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Gidding SS, Colangelo LA, Nwabuo CC, Lewis CE, Jacobs DR, Schreiner PJ, Lima JAC, Allen NB. PDAY risk score predicts cardiovascular events in young adults: the CARDIA study. Eur Heart J 2022; 43:2892-2900. [PMID: 35139198 PMCID: PMC9890625 DOI: 10.1093/eurheartj/ehac009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/24/2021] [Accepted: 01/16/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS Atherosclerotic cardiovascular disease (ASCVD) risk prediction equations apply to older adults. For this study, the Pathobiologic Determinants of Atherosclerosis in Youth (PDAY) risk score, based on post-mortem measurements of atherosclerosis in 15-34-year olds dying accidentally, was used to predict ASCVD events, specifically myocardial infarction and revascularization, in middle age, from risk measured at ≤40 years of age. METHODS AND RESULTS The Coronary Artery Risk Development in Young Adults Study (CARDIA) collected longitudinal cardiovascular risk data, coronary artery calcium (CAC) scores, and ASCVD data beginning at age 18 and 30 years with 30-year follow-up. Predictive accuracy for ASCVD of the PDAY risk score, calculated at baseline (mean age 24) and at all six CARDIA examinations up until year 15, was examined. We also examined whether the presence of CAC improved model discrimination. The cohort for this study comprised 5004 Black and White men and women, at baseline and 3558 with data at year 15. Each standard deviation increase in PDAY score, at each examination, was significantly associated with future ASCVD. Hazard ratios (per standard deviation) increased from 1.74 to 2.04 from year 0 to year 15. C-statistics ranged from 0.771 to 0.794. Coronary artery calcium measurement at age 33-45 years improved risk prediction only if the score was 0. Cumulative risk exposure over the first 15 years of the CARDIA study also had high-predictive value (c-statistic 0.798, 95% confidence interval 0.762-0.835). CONCLUSION The PDAY risk score may be used in young adults, prior to age 40 years to predict ASCVD events.
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Affiliation(s)
- Samuel S Gidding
- Geisinger Genomic Medicine Institute, Geisinger, Danville, PA, USA
- 1631 Hale Hollow Road, Bridgewater Corners, VT, USA
| | - Laura A Colangelo
- Department of Preventive Medicine, Feinberg Medical School, Northwestern University, Chicago, IL, USA
| | | | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David R Jacobs
- Division of Epidemiology and Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Pamela J Schreiner
- Division of Epidemiology and Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Joao A C Lima
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Feinberg Medical School, Northwestern University, Chicago, IL, USA
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Lloyd-Jones D. Introduction: A cardiologist's perspective. Am Heart J Plus 2022; 13:100116. [PMID: 38560072 PMCID: PMC10978182 DOI: 10.1016/j.ahjo.2022.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 04/04/2024]
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3
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Stacey I, Hung J, Cannon J, Seth RJ, Remenyi B, Bond-Smith D, Griffiths K, Sanfilippo F, Carapetis J, Murray K, Katzenellenbogen JM. Long-term outcomes following rheumatic heart disease diagnosis in Australia. Eur Heart J Open 2021; 1:oeab035. [PMID: 35919882 PMCID: PMC9242034 DOI: 10.1093/ehjopen/oeab035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/15/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
Aims Rheumatic heart disease (RHD) is a major contributor to cardiac morbidity and mortality globally. This study aims to estimate the probability and predictors of progressing to non-fatal cardiovascular complications and death in young Australians after their first RHD diagnosis. Methods and results This retrospective cohort study used linked RHD register, hospital, and death data from five Australian states and territories (covering 70% of the whole population and 86% of the Indigenous population). Progression from uncomplicated RHD to all-cause death and non-fatal cardiovascular complications (surgical intervention, heart failure, atrial fibrillation, infective endocarditis, and stroke) was estimated for people aged <35 years with first-ever RHD diagnosis between 2010 and 2018, identified from register and hospital data. The study cohort comprised 1718 initially uncomplicated RHD cases (84.6% Indigenous; 10.9% migrant; 63.2% women; 40.3% aged 5–14 years; 76.4% non-metropolitan). The composite outcome of death/cardiovascular complication was experienced by 23.3% (95% confidence interval: 19.5–26.9) within 8 years. Older age and metropolitan residence were independent positive predictors of the composite outcome; history of acute rheumatic fever was a negative predictor. Population group (Indigenous/migrant/other Australian) and sex were not predictive of outcome after multivariable adjustment. Conclusion This study provides the most definitive and contemporary estimates of progression to major cardiovascular complication or death in young Australians with RHD. Despite access to the publically funded universal Australian healthcare system, one-fifth of initially uncomplicated RHD cases will experience one of the major complications of RHD within 8 years supporting the need for programmes to eradicate RHD.
