Cvd Prevention and Control最新文献

Aim

This study examined the prevalence of coronary risk factors and significant predictors of coronary artery disease (CAD) in one of the poorest states of Eastern India among a unique ethnic urban population that is experiencing changing lifestyle patterns.

Methods

A multi-stage probability sampling from a sampling frame of 37 electoral wards geographically representative of the urban population of Berhampur, with a population of 307,724 in 2001, was based on an estimated sample of 1200 with adequate power. One thousand one hundred and seventy eight subjects (590 males; 588 females) ⩾20 years of age were finally selected. In addition to socio-demographic characteristics, physiological, behavioral, anthropometric and biochemical parameters were ascertained using interviewer-completed questionnaires and appropriate clinical examinations. Both descriptive and multivariable logistic regression analyses were performed.

Results

The overall prevalence of CAD was 10%. The main coronary risk factor prevalence rates were: hypertension (37%); smoking (27%); hypercholesterolemia (23%); diabetes (16%); central obesity (49%); physical inactivity levels (34%); and 47% had low HDL levels. Overall, age, central obesity, hypertension (adjusted odds ratio: 2.2; 95% confidence interval: 1.4; 3.4), physical inactivity levels and diabetes in females alone were significant predictors of CAD.

Conclusions

A high CAD prevalence of 10%, with higher rates of some classical cardiovascular risk factors such as diabetes, hypertension and physical inactivity levels, reinforce the need for a comprehensive CAD prevention and control program. This is the first study conducted in one of the poorest states within the fold of an emerging economy, clearly suggesting the ubiquitous nature of the CAD epidemic.

Background

Cardiovascular disorders (CVD) are due to a constellation of modifiable and non-modifiable risk factors – some known and others unknown. Such risk factors are reported to vary across ethnicities. CVD will likely become a major public health and clinical problem in Asia such that by the year 2020 Asia will have more individuals with CVD than any other region. However, the current evidence on variations in cardiovascular risk factors both from a clinical and an epidemiological perspective with special reference to developing country settings is limited. In this context, we set out to review the existing evidence and to summarize the findings.

Methods

We did not carry out a systematic review but pursued a similar structure. We abstracted the most appropriate published literature from electronic databases, namely, PubMed, Embase and the Cochrane Library applying specific search terms. We searched grey literature and followed up bibliographic references.

Results

Ethnicity is emerging as an independent risk factor contributing to the rising epidemic of CVD in developing countries. Furthermore, increasing rates of urbanization have led to striking changes in lifestyle patterns resulting in decreasing physical activity, increasing weight and, consequently, increasing rates of diabetes, hypertension and dyslipidemia in urban Asians.

Conclusions

Variations in selected cardiovascular risk factors in developing countries were identified. Prediction tools and risk assessments need to be population-specific and sensitive to ethnic minorities. This summary of evidence could help to shift priorities to populations for targeted cardiovascular prevention and control measures where resources are limited.

Background

Although prevention of heart failure (HF) is an urgent public health need with national and global implications, population-based studies are rare.

Methods and results

We studied risk factors for HF and coronary heart disease (CHD) mortality using the NIPPON DATA80 database with a 24-year follow-up. At the baseline in 1980, data were collected on study participants aged 30 years and over from randomly selected areas in Japan. We followed 9300 participants (44% men, mean age 51). Over the 24-year follow-up, there were 189 deaths from HF (82 men and 107 women) and 188 (91 men and 97 women) from CHD. Cox analyses revealed common and specific risk factors for both mortalities. Common risk factors were: systolic blood pressure for male HF (hazard ratio: 1.28 per 1SD, P = 0.02) and for CHD in both (men: 1.20, P = 0.01; women: 1.27, P = 0.003), smoking for male CHD (1.31, P = 0.004) and for female HF (1.39, P = 0.01), blood sugar for HF and CHD in men (HF: 1.21 per 1SD, P = 0.009; CHD: 1.29, P < 0.0001); T wave abnormality in male HF (2.33, P = 0.003) and female CHD (1.84, P = 0.001). Specific risk factors were: serum creatinine for HF in both (men: 1.14 per 1SD, P < 0.0001, women: 1.09, P = 0.01); total cholesterol for CHD in men (1.38 per 1SD, P = 0.001), history of valvular heart disease (6.48, P = 0.002) or stroke (2.41, P = 0.048) in male HF, and history of angina in female CHD (3.59, P = 0.003).

