Awareness Of Cardiovascular Disease Risk Research Articles

Unveiling the determinants of women's cardiovascular disease awareness in northern Italy: insights from the Call for Women project

Abstract Background Despite strides in prevention, diagnosis, and treatment of cardiovascular disease (CVD), CVD remains the leading cause of death (LCOD) in women. While global initiatives aim to enhance awareness, recent studies reveal deficiencies, particularly in Europe where misconceptions prevail, hindering women’s understanding of CVD severity. Purpose To describe determinants affecting awareness of CVD as LCOD among women in the Lombardy region, Italy. Methods A web-based survey (the ‘Call for Women’ Project) was conducted from Sep 2022 to Nov 2023, including women aged 18 and above. The primary focus was awareness of CVD as the LCOD (scaled 1 [adequate] to 2 [inadequate]). The individual predictors (i.e., determinants) of adequate awareness were assessed through a logistic regression (LR) model. Variables exhibiting a point biserial correlation coefficient (rpb) with a p-value ≤ 0.1 were included in the LR model as independent variables. The goodness-of-fit for the LR model was determined using the Hosmer-Lemeshow test and Nagelkerke’s pseudo-R2. Independent variables were entered simultaneously into the model to examine each variable’s relatively unique contribution. Results Out of 3,487 women who completed the survey, only 35.6% (n = 1,240) showed adequate awareness. The Hosmer-Lemeshow test indicated a good model fit (p-value = 0.692), suggesting that the model adequately captures the relationships between the variables and the outcome. Figure 1 shows the contribution of each individual characteristic in modulating cardiovascular risk awareness. The odds of being aware of CVD as the LCOD were significantly influenced by age, decreasing by approximately 1.3% for each additional year of age (Adj. OR = 0.987; 95% CI = 0.981–0.993; p-value < 0.001). Individuals with a lower secondary school diploma exhibited a substantial increase in the odds of awareness, with an Adj. OR of 4.999 (95% CI = 3.074–8.128; p-value < 0.001). Similarly, those with an upper secondary school diploma, a bachelor’s degree, or a master’s degree also demonstrated higher odds of awareness (Adj. OR = 2.427, 1.673, and 1.429, respectively; all p-values < 0.001). Regarding lifestyle, higher number of children was associated with increased odds of awareness, with an Adj. OR of 1.109 (95% CI = 1.027–1.197; p-value = 0.008). Consumption of dry fruits and fruits showed a positive association with an Adj. OR of 1.014 (95% CI = 1.005–1.024; p-value = 0.004), indicating a potential role of dietary habits in influencing awareness. BMI and physical activity did not exhibit statistically significant associations with awareness of CVD risk. Conclusions This pilot study, limited to one region only, reveals key determinants of awareness of CVD as the LCOD among women in northern Italy. Tailoring interventions to address these determinants has the potential to narrow the gaps in CVD awareness among women.

Prevalence and target attainment of traditional cardiovascular risk factors in patients with systemic lupus erythematosus: a cross-sectional study including 3401 individuals from 24 countries

