Interventions for cardiovascular disease prevention

Cardiovascular disease prevention is a continuum that encompasses the life-course. This article discusses preventive strategies focusing on policy and clinical initiatives including primordial prevention (lifestyle changes involving smoking, diet and exercise), primary prevention (risk factor control), and secondary prevention (acute and chronic disease management). Combined use of all the three strategies can have an immediate and large impact on reducing CVD morbidity and mortality.     

Novel treatments for cardiovascular disease prevention

The purpose of this review is to describe novel pharmacologic and nonpharmacologic preventive therapies, as well as new strategies to improve delivery of available therapies. Cardiovascular disease (CVD) is the leading cause of death worldwide, and prevention plays a critical role in curbing the global epidemic. Despite available treatment for tobacco addiction, platelet inhibition, blood pressure, and lipid lowering for reduction of atherosclerotic disease, significant gaps in treatment of total CVD remain. We review a range of new preventive treatment options, including drugs for tobacco cessation, platelet/thrombotic inhibition, lipid- and blood pressure-lowering; nonpharmacologic options such as left atrial appendage closure devices and caloric restriction; and strategies such as fixed-dose combination drugs, laboratory screening for drug tailoring, and community-based prevention programs. CVD preventive research continues to evolve and provide clinicians and patients with novel pharmacologic and nonpharmacologic therapies, including new preventive strategies.     

Constipation and risk of cardiovascular disease among postmenopausal women

Background

Constipation is common in Western societies, accounting for 2.5 million physician visits/year in the US. Because many factors predisposing to constipation also are risk factors for cardiovascular disease, we hypothesized that constipation may be associated with increased risk of cardiovascular events.

Methods

We conducted a secondary analysis in 93,676 women enrolled in the observational arm of the Women's Health Initiative. Constipation was evaluated at baseline by a self-administered questionnaire. Estimates of the risk of cardiovascular events (cumulative end point including mortality from coronary heart disease, myocardial infarction, angina, coronary revascularization, stroke, and transient ischemic attack) were derived from Cox proportional hazards models adjusted for demographics, risk factors, and other clinical variables (median follow-up 6.9 years).

Results

The analysis included 73,047 women. Constipation was associated with increased age, African American and Hispanic descent, smoking, diabetes, high cholesterol, family history of myocardial infarction, hypertension, obesity, lower physical activity levels, lower fiber intake, and depression. Women with moderate and severe constipation experienced more cardiovascular events (14.2 and 19.1 events/1000 person-years, respectively) compared with women with no constipation (9.6/1000 person-years). After adjustment for demographics, risk factors, dietary factors, medications, frailty, and other psychological variables, constipation was no longer associated with an increased risk of cardiovascular events except for the severe constipation group, which had a 23% higher risk of cardiovascular events.

Conclusion

In postmenopausal women, constipation is a marker for cardiovascular risk factors and increased cardiovascular risk. Because constipation is easily assessed, it may be a helpful tool to identify women with increased cardiovascular risk.     

Ideal cardiovascular health in Chinese urban population

Background

The American Heart Association's 2020 Strategic Goals define a new concept of cardiovascular health. However, the prevalence of ideal cardiovascular health outside of the United States is unclear, and its relationship with psychological status has not been reported.

Method

We included 9962 participants (mean age 47.1 years; 44.2% women) from the survey of the Disease Risk Evaluation and Health Management study from October 2009 to Feb 2012. The prevalence of poor, intermediate, and ideal cardiovascular health levels were calculated, and psychological status was assessed using the 21-item Depression Anxiety Stress Scales.

Results

After adjusting for sex and age, only 0.5% of the participants met ideal levels of all 7 cardiovascular health metrics, and 26.9% presented with 5 to 7 ideal health metrics. Fasting plasma glucose was the most prevalent ideal metric (71.2%), whereas physical activity was the least prevalent (18.1%). Women had a significantly higher proportion of 5 to 7 ideal health metrics compared with men (40.4% versus 13.4% after adjusting for age), and the proportion of participants who had 5 to 7 ideal health metrics significantly decreased with age (P < 0.001 for trend). Furthermore, the scores for depression, anxiety, and stress showed a negative correlation with the number of ideal health metrics, with regression coefficients of − 0.07, − 0.07, and − 0.11, respectively (P < 0.05).

Conclusions

Few adults met ideal levels of cardiovascular health. Individuals, communities, and health-care providers in China should be better integrated to pay closer attention to primordial prevention of unhealthy lifestyles and psychological problems.     

