Cvd Prevention and Control最新文献

Objective

The Malaysian NCVD-ACS (National Cardiovascular Disease Database-Acute Coronary Syndrome) registry attempts to determine the incidence and demographic profile of patients with ACS and to identify high risk group among them. It provides a comprehensive view to assess treatment strategies and adherence to existing guidelines for ACS patients; which can help in future development. It also aims to facilitate research using this database.

Methods

The study included patients with ST-segment elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) and unstable angina (UA) admitted to 11 participating sites in Malaysia from 1st January 2006 to 31st December 2006. The data were analyzed in terms of characteristics, clinical presentation, treatment, in-hospital outcome and 30-day outcome.

Results

A total of 3422 patients were enrolled, with male to female ratio of 3:1, mean age of 59 ± 12 years and mean BMI of 25.8 ± 4.4 kg/m². Among total study population, 96% had at least one established cardiovascular risk factor. In STEMI population, 70% received fibrinolytic therapy and 8% proceeded for primary percutaneous coronary intervention (PCI). Mean door-to-needle time for fibrinolytic therapy was 103 ± 143 min. Medical management was conducted for 86% of NSTEMI and 91% UA patients, with intervention for 14% and 9% respectively. The overall in-hospital mortality and 30-day mortality were 7% and 8% respectively.

Conclusion

In our NCVD-ACS registry, when compared with other registries, the subjects were much younger at presentation and had higher prevalence of established cardiovascular risk factors, indicating the importance of primary prevention programme. Majority of the patients were managed medically, with low rates of cardiac interventions, the factor being driven largely by availability of resources. Mean door-to-needle time was much higher than the recommended guidelines, an issue that needs attention. The results indicate many opportunities for improvement of in-hospital and 30-day mortality.

Background

When allocating limited resources, public and private sector leaders in health policy consider both the health and economic value of new measures for cardiovascular disease (CVD) prevention. The ability to develop and prioritize policy measures is hindered by important gaps in health economics data.

Methods and Results

The Policy Research Implementation Group (PRIG) of the National Forum for Heart Disease and Stroke Prevention convened a symposium to develop priorities for research on the economics of CVD primary prevention and elimination of CVD disparities. Suggested top opportunities include expanded CVD surveillance, advances in evaluation and economic modeling of primary prevention, and use of behavioral economics to identify new prevention strategies. Enhanced policy, funding, and leadership support are vital to realizing this research agenda.

Conclusions

Targeted research on the health and economic value of CVD prevention, especially to eliminate CVD disparities, would bolster the justification for increased investment in cardiovascular health.

Objectives

To evaluate the effectiveness of a single bolus dose of eptifibatide in elective percutaneous coronary intervention.

Methods

The outcomes of 85 consecutive patients who underwent elective coronary stenting from January 2007 to December 2007 were assessed prospectively. Forty-four patients received eptifibrate (15 mg single bolus dose) after crossing the lesion and 41 patients did not receive eptifibatide. All patients were treated with aspirin and clopidogrel before and after the procedure and all received a single bolus dose of clopidogrel (300 mg) before the procedure. All patients received weight-adjusted doses of heparin before and after the procedure. The primary endpoint for the study was the 30-day incidence of death, myocardial infarction, urgent repeat revascularization or in-hospital major bleeding. Major adverse cardiac events were assessed during hospitalization and one month post-procedure. CK-MB was measured post-procedure in all symptomatic patients.

Results

Mean age of Group I (Eptifibatide used) was 52.34 ± 8.90 years, and Group-II (Eptifibatide not used) was 49.68 ± 8.87 years. In group-I 38.63% had history of Myocardial Infarction (MI), 9.09% had history of Unstable angina (UA), 52.27% had history to chronic stable angina (SA), 54.54% was hypertensive, 40.90% were diabetic, 63.63% had dyslipidemia; 56.81% was diagnoses as single vessel disease (SVD), 36.36% was double vessel disease (DVD). Among group-II patients, 36.58 5 had history of MI, 12.19% had history of UA, 51.21% had history of SA, 51.21% was hypertensive, 26.82% was diabetic, 60.97% had dyslipidemia, 63.41% was diagnosed as a SVD, 29.26% was DVD. In short term (one month) outcome, Group I patients had statistically significant less complications in comparison to Group-II patient (p = 0.017). In Group-I only 2.27% had Q wave MI AND 2.27% had minor bleeding complication, whereas in Group-II patients 9.76% had Q wave MI, 7.32% had Non-Q MI and 4.88% needed target vessel revascularization again.

Conclusion

Single-bolus eptifibatide is a safe and highly cost-effective alternative to conventional regimens.

