suan, M. A.; Md Ali, S. M.; Kasim, S.; Mohd Arshad, M. K.; Ismail, J. R.; Ibrahim, Z. O.; Chua, N. Y. L.; Abdul Rahim, A. A.; Rusani, B. I.; Yap, L. B.; Zamrin, D. M.; Amir, M. A.; Ismail, N. I.; Mohammad Razi, A. A.; Prins, F.; Bendermacher, P.; Burg, M.; Lok, D.; van der Sluis, A.; Martens, F.; Badings, E.; Milhous, J.; van Rossum, P.; Viergever, E.; van Hessen, M.; Willems, F.; Tjon Joe Gin, R.; Swart, H.; Oomen, A.; Kromhout, S.; Lauwerijssen, I.; Daalmans, M.; Breedveld, R.; de Vries, K.; Feenema Aardema, M.; Hofma, S.; van der Borgh, R.; van Nes, E.; Göbel, E.; Oei, F.; Dorman, H.; Bos, R.; Zoet-Nugteren, S.; Emans, M.; Kragten, H.; Lenderink, T.; Feld, R.; Herrman, J.; van Bergen, P.; Gosselink, M.; Elvan, A.; Hoekstra, E.; The, S.; de Vries, R.; Zegers, E.; Oude Ophuis, T.; Remmen, J.; Bech, J.; Kooistra, J.; den Hartog, F.; Oosterhof, T.; Bartels, G.; Posma, J.; Nierop, P.; Liem, A.; van der Zwaan, C.; Asselman, M.; van Eck, J.; Gevers, R.; van Gorselen, E.; van Hal, J.; Terpstra, W.; Groenemeijer, B.; Jerzewski, A.; Hoogslag, P.; Geertman, J.; de Groot, M.; Dijkstra, B.; Loyola, A.; Sulit, D.; Mercado, M. J.; Rey, N.; Evangelista, L.; Abola, M.; Padua, L.; Morales, D.; Palomares, E.; Abat, M.; Santos, R.; Rogelio, G.; Chua, P.; Baello, R.; del Pilar, J.; Alianza, M.; Alcaraz, J.; Alcaraz, L.; Ebo, G.; Guido-Saliot, I.; Tirador, L.; Estoce, E.; Ygpuara, M.; Cruz, J.; Anonuevo, J.; Pitargue, A.; Janion, M.; Drewniak, Z.; Guzik, B.; Nowak, M.; Nosal, M.; Niewiara, Ł; Gajos, G.; Bury, K.; Czubek, U.; Misztal, M.; Grzybczak, R.; Zalewski, J.; Kruszelnicka-Kwiatkowska, O.; Żabówka, M.; Rynkiewicz, A.; Grzybowski, A.; Szałkowski, P.; Broncel, M.; Gorzelak, P.; Możdżan, M.; Olszewska Banaszczyk, M.; Szuba, A.; Tabin, M.; Chachaj, A.; Czarnecka, D.; Terlecki, M.; Klocek, M.; Maga, P.; Coman, I.; Tarlea, M.; Ghionea, M.; Gavrila, C.; Dimulescu, D.; Popescu, A.; Stoicescu, C.; Vintila, V.; Florescu, M.; Baghilovici Cretu, D.; Suran, M.; Mihalcea, D.; Lungeanu Juravle, L.; Cinteza, M.; Calin, I.; Bicescu, G.; Vasile Toma, N.; Udroiu, C.; Gherghinescu, C.; Darabont, R.; Patrascu, N.; Constantinescu, C.; Popescu, I.; Sinescu, C.; Andrei, C.; Axente, L.; Arsenescu, C.; Statescu, C.; Ardeleanu, I.; Anghel, L.; Benedek, I.; Benedek, T.; Kinga, P.; Banga, D. K.; Bobescu, E.; Doka, B.; Dobreanu, D.; Sirbu, V.; Rudzik, R.; Kantor, K.; Sus, I.; Gaita, D.; Maximov, D.; Brie, D.; Mosteoru, S.; Olariu, I.; Iancu, A.; Marc, M.; Hagiu, R.; Manole, V.; Molnar, A.; Dregoesc, I.; Iliesiu, A.; Armean, P.; Parvu, I.; Deleanu, A.; Lighezan, D.; Buzas, R.; Petrescu, L.; Nicola, R.; Dan, R.; Crisan, S.; Trasca, L.; Teodorescu, I.; Zara, O.; Tiron, T.; Tesloianu, D.; Spiridon, M.; Vintila, M.; Baluta, M.; Chioncel, O.; Stoica, E.; Kulcsar, I.; Antohi, L.; Strazhesko, I.; Tkacheva, O.; Sharashkina, N.; Pykhtina, V.; Vasyuk, Y.; Shkolnik, E.; Khadzegova, A.; Sadulaeva, I.; Ivanova, S.; Nesterova, E.; Nesvetov, V.; Shupenina, E.; Shcherbak, M.; Sizova, Z.; Beloborodova, A.; Pozdnyakov, Y.; Tarasov, A.; Shvedov, I.; Zabashta, S.; Ryzhikova, I.; Barbarash, O.; Pecherina, T.; Vatutin, M.; Inozemceva, A.; Kazachek, Y.; Mineeva, E.; Kupriyanova, T.; Voevoda, M.; Gafarov, V.; Gromova, E.; Panov, D.; Voevoda, E.; Kovalkova, N.; Ragino, Y.; Poponina, T.; Poponina, Y.; Garganeeva, N.; Repin, A.; Vershinina, E.; Borodina, E.; Kalashnikova, T.; Safyanova, O.; Osipova, I.; Antropova, O.; Pyrikova, N.; Polyakova, I.; Efremushkina, A.; Guryanova, N.; Kiseleva, E.; Lomteva, E.; Shtyrova, T.; Novikova, N.; Parfenov, D.; Volovchenko, A.; Averkov, O.; Pavlikova, E.; Vaulina, L.; Pletnikova, I.; Mishchenko, L.; Saranin, S.; Tsupko, I.; Kuznetsova, N.; Zateyshchikov, D.; Dankovtseva, E.; Vlazneva, Y.; Tolokonnikova, N.; Zhurina, M.; Zubova, E.; Aseycheva, O.; Sigalovich, E.; Vertkin, A.; Rodiukova, I.; Komissarov, S.; Sokolova, R.; Ausheva, A.; Salbieva, A.; Yusubova, A.; Isakova, S.; Hranai, M.; Obona, P.; Cisar, P.; Semetko, J.; Vanova, P.; Ferencikova, Z.; Vykoukalova, T.; Gaspar, L.; Caprnda, M.; Bendzala, M.; Pella, D.; Fedacko, J.; Hatalova, K.; Drozdakova, E.; Peter, O.; Ntsekhe, M.; de