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Fu M, Mei A, Min X, Yang H, Wu W, Zhong J, Li C, Chen J. Advancements in Cardiovascular Disease Research Affected by Smoking. Rev Cardiovasc Med 2024; 25:298. [PMID: 39228476 PMCID: PMC11367002 DOI: 10.31083/j.rcm2508298] [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: 12/05/2023] [Revised: 04/09/2024] [Accepted: 04/18/2024] [Indexed: 09/05/2024] Open
Abstract
The harmful substances in tobacco are widely recognized to exert a significant detrimental impact on human health, constituting one of the most substantial global public health threats to date. Tobacco usage also ranks among the principal contributors to cardiovascular ailments, with tobacco being attributed to up to 30% of cardiovascular disease-related deaths in various countries. Cardiovascular disease is influenced by many kinds of pathogenic factors, among them, tobacco usage has led to an increased year by year incidence of cardiovascular disease. Exploring the influencing factors of harmful substances in tobacco and achieving early prevention are important means to reduce the incidence of cardiovascular diseases and maintain health. This article provides a comprehensive review of the effects of smoking on health and cardiovascular diseases.
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Affiliation(s)
- Miaoxin Fu
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, 442000 Shiyan, Hubei, China
| | - Aihua Mei
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, 442000 Shiyan, Hubei, China
| | - Xinwen Min
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, 442000 Shiyan, Hubei, China
| | - Handong Yang
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, 442000 Shiyan, Hubei, China
| | - Wenwen Wu
- School of Public Health, Hubei University of Medicine, 442000 Shiyan, Hubei, China
| | - Jixin Zhong
- Department of Rheumatology and Immunology, Tongji Hospital, Huazhong University of Science and Technology, 430074 Wuhan, Hubei, China
| | - Chunlei Li
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, 442000 Shiyan, Hubei, China
| | - Jun Chen
- Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension), Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Hubei University of Medicine, 442000 Shiyan, Hubei, China
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Shi Y, Peng J, Liu L, Zhao Z, Xiong J, Wan X. Effect of a two-phase tobacco control regulation on incidence from ischemic stroke and hemorrhagic stroke, Shenzhen, China, 2007-2016. Tob Induc Dis 2023; 21:100. [PMID: 37533958 PMCID: PMC10392040 DOI: 10.18332/tid/168123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/16/2023] [Accepted: 06/11/2023] [Indexed: 08/04/2023] Open
Abstract
INTRODUCTION The Shenzhen government is widely considered to be most efficiently implementing smoke-free legislation in China. We evaluated and compared the impact of Shenzhen's two-phase smoke-free regulation on the incidence rates for ischemic and hemorrhagic stroke. METHODS An interrupted time series design was used to capture immediate and annual incidence changes from 2007 to 2016 for both ischemic and hemorrhagic stroke due to two-phase smoke-free regulation in Shenzhen, China, by using a generalized additive model. The first phase, implemented on 9 March 2010, required five main public places to be smoke-free. In the second phase, the comprehensive law was expanded to the whole city on 1 March 2014. RESULTS The regulation implementation during phase I was associated with a strong immediate decline in the incidence rate of ischemic stroke (-14.2%, 95% CI: -19.6 - -8.4) and hemorrhagic stroke (-10.1%, 95% CI: -18.2 - -1.2), but without showing the annual changes (p>0.05). Following the implementation of the comprehensive law, the gradual annual effect showed a significant change in ischemic stroke, with a 6.3% (95% CI: 8.9 - -3.6) reduction. Neither the immediate nor gradual decreases in hemorrhagic stroke incidences associated with the comprehensive regulation were statistically significant during phase II (p>0.05). Subgroup analyses indicate that a much larger health effect of the regulation during phase I was greater among those aged ≥65 years than among those aged 35-64 years. CONCLUSIONS Shenzhen's two-phase smoke-free regulation was well implemented. Even though the regulation did not extend to the whole city, the immediate health benefits on the incidence rates of ischemic stroke and hemorrhagic stroke could be seen. However, the health benefits brought by the implementation of comprehensive smoke-free legislation were attenuated by previous smoke-free regulations in five main public places, which were more evident in hemorrhagic stroke.
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Affiliation(s)
- Yulin Shi
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Ji Peng
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Liqun Liu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Zhiguang Zhao
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Jingfan Xiong
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Xia Wan
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China
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Akter S, Islam MR, Rahman MM, Rouyard T, Nsashiyi RS, Hossain F, Nakamura R. Evaluation of Population-Level Tobacco Control Interventions and Health Outcomes: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2322341. [PMID: 37418258 PMCID: PMC10329215 DOI: 10.1001/jamanetworkopen.2023.22341] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 05/22/2023] [Indexed: 07/08/2023] Open
Abstract
Importance Smoking causes considerable noncommunicable diseases, perinatal morbidity, and mortality. Objective To investigate the associations of population-level tobacco-control policies with health outcomes. Data Sources PubMed, EMBASE, Web of Science, Cumulated Index to Nursing and Allied Health Literature, and EconLit were searched from inception to March 2021 (updated on 1 March 2022). References were manually searched. Study Selection Studies reporting on associations of population-level tobacco control policies with health-related outcomes were included. Data were analyzed from May to July 2022. Data Extraction and Synthesis Data were extracted by 1 investigator and cross-checked by a second investigator. Analyses were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline. Main Outcomes and Measures The primary outcomes were respiratory system disease (RSD), cardiovascular disease (CVD), cancer, mortality, hospitalization, and health care utilization. The secondary outcomes were adverse birth outcomes, such as low birth weight and preterm birth. Random-effects meta-analysis was used to estimate pooled odds ratios (ORs) and 95% CIs. Results Of 4952 records identified, 144 population-level studies were included in the final analysis; 126 studies (87.5%) were of high or moderate quality. The most frequently reported policies were smoke-free legislation (126 studies), followed by tax or price increases (14 studies), multicomponent tobacco control programs (12 studies), and a minimum cigarette purchase age law (1 study). Smoke-free legislation was associated with decreased risk of all CVD events (OR, 0.90; 95% CI, 0.86-0.94), RSD events (OR, 0.83; 95% CI, 0.72-0.96), hospitalization due to CVD or RSD (OR, 0.91; 95% CI, 0.87-0.95), and adverse birth outcomes (OR, 0.94; 95% CI, 0.92-0.96). These associations persisted in all sensitivity and subgroup analyses, except for the country income category, for which a significant reduction was only observed in high-income countries. In meta-analysis, there was no clear association of tax or price increases with adverse health outcomes. However, for the narrative synthesis, all 8 studies reported statistically significant associations between tax increases and decreases in adverse health events. Conclusions and Relevance In this systematic review and meta-analysis, smoke-free legislation was associated with significant reductions in morbidity and mortality related to CVD, RSD, and perinatal outcomes. These findings support the need to accelerate the implementation of smoke-free laws to protect populations against smoking-related harm.
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Affiliation(s)
- Shamima Akter
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Rashedul Islam
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Md. Mizanur Rahman
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Thomas Rouyard
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | | | - Fahima Hossain
- Global Public Health Research Foundation, Dhaka, Bangladesh
| | - Ryota Nakamura
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
- Graduate School of Economics, Hitotsubashi University, Tokyo, Japan
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Association of Circulating microRNAs with Coronary Artery Disease and Usefulness for Reclassification of Healthy Individuals: The REGICOR Study. J Clin Med 2020; 9:jcm9051402. [PMID: 32397522 PMCID: PMC7290581 DOI: 10.3390/jcm9051402] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022] Open
Abstract
Risk prediction tools cannot identify most individuals at high coronary artery disease (CAD) risk. Oxidized low-density lipoproteins (oxLDLs) and microRNAs are actively involved in atherosclerosis. Our aim was to examine the association of CAD and oxLDLs-induced microRNAs, and to assess the microRNAs predictive capacity of future CAD events. Human endothelial and vascular smooth muscle cells were treated with oxidized/native low-density lipoproteins, and microRNA expression was analyzed. Differentially expressed and CAD-related miRNAs were examined in serum samples from (1) a case-control study with 476 myocardial infarction (MI) patients and 487 controls, and (2) a case-cohort study with 105 incident CAD cases and 455 randomly-selected cohort participants. MicroRNA expression was analyzed with custom OpenArray plates, log rank tests and Cox regression models. Twenty-one microRNAs, two previously undescribed (hsa-miR-193b-5p and hsa-miR-1229-5p), were up- or down-regulated upon cell treatment with oxLDLs. One of the 21, hsa-miR-122-5p, was also upregulated in MI cases (fold change = 4.85). Of the 28 CAD-related microRNAs tested, 11 were upregulated in MI cases-1 previously undescribed (hsa-miR-16-5p)-, and 1/11 was also associated with CAD incidence (adjusted hazard ratio = 0.55 (0.35–0.88)) and improved CAD risk reclassification, hsa-miR-143-3p. We identified 2 novel microRNAs modulated by oxLDLs in endothelial cells, 1 novel microRNA upregulated in AMI cases compared to controls, and one circulating microRNA that improved CAD risk classification.