Conclusion

Common and specific measures need to be undertaken to prevent HF and CHD mortality.

Background

Obesity is a coronary disease risk factor demonstrating inconsistent effects on acute coronary syndrome (ACS) outcome.

Methods

To explore the association of body mass index (BMI) and clinical outcome in ACS patients, we analyzed data of 5751 ACS patients (77% males) from the Acute Coronary Syndrome Israel Survey between March and April during 2002, 2004 and 2006.

Results

Patients were divided into 4 National Institutes of Health, BMI-based categories: underweight (BMI < 18.5 kg/m², n = 43); normal (BMI = 18.5–24.9 kg/m², n = 1709); overweight (BMI = 25.0–29.9 kg/m², n = 2700); obese (BMI ⩾ 30 kg/m², n = 1299). Mean BMI increased significantly in ACS patients from 2002 to 2006. Time from chest pain onset to hospitalization and invasive procedure, Killip class on admission, left ventricular ejection fraction, creatinine clearance and in-hospital therapy were similar in all four groups. Obese and overweight patients were significantly younger than underweight and normal patients (61.4 ± 12.4 and 63.3 ± 12.6 years vs. 69.9 ± 17.7 and 65.3 ± 13.7 years respectively, p for trend < 0.0001). After multivariable adjustment, overweight patients had the lowest 30-day and 1-year mortality [adjusted odds ratio (OR) 0.52, 95% confidence interval (CI) 0.39–0.68 and hazard ratio (HR) 0.65, 95% CI 0.54–0.78, respectively] followed by obese [OR 0.92, 95% CI 0.66–1.28 and HR 0.91, 95% CI 0.73–1.13], normal [1.0 and 1.0] and underweight patients [1.64, 95% CI 0.59–4.61 and 1.39, 95% CI 0.73–2.63].

Conclusion

Overweight and obese ACS patients were younger with a better survival rate than normal and underweight patients. Our observation of a U-shaped relationship between increasing BMI and mortality in ACS patients warrants cautious prospective evaluation.

The public health rewards of smoke-free policies are well documented. But in their enthusiasm to achieve such policies, public health advocates and policymakers frequently underestimate the political complexity of passing laws, and then implementing and enforcing them. Using 12 African countries as the focus of discussion, this research examines the basic political process for and the barriers to achieving smoke-free policies. Moreover, in addition to the obstacles, it examines why some countries have been experiencing comparatively more success in the smoke-free policy area. The findings of the research suggest strongly that the presence of a vigorous tobacco control civil society movement, some will on the part of government institutions, and active research support contribute significantly to successful smoke-free policies. It is also apparent that the emerging battle fronts in smoke-free policies are in the areas of implementation and enforcement, and while similar variables that affect the passing of new laws also condition these outcomes, there are the added distinct challenges of policy fatigue and additional resource constraints.

Background

Although designed to predict cardiovascular disease and type 2 diabetes mellitus, the Metabolic Syndrome (MetSyn) under-predicts these conditions in African Americans (AA). Failure of MetSyn in AA is often attributed to their relative absence of hypertriglyceridemia. It is unknown if the African experience with MetSyn will be similar or different to that in AA. Focusing on the lipid profile, our goal was to determine in West Africans (WA) and AA the pattern of variables that leads to the diagnosis of the MetSyn.

Methods

Cross-sectional analysis of 1296 subjects (364 WA, 44% male, 932 AA, 46% male). WA were from urban centers in Nigeria and Ghana and enrolled in the Africa America Diabetes Mellitus Study. AA lived in Washington, DC and participated in the Howard University Family Study.

Results

The prevalence of MetSyn was different in WA women and men: 42% vs.19%, P < 0.001, and in AA women and men: 25% vs.17%, P < 0.01. The three variables that most often led to the diagnosis of MetSyn in WA and AA were: low HDL-C, central obesity and hypertension. Less than 40% of AA and less than 25% of WA with the MetSyn had hypertriglyceridemia.

Conclusions

Elevated triglyceride levels were uncommon in both WA and AA with MetSyn. As the relative absence of hypertriglyceridemia is associated with a lack of efficacy of MetSyn in AA, caution is warranted in diagnosing MetSyn in WA, the ancestral population of AA. Prospective studies are necessary to determine if an ethnic-specific reformulation of the MetSyn scoring system for lipids might optimize risk identification in black populations.