Cvd Prevention and Control最新文献

Background

Heart failure is commonly associated with psychological symptoms. These symptoms are often neglected, underdiagnosed or inadequately treated and therefore impact negatively on the recovery of and quality of life of these patients. This study aimed at determining the frequency of psychological distress (anxiety and/or depression) and its correlates in Nigerian patients with heart failure.

Methods

The subjects comprised one hundred (1 0 0) confirmed heart failure patients in steady state. They were recruited consecutively from the cardiology outpatient clinics of two tertiary hospitals in Nigeria.

A self administered questionnaire was used to collect sociodemographic and clinical data. Psychological distress was assessed using a psychometric questionnaire – the Hospital Anxiety and Depression Scale (HADS) and the severity of heart failure was assessed according to the New York Heart Association criteria (NYHA).

Results

Anxiety was found in 16% of the patients, depression in 13% and 39% had anxiety co-morbidly presenting with depression. Psychological distress was more common in younger patients (less than 50 years) (p < 0.05). No significant association was found between psychological distress and gender, marital status, aetiology of heart failure, duration of illness and NYHA functional class (p > 0.05).

Conclusion

Anxiety and depression have been found to be common in heart failure patients in Nigeria and affects more of the younger patients.

More attention should be focused on psychological co-morbidity in heart failure in order to improve clinical outcome.

Objective

To determine the current frequency of anti-platelet use as indicated in medical charts of diabetic hypertensive patients with and without cardiovascular disease (CVD) using American Diabetes Association (ADA) guidelines compared with use in 2003.

Methodology

Data from both years were collected retrospectively from diabetic hypertensive patients attending government clinics in Nablus district, Palestine. Demographic details and medications were obtained from medical files. Diabetes mellitus and hypertension were confirmed based on documentation of the diagnosis and on listed anti-diabetic and anti-hypertensive medications. Eligibility for anti-platelet therapy was determined with reference to ADA guidelines.

Results

There were 358 patients included in the 2008 study with a mean age of 64.4 years. The mean age of the 342 patients included in the 2003 study was 64.4 ± 8.7 years. Aspirin was the only anti-platelet drug documented in the files in both years. The overall frequency of aspirin listed in 2008 was 66.5% compared to 31.5% in 2003. Among patients with CVD, aspirin therapy for secondary prevention (SP) was found in 77.9% of cases in 2008 compared to 82.4% in 2003 (P = 0.23). Among patients without CVD for whom anti-platelet therapy was indicated, aspirin was listed for primary prevention (PP) in 56.9% of cases in 2008 compared to 17.5% in 2003 (P = 0.001). In 2008, the frequency of aspirin use was independent of gender or age. However, in 2003, the frequency of aspirin use was significantly higher in men and younger patients than in women and elderly patients.

Conclusion

There has been an improvement in anti-platelet therapy using aspirin for primary prevention among high risk patients. No significant change was observed for secondary prevention over the five years. Efforts are needed to enhance the use of aspirin particularly for cardiovascular patients requiring secondary prevention.

Background and objective

Anti-hypertensive medications are recommended for prevention of recurrent ischemic stroke in hypertensive and normotensive patients. The objective of this study was to analyze the use of anti-hypertensive therapy in acute ischemic stroke survivors.

Methods

All ischemic stroke survivors discharged from Al-watani governmental hospital in Palestine from August 2006 until September 2007 were investigated. Demographic data, clinical characteristics, and different classes of anti-hypertensive medications prescribed to stroke survivors were analyzed using SPSS 15.

Results

One hundred and twenty four ischemic stroke survivors were identified, of which 80 (64.5%) had a documented history of hypertension (HTN). Two thirds of the survivors (n = 82; 66.1%) were prescribed anti-hypertensive medications, mostly as mono-therapy, at discharge. Angiotensin-converting enzyme inhibitors (ACEI) 65 (45.6%), followed by diuretics 41 (34.5%) were the most common drug classes prescribed. ACEI were used in combination with diuretics in 29 (23.4%) survivors. Among survivors with a documented history of HTN, 70 (85.5%) were prescribed anti-hypertensive medications at discharge while 12 (8.5%) of survivors with no history of HTN were prescribed anti-hypertensive medications at discharge.

Conclusion

In this study, the use of anti-hypertensive medications as a mono-therapy was common among those with a history of hypertension but not among those without a history of hypertension.

Background

High cholesterol, leukocytes (LEUK) and erythrocyte sedimentation rate (ESR) are associated with cardiovascular diseases.

Design

Cross sectional study of 10,000 healthy young men.

Methods

About 10,167 men were analyzed for the association of cholesterol concentrations and erythrocyte sedimentation rate with fitness (assessed by achieved physical working capacity at a heart rate of 170 beats per min = PWC170). Physical fitness was categorized as low (<2.5 W/kg; n = 2755) medium (2.5–2.8 W/kg; n = 3783) and good (>2.8 W/kg; n = 3629). Cholesterol was categorized as elevated cholesterol (>200 mg/dl) and normal cholesterol concentration (<200 mg/dl).

Results

Men with elevated cholesterol compared to men with normal cholesterol concentrations had significantly higher LEUK (6.34 ± 1.47 vs. 6.17 ± 1.44; p < 0.001) and ESR (2.86 ± 3.06 vs. 2.44 ± 2.43; p < 0.001). When stratified by physical fitness, this effect was present in men with low physical fitness (LEUK 6.48 ± 1.51 vs. 6.27 ± 1.44; p = 0.001; ESR 3.32 ± 3.78 vs. 2.72 ± 3.03, p < 0.001) and medium physical fitness (LEUK 6.38 ± 1.44 vs. 6.16 ± 1.43, p < 0.001; ESR 2.77 ± 3.04 vs. 2.40 ± 2.36, p < 0.001), but not in men with good physical fitness.

Conclusion

Cholesterol greater than 200 mg/dl was associated with elevated leukocytes and erythrocyte sedimentation rates, suggestive of a higher burden of inflammation. In young men with good physical fitness, this association was not present, indicating that physical fitness might be effective in preventing cardiovascular diseases by reducing the cholesterol mediated triggering of inflammation.