Systemic lupus erythematosus (SLE) is characterised by increased cardiovascular morbidity and mortality risk. We aimed to examine the prevalence of traditional cardiovascular risk factors and their control in an international survey of patients with systemic lupus erythematosus. In this multicentre, cross-sectional study, cardiovascular risk factor data from medical files of adult patients (aged ≥18) with SLE followed between Jan 1, 2015, and Jan 1, 2020, were collected from 24 countries, across five continents. We assessed the prevalence and target attainment of cardiovascular risk factors and examined potential differences by country income level and antiphospholipid syndrome coexistence. We used the Systemic Coronary Risk Evaluation algorithm for cardiovascular risk estimation, and the European Society of Cardiology guidelines for assessing cardiovascular risk factor target attainment. People with lived experience were not involved in the research or writing process. 3401 patients with SLE were included in the study. The median age was 43·0 years (IQR 33-54), 3047 (89·7%) of 3396 patients were women, 349 (10.3%) were men, and 1629 (48·1%) of 3390 were White. 556 (20·7%) of 2681 patients had concomitant antiphospholipid syndrome. We found a high cardiovascular risk factor prevalence (hypertension 1210 [35·6%] of 3398 patients, obesity 751 [23·7%] of 3169 patients, and hyperlipidaemia 650 [19·8%] of 3279 patients), and suboptimal control of modifiable cardiovascular risk factors (blood pressure [target of <130/80 mm Hg], BMI, and lipids) in the entire SLE group. Higher prevalence of cardiovascular risk factors but a better blood pressure (target of <130/80 mm Hg; 54·9% [1170 of 2132 patients] vs 46·8% [519 of 1109 patients]; p<0·0001), and lipid control (75·0% [895 of 1194 patients] vs 51·4% [386 of 751 patients], p<0·0001 for high-density lipoprotein [HDL]; 66·4% [769 of 1158 patients] vs 60·8% [453 of 745 patients], p=0·013 for non-HDL; 80·9% [1017 of 1257 patients] vs 61·4% [486 of 792 patients], p<0·0001 for triglycerides]) was observed in patients from high-income versus those from middle-income countries. Patients with SLE with antiphospholipid syndrome had a higher prevalence of modifiable cardiovascular risk factors, and significantly lower attainment of BMI and lipid targets (for low-density lipoprotein and non-HDL) than patients with SLE without antiphospholipid syndrome. High prevalence and inadequate cardiovascular risk factor control were observed in a large multicentre and multiethnic SLE cohort, especially among patients from middle-income compared with high-income countries and among those with coexistent antiphospholipid syndrome. Increased awareness of cardiovascular disease risk in SLE, especially in the above subgroups, is urgently warranted. None.

Awareness of cardiovascular risk among persons with type 2 diabetes: a qualitative study

ABSTRACT Purpose To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D). Method A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory. Result The analysis identified the core category “Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it.” Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management. Conclusion Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.

"There could be something going wrong and I wouldn't even know": a qualitative study of perceptions of people with cancer about cardiovascular disease (CVD) risk and its management.

Despite being at higher risk, many people with cancer do not receive adequate cardiovascular disease (CVD) risk assessment or management. The purpose of this research was to examine people with cancer's perceptions, experiences and needs regarding CVD risk factor awareness, assessment and management. We conducted 15 individual interviews to examine people with cancer's perspectives regarding CVD care in cancer. Reflexive thematic analysis was utilised to collect and organise data into themes and to synthesise findings. Fifteen people (6 males) diagnosed with diverse cancer types participated. Majority participants were not or only somewhat aware of CVD risk in cancer, but all expressed it was an important issue. A diverse range of priorities and needs for CVD care was discussed, including some participants' prioritisation of dealing with cancer and preferred amount, type and manner of information provision and support. Websites and brochures were identified as potential solutions for optimising CVD care. Codesign methodology should be used to engage patients in the development of flexible, tailored resources to increase awareness of CVD risk and strategies for its management. Perceptions of people with cancer regarding CVD care can inform new interventions that reduce the impact of CVD in cancer.

I Don’t Want to Think About It!: A Qualitative Study of Hypertensive Women’s Awareness and Perception of Heart Disease