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Stallings-Smith S, Hamadi HY, Peterson BN, Apatu EJI, Spaulding AC. Smoke-Free Policies and 30-Day Readmission Rates for Chronic Obstructive Pulmonary Disease. Am J Prev Med 2019; 57:621-628. [PMID: 31564604 DOI: 10.1016/j.amepre.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Previous evidence has shown that smoke-free policies reduce hospital admissions due to respiratory causes, but the impact on 30-day readmission has not been determined. As 25 states in the U.S. have not adopted comprehensive smoke-free legislation, it is likely that patients return to an environment that increases risk of a secondary event. The aim of this study is to investigate the impact of smoke-free policies on 30-day readmission rates for adults aged ≥65 years following hospitalization for chronic obstructive pulmonary disease in the U.S. METHODS Data from the U.S. Tobacco Control Laws Database, Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program, American Hospital Association, Area Health Resource File, and U.S. Census Bureau Current Population Survey were merged at the county level for years 2013-2016 and analyzed in 2018. Hierarchical Poisson regression models were utilized to calculate incidence rate ratios to determine the impact of full, partial, and no smoke-free policies on 30-day readmission rates after chronic obstructive pulmonary disease hospitalization. RESULTS Multivariable analysis adjusting for both county and hospital characteristics revealed that the presence of full (incidence rate ratio=0.81, 95% CI=0.76, 0.88) and partial (incidence rate ratio=0.87, 95% CI=0.81, 0.92) smoke-free policies were associated with fewer 30-day readmissions for chronic obstructive pulmonary disease-related hospitalizations when compared with counties with no smoke-free policy. CONCLUSIONS The implementation of smoke-free policies is an effective measure for reducing 30-day readmissions following hospitalization due to chronic obstructive pulmonary disease, with stronger policies resulting in decreased risk. Efforts to reduce chronic obstructive pulmonary disease-related 30-day readmissions should include the implementation of smoke-free policies.
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Affiliation(s)
- Sericea Stallings-Smith
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, Florida.
| | - Hanadi Y Hamadi
- Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Breck N Peterson
- Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, Florida
| | - Emma J I Apatu
- Department of Health Research Methods, Evidence, and Impact, Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Aaron C Spaulding
- Department of Health Sciences Research, Division of Health Care Policy and Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida
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Gao M, Li Y, Wang F, Zhang S, Qu Z, Wan X, Wang X, Yang J, Tian D, Zhang W. The effect of smoke-free legislation on the mortality rate of acute myocardial infarction: a meta-analysis. BMC Public Health 2019; 19:1269. [PMID: 31533693 PMCID: PMC6749716 DOI: 10.1186/s12889-019-7408-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 07/31/2019] [Indexed: 12/29/2022] Open
Abstract
Background Several studies have demonstrated that smoke-free legislation is associated with a reduced risk of mortality from acute myocardial infarction (AMI). This study aimed to examine and quantify the potential effect of smoke-free legislation on AMI mortality rate in different countries. Methods Studies were identified using a systematic search of the scientific literature from electronic databases, including PubMed, Web of Science, ScienceDirect, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI), from their inception through September 30, 2017. A random effects model was employed to estimate the overall effects of smoke-free legislation on the AMI mortality rate. Subgroup analysis was performed to explore the possible causes of heterogeneity in risk estimates based on sex and age. The results of meta-analysis after excluding the studies with a high risk of bias were reported in this study. Results A total of 10 eligible studies with 16 estimates of effect size were included in this meta-analysis. Significant heterogeneity in the risk estimates was identified (overall I2 = 94.6%, p < 0.001). Therefore, a random effects model was utilized to estimate the overall effect of smoke-free legislation. There was an 8% decline in AMI mortality after introducing smoke-free legislation (RR = 0.92, 95% confidence interval (CI): 0.90–0.94). The results of subgroup analyses showed that smoke-free legislation was significantly associated with lower rates of mortality for the following 5 diagnostic subgroups: smoke-free in workplaces, restaurants and bars (RR = 0.92, 95% CI: 0.90–0.95), smaller sample size (RR = 0.92, 95% CI: 0.89–0.95), study location in Europe (RR = 0.90, 95% CI: 0.85–0.94), regional study area (RR = 0.92, 95% CI: 0.89–0.94), and no previous local smoke-free legislation (RR = 0.91, 95% CI: 0.90–0.93). However, there was not much difference in AMI mortality rates after the legislation between the longer (RR = 0.92, 95% CI: 0.86–0.98) and shorter follow-up duration subgroups (RR = 0.92, 95% CI: 0.89–0.94). Conclusion Smoke-free legislation could significantly reduce the AMI mortality rate by 8%. The reduction in the AMI mortality rate was more significant in studies with more comprehensive laws, without prior smoke-free bans, with a smaller sample size, at the regional level, and with a location in Europe. Electronic supplementary material The online version of this article (10.1186/s12889-019-7408-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Min Gao
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Yanyu Li
- School of Humanities and Social Sciences, North China Electric Power University, Baoding, 071000, China
| | - Fugang Wang
- People's Bank of China Jinan Branch, Jinan, 250021, China
| | - Shengfa Zhang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Zhiyong Qu
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, 100005, China
| | - Xiaohua Wang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Jie Yang
- Tobacco control office, Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Donghua Tian
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China
| | - Weijun Zhang
- School of Social Development and Public Policy (SSDPP), Beijing Normal University, 19, XinjiekouWai Street, Beijing, 100875, China.
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The limits of single-group interrupted time series analysis in assessing the impact of smoke-free laws on short-term mortality. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:112-120. [PMID: 31470256 DOI: 10.1016/j.drugpo.2019.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/17/2019] [Accepted: 07/06/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Decreases in circulatory/respiratory morbimortality after the January-2006 Spanish partial smoke-free law have been found using designs without control groups, such as single-group interrupted time series (ITS), which are prone to biases. The aim was to reassess the law's impact on mortality using ITS designs with robustness checks. METHODS A comprehensive cohort of people aged ≥25 in each calendar-year of 2002-2007, living in 13 of 18 Spanish regions, was followed up between 01/2002 and 12/2007. The law included a smoking ban in indoor public and workplaces, allowing exceptions in catering, hospitality and leisure venues, and other interventions. Post-law changes in monthly coronary/respiratory mortality were estimated using segmented regression, adjusting for relevant covariates, including seasonality, extreme temperatures, influenza incidence and air pollution. The validity of results was assessed using control outcomes, hypothetical law dates, and non-equivalent control groups, analysing their results as difference-in-differences (DID) designs. RESULTS Significant immediate post-law decreases in coronary, respiratory and non-tobacco-related mortality were observed among people aged ≥70. A significant immediate post-law decrease in respiratory mortality (-12.7%) was also observed among people age 25-69, although this was neutralized by a subsequent upward trend before 1.5 years. More favourable post-law changes in coronary/respiratory mortality among the target (people aged 25-69) than control groups (people aged ≥70 or women aged ≥80) were not identified in DID designs. Establishing hypothetical law dates, immediate decreases began in February/March 2005 with maxima between April and July 2005. CONCLUSIONS After robustness checks, the results do not support a clear positive impact of the 2006 Spanish smoke-free law on short-term coronary/respiratory mortality. The favourable immediate changes observed pre- and post-law could derive mainly from the harvesting effect of the January-2005 cold wave. This highlights the risks of assessing the impact of health interventions using both morbimortality outcomes and designs without a control group and adequate robustness checks.
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Role of Apparent Temperature and Air Pollutants in Hospital Admissions for Acute Myocardial Infarction in the North of Spain. ACTA ACUST UNITED AC 2019; 72:634-640. [DOI: 10.1016/j.rec.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/21/2018] [Indexed: 01/09/2023]
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Royé D, Zarrabeitia MT, Fdez-Arroyabe P, Álvarez Gutiérrez A, Santurtún A. Papel de la temperatura aparente y de los contaminantes atmosféricos en los ingresos por infarto agudo de miocardio en el norte de España. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Critselis E, Panagiotakos DB, Georgousopoulou EN, Katsaounou P, Chrysohoou C, Pitsavos C. Exposure to second hand smoke and 10-year (2002-2012) incidence of cardiovascular disease in never smokers: The ATTICA cohort study. Int J Cardiol 2019; 295:29-35. [PMID: 31375335 DOI: 10.1016/j.ijcard.2019.07.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/17/2019] [Accepted: 07/22/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Despite WHO Framework Convention of Tobacco Control (FCTC) adoption, effective implementation of national smoking bans remains pending in several countries. This study quantified the association of second hand smoke (SHS) exposure and 10-year cardiovascular disease (CVD) among never smokers in such settings. METHODS In 2001-2002, a sample of 1514 males and 1528 females (range: 18-89 years old) were randomly selected in Greece. Frequency and duration of SHS exposure (i.e. exposure extending >30 min/day) within the home and/or workplace were assessed by interview. Following a 10-year follow-up period (2002-2012), incidence of non-fatal and fatal CVD (ICD-10) was evaluated among n = 2020 participants. The analytic study sample consisted of all never smokers (n = 910). RESULTS Despite national smoking ban implementation (2009), 44.6% (n = 406) of never smokers reported SHS exposure. While SHS exposed never smokers exhibited a more favorable profile of CVD-related risk factors at baseline, they subsequently developed similar 10-year CVD incidence rates, at a younger mean age (p = 0.001), than their non-exposed counterparts. Following adjustment for several lifestyle and clinical factors, SHS exposed never smokers exhibited a two-fold elevated 10-year CVD risk (adj. HR: 2.04, 95% CI: 1.43-2.92), particularly among women (adj. HR: 2.45, 95% CI: 1.45-4.06). SHS exposure accounted for 32% excess Population Attributable Risk (PAR) for 10-year CVD events in never smokers, with highest rates (PAR: 52%) being among those exposed in the workplace. CONCLUSION The prevention of SHS associated CVD and related healthcare costs mandates additional strategies for securing the effective implementation of comprehensive WHO FCTC based national smoking bans.