Andrade, M.; Seedat, S.; Gani, M.; van Zyl, L.; Naude, M.; Cronje, T.; van Zyl, F.; Engelbrecht, J.; Jansen, J.; Roos, J.; Makotoko, E.; Pretorius, C.; Mirna, S.; Nell, H.; Pretorius, M.; Basson, M.; Njovane, X.; Mohamed, Z.; Pillay, T.; Dawood, S.; Horak, A.; Lloyd, E.; Hitzeroth, J.; Mabin, T.; Abelson, M.; Klug, E.; Gebka, M.; Hellig, F.; Alison, M.; Bae, J.; Kim, C.; Kim, D.; Joo, S.; Park, C.; Kim, Y.; Jarnert, C.; Rydén, L.; Mooe, T.; Binsell-Gerdin, E.; Dellborg, M.; Torstensson, I.; Albertsson, P.; Hiller, M.; Perers, E.; Johansson, L.; Jansson, J. H.; Al-Khalili, F.; Almroth, H.; Andersson, T.; Eriksson Östman, M.; Pantev, E.; Utter, F.; Tengmark, B. O.; Olsson, Å; Liu, B.; Rasmanis, G.; Wahlgren, C. M.; Thott, O.; Moccetti, T.; Rossi, M. G.; Crljenica, C.; Dovgan, N.; Skarzhevskyi, O.; Kozhukhov, S.; Tseluyko, V.; Mishchuk, N.; Kuznetsov, I.; Semenikhin, S.; Matviichuk, N.; Matuzok, O.; Yakovleva, L.; Volkov, V.; Zaprovalna, O.; Serik, S.; Riabukha, V.; Koval, O.; Kaplan, P.; Ivanov, A.; Romanenko, S.; Skoromna, A.; Kononenko, L.; Saprychova, L.; Lazareva, S.; Prokhorov, O.; Vdovychenko, V.; Bychkov, M.; Demydova, A.; Kapustynska, O.; Bazylevych, A.; Dutka, R.; Vlasyuk, Z.; Shabat, M.; Rudenko, L.; Beregova, O.; Fedtchouk, L.; Gusak, I.; Vizir, V.; Sadomov, A.; Shkolovoy, V.; Nasonenko, O.; Demidenko, O.; Karpenko, O.; Ponomarenko, K.; Oryshych, G.; Nevolina, I.; Mitskevych, L.; Bezuglova, S.; Kizim, S.; Todoriuk, L.; Brodi, N.; Karpenko, L.; Malynovsky, Y.; Fedotov, S.; Malynovska, O.; Goydenko, O.; Miroshnykov, S.; Rabota, I.; Koval, V.; Ohirko, O.; Khaba, U.; Storozhuk, B.; Danylchuk, I.; Danylchuk, A.; Gutsuliak, R.; Cotton, J.; Luckraz, H.; Wrigley, B.; Venkataraman, A.; Maher, A.; Moriarty, A.; McEneaney, D.; Connolly, D.; Davis, R.; Banerjee, P.; Davey, P.; Elmahi, E.; Senior, R.; Ahmed, A.; Birdi, I.; Gedela, S.; Singh, A.; Calvert, J.; Butler, M.; Donnelly, P.; Jasinka, A.; Orr, C.; Trevelyan, J.; Routledge, H.; Carter, J.; Oxenham, H.; Peace, A.; McNeill, A.; Austin, D.; Jackson, M.; Kukreja, N.; Kotwinski, P.; Hilton, T.; Bilizarian, S.; Srivastava, S.; Walsh, R.; Fields, R.; Portnay, E.; Gogia, H.; Deits, R.; Salacata, A.; Hunter, J.; Bacharach, J.; Shammas, N.; Suresh, D.; Gurbel, P.; Banerjee, S.; Grena, P.; Bedwell, N.; Sloan, S.; Lupovitch, S.; Soni, A.; Gibson, K.; Pepper, D.; Sangrigoli, R.; Mehta, R.; Patel, J.; I-Hsuan Tsai, P.; Gillespie, E.; Harrison, A.; Dempsey, S.; Phillips, R.; Hamroff, G.; Hametz, C.; Black, R.; Lader, E.; Kostis, J.; Bittner, V.; Mcguinn, W.; Cheng, R.; Pal, J.; Malhotra, V.; Michaelson, S.; Vacante, M.; Mccormick, M.; Arimie, R.; Dukkipati, R.; Camp, A.; Dagher, G.; Kosh y, N.; Culp, J.; Thew, S.; Ferraro, A.; Costello, F.; Heiman, M.; Chilton, R.; Moran, M.; Adler, F.; Balingit, P.; Comerota, A.; Seiwert, A.; French, W.; Vardi, G.; Singh, T.; Serota, H.; Qayyum, U.; Das, S.; Harrison, R.; Vora, A.; Bakeen, F.; Omer, S.; Chandra, L.; Casaccia, G.; Tinto, J.; Sighel, C.; Giozzi, E.; Morell, Y.; Bianchini, M.; Yossen, M.; Hoyos, M.; Venturini, C.; Merkusa, C.; Carrique, A.; Carrique, P.; Fracaro, V.; Torres, M.; Crunger, P.; Espinosa, M.; Passarello, A.; Zaidman, M.; Ledesma, M.; Troncoso, C.; Aviles, A.; Rodera