Background: Research has shown an increasing number of young women between the ages 35 and 54 having heart attacks. However, data demonstrated a persisting failure to raise women’s awareness of cardiovascular disease risk. Moreover, very little has been done to date in low- and middle-income countries to educate women on cardiovascular disease risks and the high mortality rates for women. Aims: The aim of this study was to explore hypertensive women’s awareness and perceptions of heart disease. Methods: A qualitative research design using semi-structured interviews was performed. Data were analyzed using an inductive thematic analysis approach. Results: In total, 25 women participated in this study. Three main themes emerged: (1) perception of heart disease and its risk factors, (2) ‘I don’t want to think about it’: perspectives on future risk, and (3) strategies to prevent heart disease. From the participants’ narratives, it was evident that the women in this study had limited knowledge related to heart disease. Although all participants suffered from hypertension, the women still underestimated their risk of developing heart disease in the future. Many women believed that praying to God and maintaining an optimistic mindset could protect them from heart disease. Conclusion: The study’s findings highlight a clear indication of the need to implement renewed strategies for educating women about cardiovascular health tailored to target the rural populations in Indonesia. Raising women's awareness might reduce their risk of suffering from cardiovascular disease in the future.

Sociodemographic and Clinical Characteristics Associated With Improved Awareness of Cardiovascular Disease Risk in Women With Past Pregnancy Complications

Sociodemographic and Clinical Characteristics Associated With Improved Awareness of Cardiovascular Disease Risk in Women With Past Pregnancy Complications

0881 The Clinical and Policy Impact of Increasing Awareness about Sleep and CVD Health through Public health Programs for Women

Abstract Introduction Sleep is important for cardiometabolic health (CVH) and cardiovascular disease (CVD) prevention, especially for women. Relative to men, women have less awareness of CVD risk factors. Particularly, minority women have disproportionately higher prevalence of short sleep and CVD risk awareness. The primary objective of this review is to investigate the clinical, public health, and policy implications of three major public health programs: the Go Red for Women campaign, the Heart Centers for Women initiative, and the HEART for Women Act, on increasing CVD and sleep health awareness among women in the United States. The secondary objective is to create public health action plan to increase awareness of sleep health and CVD risk. The third objective is to describe barriers and facilitators of implementing the public health action plan for minority women. Methods To assess the impact of these interventions, a systematic review was conducted. Studies that directly examined the impact of the 3 CVD awareness programs on the prevalence of CVD in the U.S. Next, studies that evaluated the level of awareness of CVD risk factors and sleep were identified. The current literature was synthesized and described qualitatively to elucidate individual, provider, community and policy knowledge gaps in CVD and sleep health programs for women. Results Prevalence of CVD deaths among women decreased from 459,000/ year in 2004 to 339,500/year in 2015. Majority of these interventions include diet, exercise, and smoking cessation and exclude sleep and. Of the three programs, the Go Red for Women campaign proved to have the greatest public health and policy impact. From the results of systematic review, we created a public health action plan to increase awareness of sleep health and CVD risk. Third, we found patient, provider, and policy barriers and facilitators of implementing the public health action plan for minority women. Conclusion Public health action plans that focus on sleep health should be culturally sensitive to all women and accessible to those that live in both rural and urban areas addressing the importance of sufficient sleep and its benefits to CVH. Support (if any) K01HL135452, K07AG052685, R01AG072644, R01HL152453, R01MD007716, R01HL142066, R01AG067523, R01AG056031, and R01AG075007

Women’s awareness of cardiovascular disease risk after complications of pregnancy

BackgroundCertain maternal complications of pregnancy, including hypertensive disorders of pregnancy, gestational diabetes mellitus, birth of a growth restricted infant, idiopathic preterm labour, and placental abruption, are associated with a significantly increased risk of future maternal cardiovascular disease. In Australia, it is relatively unknown how many women with a history of complicated pregnancies are aware of their future cardiovascular disease risk. AimThe aim of this study was to determine what percentage of women attending a cardiovascular disease prevention clinic in South Australia soon after a complicated pregnancy were aware of their increased risk of cardiovascular disease. MethodsThis prospective observational study included 188 women attending a postpartum prevention clinic between 7th August 2018 and 10th February 2021. These women had experienced a serious maternal complication of pregnancy approximately seven months earlier. Women completed a self-administered health awareness survey immediately prior to their first clinic appointment to assess their awareness of their increased cardiovascular risk. FindingsOver two-thirds (69.1 %) of the women were unaware of the association between pregnancy complications and cardiovascular disease, and 6.4 % of the cohort did not realise they had experienced a complicated pregnancy. Almost 10 % of the cohort did not correctly identify the complication/s they had been diagnosed with during pregnancy. ConclusionAwareness of the association between complications of pregnancy and future cardiovascular disease was low in our cohort of women who had experienced a complication of pregnancy only seven months earlier. This emphasises the need for improved education for and communication with women to assist in implementing preventative care strategies.