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Affiliation(s)
- Elena Critselis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; University of Canberra, Faculty of Health, Canberra, Australia; University of La Trobe, College of Science, Health & Engineering, Melbourne, Australia.
| | - Ekavi N Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece; University of Canberra, Faculty of Health, Canberra, Australia; University of Notre Dame Australia, Medical School, Sydney, Australia
| | - Paraskevi Katsaounou
- Pulmonary and Critical Care Department, First ICU, School of Medicine, University of Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
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Fa-Binefa M, Clará A, Pérez-Fernández S, Grau M, Dégano IR, Marti-Lluch R, Ramos R, Marrugat J, Elosua R. Early smoking-onset age and risk of cardiovascular disease and mortality. Prev Med 2019; 124:17-22. [PMID: 31054906 DOI: 10.1016/j.ypmed.2019.04.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 03/20/2019] [Accepted: 04/28/2019] [Indexed: 01/10/2023]
Abstract
Early smoking onset age (SOA) is a public health concern with scant empirical evidence of its role in health outcomes. The study had two aims: i) to assess whether an early SOA was associated with the risk of fatal and non-fatal CVD and all-cause and CVD mortality and ii) to explore the linear and non-linear association between SOA and the outcomes of interest. Data from 4499 current or former smokers, recruited from 1995 to 2005, aged 25 to 79 years, and with a median 7.02 years of follow-up, were obtained from the REGICOR population-based cohort. In the present analysis, performed in 2018, the independent variable was SOA and the dependent variables were CVD events, CVD mortality, and all-cause mortality. Penalized smoothing spline methods were used to assess the linear and non-linear association. During follow-up, 361 deaths and 210 CVD events were recorded. A significant non-linear component was identified in the association between SOA and CVD outcomes with a cut-off point at 12 years: In the group aged ≤12 years, each year of delay in SOA was inversely associated with CVD risk (HR = 0.71; 95%CI = 0.53-0.96) and CVD mortality (HR = 0.58; 95%CI = 0.37-0.90). No association was observed in the older SOA group. A linear association was observed between SOA and all-cause mortality, and each year of delay was associated with 4% lower risk of mortality (HR = 0.96; 95%CI = 0.93-0.98). The associations were adjusted for lifelong exposure to tobacco and cardiovascular risk factors. These results reinforce the value of preventing tobacco use among teenagers and adolescents.
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Affiliation(s)
- Manel Fa-Binefa
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; School of Health and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Albert Clará
- School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain; Cardiovascular Epidemiology and Genetics Group, REGICOR, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain; Center for the Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Barcelona, Spain
| | - Silvia Pérez-Fernández
- Cardiovascular Epidemiology and Genetics Group, REGICOR, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain; Center for the Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Barcelona, Spain
| | - Maria Grau
- Cardiovascular Epidemiology and Genetics Group, REGICOR, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain; Center for the Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Barcelona, Spain
| | - Irene R Dégano
- Cardiovascular Epidemiology and Genetics Group, REGICOR, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain; Center for the Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Barcelona, Spain; Department of Medicine, Faculty of Medicine, Universitat de Vic-Central de Catalunya, Vic, Spain
| | - Ruth Marti-Lluch
- Unitat de Suport a la Recerca de Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona Institut Català de la Salut (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Spain
| | - Rafel Ramos
- Unitat de Suport a la Recerca de Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona Institut Català de la Salut (ICS), Catalonia, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Spain; Department of Medical Sciences, School of Medicine, University of Girona, Spain
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics Group, REGICOR, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain; Center for the Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, REGICOR, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain; Center for the Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Barcelona, Spain; Department of Medicine, Faculty of Medicine, Universitat de Vic-Central de Catalunya, Vic, Spain.
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12
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Rando-Matos Y, Pons-Vigués M, Rodriguez-Blanco T, Ripoll J, Llobera J, Morán J, Ballvé-Moreno JL, Violán C, Bolíbar B. Effect of comprehensive smoke-free legislation on asthma and coronary disease trends in Spanish primary care patients. Eur J Public Health 2019; 28:553-559. [PMID: 29401282 DOI: 10.1093/eurpub/cky010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background To examine the impact of comprehensive smoke-free legislation (SFL) (Law 42/2010) on the incidence and prevalence of adult asthma and coronary disease in primary health care (PHC) patients from three Spanish regions, overall and stratified by sex. Methods Longitudinal observational study conducted between 2007 and 2013 in the population over 15 years of age assigned to 66 PHC teams in Catalonia, Navarre and the Balearic Islands. Crude rates and age-standardized (truncated: asthma ≥ 16 years and coronary disease ≥ 35 years) incidence and prevalence rates using the direct method based on the European Standard Population were estimated based on data from PHC electronic health records. Joinpoint analysis was used to analyse the trends of age-standardized incidence and prevalence rates. Trends were expressed as annual percentage change and average annual percent change (AAPC). Results The standardized asthma incidence rate showed a non-significant downward trend and the standardized prevalence rates rose significantly in the three regions. Standardized coronary disease incidence and prevalence rates were considerably higher for men than for women in all regions. The standardized coronary disease incidence rates in Catalonia (AAPC: -8.00%, 95% CI: -10.46; -5.47) and Navarre (AAPC: -3.66%, 95% CI: -4.95;-2.35) showed a significant downward trend from 2007 to 2013, overall and by sex. The standardized coronary disease prevalence trend rate increased significantly in the whole period in Catalonia and the Balearic Islands, although a non-significant downward trend was observed from 2010 in Catalonia. Conclusion No changes in the trends of adult asthma and coronary disease in PHC Spanish patients were detected after the introduction of comprehensive SFL.
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Affiliation(s)
- Yolanda Rando-Matos
- Centre d'Atenció Primària (CAP) Florida Nord. Gerència d'Àmbit d'Atenció Primària Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Universitat de Girona, Girona, Spain
| | - Teresa Rodriguez-Blanco
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Joana Ripoll
- Primary Care Research Unit of Mallorca, Baleares Health Services-Ibsalut, Palma, Spain.,Instituto de Investigación Sanitaria les Illes Balears (IdSBA), Hospital Universitario Son Espases, Palma, Spain
| | - Joan Llobera
- Primary Care Research Unit of Mallorca, Baleares Health Services-Ibsalut, Palma, Spain.,Instituto de Investigación Sanitaria les Illes Balears (IdSBA), Hospital Universitario Son Espases, Palma, Spain
| | - Julio Morán
- Consultorio de Barásoain (Equipo de Atención Primaria de Tafalla), Servicio Navarro de Salud, Navarra, Spain
| | - Josep Lluís Ballvé-Moreno
- Centre d'Atenció Primària (CAP) Florida Nord. Gerència d'Àmbit d'Atenció Primària Metropolitana Sud, Institut Català de la Salut (ICS), Hospitalet de Llobregat, Barcelona, Spain.,Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Concepció Violán
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Bonaventura Bolíbar
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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13
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Lee PN, Fry JS, Thornton AJ. Updating the evidence relating smoking bans to incidence of heart disease. Regul Toxicol Pharmacol 2019; 101:172-186. [PMID: 30500390 DOI: 10.1016/j.yrtph.2018.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 11/18/2022]
Abstract
In our latest update of the evidence on smoking bans and heart disease we summarize 59 studies. We take account of the underlying trends in incidence rates as far as possible by using control data in eight studies, and by adjustment based on observed trends in cases pre- and post-ban in 40 studies, being unable to make an adjustment in the remaining 11 studies. Overall, based on 62 independent estimates from the 59 studies, we estimate that bans reduce incidence by 5.0% (95% CI 3.2-6.8%), though this estimate reduces to 2.9% (0.01-5.6%) when we exclude regional estimates where national estimates are available, and studies where trend adjustment is not possible. For 25 of the studies, quadratic rather than linear adjustment is possible, but this hardly affects the overall estimates. Ban effects are somewhat greater when the pre-ban period studied is relatively short, and in smaller studies. We compare our findings with those in other recent reviews, one of which totally ignored underlying trends and results from control populations. We discuss reasons why we believe there is likely to be a true small effect of smoking bans, and weaknesses in the data which preclude reaching any very confident conclusion.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK.
| | - John S Fry
- ROELEE Statistics Ltd, 17 Cedar Road, Sutton, Surrey, SM2 5DA, UK
| | - Alison J Thornton
- Independent Consultant, Oak Cottage, Beer Farm, Okehampton, Devon, EX20 1SG, UK
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14
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Galán I, Simón L, Boldo E, Ortiz C, Medrano MJ, Fernández-Cuenca R, Linares C, Pastor-Barriuso R. Impact of 2 Successive Smoking Bans on Hospital Admissions for Cardiovascular Diseases in Spain. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:726-734. [PMID: 29673904 DOI: 10.1016/j.rec.2017.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/10/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the impact of 2 smoking bans enacted in 2006 (partial ban) and 2011 (comprehensive ban) on hospitalizations for cardiovascular disease in the Spanish adult population. METHODS The study was performed in 14 provinces in Spain. Hospital admission records were collected for acute myocardial infarction (AMI), ischemic heart disease (IHD), and cerebrovascular disease (CVD) in patients aged ≥ 18 years from 2003 through 2012. We estimated immediate and 1-year effects with segmented-linear models. The coefficients for each province were combined using random-effects multivariate meta-analysis models. RESULTS Overall, changes in admission rates immediately following the implementation of the partial ban and 1 year later were -1.8% and +1.2% for AMI, +0.1 and +0.4% for IHD, and +1.0% and +2.8% for CVD (P>.05). After the comprehensive ban, immediate changes were -2.3% for AMI, -2.6% for IHD, and -0.8% for CVD (P>.05), only to return to precomprehensive ban values 1 year later. For patients aged ≥ 65 years of age, immediate changes associated with the comprehensive ban were -5.0%, -3.9%, and -2.3% for AMI, IHD, and CVD, respectively (P<.05). Again, the 1-year changes were not statistically significant. CONCLUSIONS In Spain, smoking bans failed to significantly reduce hospitalizations for AMI, IHD, or CVD among patients ≥ 18 years of age. In the population aged ≥ 65 years, hospital admissions due to these diseases showed significant decreases immediately after the implementation of the comprehensive ban, but these reductions disappeared at the 1-year evaluation.