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Affiliation(s)
- Ingrid Stacey
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Joseph Hung
- Medical School, University of Western Australia, Perth, Australia
| | - Jeff Cannon
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rebecca J Seth
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Bo Remenyi
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Daniela Bond-Smith
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia.,University of Hawai'i Economic Research Organisation, University of Hawai'i, Honolulu, HI, USA
| | - Kalinda Griffiths
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Centre for Big Data Research, The University of New South Wales, Sydney, Australia.,Centre for Health Equity, University of Melbourne, Melbourne, Australia
| | - Frank Sanfilippo
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,Perth Children's Hospital, Perth, Australia
| | - Kevin Murray
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
| | - Judith M Katzenellenbogen
- School of Population and Global Health, Clifton St Building, Clifton St, University of Western Australia, Perth, Australia
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Abstract
BACKGROUND AND AIMS South Asian ethnicity has been associated with increased cardiovascular risk, in the context of a greater burden of traditional cardiovascular disease risk factors. We aimed to identify the 10-year incidence of coronary heart disease (CHD) in South Asians, as compared to other racial-ethnic groups, in a retrospective cohort study, using the Kaiser Permanente Northern California integrated health care system, and to understand whether traditional risk factors could explain differences in outcomes. METHODS AND RESULTS A study cohort established in 2006, with 10-year follow-up, identified a total n = 341,309 patients, including 5149 South Asians, aged 30-70 years who underwent a screening lipid panel and had no prior history of CHD. There were a total of 460 (8.93%) patients with at least one cardiovascular event, including cardiovascular death, coronary artery revascularization, and myocardial infarction, in South Asians, as compared to 5.66% patients in the total population (p < 0.0001). In a multivariable logistic regression analysis, South Asian ethnicity, compared to White race, was associated with an adjusted odds ratio (aOR) = 2.04 (95%CI: 1.83, 2.28) in predicting the cardiovascular outcomes. CONCLUSIONS South Asian ethnicity, even after adjustment for traditional risk factors, is associated with an increased risk of coronary heart disease outcomes. This risk was greater than other studied racial-ethnic groups and second only to diabetes in CHD risk prediction.
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Affiliation(s)
- Seema Pursnani
- The Permanente Medical Group, Kaiser Permanente, Santa Clara, CA, USA.