1094-P: Awareness of Cardiovascular Disease Risk in People with Type 2 Diabetes

Objective: Independent of other risk factors, type 2 diabetes (T2D) increases the risk of heart attack or stroke two-to-threefold and the risk of death twofold. Poorly managed diabetes and commonly comorbid conditions such as hypertension and hyperlipidemia multiply this risk. This cross-sectional study investigates differences in cardiovascular disease (CVD) risk awareness in a sample of people with T2D. Methods: Participants with T2D paying for a subscription to One Drop for diabetes management completed a survey on their health. Three groups were identified: those who did not know their CVD risk, those who reported no risk, and those who reported being at risk for CVD. One-way ANOVA and chi-square tests compared groups on CVD risk factors (comorbidities, health behaviors, A1C, BMI) , self-care knowledge and interest in knowing more about risk. Results: Of the 165 participants, 20.6% did not know their risk, 32.7% indicated no risk and 46.7% indicated they were at risk for CVD. The unknown risk group had the most interest in knowing more about their CVD risk (81.3%; p&amp;lt;.001) and the least engagement in diabetes self-care behaviors (p’s&amp;lt;.05) . The group self-reporting no risk had the lowest rates of hypertension (44% vs. 60%+, p&amp;lt;.02) and hyperlipidemia (26% vs. 50%+, p&amp;lt;.001) , the least knowledge of diabetes self-care behaviors (p=.004) , and the least interest in learning more about their CVD risk (34%; p&amp;lt;.001) . The group self-reporting risk had moderate interest in learning more about their risk (58%) . Groups did not differ on self-reported A1C (p=.23) or BMI (p=.18) . Discussion: Over half of the sample reported unknown or no risk for CVD. Those who did not know their risk had high interest in knowing more about their risk but low engagement in risk-mitigating behaviors. Those reporting no risk had lower rates of comorbidities; however, there was no difference in diabetes-related risk factors between groups. These findings suggest that CVD prevention programs should be developed to complement diabetes-focused programs. Disclosure S.D.Imrisek: Employee; One Drop. J.R.Hoy-rosas: None. L.M.Lavaysse: Employee; One Drop. M.Lee: Employee; One Drop. J.Dachis: Board Member; One Drop, Employee; One Drop, Stock/Shareholder; One Drop. L.Sears: Employee; One Drop.