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Affiliation(s)
- Iñaki Galán
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain.
| | - Lorena Simón
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Boldo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Instituto de Investigación Sanitaria Puerta del Hierro, Madrid, Spain
| | - Cristina Ortiz
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María José Medrano
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Fernández-Cuenca
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Linares
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Pastor-Barriuso
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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15
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Galán I, Simón L, Boldo E, Ortiz C, Medrano MJ, Fernández-Cuenca R, Linares C, Pastor-Barriuso R. Impacto de la ley de medidas sanitarias frente al tabaquismo y su reforma en los ingresos hospitalarios por enfermedades cardiovasculares en España. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Dégano IR, Subirana I, Fusco D, Tavazzi L, Kirchberger I, Farmakis D, Ferrières J, Azevedo A, Torre M, Garel P, Brosa M, Davoli M, Meisinger C, Bongard V, Araújo C, Lekakis J, Francès A, Castell C, Elosua R, Marrugat J. Percutaneous coronary intervention reduces mortality in myocardial infarction patients with comorbidities: Implications for elderly patients with diabetes or kidney disease. Int J Cardiol 2017; 249:83-89. [DOI: 10.1016/j.ijcard.2017.07.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022]
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17
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Nazzal C, Harris JE. Lower incidence of myocardial infarction after smoke-free legislation enforcement in Chile. Bull World Health Organ 2017; 95:674-682. [PMID: 29151635 PMCID: PMC5691402 DOI: 10.2471/blt.16.189894] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the impact of a complete smoking ban in enclosed spaces on the incidence of acute myocardial infarction in Chile. Methods The population-based study involved residents of urban areas, where 80% of the Chilean population live, aged 20 years or older who had a myocardial infarction. Monthly myocardial infarction incidence and mortality rates at health-care facilities between January 2011 and December 2014 were derived from admission and mortality databases. Regression discontinuity methods were used to estimate the near-immediate impact on disease incidence of enforcing smoke-free legislation in March 2013. The same analysis was performed for ischaemic stroke, degenerative disc disease and colon cancer. Data on the concentration of fine respirable particulates were included in an additional analysis of myocardial infarction incidence in the Santiago metropolitan area. Results The enforcement of smoke-free legislation was associated with an abrupt, near-immediate decline of 0.639 cases of myocardial infarction per 100 000 adults per month (95% confidence interval, CI: 0.242 to 1.036; relative decline: 7.8%). Similar declines were observed in men and women and in people aged over and under 70 years. However, enforcement of the legislation was not associated with a significant change in the rate of ischaemic stroke, degenerative disc disease or colon cancer. The abrupt decline in myocardial infarction incidence was also observed when data on fine respirable particulates were included in an analysis for Santiago. Conclusion The enforcement of extensive smoke-free legislation in Chile was associated with an abrupt, near-immediate decline in the incidence of myocardial infarction.
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Affiliation(s)
- Carolina Nazzal
- School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Jeffrey E Harris
- Department of Economics, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts, MA 02139, United States of America
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18
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Camafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, de Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. Semergen 2017; 43:295-311. [PMID: 28532894 DOI: 10.1016/j.semerg.2016.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/05/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | | | | | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria
| | | | | | | | | | | | | | | | | | - Ciro Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - Susana Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - Pilar Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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19
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Álvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Camafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, de Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. GACETA SANITARIA 2017; 31:255-268. [PMID: 28292529 DOI: 10.1016/j.gaceta.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/24/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
| | - Pedro Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | | | | | - Olga Cortés
- Asociación Española de Pediatría de Atención Primaria
| | | | | | | | | | | | | | | | | | - Ciro Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - María Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - Susana Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - Pilar Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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20
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Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2017; 29:69-85. [PMID: 28173956 DOI: 10.1016/j.arteri.2016.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/18/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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21
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Royo-Bordonada MÁ, Armario P, Lobos Bejarano JM, Pedro-Botet J, Villar Alvarez F, Elosua R, Brotons Cuixart C, Cortés O, Serrano B, Cammafort Babkowski M, Gil Núñez A, Pérez A, Maiques A, de Santiago Nocito A, Castro A, Alegría E, Baeza C, Herranz M, Sans S, Campos P. [Spanish adaptation of the 2016 European Guidelines on cardiovascular disease prevention in clinical practice]. HIPERTENSION Y RIESGO VASCULAR 2016; 34:24-40. [PMID: 28017552 DOI: 10.1016/j.hipert.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 01/21/2023]
Abstract
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don't recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse.
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Affiliation(s)
- M Á Royo-Bordonada
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, España.
| | - P Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA
| | | | | | | | - R Elosua
- Sociedad Española de Epidemiología
| | | | - O Cortés
- Asociación Española de Pediatría de Atención Primaria
| | - B Serrano
- Sociedad Española de Medicina y Seguridad en el Trabajo
| | | | | | - A Pérez
- Sociedad Española de Diabetes
| | - A Maiques
- Sociedad Española de Medicina de Familia y Comunitaria
| | | | - A Castro
- Sociedad Española de Cardiología
| | | | - C Baeza
- Sociedad Española de Angiología y Cirugía Vascular
| | - M Herranz
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria
| | - S Sans
- Sociedad Española de Salud Pública y Administración Sanitaria
| | - P Campos
- Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, España
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22
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Periodontitis in older Swedish individuals fails to predict mortality. Clin Oral Investig 2016; 19:193-200. [PMID: 24659087 DOI: 10.1007/s00784-014-1214-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study aims to assess mortality risk and its association to health aspects in dentate individuals 60 years of age and older. MATERIALS AND METHODS Medical and periodontal data from 870 dentate individuals (age range 60–96) participating in the Swedish National Study on Aging and Care in Blekinge (SNACBlekinge)with survival statistics over 6 years were studied. RESULTS During 6 years of follow-up, 42/474 of the individuals(8.9 %), who at baseline were between age 60 and 75, and 134/396 individuals of the individuals (33.9 %), who at baseline were ≥75 years, died. Surviving dentate individuals had more teeth (mean 19.3, S.D.±7.9) than those who died (mean 15.9,S.D.±7.3; mean diff 3,3; S.E. mean diff 0.7; 95 % CI 2.0, 4.6;p=0.001). A self-reported history of high blood pressure (F=15.0, p<0.001), heart failure (F=24.5, p<0.001, observed power=0.99), older age (F=34.7, p<0.001), male gender(F=6.3, p<0.01), serum HbA1c with 6.5 % as cutoff level(F=9.3, p=0.002) were factors associated with mortality. A medical diagnosis of heart disease, diabetes, any form of cancer,or periodontitis failed to predict mortality. CONCLUSIONS A self-reported history of angina pectoris, chronic heart failure, elevated serum HbA1c, and few remaining teeth were associated with mortality risk. A professional diagnosis of cardiovascular disease, diabetes, cancer, or periodontitis was not predictive of mortality. CLINICAL RELEVANCE Self-health reports are important to observe in the assessment of disease and survival in older individual.
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Baena-Díez JM, Peñafiel J, Subirana I, Ramos R, Elosua R, Marín-Ibañez A, Guembe MJ, Rigo F, Tormo-Díaz MJ, Moreno-Iribas C, Cabré JJ, Segura A, García-Lareo M, Gómez de la Cámara A, Lapetra J, Quesada M, Marrugat J, Medrano MJ, Berjón J, Frontera G, Gavrila D, Barricarte A, Basora J, García JM, Pavone NC, Lora-Pablos D, Mayoral E, Franch J, Mata M, Castell C, Frances A, Grau M. Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis. Diabetes Care 2016; 39:1987-1995. [PMID: 27493134 DOI: 10.2337/dc16-0614] [Citation(s) in RCA: 244] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/27/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a common cause of shortened life expectancy. We aimed to assess the association between diabetes and cause-specific death. RESEARCH DESIGN AND METHODS We used the pooled analysis of individual data from 12 Spanish population cohorts with 10-year follow-up. Participants had no previous history of cardiovascular diseases and were 35-79 years old. Diabetes status was self-reported or defined as glycemia >125 mg/dL at baseline. Vital status and causes of death were ascertained by medical records review and linkage with the official death registry. The hazard ratios and cumulative mortality function were assessed with two approaches, with and without competing risks: proportional subdistribution hazard (PSH) and cause-specific hazard (CSH), respectively. Multivariate analyses were fitted for cardiovascular, cancer, and noncardiovascular noncancer deaths. RESULTS We included 55,292 individuals (15.6% with diabetes and overall mortality of 9.1%). The adjusted hazard ratios showed that diabetes increased mortality risk: 1) cardiovascular death, CSH = 2.03 (95% CI 1.63-2.52) and PSH = 1.99 (1.60-2.49) in men; and CSH = 2.28 (1.75-2.97) and PSH = 2.23 (1.70-2.91) in women; 2) cancer death, CSH = 1.37 (1.13-1.67) and PSH = 1.35 (1.10-1.65) in men; and CSH = 1.68 (1.29-2.20) and PSH = 1.66 (1.25-2.19) in women; and 3) noncardiovascular noncancer death, CSH = 1.53 (1.23-1.91) and PSH = 1.50 (1.20-1.89) in men; and CSH = 1.89 (1.43-2.48) and PSH = 1.84 (1.39-2.45) in women. In all instances, the cumulative mortality function was significantly higher in individuals with diabetes. CONCLUSIONS Diabetes is associated with premature death from cardiovascular disease, cancer, and noncardiovascular noncancer causes. The use of CSH and PSH provides a comprehensive view of mortality dynamics in a population with diabetes.