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Menotti A, Puddu PE, Adachi H, Tolonen H, Kafatos A. Association of serum cholesterol with coronary heart disease mortality during 50-year follow-up in ten cohorts of the seven countries study. Nutr Metab Cardiovasc Dis 2020; 30:1337-1346. [PMID: 32507339 DOI: 10.1016/j.numecd.2020.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM The association of serum cholesterol levels with the occurrence of coronary heart disease (CHD) mortality during a follow-up of 50 years was rarely investigated previously. Thus, we took advantage of results at hand in 10 pooled cohorts of men aged 40-59 years from the Seven Countries Study (9063 individuals and 2057 CHD fatal events) and we assessed this. METHODS AND RESULTS Cox proportional hazards models were run with CHD fatal events (as dependent variable) and cholesterol levels (as independent variables) at years 0, 10, and 25 (in 5 cohorts). Cumulative events during subsequent decades (cumulative approach: CA) and separately in each subsequent decade (partitioned approach: PA) were analyzed. The ecological correlation of average baseline serum cholesterol levels with CHD mortality was very high (R = 0.97). Serum cholesterol and CHD mortality for 50 years were associated at the individual level, and the association estimated by the Cox's coefficients (and related hazards ratios) was initially strong in both CA and PA, but slightly declined during later decades. Hazards ratios (for a difference of 40 mg/dl) ranged from 1.39 to 1.20 for CA and from 1.39 to 0.80 for PA. Coefficients were larger for CA than for PA and the decline was more evident for the latter. Partitioned coefficient became negative and significant in the last decade (from year 40-50). Coefficients derived from cholesterol levels measured at year 10 of follow-up showed similar trends but their magnitude was smaller. CONCLUSION Thus, the relationship of serum cholesterol levels with CHD mortality remained relatively stable during at least 40 years after a single cholesterol measurement at baseline in middle-aged men.
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Affiliation(s)
| | - Paolo E Puddu
- Association for Cardiac Research, Rome, Italy; EA 4650, Signalisation, électrophysiologie et imagerie des lésions d'ischémie reperfusion myocardique, Université de Normandie, Caen, Normandie, France.
| | - Hisashi Adachi
- Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University, School of Medicine, Kurume, Japan
| | - Hanna Tolonen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Anthony Kafatos
- Department of Social Medicine, Preventive Medicine and Nutrition Clinic, University of Crete, Heraklion, Crete, Greece
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6
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Wicke FS, Schaller MA, Karymova K, Beyer M, Müller BS. Ischemic stroke risk estimation in patients without oral anticoagulation: an observational cohort study based on secondary data from Germany. BMC Cardiovasc Disord 2019; 19:94. [PMID: 31014253 PMCID: PMC6480434 DOI: 10.1186/s12872-019-1074-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/09/2019] [Indexed: 02/07/2023] Open
Abstract
Background Oral anticoagulants can cause potentially serious adverse events. Therefore, before prescribing oral anticoagulants for ischemic stroke prevention in patients with atrial fibrillation (AF), stroke risk assessment is required to identify patients that are likely to benefit from treatment. Current guidelines recommend the CHA2DS2-VASc-score for stroke risk assessment. The CHA2DS2-VASc-score is based on observational studies from different treatment settings and countries. As ischemic stroke risk differs by setting and region, the aim of this study is to estimate ischemic stroke risk (stratified by the CHA2DS2-VASc-score) for a broadly representative population with AF from southern Germany and compare them to results from previous studies. Methods The study design is a retrospective cohort study on patients with atrial fibrillation based on secondary data. We calculated CHA2DS2-VASc-score based on patient’s diagnoses recorded in the year 2014 and assessed outcomes in 2015–2016. The primary outcome is hospitalization for ischemic stroke. The secondary outome is hospitalizations for any thromboembolic event, including ischemic stroke, transient ischemic attack, peripheral arterial embolism, pulmonary embolism, and mesenterial embolism. We estimated the incidence rates of the outcomes (and corresponding 95%-confidence intervals) stratified by CHA2DS2-VASc-score. Results The primary endpoint occurred in 961 of the 30,299 patients constituting the study population, resulting in a total incidence rate of 2.2 per 100 person-years. The secondary endpoint occurred in 1553 patients (3.6 per 100 person-years). Ischemic stroke rates stratified by the CHA2DS2-VASc-score tended to be lower than those reported previously. Thromboembolic event rates stratified tended to be similar to those reported previously. Conclusions Our results show that the performance of the CHA2DS2-VASc-score differs in the German population, as compared to internationally published data, with an overall trend towards lower risk of ischemic stroke in uncoagulated patients with AF. These results should not be practice changing, but they emphasize that stroke risk estimation in patients with atrial fibrillation should be further refined.