PATIENTS' PERCEPTION OF RECOVERY AFTER CARDIOVASCULAR INTERVENTIONS: AN IMPORTANT INDICATOR OF LIFESTYLE CHANGE

Cardiovascular disease (CVD) is one of the leading causes of premature death in the world.1 Recent advances in medical technology have led to lower mortality and better relative recovery in CVD patients. Today, various invasive procedures are used in cardiovascular interventions such as percutaneous coronary interventions (PCIs), which have led to improvements in the outcomes of CVD patients. However, despite the benefits of cardiovascular interventions, patients need to change their lifestyles. Therefore, patients with CVD need rehabilitation after cardiovascular interventions for complete recovery, which is often overlooked.2 Meanwhile, patients' perception of recovery after cardiovascular interventions is one of the key factors in predicting lifestyle changes in CVD patients. These patients should have a full awareness of a healthy lifestyle about physical activity, alcohol and tobacco use, and diet, as well as a proper perception of recovery after cardiovascular interventions.3 Hence, the results of a randomized controlled trial in the UK that assessed the impact of educational and rehabilitation programs on patients 'perceptions after myocardial infarction (MI) showed that educational and rehabilitation programs can lead to positive changes in patients' perceptions of recovery after cardiovascular interventions and lifestyle after MI, especially after three months of intervention. Also, patients in the intervention group reported fewer symptoms of angina compared to patients in the control group. Overall, educational and rehabilitation programs were effective in changing the perception of CVD patients and improving the functional outcome of patients after MI.4 In contrast, the results of another study in the Netherlands that evaluated the effect of a lifestyle intervention on CVD risk indicators in patients with familial hypercholesterolemia showed that there was no significant improvement between the intervention and control groups (usual care).5 The importance of this issue becomes clearer when these patients undergo invasive cardiovascular interventions. Despite the benefits of cardiovascular interventions, patients need to change their lifestyles. On the other hand, there is a link between patients' perceptions of recovery after cardiovascular interventions and lifestyle changes. Therefore, there is a need for serious attention to patients' perception of recovery after cardiovascular interventions. Obviously, patients' perceptions of recovery after cardiovascular interventions can be an important predictor of their lifestyle changes. However, to our knowledge, studies in this field are very limited. Therefore, it is suggested that researchers in future studies pay special attention to the perception of CVD patients of recovery after cardiovascular interventions as an important predictor of lifestyle changes in them after cardiovascular interventions.

Awareness of cardiovascular disease among Korean women: Results from a nationwide survey

Women underestimate the risk of cardiovascular disease (CVD). It is essential to assess and raise awareness regarding CVD among women to reduce disease burden and mortality. Therefore, we investigated the awareness regarding CVD among Korean women. We conducted a nationwide survey between December 2020 and January 2021 among a representative sample of Korean women using random-digit-dialing telephonic interviews. We sought information regarding the awareness of CVD risk; recognition of symptoms and signs; and knowledge of the cause and prevention of and appropriate response to CVD. A total of 1,050 women (mean age, 60.2 ± 11.9 years) participated in the study. Approximately 52.0% of participants were unaware of CVD, and only 26% of participants had heard of CVD. Participants considered that compared to other diseases, CVD was not an important health issue for women, and few of them thought that cerebrovascular diseases and CVD were the leading causes of death (10.9% and 7.6%, respectively). After adjustment for possible confounding factors, age >70 years, rural residence, and educational attainment below college were independently associated with a lack of awareness regarding CVD. The awareness regarding CVD being the leading cause of death in women is low, and most women do not consider it an important health issue. Therefore, special attention must be paid to educate the public regarding CVD in women.

Lessons Learned from Development of a Mobile App for Cardiovascular Health Awareness

Cardiovascular disease (CVD) is a major public health concern in the United States. In response to the federally sponsored Million Hearts Risk Check Challenge, a team of programmers, software developers, health-information technologists, and clinicians in an integrated healthcare system in Wisconsin collaborated to develop Heart Health MobileTM (HHM), designed to improve awareness of cardiovascular disease risk and promote risk factor control among users. This paper outlines the development processes and highlights key lessons learned for mobile health applications. An agile project management methodology was used to dedicate adequate resources and employ adaptive planning and iterative development processes with a self-organized, cross-functional team. The initial HHM iOS app was developed and tested, and after additional modifications, gamified and HTML 5 versions of the app were released. The development of an iOS app is low in cost and sustainable by a healthcare system. Future app modifications to enhance data security and link self-reported cardiovascular risk assessment data to patient medical records may improve performance, patient relevance, and clinician acceptance of HHM in the primary-care setting. Legal and institutional barriers regarding the capture and analyses of protected health information must be mitigated to fully capture, analyze, and report patient health outcomes for future studies.

Liver Transplant Recipient, Caregiver, and Provider Perceptions of Cardiovascular Disease and Related Risk Factors After Transplant.