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Affiliation(s)
- Jose Miguel Baena-Díez
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Judit Peñafiel
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Isaac Subirana
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain
| | - Rafel Ramos
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.,Univeristy of Girona, Girona, Spain
| | - Roberto Elosua
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - María Jesús Guembe
- Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.,Knowledge Planning, Evaluation and Management, Health Department, Navarra Government, Pamplona, Spain
| | - Fernando Rigo
- Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain
| | - María José Tormo-Díaz
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain.,Murcian Health Departament, Murcia, Spain.,University of Murcia, Murcia, Spain.,Murcian Institute of Biomedical Research, Murcia, Spain
| | - Conchi Moreno-Iribas
- Navarre Public Health Institute, Pamplona, Spain.,Research Network for Health Services in Chronic Disease, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Joan Josep Cabré
- Primary Care Center Sant Pere Centre and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
| | - Antonio Segura
- Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain
| | - Manel García-Lareo
- Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Agustín Gómez de la Cámara
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain
| | - José Lapetra
- Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.,Primary Care Division, Department of Family Medicine, Primary Care Center San Pablo, Sevilla, Spain
| | - Miquel Quesada
- Family Medicine Research Unit and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Girona, Spain
| | - Jaume Marrugat
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | | | - Jesús Berjón
- Vascular Risk in Navarra Research Group, Health Department, Navarra Government, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Guiem Frontera
- Cardiovascular Group of Balearic Islands, Palma de Mallorca, Spain
| | - Diana Gavrila
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Health and Consumers Department, Murcia Government, Murcia, Spain
| | - Aurelio Barricarte
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Navarre Public Health Institute, Pamplona, Spain.,Navarra Health Research Institute, Pamplona, Spain
| | - Josep Basora
- Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Reus-Tarragona, Spain
| | - Jose María García
- Health Science Institute, Department of Health and Social Affairs, Castille-La Mancha Government, Talavera de la Reina, Spain
| | - Natalia C Pavone
- Primary Care Center La Marina and Primary Health Care Research Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - David Lora-Pablos
- Consortium for Biomedical Research in Epidemiology and Public Health, Madrid, Spain.,Clinical Research Department, Hospital 12 Octubre Research Institute, Madrid, Spain
| | - Eduardo Mayoral
- Consortium for Biomedical Research in Obesity and Nutrition, Madrid, Spain.,Diabetes Strategy, Andalusia Health Service, Seville, Spain
| | - Josep Franch
- Primary Care Center Raval Sud and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain.,Consortium for Biomedical Research in Diabetes and Associated Metabolic Diseases, Madrid, Spain
| | - Manel Mata
- Primary Care Center La Mina and Primary Health Care Research Unit Institute Jordi Gol, Catalan Institute of Health, Barcelona, Spain
| | - Conxa Castell
- Public Health Agency, Government of Catalonia, Barcelona, Spain
| | - Albert Frances
- Department of Urology, Hospital del Mar, Barcelona, Spain
| | - María Grau
- REGICOR Study Group-Cardiovascular Epidemiology and Genetics, Hospital del Mar Medical Research Institute, Barcelona, Spain .,University of Barcelona, Barcelona, Spain
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Ruiz-Carmona C, Diaz-Duran C, Sevilla N, Cuadrado E, Clará A. Long-term Survival after Carotid Endarterectomy in a Population with a Low Coronary Heart Disease Fatality: Implications for Decision Making. Ann Vasc Surg 2016; 36:153-158. [PMID: 27321978 DOI: 10.1016/j.avsg.2016.01.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/03/2016] [Accepted: 01/22/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND According to the current guidelines, long-term survival is an important factor influencing decision making in patients with severe asymptomatic carotid stenosis. Nevertheless, data are lacking for populations with a low incidence of coronary heart disease, the main cause of death among these patients. We aimed to assess the long-term survival after carotid endarterectomy (CEA) in a Mediterranean hospital. METHODS Retrospective analysis was conducted of 291 consecutive patients (main age 69 years, 78.7% men) who underwent a CEA for symptomatic (n = 147, 50.5%) or asymptomatic (n = 144, 49.5%) carotid stenosis in 2005-2014 at the Hospital del Mar (Barcelona, Spain). A Kaplan-Meier life table was done and a multivariable Cox regression model was built for the analysis of the long-term survival-associated risk factors. RESULTS The immediate combined mortality and/or neurological morbidity rate was 2.7%. The mean follow-up was 55 months (complete in 99.7%). During follow-up 62 patients (21.3%) died, being cancer the most frequent cause (35.5%). Cumulative 3- and 5-year survival rates were 89% and 81%, respectively. Independent risk factors (Cox regression) related to survival included age (hazards ratio [HR] 1.09, P < 0.001), an American Society of Anesthesiologists class IV score (HR 4.04, P = 0.015), and the preoperative hemoglobin value (HR 0.73, P < 0.001). The discrimination of the resulting model was 0.719 (95% confidence interval 0.644-0.794). Previous symptomatic carotid stenosis was not related to long-term survival. CONCLUSIONS The long-term survival of patients submitted to CEA in our series lies in the lower limit of the estimated range by other groups and is markedly related to cancer. Our study suggests that predictive models for survival are influenced by regional characteristics.
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Affiliation(s)
- Carlos Ruiz-Carmona
- Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carles Diaz-Duran
- Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Nerea Sevilla
- Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Cuadrado
- Neurology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Clará
- Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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25
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Li YY, Yang XX, Zhou YH, Gong G, Geng HY, Kim HJ, Zhou CW, Qian Y, Wang XM, Wu J. Matrix metalloproteinase-9 Gene-1562C>T Gene Polymorphism and Coronary Artery Disease in the Chinese Han Population: A Meta-Analysis of 5468 Subjects. Front Physiol 2016; 7:212. [PMID: 27375491 PMCID: PMC4899440 DOI: 10.3389/fphys.2016.00212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 05/23/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multiple studies indicate that the matrix metalloproteinase-9 (MMP-9)-1562C>T gene polymorphism may be associated with an increased risk of coronary artery disease (CAD) in the Chinese Han population. However, a clear consensus has yet to be established. OBJECTIVE AND METHODS A meta-analysis of 5468 subjects from 10 separate studies was performed to explore the possible relationship between the MMP-9-1562C>T gene polymorphism and CAD within the Chinese Han population. Pooled odds ratio (ORs) for the association and the corresponding 95% confidence intervals (CIs) were evaluated by a random or fixed-effect model. RESULTS Our analysis confirms the association between the MMP-9-1562C>T gene polymorphism and an increased risk of CAD within the Chinese Han population under allelic (OR: 1.60, 95% CI: 1.25-2.04, P = 0.0002), recessive (OR: 3.05, 95% CI: 1.67-5.56, P = 0.0003), dominant (OR: 2.23, 95% CI: 1.49-3.35, P = 0.0001), homozygous (OR: 3.41, 95% CI: 1.87-6.23, P < 0.0001), heterozygous (OR: 2.03, 95% CI: 1.40-2.93, P = 0.0002), and additive genetic models (OR: 1.78, 95% CI: 1.33-2.39, P < 0.0001). CONCLUSIONS In the Chinese Han population, the MMP-9-1562C>T gene polymorphism is correlated with an increased risk of CAD. Therefore, Han Chinese carriers of the -1562T allele may be at an increased risk of CAD.
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Affiliation(s)
- Yan-Yan Li
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Xin-Xing Yang
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Yan-Hong Zhou
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Ge Gong
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Hong-Yu Geng
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Hyun J Kim
- Department of Radiation Oncology, University of Pennsylvania Philadelphia, PA, USA
| | - Chuan-Wei Zhou
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Yun Qian
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Xiang-Ming Wang
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
| | - Jun Wu
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University Nanjing, China
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Royo-Bordonada MA, Lobos Bejarano JM, Villar Alvarez F, Sans S, Pérez A, Pedro-Botet J, Moreno Carriles RM, Maiques A, Lizcano Á, Lizarbe V, Gil Núñez A, Fornés Ubeda F, Elosua R, de Santiago Nocito A, de Pablo Zarzosa C, de Álvaro Moreno F, Cortés O, Cordero A, Camafort Babkowski M, Brotons Cuixart C, Armario P. Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines. Neurologia 2016; 31:195-207. [PMID: 23969295 DOI: 10.1016/j.nrl.2013.04.011] [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: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 11/20/2022] Open
Abstract
Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85 mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.
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Affiliation(s)
| | | | | | - S Sans
- Sociedad Española de Salud Pública y Administración Sanitaria, España
| | - A Pérez
- Sociedad Española de Diabetes, España
| | | | | | - A Maiques
- Sociedad Española de Medicina de Familia y Comunitaria, España
| | - Á Lizcano
- Federación de Asociaciones de Enfermería Comunitaria y Atención Primaria, España
| | - V Lizarbe
- Ministerio de Sanidad, Servicios Sociales e Igualdad, España
| | | | - F Fornés Ubeda
- Sociedad Española de Medicina y Seguridad en el Trabajo, España
| | - R Elosua
- Sociedad Española de Epidemiología, España
| | | | | | | | - O Cortés
- Asociación Española de Pediatría de Atención Primaria, España
| | - A Cordero
- Sociedad Española de Cardiología, España
| | | | | | - P Armario
- Sociedad Española de Hipertensión-Liga Española de la Lucha Contra la HTA, España
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27
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Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines. NEUROLOGÍA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.nrleng.2013.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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28
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Health Impact Assessment for Second-Hand Smoke Exposure in Germany--Quantifying Estimates for Ischaemic Heart Diseases, COPD, and Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:198. [PMID: 26861366 PMCID: PMC4772218 DOI: 10.3390/ijerph13020198] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/21/2016] [Accepted: 02/03/2016] [Indexed: 12/22/2022]
Abstract
Evidence of the adverse health effects attributable to second-hand smoke (SHS) exposure is available. This study aims to quantify the impact of SHS exposure on ischaemic heart diseases (IHD), chronic obstructive pulmonary diseases (COPD), and stroke in Germany. Therefore, this study estimated and forecasted the morbidity for the three outcomes in the German population. Furthermore, a health impact assessment was performed using DYNAMO-HIA, which is a generic software tool applying a Markov model. Overall 687,254 IHD cases, 231,973 COPD cases, and 288,015 stroke cases were estimated to be attributable to SHS exposure in Germany for 2014. Under the assumption that the population prevalence of these diseases and the prevalence of SHS exposure remain constant, the total number of cases will increase due to demographic aging. Assuming a total eradication of SHS exposure beginning in 2014 leads to an estimated reduction of 50% in cases, compared to the reference scenario in 2040 for all three diseases. The results highlight the relevance of SHS exposure because it affects several chronic disease conditions and has a major impact on the population’s health. Therefore, public health campaigns to protect non-smokers are urgently needed.