Comprehensive primary prevention of cardiovascular disease in women

Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality in women. Historically, medical research has focused on male patients, and subsequently, there has been decreased awareness of the burden of ASCVD in females until recent years. The biological differences between sexes and differences in societal expectations defined by gender roles contribute to gender differences in ASCVD risk factors. With these differing risk profiles, risk assessment, risk stratification, and primary preventive measures of ASCVD are different in women and men. In this review article, clinicians will understand the risk factors unique to women, such as preeclampsia, gestational diabetes, and those that disproportionately affect them such as autoimmune disorders. With these conditions in mind, the approach to ASCVD risk assessment and stratification in women will be discussed. Furthermore, the literature behind the effects of primary preventive measures in women, including lifestyle modifications, aspirin, statins, and anticoagulation, will be reviewed. The aim of this review article was to ultimately improve ASCVD primary prevention by reducing gender disparities through education of physicians.     

Health economics of cardiovascular disease: Defining the research agenda

Background

When allocating limited resources, public and private sector leaders in health policy consider both the health and economic value of new measures for cardiovascular disease (CVD) prevention. The ability to develop and prioritize policy measures is hindered by important gaps in health economics data.

Methods and Results

The Policy Research Implementation Group (PRIG) of the National Forum for Heart Disease and Stroke Prevention convened a symposium to develop priorities for research on the economics of CVD primary prevention and elimination of CVD disparities. Suggested top opportunities include expanded CVD surveillance, advances in evaluation and economic modeling of primary prevention, and use of behavioral economics to identify new prevention strategies. Enhanced policy, funding, and leadership support are vital to realizing this research agenda.

Conclusions

Targeted research on the health and economic value of CVD prevention, especially to eliminate CVD disparities, would bolster the justification for increased investment in cardiovascular health.     

上海市心血管病主要危险因素变化趋势分析

目的：评价上海地区人群心血管病主要危险因素的变化趋势。方法：采用重复横断面调查的方法,1992、1995、1996和1999年共4次对上海市某工厂人群进行心血管病主要危险因素调查,共1118人,对收缩压、舒张压、体重指数、高血压的患病率和吸烟情况的变化趋势进行了分析。结果：（1）1992年人群基线心血管病危险因素如血压、吸烟率、血清总胆固醇、甘油三酯、HDL－胆固醇、腰臀比、体重指数结果与MONICA北京的地区监测结果相近。（2）无论男性或女性,收缩压和舒张压水平均呈上升趋势。男性收缩压平均升高12.3mmHg, 舒张压平衡升高6.4mmHg;女性依次为11.5mmHg和4.9mmHg;（3）男性高血压患病率呈上升趋势;女性变化趋势不明显。（4）男性与女性体重指数各年度比较均无显著性差异,无逐渐肥胖的倾向。（5）男性吸烟率一直维持在较高水平,1996年较1992年有明显下降,1996至1999年下降趋势不明显;女性吸烟率维持在较低水平,趋势平稳。结论：上海地区应重视吸烟和高血压的预防控制。     

Short and long term radiation induced cardiovascular disease in patients with cancer

Radiation‐induced cardiovascular disease is well described as a late effect in cancer patients treated with radiation therapy. Advancements in surgery, radiotherapy, and chemotherapy have led to an increasing number of cancer survivors with resultant long‐term side effects related to their cancer treatments. In this review, we describe the short‐ and long‐term cardiovascular consequences of mediastinal radiotherapy and discuss the optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients.     

A review of the cost of cardiovascular disease

In Canada, 74,255 deaths (33% of all deaths) in 2003 were due to cardiovascular disease (CVD). As one of the most costly diseases, CVD represents a major economic burden on health care systems. The purpose of the present study was to review the literature on the economic costs of CVD in Canada and other developed countries (United States, Europe and Australia) published from 1998 to 2006, with a focus on Canada. Of 1656 screened titles and abstracts, 34 articles were reviewed including six Canadian studies and 17 American studies. While considerable variation was observed among studies, all studies indicated that the costs of treating CVD-related conditions are significant, outlining a convincing case for CVD prevention programs.     

