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Ahmadi M, Ahadi S, Khadembashiri MA, Khadembashiri MM, Mahalleh M, AziziKia H, Zare HR, Rakhshan Khah AS, Hekmat H, Daroudi R, Akbari Sari A. Burden of ischemic heart disease in the Middle East and North Africa (MENA) and attributable risk factors: An epidemiological analysis from 1990 to 2019. IJC HEART & VASCULATURE 2024; 50:101316. [PMID: 38419602 PMCID: PMC10899721 DOI: 10.1016/j.ijcha.2023.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/11/2023] [Accepted: 11/23/2023] [Indexed: 03/02/2024]
Abstract
Introduction Despite the burden of ischemic heart disease (IHD), there remains a paucity of research on the incidence, mortality, and burden of this condition in the Middle East and North Africa (MENA) regions. This study aimed to evaluate the epidemiology and the risk factors associated with IHD in the MENA region. Methods This study was performed based on the GBD study 2019 data. We retrieved the data related to the epidemiology and burden of IHD, including prevalence, incidence, years of life lost due to premature death (YLLs), years lived with disability (YLDs), and mortality at the global level and in MENA countries across years and sexes. Results IHD accounted for approximately 2.55 million (95 % UI 2.29-2.83) incident cases in MENA in 2019, with an age-standardized incidence rate of 613.87 (95 % UI 555.84-675.16) per 100 000 people, which has decreased by 9 % between 1990 and 2019. IHD accounted for 11.01 % of DALYs causes in MENA in 2019, an increase of 68 % compared to 1990. The DALYs rate from IHD increased with age in both men and women and was higher in men than in women in all age groups, except 85-89 years age-group, in 2019. Conclusion The age-standardized prevalence and incidence of IHD are decreasing in MENA. However, this reduction is lower than the global level, which can be due to a weaker performance of the countries in the region in reducing the prevalence and incidence of the disease compared to the global average.
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Affiliation(s)
- Mohammad Ahmadi
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shana Ahadi
- School of Medicine, Jondishapour University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mehrdad Mahalleh
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hani AziziKia
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Hamid Reza Zare
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Hamidreza Hekmat
- School of Medicine, Ziaeian Hospital, International Campus, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- School of Medicine, Ziaeian Hospital, International Campus, Tehran University of Medical Sciences, Tehran, Iran
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Malta DC, Gomes CS, Veloso GA, Dias de Andrade FM, Souza JB, Freitas PC, Vasconcelhos de Oliveira PP, Naghavi M, Pinho Ribeiro AL. Burden of non-communicable diseases and the achievement of the sustainable development goals in 2030 in Mercosur countries. Public Health 2023; 223:162-170. [PMID: 37659322 DOI: 10.1016/j.puhe.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/24/2023] [Accepted: 07/10/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVES The aims of this article were to analyse the burden of NCDs and their RFs in the Mercosur countries between 1990 and 2019 and to project mortality trends for 2030. STUDY DESIGN Epidemiological study of time series. METHODS The present study used data from the Global Burden of Disease study. The absolute number of deaths, mortality rates, disability-adjusted life years, years of life lost, years lived with disability and the burden of premature mortality by NCD attributable to the RFs were evaluated. Projections were made up to 2030. Age-standardised rates were used to draw comparisons by years and by countries. The analysis was conducted using the RStudio software. RESULTS Between 1990 and 2019, a decrease was found in the premature mortality rates caused by NCDs in all the countries, except for Paraguay, which remained stable. When analysing premature mortality rates due to NCDs up to 2030, it was predicted that none of the countries would achieve the sustainable development goal of a one-third reduction in premature mortality by NCDs. Regarding the impacts of the RFs for NCDs, smoking, dietary risks, high blood pressure (BP) and high body mass index (BMI) were the main risks attributable to premature deaths due to NCDs. CONCLUSIONS The results showed that mortality rates are declining in Mercosur countries; however, none of the countries are predicted to achieve the sustainable development goal of a one-third reduction in mortality due to NCDs by 2030. In addition to access to adequate treatment, progress is required in public regulation actions to reduce RFs, such as smoking, dietary risks, high BP and high BMI.
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Affiliation(s)
- D C Malta
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - C S Gomes
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - G A Veloso
- Departamento de Estatística, Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, RJ, Brazil.
| | - F M Dias de Andrade
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - J B Souza
- Departamento de Enfermagem Materno-Infantil e Saúde Pública, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
| | - P C Freitas
- Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, DF, Brazil.
| | | | - M Naghavi
- University of Washington, Institute for Health Metrics and Evaluation, Seattle, WA, USA.
| | - A L Pinho Ribeiro
- Departamento de Clinica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
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Sozmen K, Ergor G, Sakarya S, Dinc Horasan G, Sahan C, Ekinci B, Arikan A, Sis S, Unal B. Evaluation of Blood Pressure Status and Mortality in Turkey: Findings from Chronic Diseases and Risk Factors Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1366. [PMID: 37629656 PMCID: PMC10456768 DOI: 10.3390/medicina59081366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/11/2023] [Accepted: 07/23/2023] [Indexed: 08/27/2023]
Abstract
Background and objectives: An important Non-Communicable Disease risk factor, hypertension (HT), is highly prevalent and controlled HT rates are not sufficient which increases the risk of developing premature deaths. The purpose of the study is to evaluate differences in all-cause and cardiovascular-related mortality according to HT status by using national data from Chronic Diseases and Risk Factors Survey in Turkey (2011-2017). Materials and Methods: Cox regression models were used to estimate hazard ratios (HR) for predicting the all-cause and cardiovascular system-related mortalities. Median follow-up period was 6.2 years. Results: Among individuals with HT, 41.8% was untreated, 30.1% received treatment and had controlled blood pressure, and 28.1% were under treatment but had uncontrolled BP levels. The hazard for mortality among treated & uncontrolled hypertensive participants was significantly higher for all-cause (HR = 1.32, 95% CI = 1.06-1.65), cardiovascular (HR = 2.11, 95% CI = 1.46-3.06), heart disease (HR = 2.24, 95% CI = 1.46-3.43), and Coronary Heart Disease mortality (HR = 2.66, 95% CI = 1.56-4.53) compared to normotensive participants. Conclusions: Individuals with HT who were treated but do not have controlled blood pressure in Turkey had a significantly increased risk of Cardiovascular Disease and all-cause mortality. Along with studies investigating the causes of uncontrolled blood pressure despite initiation of treatment, support should be provided to patients in cases of non-adherence to antihypertensive medication or life change recommendations.
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Affiliation(s)
- Kaan Sozmen
- Department of Public Health, Faculty of Medicine, Izmir Katip Celebi University, Izmir 35620, Türkiye
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Gul Ergor
- Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Türkiye; (G.E.); (C.S.)
| | - Sibel Sakarya
- Department of Public Health, Faculty of Medicine, Koc University, Istanbul 34010, Türkiye
| | - Gonul Dinc Horasan
- Department of Public Health, Faculty of Medicine, Izmir University of Economics, Izmir 35330, Türkiye;
| | - Ceyda Sahan
- Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Türkiye; (G.E.); (C.S.)
| | - Banu Ekinci
- Department of Chronic Diseases and Elderly Health, General Directorate of Public Health of Turkey, Ankara 06430, Türkiye; (B.E.); (A.A.); (S.S.)
| | - Ahmet Arikan
- Department of Chronic Diseases and Elderly Health, General Directorate of Public Health of Turkey, Ankara 06430, Türkiye; (B.E.); (A.A.); (S.S.)
| | - Secil Sis
- Department of Chronic Diseases and Elderly Health, General Directorate of Public Health of Turkey, Ankara 06430, Türkiye; (B.E.); (A.A.); (S.S.)
| | - Belgin Unal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
- Department of Public Health, Faculty of Medicine, Dokuz Eylul University, Izmir 35340, Türkiye; (G.E.); (C.S.)