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29
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Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C, Cochrane Tobacco Addiction Group. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2016; 2:CD005992. [PMID: 26842828 PMCID: PMC6486282 DOI: 10.1002/14651858.cd005992.pub3] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and the smoking behaviour of those populations they affect. Since the first version of this review in 2010, more countries have introduced national smoking legislation banning indoor smoking. OBJECTIVES To assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL and reference lists of included studies. We also checked websites of various organisations. Date of most recent search; February 2015. SELECTION CRITERIA We considered studies that reported legislative smoking bans affecting populations. The minimum standard was having an indoor smoking ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. Our search included a broad range of research designs including: randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before-and-after studies, interrupted time series as defined by the Cochrane Effective Practice and Organisation of Care Group, and uncontrolled pre- and post-ban data. DATA COLLECTION AND ANALYSIS One author extracted characteristics and content of the interventions, participants, outcomes and methods of the included studies and a second author checked the details. We extracted health and smoking behaviour outcomes. We did not attempt a meta-analysis due to the heterogeneity in design and content of the studies included. We evaluated the studies using qualitative narrative synthesis. MAIN RESULTS There are 77 studies included in this updated review. We retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes randomized controlled trials. Thirty-six studies used an interrupted time series study design, 23 studies use a controlled before-and-after design and 18 studies are before-and-after studies with no control group; six of these studies use a cohort design. Seventy-two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking-related diseases. A number of the studies report multiple health outcomes. There is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking-related illnesses. Effects on respiratory and perinatal health were less consistent. We found 24 studies evaluating the impact of national smoke-free legislation on smoking behaviour. Evidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long-term change in existing trends in prevalence. AUTHORS' CONCLUSIONS Since the first version of this review was published, the current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in SHS for countries and their populations. The clearest evidence is observed in reduced admissions for acute coronary syndrome. There is evidence of reduced mortality from smoking-related illnesses at a national level. There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption.
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Affiliation(s)
- Kate Frazer
- University College DublinSchool of Nursing, Midwifery & Health SystemsHealth Sciences CentreBelfieldDublin 4Ireland
| | - Joanne E Callinan
- Milford Care CentreLibrary & Information Service, Education, Research & Quality DepartmentPlassey Park RoadCastletroyLimerickIreland000
| | - Jack McHugh
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
| | - Susan van Baarsel
- University College DublinSchool of Medicine and Medical ScienceDublinIreland
| | - Anna Clarke
- National Immunisation OfficeManor StreetDublin 7Ireland
| | - Kirsten Doherty
- Education and Research CentreDepartment of Preventive Medicine and Health PromotionSt Vincent's University HospitalElm ParkDublin 4Ireland
| | - Cecily Kelleher
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
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Sipilä JOT, Gunn JM, Kauko T, Rautava P, Kytö V. Association of restaurant smoking ban and the incidence of acute myocardial infarction in Finland. BMJ Open 2016; 6:e009320. [PMID: 26826146 PMCID: PMC4735218 DOI: 10.1136/bmjopen-2015-009320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the changes in nationwide acute myocardial infarction (AMI) incidence following the implementation of a law banning smoking indoors in restaurants on 1 June 2007. METHODS Retrospective registry study of all hospitalisations for AMI in Finland. All 34,887 hospitalisations for AMI between 1 June 2005 and 31 May 2009 were identified from the Care Register for Health Care (CRHC) and statistics for tobacco consumption were obtained from the National Institute for Health and Welfare. Comorbidities for individual hospitalisations were searched from the CRHC. RESULTS The incidence rate of AMI was reduced by 6.3% (95% CI 4.1% to 8.6%; p<0.0001) in the latter half of the study period following the smoking ban when adjusted for age, gender and overall population prevalence of smoking. Short-term incidence of AMI (6-month prior vs 6 months after the smoking ban) was also reduced (4.5%, 95% CI 0.2% to 9.0%; p=0.0399) and was largest in the working middle-aged group (40-50 years) but observed also in the oldest age group (>70 years). The incidence rates declined similarly for men and women. CONCLUSIONS Banning indoor tobacco smoking in restaurants was associated with a mild additional reduction in AMI incidence on a nationwide level in Finland.
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Affiliation(s)
- Jussi Olli Tapani Sipilä
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland Department of Neurology, University of Turku, Turku, Finland Neurology Clinic, North Karelia Central Hospital, Joensuu, Finland
| | - Jarmo Mikael Gunn
- Heart Center, Turku University Hospital, Turku, Finland Department of Surgery, Faculty of Medicine, University of Turku, Turku, Finland
| | - Tommi Kauko
- Department of Biostatistics, Faculty of Medicine, University of Turku, Turku, Finland
| | - Päivi Rautava
- Department of Public Health, Faculty of Medicine, University of Turku, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital, Turku, Finland Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
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31
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Galán I, Simón L, Flores V, Ortiz C, Fernández-Cuenca R, Linares C, Boldo E, José Medrano M, Pastor-Barriuso R. Assessing the effects of the Spanish partial smoking ban on cardiovascular and respiratory diseases: methodological issues. BMJ Open 2015; 5:e008892. [PMID: 26628524 PMCID: PMC4679921 DOI: 10.1136/bmjopen-2015-008892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Recent research has assessed the impact of tobacco laws on cardiovascular and respiratory morbidity. In this study, we also examined whether the association between the implementation of the 2005 Spanish smoking ban and hospital admissions for cardiovascular and respiratory diseases varies according to the adjustment for potential confounders. DESIGN Ecological time series analysis. SETTING Residents of Madrid and Barcelona cities (Spain). OUTCOME Data on daily emergency room admissions for acute myocardial infarction, cerebrovascular disease, chronic obstructive pulmonary disease (COPD), and asthma derived from the 2003-2006 Spanish hospital admissions registry. METHODS Changes in admission rates between 2006 and the 2003-2005 period were estimated using additive Poisson models allowing for overdispersion adjusted for secular trend in admission, seasonality, day of the week, temperature, number of flu and acute respiratory infection cases, pollution levels, tobacco consumption prevalence and, for asthma cases, pollen count. RESULTS In Madrid, fully adjusted models failed to detect significant changes in hospital admission rates for any disease during the study period. In Barcelona, however, hospital admissions decreased by 10.2% (95% CI 3.8% to 16.1%) for cerebrovascular diseases and by 16.0% (95% CI 7.0% to 24.1%) for COPD. Substantial changes in effect estimates were observed on adjustment for linear or quadratic trend. Effect estimates for asthma-related admissions varied substantially when adjusting for pollen count in Madrid, and for seasonality and tobacco consumption in Barcelona. CONCLUSIONS Our results confirm that the potential impact of a smoking ban must be adjusted for the underlying secular trend. In asthma-related admissions, pollen count, seasonality and tobacco consumption must be specified in the model. The substantial variability in effects detected between the two cities of Madrid and Barcelona lends strong support for a nationwide study to assess the overall effect of a smoking ban in Spain and identify the causes of the observed heterogeneity.
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Affiliation(s)
- Iñaki Galán
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain
| | - Lorena Simón
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Víctor Flores
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Ortiz
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Rafael Fernández-Cuenca
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Cristina Linares
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Boldo
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Puerta de Hierro Biomedical Research Institute, Madrid, Spain
| | - María José Medrano
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Roberto Pastor-Barriuso
- National Centre for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Gaalema DE, Cutler AY, Higgins ST, Ades PA. Smoking and cardiac rehabilitation participation: Associations with referral, attendance and adherence. Prev Med 2015; 80:67-74. [PMID: 25900804 PMCID: PMC4592377 DOI: 10.1016/j.ypmed.2015.04.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Continued smoking after a cardiac event greatly increases mortality risk. Smoking cessation and participation in cardiac rehabilitation (CR) are effective in reducing morbidity and mortality. However, these two behaviors may interact; those who smoke may be less likely to access or complete CR. This review explores the association between smoking status and CR referral, attendance, and adherence. METHODS A systematic literature search was conducted examining associations between smoking status and CR referral, attendance and completion in peer-reviewed studies published through July 1st, 2014. For inclusion, studies had to report data on outpatient CR referral, attendance or completion rates and smoking status had to be considered as a variable associated with these outcomes. RESULTS Fifty-six studies met inclusion criteria. In summary, a history of smoking was associated with an increased likelihood of referral to CR. However, smoking status also predicted not attending CR and was a strong predictor of CR dropout. CONCLUSION Continued smoking after a cardiac event predicts lack of attendance in, and completion of CR. The issue of smoking following a coronary event deserves renewed attention.
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Affiliation(s)
- Diann E Gaalema
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | - Alexander Y Cutler
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
| | - Philip A Ades
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Medicine, Division of Cardiology, University of Vermont Medical Center, USA
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Roger VL, Gerber Y. Muertes por enfermedad coronaria: desde las cohortes de nacimiento a la prevención. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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35
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Efectos de la edad, el periodo de defunción y la cohorte de nacimiento en la mortalidad por enfermedad isquémica del corazón en el sur de España. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Agewall S. How to save six million people per year. Atherosclerosis 2015; 240:387-8. [PMID: 25881201 DOI: 10.1016/j.atherosclerosis.2015.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Affiliation(s)
- S Agewall
- Department of Cardiology, Oslo University Hospital Ullevål, Institute of Clinical Sciences, University of Oslo, Oslo, Norway.
