Cvd Prevention and Control最新文献

The primary goal of this workshop was to identify the most appropriate method to estimate the potential effect of reduction in sodium consumption on mortality. Difficulty controlling hypertension at the individual level has motivated international, federal, state, and local efforts to identify and implement population-wide strategies to better control this problem; reduction of sodium intake is one such strategy. Published estimates of the impact of sodium consumption on mortality have used different modeling approaches, effect sizes, and levels of sodium consumption, and thus their estimates of preventable deaths averted vary widely, and are not comparable. In response to this problem, the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention (DHDSP) convened and facilitated a workshop to examine different methods of estimating the effect of sodium reduction on mortality. The panelists agreed that any of the methodologies presented could provide reasonable estimates, and therefore discussion focused on challenges faced by all methods. The panel concluded that future sodium modeling efforts should generate multiple estimates employing the same scenarios and effect sizes while using different modeling techniques; in addition, future efforts should include outcomes other than mortality (morbidity, costs, and quality of life). Varying reductions in sodium should be modeled at the population level over different time intervals. In an effort to better address some of the uncertainties highlighted by this workshop, the panelists are currently considering developing multiple estimates in a collaborative manner to clarify the potential impact of population-based interventions to reduce sodium consumption.

Background

Autoantibodies against cardiac troponin I (cTnI) play an important role in the pathogenesis of experimental cardiomyopathy. We developed a new method to measure anti-cardiac troponin I autoantibody (Anti-cTnIAAB) in patients with myocarditis with or without HCV infection.

Methods

Patients with heart failure for up to 2 years, without a distinct cause, were enrolled in the Myocarditis Treatment Trial between 1986 and 1990. Frozen blood samples were available from 1315 to 2233 enrolled patients. Anti-cTnIAAB was determined by a two-step immunoassay.

Results

The mean (±SEM) value of serum Anti-cTnIAAB titer in the 1315 patients was 0.067 ± 0.003 arbitrary unit (AU), significantly higher than in 1115 healthy volunteers (0.053 ± 0.002 AU, P < 0.01). The mean Anti-cTnIAAB titer in 88 patients whose endomyocardial biopsies (EMB) satisfied the diagnostic Dallas criteria was 0.086 ± 0.010 AU, versus 0.066 ± 0.004 AU in 1227 patients whose EMB did not satisfy these criteria. The mean Anti-cTnIAAB in both groups was significantly higher than that measured in the healthy volunteers (P < 0.01). The mean Anti-cTnIAAB titer in the 88 patients with Dallas criteria-confirmed myocarditis tended to be higher than in the other 1227 patients. Among the 88 patients with Dallas criteria-confirmed myocarditis, the mean Anti-cTnIAAB titer in 5 patients infected with the hepatitis C virus infection (HCV) was significantly higher (0.146 ± 0.047 AU) than in 83 patients without HCV infection (0.082 ± 0.010 AU, P < 0.05).

Conclusions

Elevated autoantibody titers against cTnI were detected in patients with myocarditis, and were higher in HCV-infected patients. The presence of Anti-cTnIAAB might correlate with inflammation and viral infection of the heart.

Objective

The Malaysian NCVD-PCI registry attempts to determine the number and to monitor the outcomes of Percutaneous Coronary Intervention (PCI), based on selected performance indicators. It provides a comprehensive view to determine the level of adherence to existing guidelines, to evaluate the cost-effectiveness of treatment and prevention programs and to facilitate quality improvement activities of the participants. It also aims to stimulate research and to act as a reference for future studies.

Methods

It was a voluntary, multi-centered, observational, cohort study and included patients of 18 years or above, with coronary artery disease who underwent PCI at eight participating centers in the year 2007.

Results

A total of 3677 patients underwent 3920 PCI procedures with 6299 stents for 5512 lesions. The mean age of patients was 56.7 ± 10.11 years. The mean BMI was 26.38 ± 4.21 kg/m², while 80% of all subjects had a BMI above 23 kg/m². Males constituted 81.2% of the total population and 98.4% of the total population had at least one cardiovascular risk factor. Regarding PCI status, 90.1% were elective cases and 94% of cases had a low TIMI risk index at the beginning of PCI. Femoral approach accounted for 59%, radial approach for 34% and brachial approach for 1% of all cases. The median fluoroscopy time was 15.7 min and the median door-to-balloon time for primary infarct PCI was 93.5 min. The commonest site of lesion was the left anterior descending artery, accounting for 48% of all lesions and 92.8% of all lesions were de novo. The mean lesion length was 24.4 ± 15.18 mm and about 28% of all lesions had high risk characteristics. Drug-eluting stents and bare metal stents were used in 53.6% and 42.5% of cases, respectively. After PCI, 91% of all lesions achieved TIMI grade 3 flow. Regarding pharmacotherapy, 99.5% of all patients received unfractionated heparin, 5% received LMWH prior to intervention, 96% received aspirin and 98% received clopidogrel. Over-all in-hospital mortality and 30 day mortality for the entire cohort was 1.1% and 1.8%, respectively.

Conclusion

A summary of the first nationwide PCI registry has been presented. The subjects were much younger with a high prevalence of cardiovascular risk factors. The majority of cases (90%) were elective procedures with a low TIMI risk index. Mean door-to-balloon time for primary PCI was higher than the recommended guidelines. There was good prescribing of antiplatelets and heparin. Over-all in-hospital and 30 day mortality were comparable to other registries.