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Anakök GA, Awad SF, Çağlayan Ç, Huangfu P, Abu-Raddad LJ, Unal B, Critchley JA. Impact of trends and gender disparity in obesity on future type 2 diabetes in Turkey: a mathematical modelling analysis. BMJ Open 2022; 12:e053541. [PMID: 35545390 PMCID: PMC9096547 DOI: 10.1136/bmjopen-2021-053541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Using a previously developed and validated mathematical model, we predicted future prevalence of type 2 diabetes mellitus (T2DM) and major modifiable risk factors (obesity, physical inactivity and smoking) stratified by age and sex in Turkey up to the year 2050. METHODS Our deterministic compartmental model fitted nationally representative demographic and risk factor data simultaneously for Turkish adults (aged 20-79) between 1997 and 2017, then estimated future trends. Our novel approach explored the impact of future obesity trends on these projections, specifically modelling (1) a gradual fall in obesity in women after the year 2020 until it equalled the age-specific levels seen in men and (2) cessation of the rise in obesity after 2020. RESULTS T2DM prevalence is projected to rise from an estimated 14.0% (95% uncertainty interval (UI) 12.8% to 16.0%) in 2020 to 18.4% (95% UI 16.9% to 20.9%) by 2050; 19.7% in women and 17.2% in men by 2050; reflecting high levels of obesity (39.7% for women and 22.0% for men in 2050). Overall, T2DM prevalence could be reduced by about 4% if obesity stopped rising after 2020 or by 12% (22% in women) if obesity prevalence among women could be lowered to equal that of men. The higher age-specific obesity prevalence among women resulted in 2 076 040 additional women developing T2DM by the year 2050. CONCLUSION T2DM is common in Turkey and will remain so. Interventions and policies targeting the high burden of obesity (and low physical activity levels), particularly in women, could significantly impact future disease burdens.
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Affiliation(s)
- Gül Anil Anakök
- Department of Public Health, Kocaeli University School of Medicine, Kocaeli, Turkey
- Kartepe District Health Directorate, Kocaeli, Turkey
| | | | - Çiğdem Çağlayan
- Department of Public Health, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Peijue Huangfu
- Population Health Research Institute, St George's University of London, London, UK
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Belgin Unal
- Department of Public Health, Faculty of Medicine, Dokuz Eylul Universitesi, Izmir, Turkey
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Ahmadi M, Lanphear B. The impact of clinical and population strategies on coronary heart disease mortality: an assessment of Rose's big idea. BMC Public Health 2022; 22:14. [PMID: 34991551 PMCID: PMC8734316 DOI: 10.1186/s12889-021-12421-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/09/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Coronary heart disease (CHD), the leading cause of death worldwide, has declined in many affluent countries but it continues to rise in industrializing countries. OBJECTIVE To quantify the relative contribution of the clinical and population strategies to the decline in CHD mortality in affluent countries. DESIGN Meta-analysis of cross-sectional and prospective studies. DATA SOURCES PubMed and Web of Science from January 1, 1970 to December 31, 2019. METHOD We combined and analyzed data from 22 cross-sectional and prospective studies, representing 500 million people, to quantify the relative decline in CHD mortality attributable to the clinical strategy and population strategy. RESULT The population strategy accounted for 48% (range = 19 to 73%) of the decline in CHD deaths and the clinical strategy accounted for 42% (range = 25 to 56%), with moderate inconsistency of results across studies. CONCLUSION Since 1970, a larger fraction of the decline in CHD deaths in industrialized countries was attributable to reduction in CHD risk factors than medical care. Population strategies, which are more cost-effective than clinical strategies, are under-utilized.
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Affiliation(s)
- Mohadeseh Ahmadi
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Bruce Lanphear
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
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Tokgozoglu L, Kayikcioglu M, Ekinci B. The landscape of preventive cardiology in Turkey: Challenges and successes. Am J Prev Cardiol 2021; 6:100184. [PMID: 34327504 PMCID: PMC8315400 DOI: 10.1016/j.ajpc.2021.100184] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/24/2021] [Accepted: 04/04/2021] [Indexed: 12/20/2022] Open
Abstract
Turkey, like many countries, is facing a growing burden of non-communicable disease (NCD)s and is among the countries with high cardiovascular mortality in Europe. Moreover, Turkey currently has the highest rate of premature cardiovascular disease (CVD) in Europe. During the last decades, Turkey made fundamental reforms in the health system to improve the treatment of risk factors to prevent CVD. The most outstanding success was in the area of tobacco control (13.4% decrease in smoking prevalence) and decreasing the salt consumption of the population (from 18 to 9.9 g/day) leading to a significant decrease in CVD mortality from 45% to 36.8% of all deaths. However, obesity and diabetes are increasing rapidly as a result of urbanization, low physical activity and unhealthy eating and the new generation is starting to take up smoking. The increase in cardiometabolic risk factors and aging of the population are expected to increase the number of CVD deaths. All CVD risk factors except smoking are significantly more prevalent in women. In addition, rare disease is a country specific problem with a significant contribution to the high rates of premature CVD in Turkey. Despite major improvements in management in acute coronary syndromes, sustained achievement in guideline recommended goals is suboptimal. In patients with a previous cardiovascular event smoking rate is 25.5%, 80.9% of these patients are overweight (BMI ≥25 kg/m2), 30% obese (BMI ≥30 kg/m2), and LDL‐cholesterol targets of 70 mg/dL are attained in only 18%. Herein, we scrutinize the achievements and challenges of Turkey in establishing a ‘National Heart Health Policy’ aiming to decrease the burden of CVD and its risk factors.
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Affiliation(s)
- Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Meral Kayikcioglu
- Department of Cardiology, Ege University Medical Faculty, Izmir, Turkey
| | - Banu Ekinci
- Department of Chronic Disease and Elderly Health, Ministry of Health, Ankara, Turkey
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Arroyo-Quiroz C, O’Flaherty M, Guzman-Castillo M, Capewell S, Chuquiure-Valenzuela E, Jerjes-Sanchez C, Barrientos-Gutierrez T. Explaining the increment in coronary heart disease mortality in Mexico between 2000 and 2012. PLoS One 2020; 15:e0242930. [PMID: 33270684 PMCID: PMC7714134 DOI: 10.1371/journal.pone.0242930] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mexico is still in the growing phase of the epidemic of coronary heart disease (CHD), with mortality increasing by 48% since 1980. However, no studies have analyzed the drivers of these trends. We aimed to model CHD deaths between 2000 and 2012 in Mexico and to quantify the proportion of the mortality change attributable to advances in medical treatments and to changes in population-wide cardiovascular risk factors. METHODS We performed a retrospective analysis using the previously validated IMPACT model to explain observed changes in CHD mortality in Mexican adults. The model integrates nationwide data at two-time points (2000 and 2012) to quantify the effects on CHD mortality attributable to changes in risk factors and therapeutic trends. RESULTS From 2000 to 2012, CHD mortality rates increased by 33.8% in men and by 22.8% in women. The IMPACT model explained 71% of the CHD mortality increase. Most of the mortality increases could be attributed to increases in population risk factors, such as diabetes (43%), physical inactivity (28%) and total cholesterol (24%). Improvements in medical and surgical treatments together prevented or postponed 40.3% of deaths; 10% was attributable to improvements in secondary prevention treatments following MI, while 5.3% to community heart failure treatments. CONCLUSIONS CHD mortality in Mexico is increasing due to adverse trends in major risk factors and suboptimal use of CHD treatments. Population-level interventions to reduce CHD risk factors are urgently needed, along with increased access and equitable distribution of therapies.