Liver transplant recipients (LTRs) are at high risk for cardiovascular disease (CVD). We sought to characterize LTR, informal caregiver, and health care provider perceptions about CVD care after liver transplantation (LT) to inform the design of solutions to improve care. Participants included adult LTRs, their caregivers, and multispecialty health care providers recruited from an urban tertiary care network who participated in 90-minute focus groups and completed a brief survey. Focus group transcripts were analyzed using thematic analysis, and survey data were analyzed using descriptive statistics. A total of 17 LTRs, 9 caregivers, and 22 providers participated in 7 separate focus groups. Most (93.3%) LTRs and caregivers were unaware of the risk of CVD after LT. Although 54.5% of providers were confident discussing CVD risk factors with LTRs, only 36.3% were confident managing CVD risk factors in LTRs, and only 13.6% felt that CVD risk factors in their LTR patients were well controlled. Barriers to CVD care for LTRs included (1) lack of awareness of CVD risk after LT, (2) lack of confidence in an ability to provide proper CVD care to LTRs, (3) reluctance to provide CVD care without transplant provider review, and (4) complexity of communication with the multidisciplinary LTR care team about CVD care.Participant recommendations included improved education for LTRs and caregivers about CVD risk factors, electronic health record alerts for providers, clearly defined CVD care provider roles, increased use of the transplant pharmacist, and multidisciplinary provider meetings to discuss care plans for LTRs. Multiple barriers to CVD care after LT were identified, and targeted recommendations were proposed by participants. Transplant centers should integrate participants' recommendations when designing interventions to optimize CVD care for LTRs.

Sex-related trends of cardiovascular risk perception and prevention behaviors: results from the italian society of cardiovascular survey

Abstract Background Recent reports evidenced gender differences in the knowledge, perception and awareness of cardiovascular risk factors and cardiovascular diseases. Purposes To evaluate trends in awareness of cardiovascular risk, as well as knowledge of symptoms and preventive behaviors related to cardiovascular disease (CVD). Methods As part of Vivi con il Cuore (campaign with the goal of raising awareness about women's heart disease) a nationwide survey was conducted. Standardized questions on awareness of CVD risk, as well as prevention behaviors and barriers, were provided through a computer-assisted web interviewing platform to a large sample of Italians citizens ranging from 40 to 70 years old. The sample was representative of the population by age, sex, and area of geographical residence. Results A total of 1,000 subjects were included in this survey, of which 511 (51%) female. About 60% of women indicated cancer as the leading cause of death among female sex, while only 22% indicated cardiovascular disease. Similarly, when the same question was asked to men, 44% indicated cancer and 21% cardiovascular disease, observations that were consistent across age categories. Although a well sizable part of the population (90% of the interviewees) have consulted the general practitioner in the last year, only 45% of women and 56% of men declared to receive information about CVD risk. Almost 84% among men and women, recognized the importance of knowing how to understand the symptoms of a heart attack due to the possibility of survival. An additional survey was conducted among young cardiologists under 40 years old, including a total of 200 young cardiologists, similarly distributed among men and women (47% and 53% respectively). About 24% of young cardiologists indicated breast cancer as the leading cause of death in women, while only 70% reported cardiovascular diseases. Furthermore, 35% of participants reported that they did not have adequate training on the risks of heart disease in women. Conclusions In this survey, only 22% of women were aware that cardiovascular disease is the number one killer of women. Likewise, a well sizable part of young cardiologists (30%) does not recognize cardiovascular disease as the leading cause of death in women. These data should inform public health campaigns to focus on evidence-based strategies to prevent CVD and to help target messages that resonate and motivate women to take action. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Abbott

College Students' Perception of Current and Projected 30-Year Cardiovascular Disease Risk Using Cluster Analysis with Internal Validation.