Vigil, S.; Vogel, M.; Takla, M.; Funosas, C.; Ferreiro, M.; Bruno, T.; Buzzetti, C.; Lozano, J.; Alvarez Dámelio, A.; Bocanera, M.; Vicente, D.; Cenci, A.; Deluca, C.; Santana, R.; Ahuad Calvelo, A.; Alvarez D'Amelio, A.; Ahuad Calvelo, J.; Herrero, S.; Robertson, M.; Tapia, D.; Escalante, M.; Cañas, M.; Cendali, G.; Esposito, L.; Muñiz, M.; Montaña, J.; Di Vruno, M.; Strevezza, M.; Lopez Santi, M.; Massei, N.; Garate, V.; Perlo, D.; Campora, F.; Jakubowski, I.; Gonzalez Moisello, M.; Actis, M.; Schiavi, S.; Aguirre, M.; Ceirano, C.; Zillo, M.; Yunis, M.; Berdini, A.; Gerbaudo, R.; Berdini, J.; Palma, F.; Pinero, S.; Virulio, S.; Vitale, A.; Sosa Flores, G.; Ibanez Saggia, C.; Ibanez Saggia, D.; Roses, A.; Martinelli, C.; Vargas, L.; Galarza Salazan, M.; Dran, P.; Tinnirello, V.; Pelayes, S.; Bordoni, P.; Navarro, A.; Barilati, P.; Serra, R.; Nigro, A.; Cleiman, S.; Bianchi, M.; Vallejo, M.; Ingratta, M.; Tonelli, L.; Levantini, M.; Bonifacio, M.; Hansen, V.; Chaieb, A.; Majul, S.; Medina, F.; Gallinotti, P.; Madariaga, T.; Andrea, G.; Blumberg, C.; Volpe, M.; Gandur, H.; Benincasa, V.; Barreto, M.; Jure, D.; Tulloch, G.; Greenwell, D.; Forrest, N.; Nyman, E.; Mcintosh, C.; O'May, V.; Grabek, T.; Conway, B.; O’Donoghue, M.; Brady, L.; Duroux, M.; Ratcliffe, M.; Shone, S.; Connelly, A.; Ferreira-Jardim, A.; Vandernet, R.; Downes, R.; Davids, F.; Teal, L.; Knight, S.; Soraghan, D.; Spence, C.; Smith, K.; Tivendale, L.; Williams, Z.; O'Connor, M.; Walker, I.; Ferguson, L.; Holiday, J.; Griffin, R.; Palethorpe, L.; Hindom, L.; Lilwall, L.; Wadham, S.; Narasimhan, K.; van Extergem, P.; Joris, I.; Oreglia, M.; Jacobs, C.; Leus, W.; Robesyn, V.; Vanheule, K.; van den Bossche, K.; Albertijn, S.; Vissers, C.; Badts, G.; Vangenechten, K.; Derycker, K.; Dejaegher, K.; de Grande, T.; de Clippel, M.; Gayet, F.; Jorion, M.; Jourdan, A.; Tartaglia, K.; Zwinnen, W.; Roijakkers, I.; van Genechten, G.; Schoonis, A.; Bollen, J.; Janssen, A.; de Coninck, M.; Ruell, S.; Grimonprez, A.; Bouckaert, N.; van Eeckhoutte, H.; Malmendier, D.; Massoz, M.; Jacquet, S.; Vanhalst, E.; Casier, T.; Barroso, S. L.; Tamashiro, N.; Correa, C. P.; Sehnem, E. A. B.; Precoma, C. B.; Pinheiro, L.; Ruschel, K. B.; dos Reis, A. L.; Santos, M. S.; de Oliveira, L. O. S. P.; de Carvalho, L. M. G.; dos Santos, M. E. S.; Reis, L. L. F.; da Cunha, G. T.; França, F. F.; Bessa, S. K.; Vicente, C.; Ormundo, C.; Trama, L.; Pires, N. F.; Esteves, D.; Sila, O. L.; Góes, N. C.; Amorin, R. C.; Faria, M. O.; Bucalon, E. C.; Marin, L. P.; Herek, L.; Araujo, V. L.; Silva, A. F.; Lima, F.; Gomes, C. G.; Pagnan, L. G.; Novelli, C. M.; Carvalho, J. K. C.; Teodoro, A. R.; Zimmermann, E. M. B.; Beiersdorf, J. R.; Machado, B. G.; Pedroso, F. B. V.; de Vargas, T.; Peres, C. S.; dos Santos, T. F.; de Souza, S. F.; Luiz, R. O.; Ferreira, P.; Souza, D. F.; Cunha, S. M. C.; de Resende, I. M.; Furtado, C. C. F.; Soprane, A. A.; Brum, A. B.; Zorzo, J. A. T.; dos Santos, J. C.; Queiroz, L. B.; Barros, F. E.; Vianna, C. O.; Zanateli, A.; Vieira, A. P. Z.; Melo, G.; Zambonin, G. E. C.; Paiva, P.; Viana, R. M. M.; Yagihara, M. M.; Takiuti, M. M.; Miyamoto, P. B.; da