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Affiliation(s)
- Carmen Arroyo-Quiroz
- Center for Research on Population Health, National Institute of Public Health, Cuernavaca, Mexico
- Universidad Autonoma Metropolitana- Unidad Lerma, Lerma de Villada, Mexico
| | - Martin O’Flaherty
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | - Maria Guzman-Castillo
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Simon Capewell
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | | | - Carlos Jerjes-Sanchez
- Escuela de Medicina y Ciencias de la Salud, Instituto Tecnológico de Monterrey, Instituto de Cardiología y Medicina Vascular, TecSalud, Monterrey, Mexico
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Prognostic Value of Admission Mean Corpuscular Volume for Major Adverse Cardiovascular Events following Stent Implantation in Nondiabetic and Diabetic Patients with Acute Coronary Syndrome. DISEASE MARKERS 2020; 2020:7054596. [PMID: 32733619 PMCID: PMC7383318 DOI: 10.1155/2020/7054596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 06/20/2020] [Accepted: 06/29/2020] [Indexed: 01/15/2023]
Abstract
Background One of the key concerns of the clinician is to identify and manage risk factors for major adverse cardiovascular events (MACEs) in nondiabetic and diabetic patients with acute coronary syndrome (ACS) undergoing stent implantation. Mean corpuscular volume (MCV) is a marker of erythrocyte size and activity and is associated with prognosis of cardiovascular disease. However, the role of admission MCV in predicting MACEs following stent implantation in diabetes mellitus (DM), non-DM, or whole patients with ACS remains largely unknown. Methods and Results A total of 437 ACS patients undergoing stent implantation, including 294 non-DM (59.08 ± 10.24 years) and 143 DM (63.02 ± 9.92 years), were analyzed. Admission MCV was higher in non-DM than DM patients. During a median of 31.93 months follow-up, Kaplan-Meier curve demonstrated that higher admission MCV level was significantly associated with increased MACEs in whole and non-DM, but not in DM patients. In Cox regression analysis, the highest MCV tertile was associated with higher MACEs in whole ([HR] 1.870, 95% CI 1.113-3.144, P = 0.018), especially those non-DM ([HR] 2.089, 95% CI 1.077-4.501, P = 0.029) patients after adjustment of several cardiovascular risk factors. MCV did not predict MACEs in DM patients. During landmark analysis, admission MCV showed better predictive value for MACEs in the first 32 months of follow-up than in the subsequent period. Finally, the receiver operating characteristic (ROC) curve was conducted to confirmed the value of admission MCV within 32 months. Conclusion In patients with ACS, elevated admission MCV is an important and independent predictor for MACEs following stent implantation, especially amongst those without DM even after adjusting for lifestyle and clinical risk factors. However, as the follow-up period increased, the admission MCV lost its ability to predict MACEs.
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Atherosclerosis 2020; 290:140-205. [PMID: 31504418 DOI: 10.1016/j.atherosclerosis.2019.08.014] [Citation(s) in RCA: 523] [Impact Index Per Article: 130.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020; 41:111-188. [PMID: 31504418 DOI: 10.1093/eurheartj/ehz455] [Citation(s) in RCA: 4109] [Impact Index Per Article: 1027.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Mert GÖ, Başaran Ö, Mert KU, Doğan V, Özlek B, Çelik O, Özlek E, Çil C, Özdemir İH, Rencüzoğulları İ, Karadeniz FÖ, Bekar L, Aktaş M, Resulzade MM, Kalçık M, Aksan G, Çinier G, Akay K, Pekel N, Şenol U, Biteker M, Kayıkçıoğlu M. The reasons of poor lipid target attainment for secondary prevention in real life practice: Results from EPHESUS. Int J Clin Pract 2019; 73:1-9. [PMID: 31038781 DOI: 10.1111/ijcp.13358] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/09/2019] [Accepted: 04/26/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE There are lack of studies considering the suboptimal management of dyslipidemia especially in cardiology outpatient clinics. This study was conducted to assess the patient adherence to cholesterol treatment recommendations and attainment of low-density-lipoprotein cholesterol (LDL-C) goals. METHODS EPHESUS (NCT02608645) is a national, observational and multicenter registry which has been designed as a cross-sectional study to allow inclusion of all consecutive patients with hypercholesterolemia in cardiology outpatient clinics. The present subgroup analyses of the EPHESUS trial included patients with known peripheral artery disease or atherosclerotic cerebrovascular disease, and coronary heart disease namely secondary prevention. RESULTS The present analysis of the EPHESUS study included 1482 patients (62.79 ± 10.4 years, 38.2% female) with secondary prevention from 40 sites in Turkey. Regarding recommended lipid targets for LDL-C, only 267 patients (18%) were below the target of 70 mg/dL. Females were significantly more off-target when compared with male patients (396, 85.5% vs 67, 14.5%; P = 0.017). Moreover, the achievement of LDL-C goal was significantly decreased with illiteracy (233, 19.2% vs 35, 13.1%; P = 0.02). Patients who think that the cholesterol treatment should be terminated when the cholesterol level of a patient has normalised were higher in the off-target group (34.0% vs 24.7%, P < 0.001). Besides, physician perceptions about LDL-C goal for secondary prevention were significantly related with LDL-C target attainment. CONCLUSIONS EPHESUS is an important study with large population in terms of representing real-life practice of the adherence to dyslipidemia guidelines in secondary prevention patients in Turkey. Perceptions, knowledge, and compliance with the guidelines for secondary prevention have increased, but it is far below from the desired levels even in cardiology outpatient clinics. There is a need for patients' and physicians' education regarding the treatment of hyperlipidemia.
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Affiliation(s)
- Gurbet Özge Mert
- Department of Cardiology, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkey
| | - Özcan Başaran
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Volkan Doğan
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Bülent Özlek
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | | | | | | | - Lütfü Bekar
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Müjdat Aktaş
- Department of Cardiology, Faculty of Medicine Regional Training and Research Hospital, Kocaeli University, Kocaeli, Turkey
| | | | - Macit Kalçık
- Department of Cardiology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Sıslı Hamıdıye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Göksel Çinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, İstanbul, Turkey
| | - Kadriye Akay
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Nihat Pekel
- Department of Cardiology, Tekden Private Hospital, Denizli, Turkey
| | - Utku Şenol
- Department of Cardiology, Eskisehir Acıbadem Hospital, Eskişehir, Turkey
| | - Murat Biteker
- Department of Cardiology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
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Rusnak J, Behnes M, Schupp T, Lang S, Reiser L, Taton G, Bollow A, Reichelt T, Ellguth D, Engelke N, Ansari U, El-Battrawy I, Bertsch T, Nienaber CA, Akin M, Mashayekhi K, Weiß C, Borggrefe M, Akin I. Statin therapy is associated with improved survival in patients with ventricular tachyarrhythmias. Lipids Health Dis 2019; 18:119. [PMID: 31122256 PMCID: PMC6533673 DOI: 10.1186/s12944-019-1011-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 03/08/2019] [Indexed: 11/22/2022] Open
Abstract
Objectives The study sought to assess the impact of statin therapy on survival in patients presenting with ventricular tachyarrhythmias. Background Data regarding the outcome of patients with statin therapy presenting with ventricular tachyarrhythmias is limited. Methods A large retrospective registry was used including all consecutive patients presenting with ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2016. Patients with statin were compared to patients without statin therapy (non-statin). The primary prognostic endpoint was long-term all-cause death at 3 years. Uni- and multivariable Cox regression analyses were applied in propensity-score matched cohorts. Results A total of 424 matched patients was included. The rates of VT and VF were similar in both groups (VT: statin 71% vs. non-statin 68%; VF: statin 29% vs. 32%; p = 0.460). Statin therapy was associated with lower all-cause mortality at long-term follow-up (mortality rates 16% versus 33%; log rank, p = 0.001; HR = 0.438; 95% CI 0.290–0.663; p = 0.001), irrespective of the underlying type of ventricular tachyarrhythmia (VT/VF), left ventricular ejection fraction (LVEF) > 35%, presence of an activated implantable cardioverter defibrillator (ICD), cardiogenic shock or cardiopulmonary resuscitation (CPR). Conclusion Statin therapy is independently associated with lower long-term mortality in patients presenting with ventricular tachyarrhythmias on admission. Trial registration Clinicaltrials.gov, NCT02982473, 11/29/2016, Retrospectively registered.