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Disability-adjusted Life Years Lost to Ischemic Heart Disease in Spain. ACTA ACUST UNITED AC 2015; 68:968-75. [PMID: 25887346 DOI: 10.1016/j.rec.2014.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 11/21/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The health indicator disability-adjusted life years combines the fatal and nonfatal consequences of a disease in a single measure. The aim of this study was to evaluate the burden of ischemic heart disease in 2008 in Spain by calculating disability-adjusted life years. METHODS The years of life lost due to premature death were calculated using the ischemic heart disease deaths by age and sex recorded in the Spanish National Institute of Statistics and the life-table in the 2010 Global Burden of Disease study. The years lived with disability, calculated for acute coronary syndrome, stable angina, and ischemic heart failure, used hospital discharge data and information from population studies. Disability weights were taken from the 2010 Global Burden of Disease study. We calculated crude and age standardized rates (European Standard Population). Univariate sensitivity analyses were performed. RESULTS In 2008, 539 570 disability-adjusted life years were lost due to ischemic heart disease in Spain (crude rate, 11.8/1000 population; standardized, 8.6/1000). Of the total years lost, 96% were due to premature death and 4% due to disability. Among the years lost due to disability, heart failure accounted for 83%, stable angina 15%, and acute coronary syndrome 2%. In the sensitivity analysis, weighting by age was the factor that changed the results to the greatest degree. CONCLUSIONS Ischemic heart disease continues to have a huge impact on the health of our population, mainly because of premature death. The results of this study provide an overall vision of the epidemiologic situation in Spain and could serve as the basis for evaluating interventions targeting the acute and chronic manifestations of cardiac ischemia.
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Roger VL, Gerber Y. Coronary Disease Deaths: From Birth Cohorts to Prevention. ACTA ACUST UNITED AC 2015; 68:361-2. [PMID: 25770881 DOI: 10.1016/j.rec.2014.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Véronique L Roger
- Division of Cardiovascular Diseases, Department of Internal Medicine and Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United States.
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ocaña-Riola R, Mayoral-Cortés JM, Fernández-Ajuria A, Sánchez-Cantalejo C, Martín-Olmedo P, Blanco-Reina E. Age, Period, and Cohort Effects on Mortality From Ischemic Heart Disease in Southern Spain. ACTA ACUST UNITED AC 2014; 68:373-81. [PMID: 25482342 DOI: 10.1016/j.rec.2014.07.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Ischemic heart disease is the leading cause of death and one of the top 4 causes of burden of disease worldwide. The aim of this study was to evaluate age-period-cohort effects on mortality from ischemic heart disease in Andalusia (southern Spain) and in each of its 8 provinces during the period 1981-2008. METHODS A population-based ecological study was conducted. In all, 145 539 deaths from ischemic heart disease were analyzed for individuals aged between 30 and 84 years who died in Andalusia in the study period. A nonlinear regression model was estimated for each sex and geographical area using spline functions. RESULTS There was an upward trend in male and female mortality rate by age from the age of 30 years. The risk of death for men and women showed a downward trend for cohorts born after 1920, decreasing after 1960 with a steep slope among men. Analysis of the period effect showed that male and female death risk first remained steady from 1981 to 1990 and then increased between 1990 and 2000, only to decrease again until 2008. CONCLUSIONS There were similar age-period-cohort effects on mortality in all the provinces of Andalusia and for Andalusia as a whole. If the observed cohort and period effects persist, male and female mortality from ischemic heart disease will continue to decline.
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Affiliation(s)
- Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain.
| | - José María Mayoral-Cortés
- Servicio de Epidemiología y Salud Laboral, Consejería de Salud de la Junta de Andalucía, Seville, Spain
| | - Alberto Fernández-Ajuria
- Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Carmen Sánchez-Cantalejo
- Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Piedad Martín-Olmedo
- Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria de Granada, Granada, Spain
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Abstract
Multicomponent tobacco control strategies are crucial to combat the ongoing global smoking challenge. In the twenty-first century, many countries have signed up to the World Health Organization Framework Convention on Tobacco Control, and in recent years a mounting number of countries and regions have implemented partial or complete smoking bans to protect the general public from passive smoke exposure. There is substantial evidence that workers, particularly in the hospitality sector, benefit from reduced exposure. More recently, several reports have appeared from different countries showing a temporal relationship between the introduction of a smoking ban and reduced hospital admissions for cardiovascular, respiratory and maternity outcomes. This will have a measurable benefit for public health, saving many lives. Multicomponent strategies could also reduce active smoking significantly if successfully implemented worldwide.
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Lee PN, Fry JS, Forey BA. A review of the evidence on smoking bans and incidence of heart disease. Regul Toxicol Pharmacol 2014; 70:7-23. [PMID: 24956588 DOI: 10.1016/j.yrtph.2014.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 06/03/2014] [Accepted: 06/15/2014] [Indexed: 02/07/2023]
Abstract
We update an earlier review of smoking bans and heart disease, restricting attention to admissions for acute myocardial infarction. Forty-five studies are considered. New features of our update include consideration of non-linear trends in the underlying rate, a modified trend adjustment method where there are multiple time periods post-ban, comparison of estimates based on changes in rates and numbers of cases, and comparison of effect estimates according to post-ban changes in smoking restrictiveness. Using a consistent approach to derive ban effect estimates, taking account of linear time trends and control data, the reduction in risk following a ban was estimated as 4.2% (95% confidence interval 1.8-6.5%). Excluding regional estimates where national estimates are available, and studies where trend adjustment was not possible, the estimate reduced to 2.6% (1.1-4.0%). Estimates were little affected by non-linear trend adjustment, where possible, or by basing estimates on changes in rates. Ban effect estimates tended to be greater in smaller studies, and studies with greater post-ban changes in smoking restrictiveness. Though the findings suggest a true effect of smoking bans, uncertainties remain, due to the weakness of much of the evidence, the small estimated effect, and various possibilities of bias.
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Affiliation(s)
- Peter N Lee
- P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey SM2 5DA, UK.
| | - John S Fry
- P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey SM2 5DA, UK
| | - Barbara A Forey
- P.N. Lee Statistics and Computing Ltd., 17 Cedar Road, Sutton, Surrey SM2 5DA, UK
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Jones MR, Barnoya J, Stranges S, Losonczy L, Navas-Acien A. Cardiovascular Events Following Smoke-Free Legislations: An Updated Systematic Review and Meta-Analysis. Curr Environ Health Rep 2014; 1:239-249. [PMID: 25328861 DOI: 10.1007/s40572-014-0020-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Legislations banning smoking in indoor public places and workplaces are being implemented worldwide to protect the population from secondhand smoke exposure. Several studies have reported reductions in hospitalizations for acute coronary events following the enactment of smoke-free laws. OBJECTIVE We set out to conduct a systematic review and meta-analysis of epidemiologic studies examining how legislations that ban smoking in indoor public places impact the risk of acute coronary events. METHODS We searched MEDLINE, EMBASE, and relevant bibliographies including previous systematic reviews for studies that evaluated changes in acute coronary events, following implementation of smoke-free legislations. Studies were identified through December 2013. We pooled relative risk (RR) estimates for acute coronary events comparing post- vs. pre-legislation using inverse-variance weighted random-effects models. RESULTS Thirty-one studies providing estimates for 47 locations were included. The legislations were implemented between 1991 and 2010. Following the enactment of smoke-free legislations, there was a 12 % reduction in hospitalizations for acute coronary events (pooled RR: 0.88, 95 % CI: 0.85-0.90). Reductions were 14 % in locations that implemented comprehensive legislations compared to an 8 % reduction in locations that only had partial restrictions. In locations with reductions in smoking prevalence post-legislation above the mean (2.1 % reduction) there was a 14 % reduction in events compared to 10 % in locations below the mean. The RRs for acute coronary events associated with enacting smoke-free legislation were 0.87 vs. 0.89 in locations with smoking prevalence pre-legislation above and below the mean (23.1 %), and 0.87 vs. 0.89 in studies from the Americas vs. other regions. CONCLUSION The implementation of smoke-free legislations was related to reductions in acute coronary event hospitalizations in most populations evaluated. Benefits are greater in locations with comprehensive legislations and with greater reduction in smoking prevalence post-legislation. These cardiovascular benefits reinforce the urgent need to enact and enforce smoke-free legislations that protect all citizens around the world from exposure to tobacco smoke in public places.
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Affiliation(s)
- Miranda R Jones
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Joaquin Barnoya
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis MO
| | - Saverio Stranges
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Lia Losonczy
- Highland Hospital of Alameda County, Oakland, CA
| | - Ana Navas-Acien
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Elosua R. Cardiovascular risk functions: usefulness and limitations. ACTA ACUST UNITED AC 2014; 67:77-9. [PMID: 24795112 DOI: 10.1016/j.rec.2013.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Roberto Elosua
- Grupo de Epidemiología y Genética Cardiovascular, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.
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Grau M, Subirana I, Vila J, Elosua R, Ramos R, Sala J, Dégano IR, Tresserras R, Bielsa O, Marrugat J. Validation of a population coronary disease predictive system: the CASSANDRA model. J Epidemiol Community Health 2014; 68:1012-9. [PMID: 24619990 DOI: 10.1136/jech-2013-203516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The use of validated multivariate cardiovascular predictive models in a population setting is of interest for public health policy makers. We aimed to validate the estimations of the CASSANDRA model (coronary heart disease (CHD) incidence and CHD risk distribution), considering the population changes in age, sex and CHD risk factors prevalence in a 10-year period. METHODS We compared the projected CHD incidence estimated with CASSANDRA with that observed in the Girona Heart Registry (REGICOR) for 1995-2004 and 2000-2009 in the population of Girona (Spain) aged 35-74 years. We used official age and sex distributions for this population. Baseline cardiovascular risk factors prevalence and the distribution of cardiovascular risk were obtained from three cross-sectional studies performed in 1995, 2000 and 2005. To validate the future distribution of cardiovascular risk, we tested the yearly CHD risk variance over the study period. RESULTS No significant differences between the estimated and observed annual CHD incidence per 100 000 men were found in 1995-2004 (CASSANDRA=457.8 and REGICOR=420.3, incidence rate ratio (IRR) (95% CI)=0.92 (0.89 to 0.96)) and in 2000-2009 (441.4 and 409.6, respectively, IRR=0.93 (0.90 to 0.96)). However, overpredictions of 18% and 22%, respectively, were observed in women (198.8 and 160.4, IRR=0.82 (0.77 to 0.86), and 197.1 and 152.8, IRR=0.78 (0.74 to 0.83), respectively). No significant differences were found in the CHD risk variance in the three different cross-sectional studies. CONCLUSIONS The CASSANDRA model produces valid estimates, particularly in men, of the future burden of disease and in the distribution of cardiovascular risk in individuals aged 35-74 years.
