Arteriosklerose - eine lebenslange Herausforderung

Hintergrund: Trotz of sehr teurer Maßnahmen führen kardiovaskuläre Krankheitsbilder nach wie vor die Mortalitätsstatistiken in den USA und Europa an. Umso wichtiger sind die Entwicklung und Durchführung effektiver präventiver Strategien. Primärprävention: In der Optimierung des gesamten vorhandenen kardiovaskulären Risikoprofils kommt dem Sport bzw. der körperlichen Bewegung besondere Bedeutung zu. Allerdings wird die öffentliche Diskussion um den potentiellen Nutzen der körperlichen Aktivität trotz der Forderung nach einer evidenzbasierten Medizin häufig ohne Kenntnis der wissenschaftlichen Datenlage geführt. Bis heute liegt im primär-präventiven Bereich eine Fülle von epidemiologischen Untersuchungen vor, die eine signifikante Reduktion der koronaren Letalität und Morbidität durch sportliche/körperliche Aktivität unabhängig von anderen Risikofaktoren zweifelsfrei dokumentieren. Diese präventive Wirkung trifft altersunabhängig gleichermaßen für Männer wie für Frauen zu. Sekundärprävention: Hinsichtlich der Sekundärprävention bei bekannter koronarer Herzkrankheit liegt ebenfalls eine Reihe von Studien und Metaanalysen vor, die eine signifikante Redukion der Gesamtmortalität sowie der kardiovaskulären Letalität und Morbidität um 20-45% belegen konnten. Optimale Bewegungsform: Der Frage nach der "optimalen Bewegungsform" wird nach wie vor kontrovers diskutiert. So sind es nach neueren Untersuchungen keineswegs nur intensive, trainingswirksame Leistungen, speziell Ausdauerbelastungen, die von gesundheitlicher Bedeutung sind, sondern auch z. B. regelmäßiges Spazierengehen oder erhöhte Alltagsaktivitäten. Schlussfolgerung: Es is somit auf Basis der verfügbaren epidemiologischen Daten die Forderung nach mehr Bewegung im Zusammenhang mit einer gesundheitsorientierten Lebensführung zur Prävention kardiovaskulärer Erkrankungen unausweichlich. Ein frühzeitiger Beginn ist dringend erforderlich. Background: Effective prevention of cardiovascular diseases is of utmost importance in Western civilizations as they are on top of mortality statistics. Primary Prevention: Physical exercise plays an important role in optimizing the individuals cardiovascular risk profile. However in the absence of scientifically based studies the potential benefit of physical exercise is often beind discussed. Recently by several population-based studies it has been proven that physical exercise is inversely related to long-term cardiovascular mortality in both man and women of all age groups, even after adjustment for other risk factors. Secondary Prevention: Even for secondary prevention in clinical studies and meta-analyses a reduction of all causes and cardiovascular mortality of 20-45% was found after physical exercise. Type of Sports: At present it is being discussed controversially which type of sports would be most beneficial. Recent studies have shown that cardiovascular risk reduction is not only the consequence of vigorous exercise, especially endurance training, but can also be achieved by moderate training programs like walking or increased daily activities. Conclusion: Current epidemiological data reveal the necessity to perform more physical activity/exercise training, which would best be integrated in a health-oriented lifestyle. An early beginning, even in childhood, is important.     

Prescription habits of dispensing and non-dispensing doctors in Zimbabwe

The number of dispensing doctors has increased in the last decade, but the implication of this trend on the quality of health care and drug use is unknown. We present a comparative drug utilization study of 29 dispensing doctors and 28 non-dispensing doctors in Zimbabwe based on standard indicators developed by the World Health Organization. Dispensing doctors prescribed significantly more drugs per patient than non-dispensing doctors (2.3 versus 1.7), injected more patients (28.4% versus 9.5%), and prescribed more antibiotics (0.72 versus 0.54) and mixtures (0.43 versus 0.25) per encounter. Dispensing doctors also spent significantly less time on each encounter (8.7 min versus 13.0 min) than their non-dispensing colleagues. The use of generic name, brand name and essential drugs did not differ significantly between the two groups of practitioners. Multivariate analyses controlling for gender, race, place of education, location of practice and patients seen per day showed that dispensing by doctors was associated with less clinically and economically appropriate prescribing. These findings suggest that the quality of health care--as related to drug use, patient safety and treatment cost--is lower with dispensing doctors than with non-dispensing doctors.     

Mitteilungen der Deutschen Gesellschaft für Pr?vention und Rehabilitation von Herz- Kreislauferkrankungen e. V. (DGPR)

MITTEILUNGEN

Mitteilungen der Deutschen Gesellschaft für Prävention und Rehabilitation von Herz- Kreislauferkrankungen e. V. (DGPR)     

Effects of a phase II cardiac rehabilitation program performed on an outpatient basis