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Affiliation(s)
- Jonas Rusnak
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Tobias Schupp
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Linda Reiser
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Gabriel Taton
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Armin Bollow
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Reichelt
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Dominik Ellguth
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Niko Engelke
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Uzair Ansari
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | | | - Muharrem Akin
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Kambis Mashayekhi
- Clinic for Cardiology and Angiology II, Universitaetszentrum Freiburg Bad Krozingen, University of Freiburg, Bad Krozingen, Germany
| | - Christel Weiß
- Institute of Biomathematics and Medical Statistics, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Wou C, Unwin N, Huang Y, Roglic G. Implications of the growing burden of diabetes for premature cardiovascular disease mortality and the attainment of the Sustainable Development Goal target 3.4. Cardiovasc Diagn Ther 2019; 9:140-149. [PMID: 31143635 DOI: 10.21037/cdt.2018.09.04] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Non-communicable diseases (NCDs) are a major cause of deaths globally, and cardiovascular disease (CVD) is the leading cause of these deaths. 42% of NCD deaths are premature (occurring before the age of 70 years). As part of the United Nations 3rd Sustainable Development Goal (SDG) on health and wellbeing, target 3.4 is to reduce premature mortality from NCDs by one third between 2015 and 2030. This target adds to the World Health Organization (WHO) target of reducing premature deaths from NCDs by 25% between 2010 and 2025. As diabetes is a major risk factor for CVD, it is important to account for the trends in diabetes when considering premature CVD mortality. We aimed to describe the global trends in diabetes prevalence and mortality, critically review the literature on the estimated attainability of the WHO and SDG targets, and determine if and how these studies accounted for trends in diabetes. Worldwide, the prevalence of diabetes is rising, with an estimated 9.0% global prevalence in adults aged 20-69 by 2030, and low- and middle-income countries (LMICs) having the largest increase of the burden in absolute numbers and age-standardized prevalence. There is a lack of data from most LMICs on the excess CVD mortality associated with diabetes and therefore no consensus on the global risk of CVD mortality in people with diabetes. Where data do exist, there are discrepancies between studies on the direction of mortality trends from diabetes over time. We reviewed 12 studies that estimated the attainability of the WHO or SDG targets for premature NCD mortality. Seven of these considered the potential impacts of achieving the 2025 WHO risk factor targets. Six studies modelled the impact of current trends in risk factors, including diabetes, continuing toward the target dates. Four studies compared this 'business as usual' model with the attainment of the risk factor targets for the world as whole and individual regions, 2 studies for NCD mortality overall, and 2 specifically for CVD mortality. On the impact of diabetes with regards to attainment of the WHO or SDG targets for premature CVD mortality, the overall results were inconclusive. Some concluded that none of the countries or regions considered would meet the targets, and others predicted that in some areas, the targets would be met. Examining the potential impact of trends in diabetes on future CVD mortality rates in LMICs is limited by a relative lack of high quality studies, including on the age specific excess mortality associated with diabetes. Filling these data gaps will enable better estimates of the potential impacts on future CVD mortality of the rapidly increasing prevalence of diabetes in LMICs and help to better inform health policy and the attainment of SDG target 3.4.
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Affiliation(s)
- Constance Wou
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nigel Unwin
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Yadi Huang
- International Diabetes Federation, Brussels, Belgium
| | - Gojka Roglic
- Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
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Statins for the Primary Prevention of Coronary Heart Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:4870350. [PMID: 30834266 PMCID: PMC6374814 DOI: 10.1155/2019/4870350] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/06/2018] [Accepted: 12/03/2018] [Indexed: 11/17/2022]
Abstract
Object The purpose of this study was to fully assess the role of statins in the primary prevention of coronary heart disease (CHD). Methods We searched six databases (PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database) to identify relevant randomized controlled trials (RCTs) from inception to 31 October 2017. Two review authors independently assessed the methodological quality and analysed the data using Rev Man 5.3 software. Risk ratios and 95% confidence intervals (95% CI) were pooled using fixed/random-effects models. Funnel plots and Begg's test were conducted to assess publication bias. The quality of the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Sixteen RCTs with 69159 participants were included in this review. Statins can effectively decrease the occurrence of angina (RR=0.70, 95% CI: 0.58~0.85, I2 =0%), nonfatal myocardial infarction (MI) (RR=0.60, 95% CI: 0.51~0.69, I2 =14%), fatal MI (RR=0.49, 95% CI: 0.24~0.98, I2 =0%), any MI (RR=0.53, 95% CI: 0.42~0.67, I2 =0%), any coronary heart events (RR=0.73, 95% CI: 0.68~0.78, I2=0%), coronary revascularization (RR=0.66, 95% CI: 0.55~0.78, I2 = 0%), and any cardiovascular events (RR=0.77, 95% CI: 0.72~82, I2 = 0%). However, based on the current evidence, there were no significant differences in CHD deaths (RR=0.82, 95% CI: 0.66~1.02, I2=0%) and all-cause mortality (RR=0.88, 95% CI: 0.76 ~1.01, I2 =58%) between the two groups. Additionally, statins were more likely to result in diabetes (RR=1.21, 95% CI: 1.05~1.39, I2 =0%). There was no evidence of publication biases, and the quality of the evidence was considered moderate. Conclusion Statins seemed to be beneficial for the primary prevention of CHDs but have no effect on CHD death and all-cause mortality.
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Baseline Serum Uric Acid Levels Are Associated with All-Cause Mortality in Acute Coronary Syndrome Patients after Percutaneous Coronary Intervention. DISEASE MARKERS 2018; 2018:9731374. [PMID: 30647801 PMCID: PMC6311730 DOI: 10.1155/2018/9731374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/01/2018] [Accepted: 10/15/2018] [Indexed: 12/22/2022]
Abstract
Background Whether serum uric acid (UA) is associated with all-cause mortality in patients with acute coronary syndrome (ACS) following percutaneous coronary intervention (PCI) remains unclear. Methods We performed a retrospective cohort study of 2296 patients with ACS. Curve-fitting and Cox proportional-hazard regression models with a hazard ratio (HR) and 95% confidence interval (CI) were used. Results During a mean follow-up of 246.31 ± 49.16 days, 168 (7.32%) patients died from all causes. Patients were divided into two groups [the high-UA group (n = 566) and the low-UA group (n = 1730)] based on the serum UA threshold value (5.6 mg/dl) identified through curve fitting. Fifty-three (9.36%) patients died in the high-UA group, and 115 (6.65%) patients died in the low-UA group. The difference between groups was statistically significant (P = 0.031). Univariate analysis showed that the risk of all-cause mortality in the high-UA group was significantly greater than that in the low-UA group (HR = 1.45, 95% CI: 1.03 to 2.04). This difference persisted after adjustment for baseline characteristics, medical history, and medication history (HR = 1.42, 95% CI: 1.05 to 1.87). Conclusions Our study demonstrated that elevated serum UA (>5.6 mg/dl) is associated with all-cause mortality in ASC patients after PCI.
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Venkatason P, Zaharan NL, Ismail MD, Wan Ahmad WA, Mahmood Zuhdi AS. Trends and variations in the prescribing of secondary preventative cardiovascular therapies for non-ST elevation myocardial infarction (NSTEMI) in Malaysia. Eur J Clin Pharmacol 2018; 74:953-960. [PMID: 29582106 PMCID: PMC5999133 DOI: 10.1007/s00228-018-2451-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 03/19/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Information is lacking on prescribing of preventative cardiovascular pharmacotherapies for patients with non-ST elevation myocardial infarction (NSTEMI) in the Asian region. This study examined the prescribing rate of these pharmacotherapies, comparing NSTEMI to STEMI, and variations across demographics and clinical factors within the NSTEMI group in the multi-ethnic Malaysian population. METHODS This is a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry from year 2006 to 2013 (n = 30,873). On-discharge pharmacotherapies examined were aspirin, ADP-antagonists, statins, ACE-inhibitors, angiotensin-II-receptor blockers, and beta-blockers. Multivariate logistic regression was used to calculate adjusted odds ratio of receiving individual pharmacotherapies according to patients' characteristics in NSTEMI patients (n = 11,390). RESULTS Prescribing rates for cardiovascular pharmacotherapies had significantly increased especially for ADP-antagonists (76%) in NSTEMI patients. More than 85% were prescribed statins and antiplatelets but rates remained significantly lower compared to STEMI. Women and those over 65 years old were less likely to be prescribed these pharmacotherapies compared to men and younger NSTEMI patients. Chinese and Indians were more likely to receive selected pharmacotherapies compared to Malays (main ethnicity). Geographical variations were observed; East Malaysian (Malaysian Borneo) patients were less likely to receive these compared to Western region of Malaysian Peninsular. Underprescribing in patients with risk factors such as diabetes were observed with other co-morbidities influencing prescribing selectively. CONCLUSION This study uncovers demographic and clinical variations in cardiovascular pharmacotherapies prescribing for NSTEMI. Concerted efforts by policy makers, specialty societies, and physicians are required focusing on elderly, women, Malays, East Malaysians, and high-risk patients.