Cardiovascular risk factors in young adults at a national level are less than ideal specifically for hypercholesterolemia, hypertension, and diabetes. Explore college students' perception of their 30-year cardiovascular disease (CVD) risk using cluster analysis technique with internal validation. This is a descriptive and cross-sectional study. A total of 133 college students, aged 20-36 with no known history of CVD, were recruited and used to perform cluster analysis with internal validation. The mean age of the sample was 24.85 and predominately female (59.5%). The mean score for perception of cardiovascular risk factors was 21.20 ranging from 12 to 34 points on a Likert scale. The mean score for the 30-year CVD risk assessment was 5.23 ranging from 1 to 22%. Five clusters emerged from the cluster analysis. However, two of the clusters, the highest risk with moderate perception and low risk and lowest perception, were identified as areas for potential intervention as there were discrepancies between subjects' perceived risk and their actual 30-year risk. The national data and literature has indicated a lack of awareness of CVD risk among this population which our study also concurred. Identifying the discrepancies between the perceived and projected CVD risk are useful for researchers and clinicians such as nurses to take the initiative to focus on and begin to intervene in this population to reduce potential adverse events of CVD.

Differences in Lifestyle Improvements With the Intention to Prevent Cardiovascular Diseases by Socioeconomic Status in a Representative Japanese Population: NIPPON DATA2010.

BackgroundThe relationships among socioeconomic status and lifestyle improvements have not yet been examined in a representative Japanese population.MethodsWe analyzed data from 2,647 participants (1,087 men and 1,560 women) who participated in NIPPON DATA2010. This survey inquired about lifestyle improvements and socioeconomic status. Education was categorized as low (≤9 years), middle (10–12 years), and high (≥13 years). Marital status was categorized as married, divorced, widowed, and never married/other. A multivariable logistic regression model was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of lifestyle improvements with the intention of preventing cardiovascular diseases for educational attainment and marital status, with adjustments for age and awareness of cardiovascular disease risk factors.ResultsOverall, 1,507 (56.9%) participants practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome, and the OR of lifestyle improvements was significantly higher with a high education than with a low education in men (OR 2.86; 95% CI, 1.96–4.17) and women (OR 2.36; 95% CI, 1.67–3.33). The number of participants who practiced prevention and improvements in hypertension, diabetes, elevated cholesterol, and metabolic syndrome was significantly lower in divorced than in married men (OR 0.46; 95% CI, 0.22–0.95) and women (OR 0.53; 95% CI, 0.33–0.86).ConclusionsSpecific differences caused by educational attainment and marital status may exist in lifestyle improvements.

Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme

BackgroundThe National Health Service (NHS) Health Check is a cardiovascular disease (CVD) risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk...

Weight status and associated factors among HIV infected people on antiretroviral therapy in rural Dikgale, Limpopo, South Africa.

BackgroundUnderweight in human immunodeficiency virus (HIV)-infected people on antiretroviral therapy (ART) complicates the management of HIV infection and contributes to mortality, whereas overweight increases the risk of cardiovascular disease (CVD).AimThe study determined weight status and associated factors in people with HIV infection receiving ART.SettingRural primary health care clinics in Dikgale, Limpopo province, South Africa.MethodsA cross-sectional study in which data were collected using the World Health Organization (WHO) stepwise approach to surveillance (STEPS) questionnaire and calculated using WHO analysis programmes guide. Weight and height were measured using standard WHO procedures, and body mass index was calculated as weight (kg)/height (m2). Data on ART duration were extracted from patients’ files. CD4 lymphocyte counts and viral load were determined using standard laboratory techniques.ResultsOf the 214 participants, 8.9%, 54.7% and 36.4% were underweight, normal weight and overweight, respectively. Physical activity (OR: 0.99, p = 0.001) and male gender (OR: 0.29, p = 0.04) were negatively associated with overweight. Men who used tobacco were more likely to be underweight than non-tobacco users (OR: 10.87, p = 0.02). Neither ART duration nor viral load or CD4 count was independently associated with underweight or overweight in multivariate analysis.ConclusionA high proportion of people on ART were overweight and a smaller proportion underweight. There is a need to simultaneously address the two extreme weight problems in this vulnerable population through educating them on benefits of avoiding tobacco, engaging in physical activity and raising awareness of CVD risk.

