Cardiovascular complaints following the uprising of December 1989 in Romania

Health Policies in Romania to Reduce the Mortality Caused by Cardiovascular Diseases

Cardiovascular diseases (CVDs) are the main cause of death in Romania. The objective of the paper is to explain the number of deaths caused by the diseases of circulatory system in relation to health expenditures per capita, the number of public hospitals with cardiology sections and the number of cardiologists. The analysis in the paper is based on panel data models and Bayesian linear models. A panel data approach for Romanian macro-regions in the period from 1995-2016 was used to show that an increase in the number of cardiologists would reduce the number of deaths caused by the diseases of circulatory system. The Bayesian approach to national data indicated that the increase in expenditures per capita would alleviate the incidence of deaths caused by CVD. The public health policies in relation to patients with CVD should focus on the future on higher expenditures per person, but the number of public hospitals and doctors treating these diseases should also continue to grow. Future healthcare policies should be also focused on reducing the number of specialists migrating to wealthier countries.

Impact of armed conflict on cardiovascular disease risk: a systematic review

OBJECTIVES

Prolonged armed conflict may constrain efforts to address non-communicable disease in some settings. We assessed the impact of armed conflict on cardiovascular disease (CVD) risk among civilians in low/middle-income countries (LMICs).

METHODS

In February 2019, we performed a systematic review searching Medline, Embase, PsychINFO, Global Health and Web of Science without language or date restrictions. We included adult, civilian populations in LMICs. Outcomes included CVDs and diabetes, and eight clinical and behavioural factors (blood pressure, blood glucose, lipids, tobacco, alcohol, body mass index, nutrition, physical activity). We systematically reanalysed data from original papers and presented them descriptively.

RESULTS

Sixty-five studies analysed 23 conflicts, and 66% were of low quality. We found some evidence that armed conflict is associated with an increased coronary heart disease, cerebrovascular and endocrine diseases, in addition to increased blood pressure, lipids, alcohol and tobacco use. These associations were more consistent for mortality from chronic ischaemic heart disease or unspecified heart disease, systolic blood pressure and tobacco use. Associations between armed conflict and other outcomes showed no change, or had mixed or uncertain evidence. We found no clear patterning by conflict type, length of follow-up and study quality, nor strong evidence for publication bias.

CONCLUSIONS

Armed conflict may exacerbate CVDs and their risk factors, but the current literature is somewhat inconsistent. Postconflict reconstruction efforts should deliver low-resource preventative interventions through primary care to prevent excess CVD-related morbidity and mortality.

PROSPERO REGISTRATION NUMBER

CRD42017065722.

Emotional triggering of cardiac events

Psychological factors may contribute not only to the evolution of coronary atherosclerosis and long-term risk of coronary heart disease, but also to the triggering of acute cardiac events in patients with advanced atherosclerosis. Evidence for emotional triggering of cardiac events derives both from population-based studies of hospital admissions and sudden deaths following major traumas such as earthquakes and terrorist incidents, and from individually based interview studies with survivors of acute coronary syndromes (ACS). The latter indicate that acute anger, stress and depression or sadness may trigger ACS within a few hours in vulnerable individuals. The psychobiological processes underlying emotional triggering may include stress-induced haemodynamic responses, autonomic dysfunction and parasympathetic withdrawal, neuroendocrine activation, inflammatory responses involving cytokines and chemokines, and prothrombotic responses, notably platelet activation. These factors in turn promote coronary plaque disruption, myocardial ischaemia, cardiac dysrhythmia and thrombus formation. The implications of these findings for patient care and ACS prevention are outlined.

Emotional triggers of acute coronary syndromes: strength of evidence, biological processes, and clinical implications

Emotional triggers of acute coronary syndromes include population-level events such as earthquakes and terrorist attacks, and individual experiences of acute anger, stress and depression. The methodology of studying emotional triggers has developed markedly over recent years, though limitations remain. The biological processes underlying triggering include acute autonomic dysregulation, neuroendocrine activation, hemostatic and inflammatory responses which, when associated with plaque disruption, promote myocardial ischemia, cardiac dysrhythmia and thrombosis formation. Prevention and management strategies for ameliorating emotional triggering remain to be effectively developed.

Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique

OBJECTIVE

The objective of this study was to review the evidence that behavioral and emotional factors are triggers of acute coronary syndromes.

METHOD

Systematic review of the published literature from 1970 to 2004 of trigger events, defined as stimuli or activities occurring within 24 hours of the onset of acute coronary syndromes.

RESULTS

There is consistent evidence that physical exertion (particularly by people who are not normally active), emotional stress, anger, and extreme excitement can trigger acute myocardial infarction and sudden cardiac death in susceptible individuals. Many triggers operate within 1 to 2 hours of symptom onset. There are methodologic limitations to the current literature, including sampling, retrospective reporting, and presentation biases, the role of memory decay and salience, and reverse causation because of silent prodromal events.

CONCLUSIONS

Behavioral and emotional factors are probable triggers of acute coronary syndromes in vulnerable individuals, and the pathophysiological processes elicited by these stimuli are being increasingly understood. The benefits to patients of knowledge to these processes have yet to accrue.