Community Interventions for Health (CIH) is a 3 year pilot study focusing on testing chronic disease prevention activities in developing country settings. CIH uses structural interventions and community mobilization, supported by health education and social marketing/media. The activities of CIH are pervasive throughout defined community settings using schools, work places, health care settings, and the community at large to create sustainable change. CIH seeks to: (1) assess the impact of the interventions on individuals and on the community, (2) assess the best methods for intervention implementation, (3) identify adaptations needed for global replication, and (4) identify community-specific barriers and facilitators to change. Additionally, the CIH study provides the larger medical and public health community with research and evaluation tools and methodology, including context assessment manuals, environmental scan tools and processes, and adaptations for developing country settings. CIH is building a large dataset of common measures across countries that may be used to inform local and national policies and practices. The purpose of this paper is to present the results of a several year planning process that includes a theoretical framework and study design that highlights the key elements of conducting complex community interventions in developing country settings.

Purpose of the research

Does remote preconditioning by aortic constriction (RPAC) afford cardioprotection similar to classical or other remote ischaemic preconditioning stimulus? Moreover, the study was also designed to investigate the role of inducible nitric oxide synthase (iNOS) in remote preconditioning by aortic constriction. There are sufficient evidence that ‘ischaemic preconditioning’ has surgical applications and affords clinically relevant cardioprotection. Transient occlusion of the circumflex artery, renal artery, limb artery or mesenteric artery preconditions the myocardium against ischaemia/reperfusion injury in case of ischaemic heart disease leading to myocardial infarction. Here, the abdominal aorta was selected to produce RPAC.

The principal results

Four episodes of ischaemia/reperfusion of 5 min each to the abdominal aorta produced RPAC by assessment of infarct size, lactate dehydrogenase (LDH) and creatine phosphokinase (CK). These studies suggest RPAC produced acute (FWOP) and delayed (SWOP) cardioprotective effects. RPAC demonstrated a significant decrease in ischaemia/reperfusion-induced release of LDH, CK and extent of myocardial infarct size. l-NAME (nitro-l-arginine-methylester) (10 mg kg⁻¹ I.V.), aminoguanidine (150 mg kg⁻¹ s.c.), aminoguanidine (300 mg kg⁻¹ s.c.), S-methyl isothiourea (3 mg kg⁻¹ I.V.) and 1400W (1 mg kg⁻¹ I.V.) administered 10 min. before global ischaemia/reperfusion produced no marked effect. Aminoguanidine (150 mg kg⁻¹ s.c.), aminoguanidine (300 mg kg⁻¹ s.c.), S-methyl isothiourea (3 mg kg⁻¹ I.V.) and 1400W (1 mg kg⁻¹ I.V.) pre-treatment after RPAC produced no significant effect on acute RPAC-induced decrease in LDH, CK and infarct size, whereas l-NAME (10 mg kg⁻¹ I.V.) increased RPAC-induced decrease in LDH, CK and infarct size. The most interesting observation is with respect to delayed RPAC, where all NOS inhibitors’ pre-treatment attenuate RPAC-induced decrease in LDH, CK and infarct size.

Major conclusions

RPAC affords cardioprotection similar to classical or other remote ischaemic preconditioning stimulus. Moreover, late or delayed phase of RPAC has been mediated iNOS, whereas it is not involved in acute RPAC.

Hypertension is inadequately controlled in most patients due to poor adherence to treatment. Not much is known about the underlying reasons for poor adherence. The main objective of this study was to assess medication adherence in hypertensive patients and to identify the main barriers associated with medication adherence. A questionnaire-based survey was conducted in the medicine outpatient department of Kempe Gowda Institute of Medical Sciences and Research Centre, Bangalore, India. Self reported adherence was measured by using a short validated questionnaire and detailed patient interviews. Of the 608 patients participated, non-adherence was found in 49.67% of patients. Belief barrier was reported in 39.14% patients. Access barrier and recall barrier were reported by 82.57% and 62.17%, respectively. 78.62% of patients reported that it is difficult to pay for the medication and 54.93% indicated that it is difficult to get a refill on time. It was concluded that about half of the Indian patients studied were not adherent to their antihypertensive regimen and this might result in poor blood pressure control. Non-adherence to hypertension management remains a major limiting factor among Indians in the effective control of hypertension and in the prevention of cardiovascular diseases.

Objective

To determine the cardiovascular disease risk factor profile of Pakistani patients.

Material and methods

In this cross sectional study, 10,000 patients with CVD were recruited. This 1 year study was conducted in the outpatient department of Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC-NIHD), which provides primary, secondary and tertiary cardiac care to patients from all over the country. The CVD risk factors studied included hypertension, diabetes, dyslipidemia, obesity, smoking, alcohol intake, inactivity, eating <5 portions of fruits and/or vegetables per day.

Results and discussion

Of the study participants 73.5% were males while 26.5% were females. Their average age was 53.83 ± 14.18 years and 51.68 ± 15.83 years, respectively. The frequency of premature CVD was 27.2% in males and 49.1% in females. 46.9% males and 77.4% females had abdominal obesity, 15.6% men and 1.9% women being current smokers. Blood cholesterol levels were >200 mg/dl in 10% of all study subjects. In a decreasing order, poor lipid values were seen for HDL, VLDL, TG, cholesterol, LDL and LDL/HDL. Diabetes and hypertension affected 18.5% and 8% study subjects, respectively. Mean BMI was 21.02 kg/m² in men and 22.41 kg/m² in women. 64.5% participants did not take five or more servings of fruits and/or vegetables per day. 66% males and 68% females were physically inactive.

Conclusion

Risk factors in Pakistani patients can be rank ordered as abdominal obesity, eating <5 portions of fruits and/or vegetables per day, HDL, physical inactivity, diabetes, VLDL, TG, smoking, cholesterol, hypertension, obesity, LDL, LDL/HDL and alcohol.