Epidemiologic studies targeting primary cardiovascular disease prevention in South Asia

South Asia has experienced a 73% increase in healthy life years lost due to ischemic heart disease between 1990 and 2010. There is a lack of quality data relating to cardiovascular risk factors and disease from this region.Several observational and prospective cohorts in South Asia have been established in recent times to evaluate the burden of cardiovascular disease and their risk factors. The Prospective Rural Urban Epidemiology (PURE) study is the largest of these studies that has provided data on social, environmental, behavioral and biologic risk factors that influence heart disease and diabetes. Some studies have also borrowed data from large datasets to provide meaningful insights. These studies have allowed a better understanding of cardiovascular disease risk factors indigenous to the South Asian population along with conventional risk factors. Culturally sensitive interventions geared towards treating risk factors identified in these studies are needed to fully realize the true potential of these epidemiologic studies.     

心血管病患者中的阿司匹林抵抗

目的　前瞻性地评价心血管病患者发生阿司匹林抵抗 (AR)的流行病学概况 ,并探讨其预测因子。方法　 35 2例病情稳定的心血管病住院患者 ,每日服用阿司匹林 10 0mg ,连服 7天 ,服用最后一剂后 2 4h内抽取的空腹静脉血为血样 ,分别用二磷酸腺苷 (ADP)、花生四烯酸 (AA)诱导血小板凝集试验 (PAgT) ,检测血小板聚集率。结果　患者中AR发生率为 3.98% ,阿司匹林半敏感 (ASR)者占 2 5 .9% ,且AR或ASR患者中的女性较AS者多(35 .2 %vs 18.2 % ,P =0 .0 0 1) ,而AS者中吸烟者较AR或ASR者多 (0 %vs 9.5 % ,P =0 .0 0 2 )。结论　阿司匹林用于抗血小板治疗及预防动脉硬化事件的心血管病患者 ,若有AR存在可选择其他安全有效的抗血小板制剂长期服用 ,预测AR及抗血小板治疗个体化 ,将是抗血小板治疗未来的方向     

Primary and secondary prevention strategy for cardiovascular disease in diabetes mellitus

The majority of individuals with diabetes die from cardiovascular disease (CVD) and related complications. The risk of CVD is 2 to 4 fold greater in diabetes and largely magnified by co-morbidities that aggregate along with it. Sufficient evidence-based data now exist to support multifactorial risk intervention with specific targets for goal-directed therapy for both primary and secondary prevention. These interventions have shown survival benefit in addition to prevention of vascular complications. Prevention of diabetes and delaying its onset should also be an important aspect in future health care strategy and research to confront the oncoming tsunami of CVD related to diabetes.     

学龄期儿童心血管疾病危险因素现状调查

目的：为了解城市学龄期儿童心血管疾病危险因素的现状。方法：对长沙市 ４９５ 名９～１４ 岁儿童的血压、血脂、血糖、肥胖、膳食与运动习惯以及心血管病家族史等心血管疾病危险因素进行调查。结果：血压偏高检出率为４．８４％ ,血脂单项指标异常检出率为０．４０％ ～１７．３７％ ,总异常检出率为２１．８２％ 。３７．７５％ 儿童血脂水平超过膳食干预的推荐值。１．０１％ 儿童的空腹血糖≥６．７２ｍ ｍ ｏｌ／ Ｌ。４．６５％ 儿童超重度≥２０％ ,体重指数≥２４ 者占３．６３％ 。大部分儿童摄入脂肪及胆固醇较多,２２．６２％ 的儿童缺乏体育锻炼,５７．７８％ 家庭中有吸烟者,２６．８６％ 有心血管疾病家族史。结论：加强儿童时期心血管病危险因素的监测与干预势在必行。     

Physical activity in primary and secondary prevention of cardiovascular disease: Overview updated

Although the observed progress in the cardiovascular disease treatment, the incidence of new and recurrent coronary artery disease remains elevated and constitutes the leading cause of death in the developed countries. Three-quarters of deaths due to cardiovascular diseases could be prevented with adequate changes in lifestyle, including increased daily physical activity. New evidence confirms that there is an inverse dose-response relationship between physical activity and cardiovascular disease and mortality risk. However, participation in moderate to vigorous physical activity may not fully attenuate the independent effect of sedentary activities on increased risk for cardiovascular diseases. Physical activity also plays an important role in secondary prevention of cardiovascular diseases by reducing the impact of the disease, slowing its progress and preventing recurrence. Nonetheless, most of eligible cardiovascular patients still do not benefit from secondary prevention/cardiac rehabilitation programs. The present review draws attention to the importance of physical activity in the primary and secondary prevention of cardiovascular diseases. It also addresses the mechanisms by which physical activity and regular exercise can improve cardiovascular health and reduce the burden of the disease.     