Silva, M. F.; Borin, L. A.; Chiazzini, S. M. L.; Fleck, N.; Batista, R. F.; Cardoso, D. T.; MCamasmie, P.; Assompção, R. P.; Marques, L. L.; Leung, S.; Lewis, C.; Tytus, A.; Clarus, S.; Juranics, S.; Pandey, M.; Frenette, L.; Magi, A.; Nowacki, B.; Otis, J.; Fox, B.; Corke, R.; Miller, B.; Rizzo, A.; Trombetta, L.; Power, P.; Richert, L.; Haligowski, R.; Macrae, C.; Kooistra, L.; Urso, C.; Fox, S.; Felbel, S.; Stafford, C.; Stata, C.; Barnabe, B.; Mehta, K.; Faul, J.; Gohel, J.; Bhakta, S.; Harwood, A.; McPherson, C.; Marucci, J.; Manasterski, L.; Veenhuyzen, J.; Ramadan, D.; Madden, B.; Jetha, A.; Pajevic, M.; Dube, C.; Rolfe, B.; O’Blenis, G.; Roy, L.; Dihel, C.; Butler, J.; Simmavong, K.; Bartol, C.; Bozek, B.; Hart, B.; Shier, M.; Coughlin, M.; Lamantia, C.; Lamantia, D.; Vilag, C.; Fecteau, J.; Dionne, J.; Péloquin, G.; Hogg, N.; Welsh, S.; Weerasingam, S.; Lantz, M.; Lounsbury, N.; Martin, E.; Mitchell, L.; Morgen, G.; Nelson, S.; Pelzer, E.; Sorensen, S.; Leblanc, A.; Bourlaud, A. S.; Prémont, A.; Léger, P.; Larivière, M. M.; Tremblay, H.; Bergeron, A.; Dumont, J.; Keilani, S.; Landry, P.; Deneufbourg, I.; Breton, C.; Bilodeau, N.; Côté, M.; Dumont, F.; Dufort, L.; Marcoux, D.; David, M.; Otis, R.; Parks, J.; Cepidoza, C.; Janz, W.; Weighell, W.; Yaworski, S.; Boyd, K.; Lambert, J.; Shea-Landry, G.; Reid, K.; Thiessen, S.; Nemtean, D.; Futers, S.; Drouin, K.; Masson, C.; Arseneault, M. C.; Lachance, N.; Bergeron, C.; Boudreault, C.; Perkins, L.; Barnett, A.; Fortin, J.; Duclos, R.; Vallières, C.; Bouchard-Pilote, C.; Ouimet, F.; Roberge, B.; Couture, M. L.; Deshaies, D.; Bastien, A.; Chartrand, M. J.; Gagné, N. L.; Desbiens, K.; Alarie, P.; Cassan, J.; Ducharme, Y.; Roy D Tapps, I.; Bolduc, H.; Laliberté, J.; Hickey, L.; Spero, M.; Bernstein, M.; Clement, J.; Pawluch, A.; Ricci-Bonzey, M.; Richer, J.; Vaillancourt, J.; Ward, B.; Mostafai Rad, P.; Oleski, L.; Karkhanis, R.; Hartleib, V.; Poirier, R.; Hidalgo, J.; Hernandez, C.; Obreque, C.; Quilapi, D.; Villa, F.; Iturriaga, C.; Ferrada, M.; Navarrete, S.; Becerra, E.; Vargas, C.; Roque, C.; Alarcon, J.; Diaz, D.; Sepulveda, M.; Villan, C.; Garcia, N.; Lara, C.; Lezana, B.; Basso, N.; Torres, G.; Pasmino, C.; Gonzalez, S.; Medina, D.; Rodriguez, T.; Guo, T.; Chen, S.; Han, W.; Shi, D.; Zhang, Q.; Li, W.; Cui, L.; Huang, Z.; Gong, X.; Liu, D.; Tan, S.; Caicedo, L.; Rodriguez, A.; Mejia, I.; Escalante Ruiz, J.; Camera Ochoa, C.; Conrrado Ortega, Y.; Accini Diaz, A.; Rodriguez, B.; Lopez-Lopez, J.; Di Stefano, K.; Florez, L.; Manco, T.; Rodriguez, D.; Urina, A.; de La Hoz, L.; Almendrales, L.; Bello, O.; Urrea Valencia, H.; Correa Rivera, P.; Perdomo, I.; Alzate, J.; Rivera, E.; Jimenez, N. N.; DMoreno, N.; Guzman, A.; Betancourt, S.; Mendoza Marin, H.; Leyva, M.; Ortiz, M.; Marin, E.; Angie Lorena, A.; Alvarez, Y.; Cervantes Hurtado, A.; Accini Mendoza, A.; Trujillo Accini, M.; Eguis, B.; del Portillo, C.; Ortega, M.; Delgado, P.; Arciniegas, J.; Rodriguez, L.; Melo Sanchez, S.; Chavera, I.; Pastrana Mendoza, M.; Negrette Quintero, A.; Zidek, M.; Hajkova, D.; Rozskowska, P.; Opavska, I.; Souckova, E.; Matuskova, E.; Kratochvilova, T.; Pavelec, P.; Zelenkova, V.; Dolezalova, Z.; Márquez, M.; Moreira, D.; Zuleta, M.; Santana, G.; Coello, A.; Andrade, G.; Salazar, J.; Rivadeneira, J.; Vaerma, J.; Lappalainen, S.; Silvennoinen, S.; Haaraoja, A.; Valimaki, S.; Roine, E.; Abergel, H.; Msakni, W.; Fuentes, A.; Briday, G.; David, A.; Soltani, S.; Decorps, A.; Chettouh, M.; Douillet, M.; Zamiti-Smondel, A.; Cuccu, L.; Salhi, N.; Helene, M.; Martin, S.; Merah, A.; Daher, P.; Laurie, S.; Roussel, L.; Leperchois, C.; Delelo, E.; Thalamy, A.; Chazot, E.; Tahirovic, E.; Watson, S.; Brettschneider, B.; Maas, M.; Euler, K.; Rahn, G.; Beissner, S.; Anuschek, V.; Tu, E.; Buerger, M.; Schemann, J.; Klinger, C.; Kurzidim, T.; Sahbani, S.; Laszig, S.; Beilfuss, M.; Foerster, A.; Eichinger, G.; Rupprecht, M.; Kuehnert, J.; Wendler-Huelse, I.; Buelow-Johansen, B.; Baierlein, A.; Iselt, M.; Sievert, B.; Frommhold, R.; Wolf, T.; Hahn, M.; Schoen, B.; Acimic, C.; Ludwig, M.; Funkat, A.; Wagner, I.; Schink, M.; Calvo-Sanchez, D.; Felfoldine Feil, J.; Patakine