Gender, Ethnicity, and Cardiovascular Disease

Prediction models for the risk of cardiovascular diseases in Chinese patients with type 2 diabetes mellitus: a systematic review

OBJECTIVES

Diabetes mellitus (DM) is a serious public health issue worldwide, and DM patients have higher risk of cardiovascular diseases (CVDs), which is the leading cause of DM-related deaths. China has the largest DM population, yet a robust model to predict CVDs in Chinese DM patients is still lacking. This systematic review is carried out to summarize existing models and identify potentially important predictors for CVDs in Chinese DM patients.

STUDY DESIGN

Systematic review.

METHODS

Medline and Embase were searched for data from April 1st, 2011 to May 31st, 2018. A study was eligible if it developed CVD (defined as total CVD or any major cardiovascular component) risk prediction models or explored potential predictors of CVD specifically for Chinese people with type 2 DM. Standardized forms were utilized to extract information, appraise applicability, risk of bias, and availabilities.

RESULTS

Five models and 29 studies focusing on potential predictors were identified. Models for a primary care setting, or to predict total CVD, are rare. A number of common predictors (e.g. age, sex, diabetes duration, smoking status, glycated hemoglobin (HbA1c), blood pressure, lipid profile, and treatment modalities) were observed in existing models, in which urine albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) are highly recommended for the Chinese population. Variability of blood pressure (BP) and HbA1c should be included in prediction model development as novel factors. Meanwhile, interactions between age, sex, and risk factors should also be considered.

CONCLUSIONS

A 10-year prediction model for CVD risk in Chinese type 2 DM patients is lacking and urgently needed. There is insufficient evidence to support the inclusion of other novel predictors in CVDs risk prediction functions for routine clinical use.

Status and Trends in Swedish Dissertations in the Area of Cardiovascular Nursing

In Europe, cardiovascular nursing (CVN) is a young branch of nursing science. The explicit knowledge contained in CVN dissertations has, so far, not been studied in Europe, and this is especially true in the case of Sweden. Accordingly, the aim of this literature study was to describe the status of and compare trends in Swedish dissertations in the area of CVN in terms of organisational structure, approach, research strategy, social orientation and socio-demographic aspects. The literature search resulted in 29 dissertations and a 26-item questionnaire that illuminated the problem areas. Most dissertations were produced in the universities of Göteborg, Halmstad and Linköping; a minority had a nurse as main supervisor; rehabilitation was the most common CVN approach; very few of the dissertations had an experimental design; and the majority was hospital-based. The main trends were (A) an increase in dissertations that were written during the last 6 years, (B) an increased number of nurses as main supervisors as well as publication in nursing journals, (C) an increase in hospital care settings while a decrease in community settings, and finally, (D) an increased number of dissertations addressing the issues of tertiary prevention as well as focusing on patients and next-of-kin as target groups. An important implication is to stimulate nurse-led interventions at all preventative levels in order to maintain or improve the cardiac health of both healthy and sick individuals, but also in order to visualize CVN and distinguish it from cardiology.

African Americans' Perceptions of Adherence to Medications and Lifestyle Changes Prescribed to Treat Hypertension

More than 80 million Americans have hypertension (HTN), and African Americans (AAs) are disproportionately affected. AAs also have lower rates of adherence to HTN treatment. It is important to understand AAs' perceptions of adherence to develop effective interventions. The aim of this study is to examine AAs' perceptions of adherence to medications and lifestyle changes prescribed to treat HTN. In this qualitative study, we used purposive sampling to recruit Southern AAs with HTN aged 21 and older from a free, faith-based clinic. We recorded individual, in-person interviews about perceptions related to adherence to treatment of HTN and analyzed verbatim transcripts using content analysis and constant comparison. We also conducted medical record audits. Twenty-nine AAs participated (52% female, 38% were <50 years of age, 52% had taken anti-HTN medications for ≥5 years). Audits indicated that 65% had uncontrolled HTN during the previous year. Two main themes included causes of HTN and ways to improve blood pressure. Perceived causes of HTN included diet, stress, unhealthy actions, genes, and obesity. Ways to improve HTN included using cultural treatments "passed down," increasing exercise, reducing stress, and losing weight. Many reported using home remedies to control HTN, including drinking pickle juice. More than half of this sample had uncontrolled HTN. They identified influences of culture on perceptions of adherence including causes and treatment of HTN, and possibly detrimental home remedies. It is imperative that clinicians identify culturally appropriate interventions for this high-risk group.

A review on the genetic, environmental, and lifestyle aspects of the early-life origins of cardiovascular disease

This article is a comprehensive review on developmental origins of health and disease regarding various factors related to the origins of cardiovascular diseases from early life. It presents a summary of the impacts of various factors such as epigenetics; gene-environment interaction; ethnic predisposition to cardiovascular diseases and their underlying risk factors; prenatal factors; fetal programming; maternal weight status and weight gain during pregnancy; type of feeding during infancy; growth pattern during childhood; obesity; stunting; socioeconomic status; dietary and physical activity habits; active, secondhand, and thirdhand smoking, as well as environmental factors including air pollution and global climate change on the development and progress of cardiovascular diseases and their risk factors. The importance of early identification of predisposing factors for cardiovascular diseases for primordial and primary prevention of cardiovascular diseases from early life is highlighted.

Disparities in amputations in minorities

BACKGROUND

As a result of the impact of health disparities on the healthcare system such as their influence on arenas significant to healthcare distribution, including cost, quality, and access, identification and resolution of health disparities is a primary national agenda item. Resolution of disparities in amputation is an area of opportunity that warrants further consideration.

QUESTIONS/PURPOSES

The purposes of our review are to highlight current data on disparities in amputation in minorities and to consider future goals related to an elimination of this disparity.

METHODS

Studies on disparities in amputation were accessed using the following databases: PubMed, Cinahl, OVID/Medline, Embase, and Cochrane databases. In each database, a search of title/abstract was performed for the search terms "disparities and amputation," "race and amputation," and "diabetes and amputation." Each search was limited by human and English language. Where are we now? A disparity exists in both frequency and level of amputation in minorities both in the presence and absence of a diagnosis of diabetes. Where do we need to go? A need exists for future research involving a more deliberate examination of the use of preventive screening for patients at high risk for amputation across medical settings. How do we get there? Research in this area would benefit from funding, large-scale data collection, and physician exposure to education on high-risk patients and preventive screening opportunities.