Management Of Cardiovascular Disease Risk Factors Research Articles

The potential impact of new national guidance on primary prevention of cardiovascular disease in people living with HIV.

IntroductionCardiovascular disease (CVD) is the leading cause of death in England and Wales. As people living with HIV (PLWH) age, proactive management of CVD risk factors is crucial. The long-awaited draft guidelines for CVD from the National Institute of Clinical Excellence (NICE) propose lipid modification (with statins) and lifestyle modification for 40–74 year olds with >10% (previously >20%) 10-year risk of CVD using QRISK2. We currently use Framingham so compared 3 CVD risk calculators in our cohort and analyzed the impact of a change in CVD threshold on the proportion of our patients who would need intervention.Materials and MethodsFramingham, QRISK2 and JBS3 cardiovascular risk calculators were compared in a group of randomly selected patients. Then, to analyze the impact of a change in primary prevention threshold on our cohort, we interrogated a prospectively collected database to identify all individuals who had a documented Framingham risk assessment and applied the current/proposed thresholds accordingly. We performed the same analysis for the three calculator subgroup (recalculating Framingham risk). Finally we surveyed HIV services in England & Wales regarding their choice of calculator.ResultsWe compared the 3 CVD risk calculators in 100 patients, see Table 1.In terms of eligibility for primary prevention 20.9% (916/4383) had documented Framingham risk assessment as part of routine care. Using a 20% threshold, 8.8% (81/916) would require intervention, increasing to 35.2% (322/916) with a threshold for intervention of 10%. Restricting analysis to the 100 patients to whom we applied all three calculators resulted in the following proportion requiring intervention with a 20%/10% threshold, respectively: Framingham 28%/76%, QRISK2 20%/53%, JBS3 15%/42% (four patients were excluded due to incomplete data).ConclusionsReducing the threshold for cardiovascular preventative measures to 10% vastly increases the number of patients requiring primary intervention, from two- to fourfold depending on risk calculator used. This may have significant implications, including cost, drug–drug interactions and patient experience, that HIV physicians and general practitioners will need to address, ideally in a coordinated and patient-focused manner.

Interventions to reduce clinical inertia in cardiac risk factor management in renal transplant recipients.

Cardiovascular disease (CVD) is the leading cause of death in renal transplant recipients (RTRs). Clinical inertia (CI) is defined as "recognition of the problem, but failure to act." The effect of educational interventions in minimizing CI in CVD risk factor management was assessed. Educational sessions were conducted among 201 RTRs to inform them about their goals for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C) and glycated hemoglobin (HbA1c). Physicians were reminded about treatment goals using checklists. Pre-intervention and post-intervention CI was measured as "no action" or "appropriate action" by the physicians. Post-intervention percentage of RTRs with "no clinical action" for BP, LDL-C, and HbA1c control decreased from 10.8% to 3.8% (P=.02), 28.2% to 11.1% (P=.008), and 10.3% to 4.5% (P=.05), respectively, while those with "appropriate action" increased from 66.2% to 83.3% (P<.001), 68.7% to 79.4% (P=.008), and 85.1% to 93.2% (P=.03), respectively. Educational interventions and patient participation were shown to reduce CI.

Aortic Pulse Wave Velocity Improves Cardiovascular Event Prediction: An Individual Participant Meta-Analysis of Prospective Observational Data From 17,635 Subjects

The goal of this study was to determine whether aortic pulse wave velocity (aPWV) improves prediction of cardiovascular disease (CVD) events beyond conventional risk factors. Several studies have shown that aPWV may be a useful risk factor for predicting CVD, but they have been underpowered to examine whether this is true for different subgroups. We undertook a systematic review and obtained individual participant data from 16 studies. Study-specific associations of aPWV with CVD outcomes were determined using Cox proportional hazard models and random effect models to estimate pooled effects. Of 17,635 participants, a total of 1,785 (10%) had a CVD event. The pooled age- and sex-adjusted hazard ratios (HRs) per 1-SD change in loge aPWV were 1.35 (95% confidence interval [CI]: 1.22 to 1.50; p < 0.001) for coronary heart disease, 1.54 (95% CI: 1.34 to 1.78; p < 0.001) for stroke, and 1.45 (95% CI: 1.30 to 1.61; p < 0.001) for CVD. Associations stratified according to sex, diabetes, and hypertension were similar but decreased with age (1.89, 1.77, 1.36, and 1.23 for age ≤50, 51 to 60, 61 to 70, and >70 years, respectively; pinteraction <0.001). After adjusting for conventional risk factors, aPWV remained a predictor of coronary heart disease (HR: 1.23 [95% CI: 1.11 to 1.35]; p < 0.001), stroke (HR: 1.28 [95% CI: 1.16 to 1.42]; p < 0.001), and CVD events (HR: 1.30 [95% CI: 1.18 to 1.43]; p < 0.001). Reclassification indices showed that the addition of aPWV improved risk prediction (13% for 10-year CVD risk for intermediate risk) for some subgroups. Consideration of aPWV improves model fit and reclassifies risk for future CVD events in models that include standard risk factors. aPWV may enable better identification of high-risk populations that might benefit from more aggressive CVD risk factor management.