We investigated the association of the variability of acute myocardial infarction (AMI) occurrences between warm and colder periods and the conventional cardiovascular risk-factors. For the registered 429 first-ever-AMI event, the odd of suffering an AMI during the colder period was significantly higher (OR 1.47, 95%CI: 1.21–1.78). None of the conventional cardiovascular risk factors explains the excess risk of AMI during the colder period pointing towards the influence of AMI triggering factors in the time preceding onset of AMI irrespective of presence or absence of cardiovascular risk-factors.

There are conflicting reports about the role of conventional risk factors in coronary artery disease from some of the studies in India. The present study tried to determine the association of conventional risk factors in patients with coronary artery disease (CAD) and correlate with findings on coronary angiography.

Material and methods

Study was conducted at the PGIMER in 1003 consecutive patients with angiographic proven coronary artery disease. They were assessed for cardiovascular risk factors like age, sex, history of smoking, diabetes, hypertension (physician diagnosed) and family history of CAD. Anthropometric data for height, weight, body mass index (BMI), waist circumference and waist hip ratio were recorded using standard methods. Lipid profile and blood sugar estimation was done.

Results

The mean age was 56 ± 10.8 years with 82.8% were males. Hypertension, diabetes mellitus, history of smoking, family history and dyslipidemia were present in 59.6%, 25.8%, 32%, 6.8%, and 56% respectively. Central obesity was seen in 75.6% of male (WHR > 0.90) and 88.3% of female (WHR > 0.80) patients. Single, double and triple vessel disease was present in 50.4%, 28.2% and 16% cases respectively. Types A, B and C lesions were seen in 32.7%, 41.3%, and 37.6% cases respectively. About two fifth (39.8%) cases presented with acute myocardial infarction, 22.4% with unstable angina/NSTEMI and 37.8% with chronic stable angina. Logistic regression analysis showed that diabetes, waist hip ratio and raised triglycerides were significantly associated with increasing severity of lesion. Further diabetes also showed significant association with increased vessel wall involvement. Health promotion programmes focusing on conventional risk factors and secondary prevention focusing on early diagnosis, management and lifestyle modifications may be the key interventions for prevention and control of CAD.

Background

We examined the circadian periodicity of acute myocardial infarction (AMI) onset to identify any existing specific pattern using 17-year AMI registration data.

Methods

Data were obtained from the Takashima AMI Registry, which covered a stable population of approximately 55,000 in Takashima County in central Japan. Out of 429 registered first-ever AMI events from 1988–2004, there were 352 events with classifiable onset time. AMI onset was categorized as occurring at night (midnight to 6 a.m.), morning (6 a.m. to noon), afternoon (noon to 6 p.m.) or evening (6 p.m. to midnight).

Results

There was a significant diurnal variation in AMI incidence (P < 0.001) with the highest proportion in the morning (32.4%, 95% CI: 27.7–37.5) and lowest in the nighttime (17.4%, 95% CI: 13.7–21.7). An excess AMI incidence in the morning was observed in both genders and in subjects ⩾65 years old. A second surge was also observed during the later part of the day. The morning excess of AMI incidence was similar across seasons and days of the week. For all AMIs, the age and gender adjusted risk was 1.82 (95% CI: 1.33–2.49) times higher in the morning than at night.

Conclusion

A diurnal pattern of AMI onset was observed in a Japanese population with a morning peak and nighttime trough, and the pattern was similar across seasons of the year and days of the week.

Objective

To describe the extent and content of tobacco-related images, advertising and articles published in the largest Argentinean newspapers before and after a voluntary advertising ban implemented in 2001.

Methods

Issues from four months of each year of the four main national newspapers were examined from 1995 to 2004. We recorded the number of tobacco images (advertisement or not), tobacco-focused articles, space used, and placement within the newspaper. Regression analyses evaluated time trends.

Results

We identified 1800 images and articles from 4828 different issues. Non-advertisement images were the most frequent (71.2%), followed by articles (20%) and advertisement images (8.8%). Advertisements only appeared in the two best selling newspapers with a majority (57%) in the Sunday magazine and 21% in the sports sections. Non-advertisement images were published in the sports and entertainment sections (55%) and showed a public figure in 88%. Of 336 articles, 39% focused on health topics and 55% emphasized the negative effects of tobacco on health. Regression models showed that prior to 2001 there were significant time-related decreases in ad images and articles and significant increases in non-ad images. The trend of each outcome changed direction beginning in 2001 and the magnitude of the change in trend was significant for ad images and non-ad images. The number of non-ad images dropped significantly in 2001 from a model-predicted value of 178 per year to 103 non-ad images and remained constant thereafter.

Conclusions

Tobacco images exceeded information about tobacco hazards in Argentinean newspapers over this period. Advertisement increased from 2001 to 2005, following the voluntary advertisements ban. Partial advertisement bans are ineffective and a total ban is imperative.