Sumegi, T.; Miko-Pauer, R.; Courcy, M.; Kelly, C.; Farrell, D.; Kirrane, C.; Hall, M.; Gilroy, E.; Kelsey, M.; Andrew, G.; Joyce, M.; Conway, S.; Duane, L.; Omer, T.; Zuker, S.; Platner, N.; Saranga, H.; Kaufman, E.; Livshitz, L.; Genin, I.; Klainman, M.; Uziel Iunger, K.; Abitbul, A.; Fishman, B.; Greenshtein, I.; Tubul, O.; Lasri, E.; Zvi, R.; Yablonski, A.; Helmer Levin, L.; Lunetto, M. L.; Savoldi, D.; Fiorini, M.; Ramani, F.; Mariottoni, B.; Rizzotti, D.; Di Matteo, C.; Musio, S.; Pieroni Minciaroli, S.; Serani, S.; Aloisi, A.; Attanasio, C.; Tricoli, M.; Giordano, V.; Andrioli, V.; Biundo, V.; Tullio, L.; Schiff, D.; Trovarelli, P.; Chiodi, R.; Sampaolesi, S.; Cina, M. T.; Abatello, M.; de Tora, M.; Pietrucci, F.; Pezzetta, S.; Chiminelli, E.; Dall’Asta, A.; Bennati, M.; Elia, A.; Bizzoco, M.; Iaquaniello, A.; Spigarelli, R.; Cremonesi, C.; Gagliardi, M.; Torricelli, L.; Ijichi, N.; Shiraiwa, K.; Murakami, M.; Takeshita, K.; Sato, M.; Shiratori, A.; Kinjo, K.; Tomita, K.; Mizuno, M.; Kurihara, F.; Tachibana, M.; Nitta, Y.; Unno, K.; Hiramatsu, H.; Sano, A.; Nanatsumura, M.; Tanikawa, I.; Uesugi, K.; Banno, S.; Miyata, T.; Kujuji, A.; Kawai, K.; Maegawa, A.; Koseki, T.; Watanabe, Y.; Aoki, S.; Maesawa, M.; Suzuki, A.; Itose, Y.; Konishi, K.; Fujieda, K.; Nakade, S.; Minami, M.; Yoneda, J.; Akiyama, R.; Sakai, S.; Nakatani, K.; Yamazaki, A.; Funama, M.; Kaneko, E.; Morii, S.; Onishi, M.; Sone, A.; Sagawa, N.; Iwai, F.; Kawahara, A.; Hasimoto, C.; Ueki, M.; Kamiji, M.; Ando, M.; Yokoo, M.; Okada, Y.; Yamada, H.; Matsushige, N.; Nagato, A.; Matsumoto, R.; Nishikawa, M.; Oka, I.; Kitou, S.; Tachiuchi, M.; Nakagawa, M.; Yoneda, S.; Iwasa, K.; Matsuda, J.; Oda, A.; Tokudome, S.; Kaneyuki, Y.; Higaki, M.; Yoneda, H.; Kajita, C.; Suwa, K.; Sato, E.; Nagata, T.; Kubo, Y.; Umesu, A.; Ohashi, K.; Takeuchi, M.; Tanaka, I.; Nobehara, T.; Yamano, R.; Yumiba, A.; Hamada, M.; Nishihata, T.; Ohashi, Y.; Morita, M.; Endo, M.; Matsugi, M.; Tateishi, H.; Nakamori, R.; Yamashita, Y.; Okabe, M.; Matsuo, M.; Ono, T.; Shigeyama, Y.; Ichiyanagi, M.; Sugimori, K.; Ohmura, C.; Igarashi, M.; Aotsuka, S.; Komoda, N.; Watanabe, M.; Enomoto, Y.; Suzuki, Y.; Kawaguchi, A.; Kasahara, A.; Koide, A.; Sakatani, T.; Kurihara, T.; Yokota, S.; Futagi, R.; Amemiya, Y.; Ono, E.; Maeda, A.; Kadono, K.; Ishiguchi, Y.; Kikuchi, R.; Kuramatsu, M.; Nakamura, E.; Chiba, S.; Higa, A.; Kitahashi, M.; Tanaka, H.; Ito, T.; Oba, M.; Tsubouchi, M.; Toshima, M.; Morishita, M.; Miyano, A.; Kondo, M.; Watanabe, K.; Shibata, R.; Tosaki, Y.; Ito, Y.; Saoda, M.; Yamasaki, E.; Kadosaki, S.; Motooka, S.; Akiyoshi, H.; Morio, S.; Nemoto, H.; Yoshizawa, S.; Okabe, N.; Semba, K.; Yoshida, A.; Lee, Y.; Yoshida, M.; Iwashita, Y.; Takeda, A.; Maezato, M.; Kawahira, K.; Yoshikawa, M.; Okamoto, N.; Nishimura, M.; Matsuura, K.; Fukunaga, M.; Fukai, K.; Osakabe, Y.; Yamamura, K.; Koike, M.; Shibuya, S.; Shiramata, M.; Ono, Y.; Tsujimoto, Y.; Tadokoro, T.; Morishita, N.; Matsuo, Y.; Yumoto, I.; Sakazaki, S.; Atarashi, A.; Nabata, Y.; Okuda, N.; Fujita, A.; Matsuo, A.; Ishizawa, Y.; Shibata, H.; Ootsuka, M.; Taimatsu, R.; Takeuchi, A.; Sumi, Y.; Yamamoto, F.; Araki, Y.; Tanaka, A.; Kuroda, S.; Sakata, R.; Okada, N.; Sawada, Y.; Miyata, M.; Asayama, H.; Koga, N.; Miki, T.; Yamaguchi, N.; Hashimoto, A.; Fukuike, C.; Kubo, A.; Yamasaki, M.; Mori, Y.; Nakayama, S.; Kobayashi, Y.; Takenaka, S.; Mashima, M.; Katsuta, H.; Matsumura, T.; Yanagida, S.; Watanabe, N.; Kodama, S.; Kusano, M.; Yamamoto, N.; Kamada, R.; Suzuki, K.; Itami, K.; Hasebe, Y.; Fujita, N.; Kubota, S.; Usuki, A.; Okamoto, M.; Uno, S.; Chikuma, A.; Kishikawa, H.; Yano K