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Affiliation(s)
- Felix S Wicke
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Martin A Schaller
- Department of Neurology, Goethe-University, Schleusenweg 2-16, 60528, Frankfurt, Germany
| | - Kateryna Karymova
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Martin Beyer
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Beate S Müller
- Institute of General Practice, Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
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Abstract
Effective combination antiretroviral therapy (ART) has enabled human immunodeficiency virus (HIV) infection to evolve from a generally fatal condition to a manageable chronic disease. This transition began two decades ago in high-income countries and has more recently begun in lower income, HIV endemic countries (HIV-ECs). With this transition, there has been a concurrent shift in clinical and public health burden from AIDS-related complications and opportunistic infections to those associated with well-controlled HIV disease, including cardiovascular disease (CVD). In the current treatment era, traditional CVD risk factors and HIV-related factors both contribute to an elevated risk of myocardial infarction, stroke, heart failure, and arrhythmias. In HIV-ECs, the high prevalence of persons living with HIV and growing prevalence of CVD risk factors will contribute to a growing epidemic of HIV-associated CVD. In this review, we discuss the epidemiology and pathophysiology of cardiovascular complications of HIV and the resultant implications for public health efforts in HIV-ECs.
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Affiliation(s)
- Matthew J Feinstein
- Division of Cardiovascular Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, USA.
| | - Milana Bogorodskaya
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Gerald S Bloomfield
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark J Siedner
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Gene F Kwan
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christopher T Longenecker
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Division of Cardiology, Department of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Affiliation(s)
- Marta Manczuk
- The Cancer Epidemiology and Prevention Division, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, ul. Wawelska 15B, 02-034 Warsaw, Poland.
| | - Georgeta Vaidean
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Fairleigh Dickinson University School of Pharmacy, Florham Park, NJ, USA.
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Condén E, Rosenblad A. Insomnia predicts long-term all-cause mortality after acute myocardial infarction: A prospective cohort study. Int J Cardiol 2016; 215:217-22. [PMID: 27128534 DOI: 10.1016/j.ijcard.2016.04.080] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Sleep impairment such as insomnia is an established risk factor for the development of cardiovascular disease and acute myocardial infarction (AMI). The aim of the current study was to examine the association between insomnia and all-cause mortality among AMI patients. METHODS This prospective cohort study used data on n=732 patients recruited from September 2006 to May 2011 as part of the Västmanland Myocardial Infarction Study (VaMIS), a prospective cohort study of AMI patients living in Västmanland County, Sweden. Participants were followed up for all-cause mortality until December 9, 2015. The outcome of interest was time-to-death (TTD), with the presence of insomnia being the risk factor of main interest. Data were analyzed using a piecewise Cox regression model with change point for insomnia at two years of follow-up, adjusted for socioeconomic, lifestyle and clinical risk factors. RESULTS In total, n=175 (23.9%) of the participants suffered from insomnia. During a mean (SD) follow-up time of 6.0 (2.5) years (4392person-years), a total of n=231 (31.6%) participants died, n=77 (44.0%) in the insomnia group and n=154 (27.6%) in the non-insomnia group (log-rank test p<0.001). In a multiple adjusted piecewise Cox regression model, insomnia did not imply a higher risk of death during the first two years after AMI (HR 0.849; 95% CI 0.508-1.421; p=0.534). During the period after the first two years, however, insomnia implied a 1.6 times higher risk of death (HR 1.597; 95% CI 1.090-2.341; p=0.016). CONCLUSIONS Insomnia implies a higher risk of death among AMI patients in the long term.