Global health policy in the 21st century: Challenges and opportunities to arrest the global disability burden from musculoskeletal health conditions

The profound burden of disease associated with musculoskeletal health conditions is well established. Despite the unequivocal disability burden and personal and societal consequences, relative to other non-communicable diseases (NCDs), system-level responses for musculoskeletal conditions that are commensurate with their burden have been lacking nationally and globally. Health policy priorities and responses in the 21st century have evolved significantly from the 20th century, with health systems now challenged by an increasing prevalence and impact of NCDs and an unprecedented rate of global population ageing. Further, health policy priorities are now strongly aligned to the 2030 Sustainable Development Goals. With this background, what are the challenges and opportunities available to influence global health policy to support high-value care for musculoskeletal health conditions and persistent pain? This paper explores these issues by considering the current global health policy landscape, the role of global health networks, and progress and opportunities since the 2000–2010 Bone and Joint Decade for health policy to support improved musculoskeletal health and high-value musculoskeletal health care.     

Safety and tolerability of intradermal influenza vaccination in patients with cardiovascular disease

Background It is well-established that influenza vaccination reduces adverse cardiovascular outcomes in patients with cardiovascular diseases （CVD）, however, the vaccine coverage rate in most countries remains low. The concern about the local adverse effects of intramus-cular injection, particularly in CVD patients receiving antithrombotic therapy, is one of the important impediments. This study was con-ducted to assess the safety, side effects and tolerability of intradermal influenza vaccine in CVD patients. Methods This was an observa-tional study in adult CVD patients who had undergone vaccination against seasonal influenza by intradermal vaccination between May 16th and May 30th, 2012 at Maharaj Nakorn Chiang Mai Hospital. The medical history, patients＇ acceptability and adverse effects were collected using a written questionnaire completed by the patient immediately following vaccination and by a telephone survey eight days later. Results Among 169 patients, 52.1%were women and the mean age was 63 ＆#177; 12 years. Coronary artery disease, valvular heart disease and dilated cardiomyopathy were present in 121 （71.6%）, 40 （23.7%） and 8 （4.7%）, respectively. Antithrombotics were used in 89.3%. After vaccination, the pain score was 0, 1 or 2 （out of 10） in 44.4%, 15.1%, and 27.6%of the patients, respectively. Eight days after vaccination, the common adverse reactions were itching 19 （11.9%）, swelling 9 （5.7%） and fatigue （4.7%）. No hematoma or bruising was reported. Conclusions The intradermal influenza vaccination is safe and well tolerates with high rates of satisfaction in CVD patients. This technique should be useful in expanding influenza vaccine coverage.     

1992-2002年北京一组队列人群心血管病危险因素变化趋势研究

目的评价北京地区队列人群1992--2002年10年心血管病危险因素变化趋势。方法于1992年和2002年分别对同一组个体,按照世界卫生组织MONICA方案心血管病危险因素调查方法进行调查。对血压、体重指数、腰围、臀围、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和甘油三酯、血糖、高血压患病率、治疗率和控制率的变化进行比较。结果（1）1992-2002年相同年龄组（45～54岁和55～64岁）比较心血管病危险因素水平呈显著升高的趋势。（2）1992年理想血压者,2002年有19．0％的人成为高血压患者;正常血压者,45．3％的人成为高血压患者。（3）1992年血脂正常者,2002年有43．8％的人成为血脂异常者。（4）1992年体重指数正常者,2002年有37．0％的人成为超重者;腰围正常者,有43．7％的人成为高腰围者。（5）1992年无代谢综合征者,2002年有14．6％的人成为有代谢综合征者。结论本队列人群10年心血管病危险因素水平明显上升,其主要危险因素均与生活方式密切相关。改变不良生活方式是控制和减慢主要危险因素上升的速度和减少心血管病发病的关键。     

非酒精性脂肪性肝病在心血管疾病发生发展中的作用

随着经济水平的提高、饮食结构和生活方式的改变,非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)的发病率不断上升,逐渐成为全球慢性肝病的主要病因.心血管疾病(cardiovascular disease,CVD)作为NAFLD患者的主要死亡原因,越来越多的研究发现两者之间存在相关性;NAFLD患者CVD发生发展的风险更大,其机制可能与血管和内皮细胞功能障碍、胆汁酸代谢、氧化应激、全身炎症反应和肾素-血管紧张素系统的激活等相关.其中,代谢综合征在两者联系中发挥了重要的作用.因此,早期识别NAFLD患者心血管疾病相关危险因素,进而减少心血管相关并发症,对于改善该类患者的预后至关重要.