BACKGROUND AND OBJECTIVE: In Germany, phase II cardiac rehabilitation has always been carried out on an inpatient basis. Meanwhile, the governmental health authorities are demanding more flexible solutions for cardiac rehabilitation. The objective of this study is to examine the effects of phase II cardiac rehabilitation performed on an outpatient basis (OCR) in a larger patient cohort. These are the first results of patients before and directly after the OCR performed at six different rehabilitation centers. PATIENTS AND METHODS: The study group consisted of 479 men and 74 women, 56.1 +/- 11.5 years. Cardiovascular indications for the OCR were myocardial infarction in 219 cases, coronary artery disease (CAD) in 92, in 84 cases with invasive procedures, coronary artery bypass graft in 185, cardiac valve surgery in 26, and other cardiac diseases in 29. 70% of the patients were worker, 25% without professional training. Staying with the family (42%) and aversion to stationary programs (61%)were the main reasons for the choice of OCR. Without OCR,27.4% would have refused any rehabilitation program. RESULTS: Maximal physical performance increased from 97.8 + - 31.4 to 120.4 +/- 37.3 W (p < 0.001). LDL cholesterol was reduced from 145.9 +/- 42.7 to 117.5 +/- 34.7 mg% (p < 0.001), triglycerides from 203.3 +/- 136.0 to 161.9 +/- 91.6 mg% (p < ).010), HDL cholesterol increased from 39.8 + 11.2 to 41.0 +/- 11.3 mg% (p = 0.003).The use of lipid-lowering therapy in CAD patients increased from 63.1% to 80.7%. A reduction in body mass index from 27.1 +/- 3.6 to 26.9 +/- 3.5 kg/m2 (p = 0.010) was demonstrated. The number of active smokers decreased from 53.8% to 25.6%. CONCLUSION: The results obtained are interesting with respect to the patients' social status. With 70% general laborers, our cohort is in contrast to previously published OCR data. On the whole, these results demonstrate that rehabilitative measures can also be implemented on an outpatient basis, without a decrease in the quality of treatment. This also applies to patients who represent lower socioeconomic levels. The results should motivate to work harder and more sufficiently on the development of more flexible cardiac rehabilitation programs.     

Inaccuracy in self-report of fractures may underestimate association with health outcomes when compared with medical record based fracture registry

Introduction and objective Misreporting fractures in questionnaires is known. However, the effect of misreporting on the association of fractures with subsequent health outcomes has not been examined. Methods Data from a fracture registry (FR) developed from an extensive review of radiographic and medical records were related to self-report of fracture for 2,255 participants from the AGES Reykjavik Study. This data was used to determine false negative and false positive rates of self-reported fractures, correlates of misreporting, and the potential effect of the misreporting on estimates of health outcomes following fractures. Results In women, the false positive rate decreased with age as the false negative rate increased with no clear trend with age in men. Kappa values for agreement between FR and self-report were generally higher in women than men with the best agreement for forearm fracture (men 0.64 and women 0.82) and the least for rib (men 0.28 and women 0.25). Impaired cognition was a major factor associated with discordant answers between FR and self-report, OR 1.7 (95% CI: 1.3–2.1) (P < 0.0001). We estimated the effect of misreporting on health after fracture by comparison of the association of the self-report of fracture and fracture from the FR, adjusting for those factors associated with discordance. The weighted attenuation factor measured by mobility and muscle strength was 11% (95% CI: 0–24%) when adjusted for age and sex but reduced to 6% (95% CI: −10–22%) when adjusted for cognitive impairment. Conclusion Studies of hip fractures should include an independent ascertainment of fracture but for other fractures this study supports the use of self-report. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Prevalence of cardiovascular risk factors in middle-aged type 2 diabetic automobile employees assessed at the workplace--the Praeford study

OBJECTIVE: The purpose of this study was to provide contemporary data on the prevalence of cardiovascular risk factors in middle-aged diabetic employees in Germany. METHODS: Cardiovascular risk factors were assessed at the workplace in employees of the automobile industry who identified themselves as having type 2 diabetes mellitus. The proportion of subjects reaching the target values for hemoglobin A1c (HbA1c), systolic blood pressure, and low-density lipoprotein (LDL) cholesterol was analyzed. RESULTS: Among 4234 employees, 91 employees with diabetes were identified (mean age, 52 years). Only 7 of 91 (8%) diabetic employees achieved all three recommended target values. Blood pressure targets were achieved by 26%, HbA1c target value by 54%, and LDL target value by 31% of employees. CONCLUSION: Only a negligible proportion of working people with diabetes achieve the recommended target values. This sobering result questions current management modalities and calls for new treatment and monitoring strategies for working people with diabetes.     

How Do We Assess Energy Availability and RED-S Risk Factors in Para Athletes?

Low energy availability (LEA) is considered to be the underlying cause of a number of maladaptations in athletes, including impaired physiological function, low bone mineral density (BMD), and hormonal dysfunction. This is collectively referred to as ‘Relative Energy Deficiency in Sport’ (RED-S). LEA is calculated through assessment of dietary energy intake (EI), exercise energy expenditure (EEE) and fat-free mass (FFM). The incidence of LEA in Paralympic athletes is relatively unknown; however, there are legitimate concerns that Para athletes may be at even higher risk of LEA than able-bodied athletes. Unfortunately, there are numerous issues with the application of LEA assessment tools and the criterion for diagnosis within the context of a Para population. The calculation of EEE, in particular, is limited by a distinct lack of published data that cover a range of impairments and activities. In addition, for several RED-S-related factors, it is difficult to distinguish whether they are truly related to LEA or a consequence of the athlete’s impairment and medical history. This narrative review outlines deficits and complexities when assessing RED-S and LEA in Para athletes, presents the information that we do have, and provides suggestions for future progress in this important area of sports nutrition.