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Affiliation(s)
- Emelie Condén
- Center for Clinical Research Västerås, Uppsala University, Västerås, Sweden; Department of Medicine, Västmanland County Hospital Västerås, Västerås, Sweden.
| | - Andreas Rosenblad
- Center for Clinical Research Västerås, Uppsala University, Västerås, Sweden
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Vanniyasingam T, Rodseth RN, Lurati Buse GA, Bolliger D, Burkhart CS, Cuthbertson BH, Gibson SC, Mahla E, Leibowitz DW, Biccard BM, Thabane L. Predicting the occurrence of major adverse cardiac events within 30 days of a vascular surgery: an empirical comparison of the minimum p value method and ROC curve approach using individual patient data meta-analysis. Springerplus 2016; 5:304. [PMID: 27066338 PMCID: PMC4783313 DOI: 10.1186/s40064-016-1936-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/25/2016] [Indexed: 12/16/2022]
Abstract
We aimed to compare the minimum p value method and the area under the receiver operating characteristics (ROC) curve approach to categorize continuous biomarkers for the prediction of postoperative 30-day major adverse cardiac events in noncardiac vascular surgery patients. Individual-patient data from six cohorts reporting B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NTproBNP) were obtained. These biomarkers were dichotomized using the minimum p value method and compared with previously reported ROC curve-derived thresholds using logistic regression analysis. A final prediction model was developed, internally validated, and assessed for its sensitivity to clustering effects. Finally, a preoperative risk score system was proposed. Thresholds identified by the minimum p value method and ROC curve approach were 115.57 pg/ml (p < 0.001) and 116 pg/ml for BNP, and 241.7 pg/ml (p = 0.001) and 277.5 pg/ml for NTproBNP, respectively. The minimum p value thresholds were slightly stronger predictors based on our logistic regression analysis. The final model included a composite predictor of the minimum p value method’s BNP and NTproBNP thresholds [odds ratio (OR) = 8.5, p < 0.001], surgery type (OR = 2.5, p = 0.002), and diabetes (OR = 2.1, p = 0.015). Preoperative risks using the scoring system ranged from 2 to 49 %. The minimum p value method and ROC curve approach identify similar optimal thresholds. We propose to replace the revised cardiac risk index with our risk score system for individual-specific preoperative risk stratification after noncardiac nonvascular surgery.
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Affiliation(s)
- Thuva Vanniyasingam
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Sciences Centre, Room 2C7, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Reitze N Rodseth
- Perioperative Research Unit, Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa ; Department of Anaesthetics, Grey's Hospital, Pietermaritzburg, South Africa
| | - Giovanna A Lurati Buse
- Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Daniel Bolliger
- Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | | | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON Canada
| | | | - Elisabeth Mahla
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - David W Leibowitz
- Division of Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bruce M Biccard
- Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Sciences Centre, Room 2C7, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON Canada ; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON Canada ; Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON Canada ; Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, ON Canada
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DeFilippis AP, Blaha MJ. Can the AHA-ACC ASCVD risk score be applied outside the United States in Korea? Atherosclerosis 2015; 242:560-2. [PMID: 26318105 DOI: 10.1016/j.atherosclerosis.2015.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/21/2022]
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Dhabriya R, Agrawal M, Gupta R, Mohan I, Sharma KK. Cardiometabolic risk factors in the Agarwal business community in India: Jaipur Heart Watch-6. Indian Heart J 2015; 67:347-50. [PMID: 26304567 DOI: 10.1016/j.ihj.2015.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 03/22/2015] [Accepted: 03/29/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Agarwal is one of the largest business communities in India. To determine prevalence of cardiovascular risk factors and their distribution according to educational status (ES) in this community we performed a study. METHODS 1781 (men 1039, women 742) of 2500 selected subjects (71.2%) were evaluated and fasting blood sample obtained in 1130. RESULTS Age-adjusted prevalence of risk factors was tobacco use 12.2%, sedentary habits 54.2%, overweight/obesity 54.4%, obesity 19.5%, abdominal obesity 61.2%, hypertension 36.0%, diabetes 19.2%, hypercholesterolemia ≥200 mg/dl 25.8%, low HDL cholesterol 29.2%, hypertriglyceridemia 32.8% and metabolic syndrome 22.3%. Low ES subjects had significantly greater prevalence of sedentary habits, low fruit/vegetable intake, hypertension, low HDL cholesterol and diabetes. CONCLUSIONS Cardiometabolic risk factors are highly prevalent in the Agarwal business community. Prevalence is greater in subjects with low educational status.