Nakano, C.; Otaguro, M.; Kayashima, Y.; Shinoda, M.; Jaafar, S. M.; Baharuddin, S.; Gembor, J.; Ahmad, H.; Syed Mansor, S. M.; Abdullah, W. M.; Shafie, Z.; Muhamad Yunus, S.; Alwi, S. M.; Hussin, N.; Basri, N. A.; Ling Ling, L.; Naem, N. S.; Rutten, R.; Rademaker, H.; van Buijsen, M.; Scholten, M.; Stuij, S.; van Zeijst, M.; van Houwelingen, K.; Engelen, W.; Kramer, H.; Maassen, E.; Verhoeven, P.; Awater, J.; Terwisscha van Scheltinga, C.; Meijlis, P.; Blom, L.; Bos, M.; van der Wal, M.; van Laerhoven, G.; Jacobs, T.; Tan-Urgert, B.; van de Gaag, J.; den Boer, P.; Verlek, E.; Lardinois, R.; Coenjaerds, C.; Hendrick, R.; Schoep, J.; Froma, E.; van Nes, C.; Beuving, D.; Krikken, J.; Drent, I.; Geerlings, F.; Buvelot, S.; Wissenburg, A.; Dijkshoorn, A.; van Setten van der Meer, L.; Singerling, M.; van Wijk, D.; Bor, A.; Aukema-Wouda, Z.; Hendriks-van Woerden, M.; Kort, I.; Danse, I.; van der Knaap, M.; de Jong, C.; Temminck, M.; Schaefer, T.; van der Ven, N.; Drost, I.; Mulder, R.; de Vos, A.; de Hoop, M.; Post, G.; Wielandt, D.; Edorot, N.; de Castro, K.; Flotildes, M.; Mulingtapang, T.; Vasquez, S.; Facundo, S.; Peralta, M.; Jose, M.; Bandiez, J.; Sulit, P.; Joaquin, F.; Arbis, M. G.; Silva, C.; Delgado, D.; de Leon, R.; Maglasang, P.; Sian, A.; Alagban, C.; Alcorano, J.; Marcelo, M. J.; Dela Pena, C.; Hyra, I.; Malkiewicz, B.; Mosakowska, K.; Cana, I.; Dobrin, I.; Lautaru, A.; Manescu, G.; Samoila, N.; Lacatus, M.; Apostoie, A.; Prunoiu, M.; Tilinca, M.; Budeanu, A.; Nedelcu, C.; Dumitrache, N.; Boeru, L.; Zhuravleva, E.; Gundova, M.; Hoffmannova, J.; Svitkova, M.; Pekarova, T.; Ujacka, K.; Zsoriova, T.; Kubincova, K.; Jankovicova, Z.; Talliard, C.; Tyumbu, N.; Mngoma, N.; Kannemeyer, M.; Mostert, J.; Page, A.; Krahenbuhl, C.; Tredoux, C.; Hendricks, L.; Oliver, S.; Le Grange, M.; Naidoo, V.; Bae, Y.; Kim, H.; Lee, J.; Yu, N.; An, S.; Kim, E.; Yang, K.; Woo, J.; Kim, S.; Rasck, J.; Smetana, S.; Ajax, K.; Bylander, L.; Lindberg, A.; Dellborg, H.; Hultsberg-Olsson, G.; Harsmar, K.; Knutsson, A.; Håkansson, L.; Kåveryd-Holmström, M.; Lundmark, L. M.; Norrfors, B.; Löf, P.; Skoglund, K.; Torgersruud, M.; Johansson, K.; Mattsson, A.; Quist, M.; Haglund, P.; Lundell, L.; Gunvasdotter, S.; Rangman, B.; Liu, R.; Shi, J.; Förstedt, G.; Nylund, L.; Welin-Berger, B.; Nilsson, O.; Garcia-Värlid, A.; Forlenza, R.; Kaminska, K.; Nagorna, T.; Cottam, V.; Harper, R.; Gilchrist, M.; Musanhu, R.; Mackin, A.; Turner, A.; Willetts, S.; Cadd, A.; Evans, J.; Young, G.; Sevillano, A.; Brodie, K.; Eccles, A.; Kelly, S.; Doughty, A.; Gray, J.; Gibson, M.; Finlayson, M.; Domingo, D.; Brazee, L.; Renaud, K.; Doman, A.; Meyer, R.; Beatty, J.; Morgan, T.; Rodas, E.; Campbell, D.; Mcquarrie, M.; Battistelli, E.; Eisenbraun, P.; Farley, R.; Park, H.; Dwyer, J.; Adams, K.; Schneider, W.; Barbour, C.; Whyne, E.; Budzinski, S.; Craig, M.; Gilley Elmore, J.; Scott, D.; Bellini, S.; Pepper, M.; Gunderson, K.; Stipek, I.; Schwarz, L.; Watkins, K.; Moore, V.; Palao, A.; Keane-Richmond, P.; Franklin, L.; Ward, L.; Kostedt, G.; Bailey, S.; Hollenweger, L.; Solomon, A.; Johnson, D.; Gloer, K.; Meyer, M.; Boleyn, M.; Nieters, D.; Humphrey, K.; Bohn, A.; Mueller, G.; Mckenzie, H.; Edwards, T.; Velky, J.; Cole, C.; Diederick, M.; Burg, S.; Coulson, T.; Karunaratne, K.; Gunasekera, R.; Cook, S.; Fisher, S.; Garrison, K.; Passey, L.; Kuykendall, K.; Luck, K.; Ramia, L.; Joan, H.; Reynoso, F.; Farley, M.; Shuman, S.; Santana-Fernandes, E.; Ventimiglia, A.; Steele, V.; Gers, L.; Brown, P.; Wilson, J.; Freebersyser, J.; Reno, M.; Buettner, N.; McGovern, M.; Hubbard, T.; Elmore, H.; Payne, D.; Mccann, M.; Decker, S.; Sharp, A.; Forgey, E.; Broussard, E.; Juett, U.; Siddiqui, A.