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Affiliation(s)
- Padmaa Venkatason
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Nur Lisa Zaharan
- Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Muhammad Dzafir Ismail
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Myftiu S, Sulo E, Burazeri G, Daka B, Sharka I, Shkoza A, Sulo G. Clinical Profile and Management of Patients with Incident and Recurrent Acute Myocardial Infarction in Albania - a Call for More Focus on Prevention Strategies. Zdr Varst 2017; 56:236-243. [PMID: 29062398 PMCID: PMC5639813 DOI: 10.1515/sjph-2017-0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 08/07/2017] [Indexed: 11/15/2022] Open
Abstract
Background The clinical profile of acute myocardial infarction (AMI) patients reflects the burden of risk factors in the general population. Differences between incident (first) and recurrent (repeated) events and their impact on treatment are poorly described. We studied potential differences in the clinical profile and in-hospital treatment between patients hospitalised with an incident and recurrent AMI. Methods A total of 324 patients admitted in the Coronary Care Unit of ‘Mother Teresa’ hospital, Tirana, Albania (2013-2014), were included in the study. Information on AMI type, complications and risk factors was obtained from patient’s medical file. Logistic regression analyses were used to explore differences between the incident and recurrent AMIs regarding clinical profile and in-hospital treatment. Results Of all patients, 50 (15.4%) had a prior AMI. Compared to incident cases, recurrent cases were older (P=0.01), more often women (P=0.01), less educated (P=0.01), and smoked less (P=0.03). Recurrent cases experienced more often heart failure (HF) (OR=2.48; 95% CI: 1.31–4.70), impaired left ventricular ejection fraction (OR=1.97; 95% CI:1.05–3.71), and multivessel disease (OR=6.32; 95% CI: 1.43–28.03) than incident cases. In-hospital use of beta-blockers was less frequent among recurrent compared to incident cases (OR=0.45; 95% CI: 0.24–0.85), while no statistically significant differences between groups were observed regarding angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, statin, aspirin or invasive procedures. Conclusion A more severe clinical expression of the disease and underutilisation of treatment among recurrent AMIs are likely to explain their poorer prognosis compared to incident AMIs.
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Affiliation(s)
- Sokol Myftiu
- Department of Cardiology, University Hospital "Mother Teresa", Tirana, Albania
| | - Enxhela Sulo
- University of Bergen, Faculty of Medicine and Dentistry, Department of Global Public Health and Primary Care, Kalfarveien31, Bergen 5018, Norway
| | - Genc Burazeri
- Maastricht University, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Department of International Health, MaastrichtThe Netherlands
| | - Bledar Daka
- University of Gothenburg, Department of Public Health and Community Medicine, Gothenburg, Sweden
| | - Ilir Sharka
- Department of Cardiology, University Hospital "Mother Teresa", Tirana, Albania
| | - Artan Shkoza
- University of Medicine, Faculty of Medicine, Tirana, Albania
| | - Gerhard Sulo
- University of Bergen, Faculty of Medicine and Dentistry, Department of Global Public Health and Primary Care, Kalfarveien31, Bergen 5018, Norway
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Özdemir R, Dinç Horasan G, Rao C, Sözmen MK, Ünal B. An evaluation of cause-of-death trends from recent decades based on registered deaths in Turkey. Public Health 2017; 151:121-130. [PMID: 28787632 DOI: 10.1016/j.puhe.2017.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/07/2017] [Accepted: 07/07/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Although cause-of-death analyses are very important to define public health policy priorities and to evaluate health programs, there is very limited knowledge about mortality profiles and trends in Turkey. The aim of this study was to measure the trends in mortality within three broad cause-of-death groups and their distribution by age groups and gender and to describe the changes of leading causes of death between 1980 and 2013 in Turkey. STUDY DESIGN Descriptive study. METHODS In the study, data on the number of deaths by year, gender, age and cause was obtained from the Turkish Statistical Institute. The causes of death were classified as group I: communicable, maternal, perinatal, and nutritional conditions; group II: non-communicable diseases (NCDs); and group III: injuries. Unknown or ill-defined causes of death were distributed within group I and group II. The percentage distribution of the cause-of-death groups by gender and age groups between 1980 and 2013 was identified. Age-standardized mortality rates (ASMRs) per 100,000 of broad causes-of-death groups were calculated using European Standard Population 1976 between 1980 and 2008. Changes in mortality rates per hundred were calculated using the formula ([the rate of last year of the period-the rate of the first year of the period]/the rate of the first year of the period). Gender and age-specific data were analyzed using the Joinpoint software to examine trends and significant changes in trends of mortality rates. RESULTS Crude death rates for group I, group II, and group III were 157.3, 147.2, and 21.4 per 100,000 in 1980 and 35.3, 377.5, and 15.8 in 2008 for males; 161.8, 120.2, and 5.8 in 1980 and 38.6, 318.4, and 6.4 in 2008 for females, respectively. ASMRs for group I, group II, and group III were 146.3, 394.3, and 29.3 per 100,000 in 1980 and 49.7, 723.6, and 18.8 in 2008 for males; 138.0, 291.5, and 7.6 per 100,000 in 1980 and 47.7, 478.8, and 7.2 in 2008 for females, respectively. The mortality rates of group I for almost all age groups particularly below 5 years of age decreased significantly. CONCLUSION This study indicates that Turkey is at an advanced stage in the epidemiological transition, with the majority of the causes of death from NCDs. Considering the regional differences, it is necessary to carry out studies on the specific details of epidemiological transition and the social determinants of deaths in Turkey.
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Affiliation(s)
- R Özdemir
- Karabuk University, The Faculty of Health Sciences, Occupational Health and Safety Department, Karabuk, Turkey.
| | - G Dinç Horasan
- Celal Bayar University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Manisa, Turkey.
| | - C Rao
- National Centre for Epidemiology & Population Health Research School of Population Health, Australian National University, Canberra, Australia.
| | - M K Sözmen
- Izmir Katip Çelebi University Medical Faculty, Department of Public Health, İzmir, Turkey.
| | - B Ünal
- Dokuz Eylul University Medical Faculty, Department of Public Health, İzmir, Turkey.
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Ali MK, Jaacks LM, Kowalski AJ, Siegel KR, Ezzati M. Noncommunicable Diseases: Three Decades Of Global Data Show A Mixture Of Increases And Decreases In Mortality Rates. Health Aff (Millwood) 2017; 34:1444-55. [PMID: 26355045 DOI: 10.1377/hlthaff.2015.0570] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Noncommunicable diseases are the leading health concerns of the modern era, accounting for two-thirds of global deaths, half of all disability, and rapidly growing costs. To provide a contemporary overview of the burdens caused by noncommunicable diseases, we compiled mortality data reported by authorities in forty-nine countries for atherosclerotic cardiovascular diseases; diabetes; chronic respiratory diseases; and lung, colon, breast, cervical, liver, and stomach cancers. From 1980 to 2012, on average across all countries, mortality for cardiovascular disease, stomach cancer, and cervical cancer declined, while mortality for diabetes, liver cancer, and female chronic respiratory disease and lung cancer increased. In contrast to the relatively steep cardiovascular and cancer mortality declines observed in high-income countries, mortality for cardiovascular disease and chronic respiratory disease was flat in most low- and middle-income countries, which also experienced increasing breast and colon cancer mortality. These divergent mortality patterns likely reflect differences in timing and magnitude of risk exposures, health care, and policies to counteract the diseases. Improving both the coverage and the accuracy of mortality documentation in populous low- and middle-income countries is a priority, as is the need to rigorously evaluate societal-level interventions. Furthermore, given the complex, chronic, and progressive nature of noncommunicable diseases, policies and programs to prevent and control them need to be multifaceted and long-term, as returns on investment accrue with time.