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Affiliation(s)
- Ritu Dhabriya
- Department of Home Science, University of Rajasthan, Jaipur 302004, India
| | - Mukta Agrawal
- Department of Home Science, University of Rajasthan, Jaipur 302004, India
| | - Rajeev Gupta
- Department of Medicine, Fortis Escorts Hospital, Jaipur 302017, India.
| | - Indu Mohan
- Department of Preventive and Social Medicine, RUHS College of Medical Sciences, Jaipur 302023, India
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13
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Carlsson AC, Wändell P, Gasevic D, Sundquist J, Sundquist K. Neighborhood deprivation and warfarin, aspirin and statin prescription - A cohort study of men and women treated for atrial fibrillation in Swedish primary care. Int J Cardiol 2015; 187:547-52. [PMID: 25863300 DOI: 10.1016/j.ijcard.2015.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/01/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND We aimed to study differences in the prescribing of warfarin, aspirin and statins to patients with atrial fibrillation (AF) in socio-economically diverse neighborhoods. We also aimed to explore the effects of neighborhood deprivation on the relationship between CHADS2 risk score and warfarin prescription. METHODS Data were obtained from primary health care records that contained individual clinical data that were linked to national data on neighborhood of residence and a deprivation index for different neighborhoods. Logistic regression was used to estimate the potential neighborhood differences in prescribed warfarin, aspirin and statins, and the association between the CHADS2 score and prescribed warfarin treatment, in neighborhoods with high, middle (referent) and low socio-economic (SES). RESULTS After adjustment for age, socio-economic factors, co-morbidities and moves to neighborhoods with different SES during follow-up, adults with AF living in high SES neighborhoods were more often prescribed warfarin (men odds ratio (OR) (95% confidence interval (CI): 1.44 (1.27-1.62); and women OR (95% CI): 1.19 (1.05-1.36)) and statins (men OR (95% CI): 1.23 (1.07-1.41); women OR (95% CI): 1.23 (1.05-1.44)) compared to their counterparts residing in middle SES. Prescription of aspirin was lower in men from high SES neighborhoods (OR (95% CI): 0.75 (0.65-0.86)) than in those from middle SES neighborhoods. Higher CHADS2 risk scores were associated with higher warfarin prescription which remained after adjustment for neighborhood SES. CONCLUSIONS The apparent inequalities in pharmacotherapy seen in the present study call for resource allocation to primary care in neighborhoods with low and middle socio-economic status.
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Affiliation(s)
- Axel C Carlsson
- Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden; Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
| | - Per Wändell
- Division of Family Medicine, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Danijela Gasevic
- Centre for Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden; Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA
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14
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Kettunen JA, Kujala UM, Kaprio J, Bäckmand H, Peltonen M, Eriksson JG, Sarna S. All-cause and disease-specific mortality among male, former elite athletes: an average 50-year follow-up. Br J Sports Med 2014; 49:893-7. [PMID: 25183628 DOI: 10.1136/bjsports-2013-093347] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2014] [Indexed: 11/04/2022]
Abstract
AIM To investigate life expectancy and mortality among former elite athletes and controls. METHODS HR analysis of cause-specific deaths sourced from the national death registry for former Finnish male endurance, team and power sports athletes (N=2363) and controls (N=1657). The median follow-up time was 50 years. RESULTS Median life expectancy was higher in the endurance (79.1 years, 95% CI 76.6 to 80.6) and team (78.8, 78.1 to 79.8) sports athletes than in controls (72.9, 71.8 to 74.3). Compared to controls, risk for total mortality adjusted for socioeconomic status and birth cohort was lower in the endurance ((HR 0.70, 95% CI 0.61 to 0.79)) and team (0.80, 0.72 to 0.89) sports athletes, and slightly lower in the power sports athletes (0.93, 0.85 to 1.03). HR for ischaemic heart disease mortality was lower in the endurance (0.68, 0.54 to 0.86) and team sports (0.73, 0.60 to 0.89) athletes. HR for stroke mortality was 0.52 (0.33 to 0.83) in the endurance and 0.59 (0.40 to 0.88) in the team sports athletes. Compared to controls, the risk for smoking-related cancer mortality was lower in the endurance (HR 0.20, 0.08 to 0.47) and power sports (0.40, 0.25 to 0.66) athletes. For dementia mortality, the power sports athletes, particularly boxers, had increased risk (HR 4.20, 2.30 to 7.81). CONCLUSIONS Elite athletes have 5-6 years additional life expectancy when compared to men who were healthy as young adults. Lower mortality for cardiovascular disease was in part due to lower rates of smoking, as tobacco-related cancer mortality was especially low.