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Affiliation(s)
- Maria Grau
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Isaac Subirana
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Joan Vila
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Rafel Ramos
- Docent and Research Unit of Family Medicine, IDIAP Jordi Gol (University Institute in Primary Care Research Jordi Gol), Girona, Spain Departament of Medicine, University of Girona, Girona, Spain
| | - Joan Sala
- Cardiology Unit, University Hospital Josep Trueta, Girona, Spain
| | - Irene R Dégano
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Oscar Bielsa
- Department of Urology, Hospital del Mar, Barcelona, Spain
| | - Jaume Marrugat
- Cardiovascular Epidemiology and Genetics Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Medrano MJ, Alcalde-Cabero E, Ortíz C, Galán I. Effect of cardiovascular prevention strategies on incident coronary disease hospitalisation rates in Spain; an ecological time series analysis. BMJ Open 2014; 4:e004257. [PMID: 24534258 PMCID: PMC3927998 DOI: 10.1136/bmjopen-2013-004257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To assess the overall population impact of primary prevention strategies (promotion of healthy lifestyles, prevention of smoking and use of vascular risk drug therapy) of coronary disease in Spain. DESIGN Ecological time series analysis, 1982-2009. SETTING All public and private hospitals in Spain. PARTICIPANTS General population. OUTCOME Incident coronary disease hospitalisation as derived from official hospital discharge data. METHODS Annual hospitalisation rates were modelled according to nationwide use of statins, antihypertensive, antidiabetic and antiplatelet drugs, and prevalences of smoking, obesity and overweight. Additive generalised models and mixed Poisson regression models were used for the purpose, taking year as the random-effect variable and adjusting for age, sex, prevalence of vascular risk factors and the number of hospital beds in intensive and coronary care units. RESULTS Across 28 years and 671.5 million person-years of observation, there were 2 986 834 hospitalisations due to coronary disease; of these, 1 441 980 (48.28%) were classified as incident. Hospitalisation rates increased from 1982 to 1996, with an inflection point in 1997 and a subsequent 52% decrease until 2009. Prevalences of smoking, obesity, overweight and use of vascular risk drug therapy were significantly associated with hospitalisation rates (p<0.001): incidence rates ratios (95% CI) for the fourth versus the first quartile were 1.46 (1.42 to 1.50), 1.80 (1.78 to 1.83), 1.58 (1.55 to 1.60) and 0.57 (0.51 to 0.63), respectively. These variables accounted for 92% of interannual variability. CONCLUSIONS After decades of continuous rises, hospitalisation due to incident ischaemic heart disease has been cut by half, an achievement associated with the decline in smoking and the increase in vascular risk drug therapy. These results indicate that these two primary prevention strategies have been effective at a population level, thanks to an appropriate balance between financial and health goals, something that should be left intact despite the current economic crisis. Future strategies ought to lay special stress on excessive body weight prevention.
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Affiliation(s)
- María José Medrano
- National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
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Sayols-Baixeras S, Lluís-Ganella C, Lucas G, Elosua R. Pathogenesis of coronary artery disease: focus on genetic risk factors and identification of genetic variants. Appl Clin Genet 2014; 7:15-32. [PMID: 24520200 PMCID: PMC3920464 DOI: 10.2147/tacg.s35301] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Coronary artery disease (CAD) is the leading cause of death and disability worldwide, and its prevalence is expected to increase in the coming years. CAD events are caused by the interplay of genetic and environmental factors, the effects of which are mainly mediated through cardiovascular risk factors. The techniques used to study the genetic basis of these diseases have evolved from linkage studies to candidate gene studies and genome-wide association studies. Linkage studies have been able to identify genetic variants associated with monogenic diseases, whereas genome-wide association studies have been more successful in determining genetic variants associated with complex diseases. Currently, genome-wide association studies have identified approximately 40 loci that explain 6% of the heritability of CAD. The application of this knowledge to clinical practice is challenging, but can be achieved using various strategies, such as genetic variants to identify new therapeutic targets, personal genetic information to improve disease risk prediction, and pharmacogenomics. The main aim of this narrative review is to provide a general overview of our current understanding of the genetics of coronary artery disease and its potential clinical utility.
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Affiliation(s)
- Sergi Sayols-Baixeras
- Cardiovascular epidemiology and Genetics Research Group, Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | - Carla Lluís-Ganella
- Cardiovascular epidemiology and Genetics Research Group, Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | - Gavin Lucas
- Cardiovascular epidemiology and Genetics Research Group, Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular epidemiology and Genetics Research Group, Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
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Brotons C, Cuende JI, Fernández Pardo J, Plana N, Moral I. [Ischaemic heart disease]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2013; 25:203-210. [PMID: 24238749 DOI: 10.1016/j.arteri.2013.10.003] [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: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 06/02/2023]
Abstract
In the year 2011, cardiovascular diseases were responsible of 31.2% of total deaths in Spain. The absolute number of cases of acute coronary syndrome in this year will be approximately 115,752 cases (95%CI: 114,822-116,687). The prevalence of stable angina in the population aged 25-74 years is 2.6% in men and 3.5% in women. Cardiovascular diseases were in the year 2011 the first cause of hospitalizations representing 14.1% of the total hospitalizations. Diagnose of ischaemic heart disease and acute myocardial infarction were responsible of 110,950 and 50,064 hospitalizations, respectively. In the year 2003, the hospitalization rate was 314 while in the year 2011 was 237 per 100,000, a reduction of 24.4%. The average cost of hospitalization due to ischaemic heart disease in 1997 was 3,093.7euros while in the year 2011 was 7,028.71euros. Cardiovascular mortality rates have decreased from 2007 to 2011, showing a relative reduction of 7% in women and 8% in men. With regard to myocardial infarction, it was observed a relative reduction of 17% in men and 20% in women. According to EUROASPIREIII survey done in 8,966 patients with ischaemic heart disease in Europe, 17% of patients were still smokers, 35% were obese, 56% has uncontrolled blood pressure, 51% has raised blood cholesterol and 25% were diabetics. With regard to drugs utilisation, 91% were treated with antiplatelets agents, 80% with beta blockers, 71% with ACE inhibitors/ARBs.
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Affiliation(s)
- Carlos Brotons
- Unidad de Investigación, Equip d'Atenció Primària Sardenya, Unidad Docente ACEBA, Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, España.
| | - José I Cuende
- Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial de Palencia, Palencia, España
| | - Jacinto Fernández Pardo
- Unidad de Hipertensión y Lípidos, Hospital General Universitario Reina Sofía, Murcia, España
| | - Nuria Plana
- Unitat de Investigació Clínica (UIC), Unitat de Medicina Vascular i Metabolisme, Hospital Universitari Sant Joan, Reus, Tarragona, España
| | - Irene Moral
- Unidad de Investigación, Equip d'Atenció Primària Sardenya, Unidad Docente ACEBA, Instituto de Investigación Biomédica Sant Pau (IIB-Sant Pau), Barcelona, España
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Royo-Bordonada M, Lobos Bejarano J, Villar Alvarez F, Sans S, Pérez A, Pedro-Botet J, Moreno Carriles R, Maiques A, Lizcano Á, Lizarbe V, Gil Núñez A, Fornés Ubeda F, Elosua R, de Santiago Nocito A, de Pablo Zarzosa C, de Álvaro Moreno F, Cortés O, Cordero A, Camafort Babkowski M, Brotons Cuixart C, Armario P. Comentarios del Comité Español Interdisciplinario de Prevención Cardiovascular (CEIPC) a las Guías Europeas de Prevención Cardiovascular 2012. HIPERTENSION Y RIESGO VASCULAR 2013. [DOI: 10.1016/j.hipert.2013.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Royo-Bordonada MA, Lobos Bejarano JM, Villar Alvarez F, Sans S, Pérez A, Pedro-Botet J, Moreno Carriles RM, Maiques A, Lizcano A, Lizarbe V, Gil Núñez A, Fornés Ubeda F, Elosua R, de Santiago Nocito A, de Pablo Zarzosa C, de Álvaro Moreno F, Cortés O, Cordero A, Camafort Babkowski M, Brotons Cuixart C, Armario P. [Statement of the Spanish Interdisciplinary Cardiovascular Prevention Committee (CEIPC for its Spanish acronym) on the 2012 European Cardiovascular Prevention Guidelines]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2013; 25:127-139. [PMID: 23726872 DOI: 10.1016/j.arteri.2013.03.003] [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: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 06/02/2023]
Abstract
Based on the two main frameworks for evaluating scientific evidence (SEC and GRADE) European cardiovascular prevention guidelines recommend interventions across all life stages using a combination of population-based and high-risk strategies with diet as the cornerstone of prevention. The evaluation of cardiovascular risk (CVR) incorporates HDL levels and psychosocial factors, a very high risk category, and the concept of age-risk. They also recommend cognitive-behavioural methods (e.g., motivational interviewing, psychological interventions) led by health professionals and with the participation of the patient's family, to counterbalance psychosocial stress and reduce CVR through the institution of positive habits such as a healthy diet, physical activity, smoking cessation, and adherence to treatment. Additionally, public health interventions - such as smoking ban in public areas or the elimination of trans fatty acids from the food chain - are also essential. Other innovations include abandoning antiplatelet therapy in primary prevention and the recommendation of maintaining blood pressure within the 130-139/80-85mmHg range in diabetic patients and individuals with high CVR. Finally, due to the significant impact on patient progress and medical costs, special emphasis is given to the low therapeutic adherence levels observed. In sum, improving cardiovascular prevention requires a true partnership among the political class, public administrations, scientific and professional associations, health foundations, consumer associations, patients and their families. Such partnership would promote population-based and individual strategies by taking advantage of the broad spectrum of scientific evidence available, from clinical trials to observational studies and mathematical models to evaluate population-based interventions, including cost-effectiveness analyses.
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