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Affiliation(s)
- Mohammed K Ali
- Mohammed K. Ali is an associate professor in the Hubert Department of Global Health, Rollins School of Public Health, at Emory University, in Atlanta, Georgia
| | - Lindsay M Jaacks
- Lindsay M. Jaacks is a postdoctoral fellow in the Hubert Department of Global Health, Rollins School of Public Health, at Emory University
| | - Alysse J Kowalski
- Alysse J. Kowalski is a research associate in the Hubert Department of Global Health, Rollins School of Public Health, at Emory University
| | - Karen R Siegel
- Karen R. Siegel is an adjunct assistant professor in the Hubert Department of Global Health, Rollins School of Public Health, at Emory University
| | - Majid Ezzati
- Majid Ezzati is chair in global environmental health in the Faculty of Medicine, School of Public Health, Imperial College London, in the United Kingdom
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Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM, Gordon D. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res 2017; 120:366-380. [PMID: 28104770 PMCID: PMC5268076 DOI: 10.1161/circresaha.116.309115] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/23/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023]
Abstract
If the control of infectious diseases was the public health success story of the first half of the 20th century, then the decline in mortality from coronary heart disease and stroke has been the success story of the century's past 4 decades. The early phase of this decline in coronary heart disease and stroke was unexpected and controversial when first reported in the mid-1970s, having followed 60 years of gradual increase as the US population aged. However, in 1978, the participants in a conference convened by the National Heart, Lung, and Blood Institute concluded that a significant recent downtick in coronary heart disease and stroke mortality rates had definitely occurred, at least in the US Since 1978, a sharp decline in mortality rates from coronary heart disease and stroke has become unmistakable throughout the industrialized world, with age-adjusted mortality rates having declined to about one third of their 1960s baseline by 2000. Models have shown that this remarkable decline has been fueled by rapid progress in both prevention and treatment, including precipitous declines in cigarette smoking, improvements in hypertension treatment and control, widespread use of statins to lower circulating cholesterol levels, and the development and timely use of thrombolysis and stents in acute coronary syndrome to limit or prevent infarction. However, despite the huge growth in knowledge and advances in prevention and treatment, there remain many questions about this decline. In fact, there is evidence that the rate of decline may have abated and may even be showing early signs of reversal in some population groups. The National Heart, Lung, and Blood Institute, through a request for information, is soliciting input that could inform a follow-up conference on or near the 40th anniversary of the original landmark conference to further explore these trends in cardiovascular mortality in the context of what has come before and what may lie ahead.
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Affiliation(s)
- George A Mensah
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD.
| | - Gina S Wei
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Paul D Sorlie
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Lawrence J Fine
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Yves Rosenberg
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Peter G Kaufmann
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Michael E Mussolino
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Lucy L Hsu
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Ebyan Addou
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - Michael M Engelgau
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
| | - David Gordon
- From the Center for Translation Research and Implementation Science (CTRIS) (G.A.M., M.M.E.) and Division of Cardiovascular Sciences (G.S.W., P.D.S., L.J.F., Y.R., P.G.K., M.E.M., L.L.H., E.A., D.G.), National Heart, Lung, and Blood Institute (NHLBI), National Institutes of Health (NIH), Bethesda, MD
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Koopman C, Vaartjes I, van Dis I, Verschuren WMM, Engelfriet P, Heintjes EM, Blokstra A, Deeg DJH, Visser M, Bots ML, O’Flaherty M, Capewell S. Explaining the Decline in Coronary Heart Disease Mortality in the Netherlands between 1997 and 2007. PLoS One 2016; 11:e0166139. [PMID: 27906998 PMCID: PMC5132334 DOI: 10.1371/journal.pone.0166139] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/23/2016] [Indexed: 11/22/2022] Open
Abstract
Objective We set out to determine what proportion of the mortality decline from 1997 to 2007 in coronary heart disease (CHD) in the Netherlands could be attributed to advances in medical treatment and to improvements in population-wide cardiovascular risk factors. Methods We used the IMPACT-SEC model. Nationwide information was obtained on changes between 1997 and 2007 in the use of 42 treatments and in cardiovascular risk factor levels in adults, aged 25 or over. The primary outcome was the number of CHD deaths prevented or postponed. Results The age-standardized CHD mortality fell by 48% from 269 to 141 per 100.000, with remarkably similar relative declines across socioeconomic groups. This resulted in 11,200 fewer CHD deaths in 2007 than expected. The model was able to explain 72% of the mortality decline. Approximately 37% (95% CI: 10%-80%) of the decline was attributable to changes in acute phase and secondary prevention treatments: the largest contributions came from treating patients in the community with heart failure (11%) or chronic angina (9%). Approximately 36% (24%-67%) was attributable to decreases in risk factors: blood pressure (30%), total cholesterol levels (10%), smoking (5%) and physical inactivity (1%). Ten% more deaths could have been prevented if body mass index and diabetes would not have increased. Overall, these findings did not vary across socioeconomic groups, although within socioeconomic groups the contribution of risk factors differed. Conclusion CHD mortality has recently halved in The Netherlands. Equally large contributions have come from the increased use of acute and secondary prevention treatments and from improvements in population risk factors (including primary prevention treatments). Increases in obesity and diabetes represent a major challenge for future prevention policies.
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Affiliation(s)
- Carla Koopman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Heart Foundation, The Hague, the Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Heart Foundation, The Hague, the Netherlands
- * E-mail:
| | | | - W. M. Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Peter Engelfriet
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | | | - Anneke Blokstra
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Dorly J. H. Deeg
- EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
| | - Marjolein Visser
- EMGO Institute for Health and Care Research, VU Medical Center, Amsterdam, The Netherlands
- Department of Health Sciences, VU University, Amsterdam, The Netherlands
- Department of Dietetics and Nutrition Sciences, Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin O’Flaherty
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Simon Capewell
- Department of Public Health & Policy, Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WMM, Vlachopoulos C, Wood DA, Zamorano JL, Cooney MT. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37:2999-3058. [PMID: 27567407 DOI: 10.1093/eurheartj/ehw272] [Citation(s) in RCA: 1868] [Impact Index Per Article: 233.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, Hoes AW, Jennings CS, Landmesser U, Pedersen TR, Reiner Ž, Riccardi G, Taskinen MR, Tokgozoglu L, Verschuren WM, Vlachopoulos C, Wood DA, Zamorano JL. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Atherosclerosis 2016; 253:281-344. [DOI: 10.1016/j.atherosclerosis.2016.08.018] [Citation(s) in RCA: 558] [Impact Index Per Article: 69.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Mendy VL, Vargas R, El-sadek L. Trends in Heart Disease Mortality among Mississippi Adults over Three Decades, 1980-2013. PLoS One 2016; 11:e0161194. [PMID: 27518895 PMCID: PMC4982678 DOI: 10.1371/journal.pone.0161194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022] Open
Abstract
Heart disease (HD) remains the leading cause of death among Mississippians; however, despite the importance of the condition, trends in HD mortality in Mississippi have not been adequately explored. This study examined trends in HD mortality among adults in Mississippi from 1980 through 2013 and further examined these trends by race and sex. We used data from Mississippi Vital Statistics (1980-2013) to calculate age-adjusted HD mortality rates for Mississippians age 25 or older. Cases were identified using underlying cause of death codes from the International Classification of Diseases, Ninth Revision (ICD-9: 390-398, 402, 404-429) and Tenth Revision (ICD-10), including I00-I09, I11, I13, and I20-I51. Joinpoint software was used to calculate the average annual percent change in HD mortality rates for the overall population and by race and sex. Overall, the age-adjusted HD mortality rate among Mississippi adults decreased by 36.5% between 1980 and 2013, with an average annual percent change of -1.60% (95% CI -2.00 to -1.30). This trend varied across subgroups: HD mortality rates experienced an average annual change of -1.34% (95% CI -1.98 to -0.69) for black adults; -1.60% (95% CI -1.74 to -1.46) for white adults; -1.30% (95% CI -1.50 to -1.10) for all women, and -1.90% (95% -2.20 to -1.50) for all men. From 1980 to 2013, there was a continuous decrease in HD mortality among adult Mississippians. However, the magnitude of this reduction differed by race and sex.