    2017-01-01

    We evaluated whether rivaroxaban alone or in combination with aspirin would be more effective than aspirin alone for secondary cardiovascular prevention. In this double-blind trial, we randomly assigned 27,395 participants with stable atherosclerotic vascular disease to receive rivaroxaban (2.5 mg

  7. Reducing the risk of cardiovascular disease in older women | Davey ...

    African Journals Online (AJOL)

    Cardiovascular disease (CVD) is the leading cause of death in women older than 50 years. Risk factors for CVD differ in some aspects from those in men. The prevention of CVD in women has undergone a reappraisal with the publication of studies looking at the use of menopausal hormone therapy for both primary and ...

  8. Cardiovascular Disease Risk Factors among Emerging Adults in College

    Science.gov (United States)

    Abshire, Demetrius Alexander

    2014-01-01

    The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions…

  9. Physical activity and cardiovascular disease risk factors among ...

    African Journals Online (AJOL)

    Background: Cardiovascular diseases (CVD) risk factors are increasing at an unprecedented rate in developing countries. However, fewer studies have evaluated the role of physical activity in preventing CVD in these countries. We assessed level physical activity and its relationship with CVD risk factors among young and ...

  10. Disease Human - MDC_CardiovascularMortality2006

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Polygon feature class based on Zip Code boundaries showing the rate of deaths due to major cardiovascular diseases per 1000 residents of Miami-Dade County in 2006.