Barriers, facilitators, and effective interventions for lowering cardiovascular disease risk in people with severe mental illnesses: evidence from a systematic review and focus group study

BackgroundPeople with severe mental illnesses die early from cardiovascular disease (CVD). They have increased CVD risk factors, yet are less likely to receive appropriate treatments. Little is known about effective interventions to reduce CVD risk in severe mental illness. This study aimed to consolidate the best available evidence on lowering CVD risk in severe mental illness in primary care. Methods75 participants took part in 14 focus groups. Participants included people with severe mental illness, general practitioners, practice nurses, community mental health staff, and carers. Staff were asked to identify the training, resources, and systems required to lower CVD risk in severe mental illness, while access to services, motivation, and capability to lower CVD risk were explored with people with severe mental illness. Effective interventions were identified through a systematic review. We searched the Cochrane Library for systematic reviews of randomised controlled trials (RCTs) and the Cochrane Schizophrenia and Cochrane Depression, Anxiety and Neurosis Group Trial Registers between 1966 and 2014 for additional RCTs. Search terms were (schizophrenia, severe mental illness, bipolar, mania, manic, hypomani*, psychos*, psychotic, rapid cycling, schizoaffective) AND (physical, cardio*, metabolic, weight, tobacco, smok, medical, alcohol, nutrition, diet, health, diabet*, blood pressure, hypertension, cholesterol, statin). Non-English language papers were excluded. Data from included studies were extracted with a template to record methodological and substantive characteristics. FindingsFocus groups identified five barriers: negative perceptions of severe mental illnesses, difficulties accessing services, difficulties managing a healthy lifestyle, not attending appointments, and lack of awareness of CVD risk. Five facilitators included social support, improving patient engagement, continuity of care, positive feedback, and goal setting. 15 systematic reviews and 28 additional RCTs were included. Effective pharmacological and behavioural interventions to manage weight and promote smoking cessation or reduction were identified. There was minimal evidence of effective interventions to reduce alcohol use and blood glucose and no evidence for interventions targeting cholesterol, hypertension, or diabetes. InterpretationCVD risk attributable to weight and smoking can be reduced in severe mental illness; other risk factors must currently be managed as for other populations. However we identified factors that can be incorporated in the design, delivery, and evaluation of services to reduce CVD risk for people with severe mental illness in primary care. New interventions should address these barriers and harness facilitating factors to reduce CVD risk in this population. FundingThis work was funded as part of a National Institute for Health Research Programme grant for applied research (ref RP-PG-0609-10156).

Statin Adherence: Does Gender Matter?

Cardiovascular disease (CVD) continues to be the leading cause of death for men and women in the USA. Statins have contributed significantly to noted declines in cardiovascular-related mortality in the last decade; however, the benefit of statins is inequitable across genders. Women continue to be less likely to take statins and to meet target LDL goals than men. As a possible contributing factor to this disparity, we explore the evidence for gender-based differences in provision of, and adherence to statins. Compared with men, women are less likely to adhere to statins. Potential reasons for this gender difference in use of statins can be observed across all phases of adherence including both intentional and unintentional non-adherence. Notable gender-specific contributing factors for statin non-adherence include decreased provider and patient awareness of CVD risk among women, higher risk of statin intolerance among women, and competing demands associated with family caregiving responsibilities. Similar to limitations in the broader CVD literature, there is inadequate inclusion of gender-specific analyses in statin-related trials. Gender-based disparities in statin adherence can be linked to both provider level, psychosocial, and medication intolerance factors. Interventions designed to improve statin adherence should take gender-specific challenges into consideration such as women being older at the time of increased CVD risk, higher rates of statin intolerance, and potentially greater caregiving responsibilities.