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Affiliation(s)
- Vincent L. Mendy
- Office of Health Data and Research, Mississippi State Department of Health, Jackson, Mississippi, United States of America
- * E-mail:
| | - Rodolfo Vargas
- Office of Health Data and Research, Mississippi State Department of Health, Jackson, Mississippi, United States of America
| | - Lamees El-sadek
- Office of Health Data and Research, Mississippi State Department of Health, Jackson, Mississippi, United States of America
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Björck L, Rosengren A, Winkvist A, Capewell S, Adiels M, Bandosz P, Critchley J, Boman K, Guzman-Castillo M, O’Flaherty M, Johansson I. Changes in Dietary Fat Intake and Projections for Coronary Heart Disease Mortality in Sweden: A Simulation Study. PLoS One 2016; 11:e0160474. [PMID: 27490257 PMCID: PMC4973910 DOI: 10.1371/journal.pone.0160474] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/20/2016] [Indexed: 12/05/2022] Open
Abstract
Objective In Sweden, previous favourable trends in blood cholesterol levels have recently levelled off or even increased in some age groups since 2003, potentially reflecting changing fashions and attitudes towards dietary saturated fatty acids (SFA). We aimed to examine the potential effect of different SFA intake on future coronary heart disease (CHD) mortality in 2025. Methods We compared the effect on future CHD mortality of two different scenarios for fat intake a) daily SFA intake decreasing to 10 energy percent (E%), and b) daily SFA intake rising to 20 E%. We assumed that there would be moderate improvements in smoking (5%), salt intake (1g/day) and physical inactivity (5% decrease) to continue recent, positive trends. Results In the baseline scenario which assumed that recent mortality declines continue, approximately 5,975 CHD deaths might occur in year 2025. Anticipated improvements in smoking, dietary salt intake and physical activity, would result in some 380 (-6.4%) fewer deaths (235 in men and 145 in women). In combination with a mean SFA daily intake of 10 E%, a total of 810 (-14%) fewer deaths would occur in 2025 (535 in men and 275 in women). If the overall consumption of SFA rose to 20 E%, the expected mortality decline would be wiped out and approximately 20 (0.3%) additional deaths might occur. Conclusion CHD mortality may increase as a result of unfavourable trends in diets rich in saturated fats resulting in increases in blood cholesterol levels. These could cancel out the favourable trends in salt intake, smoking and physical activity.
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Affiliation(s)
- Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- * E-mail:
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Anna Winkvist
- Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Simon Capewell
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin Adiels
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Piotr Bandosz
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Julia Critchley
- St George's, University of London, Population Health Research Institute, Cranmer Terrace, London, United Kingdom
| | - Kurt Boman
- Research Unit, Medicine-Geriatric, Skellefteå, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Martin O’Flaherty
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
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Sahan C, Sozmen K, Unal B, O'Flaherty M, Critchley J. Potential benefits of healthy food and lifestyle policies for reducing coronary heart disease mortality in Turkish adults by 2025: a modelling study. BMJ Open 2016; 6:e011217. [PMID: 27388358 PMCID: PMC4947784 DOI: 10.1136/bmjopen-2016-011217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/07/2016] [Accepted: 06/09/2016] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This study uses a modelling approach to compare the potential impact of future risk factor scenarios relating to smoking, physical activity levels, dietary salt, saturated fat intake, mean body mass index (BMI) levels, diabetes prevalence and fruit and vegetable (F&V) consumption on future coronary heart disease (CHD) mortality in Turkey for year 2025. DESIGN A CHD mortality model previously developed and validated in Turkey was extended to predict potential trends in CHD mortality from 2008 to 2025. SETTING Using risk factor trends data from recent surveys as a baseline, we modelled alternative evidence-based future risk factor scenarios (modest/ideal scenarios). Probabilistic sensitivity analyses were conducted to account for uncertainties. SUBJECT Projected populations in 2025 (aged 25-84) of 54 million in Turkey. RESULTS Assuming lower mortality, modest policy changes in risk factors would result in ∼25 635 (range: 20 290-31 125) fewer CHD deaths in the year 2025; 35.6% attributed to reductions in salt consumption, 20.9% to falls in diabetes, 14.6% to declines in saturated fat intake and 13.6% to increase in F&V intake. In the ideal scenario, 45 950 (range: 36 780-55 450) CHD deaths could be prevented in 2025. Again, 33.2% of this would be attributed to reductions in salt reduction, 19.8% to increases in F&V intake, 16.7% to reductions in saturated fat intake and 14.0% to the fall in diabetes prevalence. CONCLUSIONS Only modest risk factor changes in salt, saturated/unsaturated fats and F&V intake could prevent around 16 000 CHD deaths in the year 2025 in Turkey, even assuming mortality continues to decline. Implementation of population-based, multisectoral interventions to reduce salt and saturated fat consumption and increase F&V consumption should be scaled up in Turkey.
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Affiliation(s)
- Ceyda Sahan
- Faculty of Medicine, Department of Public Health, Dokuz Eylül University, Izmir, Turkey
| | - Kaan Sozmen
- Faculty of Medicine, Department of Public Health, Kâtip Çelebi University, Izmir, Turkey
| | - Belgin Unal
- Faculty of Medicine, Department of Public Health, Dokuz Eylül University, Izmir, Turkey
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Julia Critchley
- Division of Population Health Sciences and Education, St George's, University of London, London, UK
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Determinants of prevalence, awareness, treatment and control of high LDL-C in Turkey. Anatol J Cardiol 2016; 16:370-84. [PMID: 27282671 PMCID: PMC5331367 DOI: 10.14744/anatoljcardiol.2016.7018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: High blood cholesterol is one of the main modifiable risk factors for cardiovascular diseases (CVDs). The aim of the study is to determine the factors associated with the prevalence, awareness, treatment, and control of high “low-density lipoprotein-cholesterol” (LDL-C) among adults aged ≥20 years in Turkey. Methods: We used data from Chronic Diseases and Risk Factors Survey conducted in 2011–2012. The presence of high LDL-C, lipid-lowering treatment eligibility, and achievement of target LDL-C were defined according to the third Adult Treatment Panel guidelines on treatment of high cholesterol. Multivariate logistic regression analyses were performed to determine the associations between participant characteristics and high LDL-C prevalence, awareness, treatment, and control. Results: Framingham risk score categorization was performed for 13121 individuals aged ≥20 years. Approximately, 28% of the participants presented with high LDL-C. Among those with high LDL-C, 55.8% were aware of their situation; among those aware of high LDL-C, 46.9% were receiving lipid-lowering medication, and 50.6% of individuals who were receiving treatment achieved target LDL-C levels on the basis of their coronary heart disease (CHD) risk. Control of high LDL-C was negatively associated with the presence of diabetes mellitus (odds ratio: 0.36, 95% CI: 0.27–0.49, p<0.001). Conclusion: Despite the high awareness rates, there was a high proportion of adults who did not receive treatment or achieve recommended levels of LDL-C during treatment. The low treatment and control levels among individuals based on their CHD risk levels call for a better application of recommendations regarding personal preventive measures and treatments in Turkey.
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Case management does not decrease mortality of patients with myocardial infarction or unstable angina: Evidence from a systematic review. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Jousilahti P, Laatikainen T, Peltonen M, Borodulin K, Männistö S, Jula A, Salomaa V, Harald K, Puska P, Vartiainen E. Primary prevention and risk factor reduction in coronary heart disease mortality among working aged men and women in eastern Finland over 40 years: population based observational study. BMJ 2016; 352:i721. [PMID: 26932978 PMCID: PMC4772739 DOI: 10.1136/bmj.i721] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To estimate how much changes in the main risk factors of cardiovascular disease (smoking prevalence, serum cholesterol, and systolic blood pressure) can explain the reduction in coronary heart disease mortality observed among working aged men and women in eastern Finland. DESIGN Population based observational study. SETTING Eastern Finland. PARTICIPANTS 34,525 men and women aged 30-59 years who participated in the national FINRISK studies between 1972 and 2012. INTERVENTIONS Change in main cardiovascular risk factors through population based primary prevention. MAIN OUTCOME MEASURES Predicted and observed age standardised mortality due to coronary heart disease. Predicted change was estimated with a logistic regression model using risk factor data collected in nine consecutive, population based, risk factor surveys conducted every five years since 1972. Data on observed mortality were obtained from the National Causes of Death Register. RESULTS During the 40 year study period, levels of the three major cardiovascular risk factors decreased except for a small increase in serum cholesterol levels between 2007 and 2012. From years 1969-1972 to 2012, coronary heart disease mortality decreased by 82% (from 643 to 118 deaths per 100,000 people) and 84% (114 to 17) among men and women aged 35-64 years, respectively. During the first 10 years of the study, changes in these three target risk factors contributed to nearly all of the observed mortality reduction. Since the mid-1980s, the observed reduction in mortality has been larger than predicted. In the last 10 years of the study, about two thirds (69% in men and 66% in women) of the reduction could be explained by changes in the three main risk factors, and the remaining third by other factors. CONCLUSION Reductions in disease burden and mortality due to coronary heart disease can be achieved through the use of population based primary prevention programmes. Secondary prevention among high risk individuals and treatment of acute events of coronary heart disease could confer additional benefit.