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Affiliation(s)
| | - Urho M Kujala
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, Hjelt Institute, Helsinki, Finland Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland University of Helsinki, Institute for Molecular Medicine (FIMM), Helsinki, Finland
| | - Heli Bäckmand
- Health and Social Welfare Department, City of Vantaa, Finland
| | - Markku Peltonen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland Vasa Central Hospital, Vasa, Finland Folkhälsan Research Centre, Helsinki, Finland Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - Seppo Sarna
- Department of Public Health, University of Helsinki, Hjelt Institute, Helsinki, Finland
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15
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Brown WJ, Pavey T, Bauman AE. Comparing population attributable risks for heart disease across the adult lifespan in women. Br J Sports Med 2014; 49:1069-76. [PMID: 24809696 DOI: 10.1136/bjsports-2013-093090] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND Recent estimates suggest that high body mass index (BMI), smoking, high blood pressure (BP) and physical inactivity are leading risk factors for the overall burden of disease in Australia. The aim was to examine the population attributable risk (PAR) of heart disease for each of these risk factors, across the adult lifespan in Australian women. METHODS PARs were estimated using relative risks (RRs) for each of the four risk factors, as used in the Global Burden of Disease Study, and prevalence estimates from the Australian Longitudinal Study on Women's Health, in 15 age groups from 22-27 (N=9608) to 85-90 (N=3901). RESULTS RRs and prevalence estimates varied across the lifespan. RRs ranged from 6.15 for smoking in the younger women to 1.20 for high BMI and high BP in the older women. Prevalence of risk exposure ranged from 2% for high BP in the younger women to 79% for high BMI in mid-age women. In young adult women up to age 30, the highest population risk was attributed to smoking. From age 31 to 90, PARs were highest for physical inactivity. CONCLUSIONS From about age 30, the population risk of heart disease attributable to inactivity outweighs that of other risk factors, including high BMI. Programmes for the promotion and maintenance of physical activity deserve to be a much higher public health priority for women than they are now, across the adult lifespan.