  11. Translational Perspective on Epigenetics in Cardiovascular Disease

    NARCIS (Netherlands)

    van der Harst, Pim; de Windt, Leon J.; Chambers, John C.

    2017-01-01

    A plethora of environmental and behavioral factors interact, resulting in changes in gene expression and providing a basis for the development and progression of cardiovascular diseases. Heterogeneity in gene expression responses among cells and individuals involves epigenetic mechanisms. Advancing

  12. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries.

    LENUS (Irish Health Repository)

    Kotseva, Kornelia

    2009-03-14

    The first and second EUROASPIRE surveys showed high rates of modifiable cardiovascular risk factors in patients with coronary heart disease. The third EUROASPIRE survey was done in 2006-07 in 22 countries to see whether preventive cardiology had improved and if the Joint European Societies\\' recommendations on cardiovascular disease prevention are being followed in clinical practice.

  13. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease

    DEFF Research Database (Denmark)

    Sabatine, Marc S; Giugliano, Robert P; Keech, Anthony C

    2017-01-01

    -blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were receiving statin therapy. Patients were randomly assigned to receive evolocumab (either 140 mg every 2 weeks or 420 mg...... on a background of statin therapy lowered LDL cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. These findings show that patients with atherosclerotic cardiovascular disease benefit from lowering of LDL cholesterol levels below current......BACKGROUND: Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and lowers low-density lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it prevents cardiovascular events is uncertain. METHODS: We conducted a randomized, double...

  14. Cardiovascular disease, risk factors and heart rate variability in the elderly general population: Design and objectives of the CARdiovascular disease, Living and Ageing in Halle (CARLA) Study

    NARCIS (Netherlands)

    K.H. Greiser (Karin Halina); A. Kluttig (Alexander); B. Schumann (Barbara); J.A. Kors (Jan); C.A. Swenne (Cees); O. Kuss (Oliver); K. Werdan (Karl); J. Haerting (Johannes)

    2005-01-01

    textabstractBackground: The increasing burden of cardiovascular diseases (CVD) in the ageing population of industrialized nations requires an intensive search for means of reducing this epidemic. In order to improve prevention, detection, therapy and prognosis of cardiovascular diseases on the

  15. Relationship between Inflammation and Cardiovascular Diseases

    OpenAIRE

    Riddhi Patel; Henish Patel; Rachana Sarawade

    2013-01-01

    Inflammation is a part of complex biological response of vascular tissue to harmful stimuli such as pathogens, damaged cells or irritants. Recent advance in basic science have established a fundamental role for inflammation immediating all stages of cardiovascular diseases from initiation, progression and complications. Inflammation is thread linking to cardiovascular diseases. Clinical studies have shown that this emerging biology of inflammation play important role in pathogenesis of acute ...

  16. Multimorbidity in Older Patients with Cardiovascular Disease.

    Science.gov (United States)

    Dunlay, Shannon M; Chamberlain, Alanna M

    2016-01-01

    Multimorbidity affects more than two thirds of older individuals and the vast majority of patients with chronic cardiovascular disease. Patients with multimorbidity have high resource utilization, poor mobility, and poor health status and are at an increased risk for death. The presence of multimorbidity imposes numerous management challenges in caring for patients with chronic cardiovascular disease. It complicates decision-making, promotes fragmented care, and imposes an immense burden on the patient and their social support system. Novel models of care, such as the cardiovascular patient-centered medical home, are needed to provide high-quality, efficient, effective care to this growing population.

  17. Association between cardiovascular disease and socioeconomic level in Portugal.

    Science.gov (United States)

    Ribeiro, Sónia; Furtado, Cláudia; Pereira, João

    2013-11-01

    Cardiovascular disease is the leading cause of morbidity, mortality and disability in Portugal. Socioeconomic level is known to influence health status but there is scant evidence on socioeconomic inequalities in cardiovascular disease in Portugal. To analyze the distribution of cardiovascular disease in the Portuguese population according to socioeconomic status. We conducted a cross-sectional study using data from the fourth National Health Survey on a representative sample of the Portuguese population. Socioeconomic inequalities in cardiovascular disease, risk factors and number of medical visits were analyzed using odds ratios according to socioeconomic status (household equivalent income) in the adult population (35-74 years). Comparisons focused on the top and bottom 50% and 10% of household income distribution. Of the 21 807 individuals included, 53.3% were female, and mean age was 54 ± 11 years. Cardiovascular disease, stroke, ischemic heart disease, hypertension, diabetes, obesity and physical inactivity were associated with lower socioeconomic status, while smoking was associated with higher status; number of medical visits and psychological distress showed no association. When present, inequality was greater at the extremes of income distribution. The results reveal an association between morbidity, lifestyle and socioeconomic status. They also suggest that besides improved access to effective medical intervention, there is a need for a comprehensive strategy for health promotion and disease prevention that takes account of individual, cultural and socioeconomic characteristics. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  18. Cardiovascular Risk and Hippocampal Thickness in Alzheimer’s Disease

    Directory of Open Access Journals (Sweden)

    Markus Donix

    2013-01-01

    Full Text Available Cardiovascular risk factors influence onset and progression of Alzheimer’s disease. Among cognitively healthy people, changes in brain structure and function associated with high blood pressure, diabetes, or other vascular risks suggest differential regional susceptibility to neuronal damage. In patients with Alzheimer’s disease, hippocampal and medial temporal lobe atrophy indicate early neuronal