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Affiliation(s)
- Pekka Jousilahti
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Tiina Laatikainen
- University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland
| | - Markku Peltonen
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Katja Borodulin
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Satu Männistö
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Kennet Harald
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Pekka Puska
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
| | - Erkki Vartiainen
- National Institute for Health and Welfare, Department of Health, PO Box 30, 00271 Helsinki, Finland
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Islek D, Sozmen K, Unal B, Guzman-Castillo M, Vaartjes I, Critchley J, Capewell S, O'Flaherty M. Estimating the potential contribution of stroke treatments and preventative policies to reduce the stroke and ischemic heart disease mortality in Turkey up to 2032: a modelling study. BMC Public Health 2016; 16:46. [PMID: 26781488 PMCID: PMC4717543 DOI: 10.1186/s12889-015-2655-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/18/2015] [Indexed: 01/12/2023] Open
Abstract
Background Stroke and Ischemic Heart Diseases (IHD) are the main cause of premature deaths globally, including Turkey. There is substantial potential to reduce stroke and IHD mortality burden; particularly by improving diet and health behaviours at the population level. Our aim is to estimate and compare the potential impact of ischemic stroke treatment vs population level policies on ischemic stroke and IHD deaths in Turkey if achieved like other developed countries up to 2022 and 2032. Methods We developed a Markov model for the Turkish population aged >35 years. The model follows the population over a time horizon of 10 and 20 years. We modelled seven policy scenarios: a baseline scenario, three ischemic stroke treatment improvement scenarios and three population level policy intervention scenarios (based on target reductions in dietary salt, transfat and unsaturated fat intake, smoking prevalence and increases in fruit and vegetable consumption). Parameter uncertainty was explored by including probabilistic sensitivity analysis. Results In the baseline scenario, we forecast that approximately 655,180 ischemic stroke and IHD deaths (306,500 in men; 348,600 in women) may occur in the age group of 35–94 between 2012 and 2022 in Turkey. Feasible interventions in population level policies might prevent approximately 108,000 (62,580–326,700) fewer stroke and IHD deaths. This could result in approximately a 17 % reduction in total stroke and IHD deaths in 2022. Approximately 32 %, 29 %, 11 % and 6 % of that figure could be attributed to a decreased consumption of transfat, dietary salt, saturated fats and fall in smoking prevalence and 22 % could be attributed to increased fruit and vegetable consumption. Feasible improvements in ischemic stroke treatment could prevent approximately 9 % fewer ischemic stroke and IHD deaths by 2022. Conclusions Our modeling study suggests that effective and evidence-based food policies at the population level could massively contribute to reduction in ischemic stroke and IHD mortality in a decade and deliver bigger gains compared to healthcare based interventions for primary and secondary prevention. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2655-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duygu Islek
- Department of Public Health, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey.
| | - Kaan Sozmen
- Department of Public Health, Faculty of Medicine, Katip Celebi University, İzmir, Turkey.
| | - Belgin Unal
- Department of Public Health, Dokuz Eylul University, Faculty of Medicine, İzmir, Turkey.
| | - Maria Guzman-Castillo
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK. .,Deparment of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
| | - Ilonca Vaartjes
- Deparment of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
| | - Julia Critchley
- Deparment of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
| | - Simon Capewell
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK. .,Deparment of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
| | - Martin O'Flaherty
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, UK. .,Deparment of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.
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Wong MCS, Zhang DX, Wang HHX. Rapid emergence of atherosclerosis in Asia: a systematic review of coronary atherosclerotic heart disease epidemiology and implications for prevention and control strategies. Curr Opin Lipidol 2015; 26:257-69. [PMID: 26103609 DOI: 10.1097/mol.0000000000000191] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is a global epidemic of coronary heart disease (CHD) caused by atherosclerosis. We discussed its emergence, underlying reasons, and implications for prevention and control strategies in Asia. RECENT FINDINGS Most countries in Asia are experiencing the challenges from CHD, with the mortality rate varying from 103 to 366 per 100 000 adult populations, reported by recently published studies. Raised population cholesterol levels played a pivotal role. Men, older adults, and those with dyslipidemia, hypertension, and diabetes were high-risk individuals. During the past decade, there was a marked rising trend of atherosclerosis-related burden particularly in Eastern Asia where an alarming increase of 117.2 and 115.3% of total deaths and disability adjusted life-years, respectively, were observed. The rise of CHD could be attributed to unhealthy lifestyles, clinical-risk factors, psychosocial factors, and public health transitions. Ageing, urbanization, and increase in prosperity may serve as underlying key drivers. SUMMARY The burden of CHD is substantial, whereas contributors are multifactorial. This grand challenge should be a top priority for injecting healthcare resources. The formulation of public health measures will need to adopt an integrated and life-course approach, based on the need and risks of different population subgroups in Asia.
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Affiliation(s)
- Martin C S Wong
- aJC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong bSchool of Public Health, Sun Yat-Sen University, Guangzhou, P.R. China cGeneral Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, UK *Martin C.S. Wong and De Xing Zhang contributed equally to the writing of this article
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Ozgonul C, Sertoglu E, Ozge G, Kucukevcilioglu M, Mumcuoglu T. Appropriate evaluation of ocular parameters in coronary artery bypass grafting surgery patients. Perfusion 2015; 31:89-90. [PMID: 25953930 DOI: 10.1177/0267659115586281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- C Ozgonul
- Department of Ophthalmology, Van Military Hospital, Van, Turkey
| | - E Sertoglu
- Anittepe Dispensary, Biochemistry Laboratory, Ankara Mevki Military Hospital, Ankara, Turkey
| | - G Ozge
- Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey
| | - M Kucukevcilioglu
- Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey
| | - T Mumcuoglu
- Department of Ophthalmology, Gulhane Military Medical Academy, Ankara, Turkey
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Björck L, Capewell S, O’Flaherty M, Lappas G, Bennett K, Rosengren A. Decline in Coronary Mortality in Sweden between 1986 and 2002: Comparing Contributions from Primary and Secondary Prevention. PLoS One 2015; 10:e0124769. [PMID: 25942424 PMCID: PMC4420282 DOI: 10.1371/journal.pone.0124769] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/12/2015] [Indexed: 12/31/2022] Open
Abstract
Background The relative importance of risk factor reduction in healthy people (primary prevention) versus that in patients with coronary heart disease (secondary prevention) has been debated. We aimed to quantify the contribution of the two. Methodology We used the previously validated IMPACT model to estimate contributions from primary prevention (reducing risk factors in the population, particularly smoking, cholesterol and systolic blood pressure) and from secondary prevention (reducing risk factors in coronary heart disease patients) in the Swedish population. Principal Findings Between 1986 and 2002, about 8,690 fewer deaths were related to changes in the three major risk factors. Population cholesterol fell by 0.64 mmol/L, with approximately 5,210 fewer deaths attributable to diet changes (4,470 in healthy people740 in patients.) plus 810 to statin treatment (200 in healthy people, 610 in patients). Overall smoking prevalence decreased by 10.3%, resulting in 1,195 fewer deaths, attributable to smoking cessation (595 in healthy people, 600 in patients). Mean population systolic blood pressure fell by 2.6 mmHg, resulting in 900 fewer deaths (865 in healthy people, 35 in patients), plus 575 fewer deaths attributable to antihypertensive medication in healthy people. The majority of falls in deaths attributable to risk factors occurred in people without known heart disease: 6,705 fewer deaths compared with 1,985 fewer deaths in patients (secondary prevention), emphasizing the importance of promoting health interventions in the general population. Conclusions The largest effects on mortality came from primary prevention, giving markedly larger mortality reductions than secondary prevention.
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Affiliation(s)
- Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- * E-mail:
| | - Simon Capewell
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Martin O’Flaherty
- Division of Public Health, University of Liverpool, Liverpool, United Kingdom
| | - Georgios Lappas
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Kathleen Bennett
- Department of Pharmacology and Therapeutics, Trinity Centre for Health Sciences, St James’s Hospital, Dublin, Ireland
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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MedCHAMPS: Mediterranean studies of cardiovascular disease and hyperglycaemia: analytical modelling of population socio-economic transitions. Int J Public Health 2014; 60 Suppl 1:S1-2. [PMID: 25398319 DOI: 10.1007/s00038-014-0618-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022] Open
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Cardiovascular risk factor trends in the Eastern Mediterranean region: evidence from four countries is alarming. Int J Public Health 2014; 60 Suppl 1:S3-11. [DOI: 10.1007/s00038-014-0610-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 12/22/2022] Open
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