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Affiliation(s)
- Wendy J Brown
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement Studies, University of Queensland, St Lucia, Queensland, Australia
| | - Toby Pavey
- Centre for Research on Exercise, Physical Activity and Health, School of Human Movement Studies, University of Queensland, St Lucia, Queensland, Australia
| | - Adrian E Bauman
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Ried-Larsen M, Grøntved A, Kristensen PL, Froberg K, Andersen LB. Moderate-and-vigorous physical activity from adolescence to adulthood and subclinical atherosclerosis in adulthood: prospective observations from the European Youth Heart Study. Br J Sports Med 2013; 49:107-12. [PMID: 23584827 DOI: 10.1136/bjsports-2013-092409] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM To investigate the independent associations between mean exposure to or the change in moderate-and-vigorous physical activity (PA) from adolescence to adulthood and subclinical atherosclerosis in adulthood. METHODS This was a prospective cohort study among Danish boys and girls (N=277) followed for up to 12 years (age 15.7 (0.4) at baseline) enrolled in the European Youth Heart Study. PA intensity was objectively measured at baseline and follow-up, and ultrasonography was performed on the Carotid arteries at follow-up. Data on carotid intima-media thickness (cIMT), Carotid Compliance and Young's Elastic Modules were used as outcome measures. RESULTS In the multivariable analyses (adjusted for personal-lifestyle and demographic factors) the mean exposure to moderate-and-vigorous PA from adolescence to adulthood was negatively associated with Young's Elastic Modules (β=-0.001×10(3) kPa (95% CI -0.0015 to -0.0002), p=0.02) and positively associated with Carotid Compliance (β=0.004 mm(2) kPa(-1) (95% CI 0.002 to 0.008), p=0.003) and cIMT (β=0.0003 mm (95% CI 0.00001 to 0.0007), p=0.013). Increases in moderate-and-vigorous PA from adolescence to adulthood were negatively associated with Young's Elastic Modules in adulthood (β=-0.00007×10(3) kPa (95% CI -0.0012 to -0.0001), p=0.01). Furthermore, participants with the largest decline in moderate-and-vigorous PA from adolescence to adulthood displayed significantly less compliant arteries compared with the remaining sample (p<0.05). CONCLUSIONS High mean exposure to moderate-and-vigorous PA levels and increases herein were independently associated with lower levels of carotid arterial stiffness in adulthood.
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Affiliation(s)
- Mathias Ried-Larsen
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Peter Lund Kristensen
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Karsten Froberg
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark
| | - Lars Bo Andersen
- Research Unit for Exercise Epidemiology, Institute of Sport Science and Clinical Biomechanics, Centre of Research in Childhood Health, University of Southern Denmark, Odense, Denmark Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Silaruks S, Sriratanasathavorn C, Rawdaree P, Kunjara-Na-Ayudhaya R, Thinkhamrop B, Sritara P. Lipid-lowering therapy using statins in patients with cardiovascular risk in clinical practice in Thailand. Heart Asia 2011; 3:99-103. [PMID: 27326004 PMCID: PMC4898574 DOI: 10.1136/heartasia-2011-010036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/20/2011] [Indexed: 12/17/2022]
Abstract
Background Since the release in Thailand in 2001 of the Third Guidelines by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults or the Adult Treatment Panel (ATP III), there have been no nationwide studies on the proportion of dyslipidaemic patients who have achieved the low-density lipoprotein cholesterol (LDL-C) goals. The authors therefore aimed to estimate the percentage achievement of LDL-C goals based on the modified NCEP ATP III guidelines in intermediate- to high-risk patients. Methods The authors conducted a hospital-based, cross-sectional, epidemiological survey. Patients (1240) were selected consecutively from 50 hospitals across Thailand. Patients were included if they had been treated with statins for at least 3 months. Results Two-thirds were female, and the mean age was 61.7±9.5 years. The median duration of statin treatment was 21 months. Half (633/ 1240) of the patients achieved the LDL-C goal levels as defined by the NCEP guidelines (51.1%, 95% CI 48.3% to 53.8%). The very-high-risk group had the lowest percentage achievement (11.6%; 95% CI 1.6% to 21.6%), compared with 54.2% (95% CI 50.9% to 57.4%) for the high-risk group and 47.0% (95% CI 41.1% to 52.8%) for the moderate-risk group. More males achieved the LDL-C goals than females (55.6% vs 48.9%; p=0.029). Conclusions Overall, 51.1% of the patients with cardiovascular risk, on statins treatment, achieved the NCEP ATP III LDL-C goal levels.
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Affiliation(s)
| | - Charn Sriratanasathavorn
- Her Majesty's Cardiac Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Petch Rawdaree
- Endocrinology Unit, BMA Medical College, Vajira Hospital, Thailand
| | | | - Bandit Thinkhamrop
- Department of Biostatistics and Demography, University, Khon Kaen, Thailand
| | - Piyamitr Sritara
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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