SP0196 Picturing the problem: Cardiovascular disease impact in inflammatory rheumatic diseases

Inflammatory rheumatic diseases, particularly rheumatoid arthritis but also the spondyloarthropathies (SpA), associate with increased cardiovascular disease (CVD) morbidity and mortality. There appears to be a gradient, with the risk of...

The Impact of Cardiovascular Disease and Risk Factor Treatment on Ethnic Disparities in Kidney Transplant

There is limited data on the use of cardiovascular disease (CVD) risk factor medications following renal transplant, especially when comparing use across ethnicities. The aim of this study was to compare the incidence, treatment, and impact of CVD between ethnicities in kidney transplant recipients. This was a retrospective cohort study of adults who underwent transplant between 2000 and 2008 within our academic medical transplant center. Pediatrics, multiorgan transplants, and those lost to follow-up were excluded. Data collection included all transplant and sociodemographic characteristics, medication use, CVD risk factor management, and follow-up events, including acute rejection, graft loss, and death. A total of 987 patients were included and followed for a mean of 6.7 ± 3.0 years. The baseline demographics revealed black patients were equally likely to have preexisting CVD (24% vs 25%, P = .651), but more likely to have preexisting diabetes (35% vs 23%, P < .001) or hypertension (97% vs 94%, P = .029). Black patients had poorer treatment of CVD risk factors, with lower rates of control of diabetes (35% vs 51%, P < .05) and dyslipidemia (37% vs 42%, P < .05). Black renal transplant recipients who had preexisting CVD had reduced graft survival rates compared to white patients (10-year rate 50% vs 60%, P = .033), but similar rates of graft survival were found in those without CVD (10-year rate 70% vs 71% in white patients, P = .483). CVD is common in transplant recipients, with black patients having higher rates and poorer control of diabetes and dyslipidemia.

Personalizing cardiovascular disease prevention among breast cancer survivors

With the advancement of breast cancer therapies, most women diagnosed with breast cancer in the United States are now expected to survive their disease, and management of competing comorbidities, particularly cardiovascular disease (CVD), is crucial. Recent studies have suggested that CVD is the most common cause of death for women diagnosed with ductal carcinoma in situ or stage I disease and for women aged more than 80 years with stage II disease. Various breast cancer therapies, including targeted therapies, can accentuate CVD risk; referrals for cardiology opinion are not uncommon at the time at which treatment options are under consideration. The use of less cardiotoxic alternatives, such as liposomal doxorubicin, and intensity-modulated radiation therapy should be considered when appropriate. Doppler myocardial imaging and cardiac MRI might allow early recognition of cardiotoxicity. It is important to weigh both the risk of CVD and that of breast cancer recurrence in a breast cancer survivor. Certain interventions for the primary prevention of CVD, including diet, physical activity, smoking cessation and aspirin, can reduce breast cancer risk as well. The management of CVD risk factors is of increasing importance in the management of breast cancer survivors.

Improving Cardiovascular Disease Screening in Community Mental Health Centers

Increased mortality among the seriously mentally ill is largely due to cardiovascular disease (CVD). This applied research project examined a process of CVD screening at a community mental health center, then implemented and evaluated an improved process of identifying and managing CVD risk factors. Patient records (n = 130) were reviewed at baseline and 6 months posteducational intervention and implementation of new monitoring tools. Statistical analysis showed significant process improvement (p < .001). Advanced practice registered nurses can design and implement improved CVD screening to mitigate morbidity and mortality in the seriously mentally ill.

A Culture of Care: The French Approach to Cardiovascular Risk Factor Management

The objective of this study was to describe French primary care physicians' beliefs about cardiovascular disease (CVD) risk factors and best practices for managing CVD. This study comprised a purposive convenience sample of 656 primary care physicians in France, recruited from contacts made through the French Society of General Medicine. We compiled the physicians' responses to free text questions taken from an Internet-based survey and analyzed them using a qualitative approach. Physician's responses were inductively analyzed using content analysis. Responses were thematically coded, tabulated, and computed for frequencies. Overall themes and verbatim examples are presented in this article. The French physicians in our study are generally happy with their country's health care system and cite equity as the primary reason. Interestingly, along with food and lifestyle differences, they also cite equity of their health system as the reason for the lower CVD death rate in France, Japan, and Israel compared with the United States. The physicians believe that they are successful at managing CVD risk factors by emphasizing aspects of the doctor-patient relationship, including spending more time with patients and focusing on education. Physicians who are on the front line of care and management offer a fresh perspective on best practices for CVD prevention and management. The equity of the French health care system supports a "culture of care" in France that might lead to better outcomes for CVD risk factor patients than in the United States.

OS106. The postpartum preeclampsia clinic (PPPEC) – an interdisciplinary clinic for cardiovascular risk reduction for women with preeclampsia

Preeclampsia (PEC) is a well-established risk factor for the development of future premature cardiovascular disease (CVD). However, women with PEC are not routinely counselled about these longterm risks, nor are their risk factors regularly assessed or treated for prevention of CVD. An interdisciplinary PPPEC clinic was recently established at the University of Alberta in order to address patient education and CVD risk factor management. (1) To describe the implementation of a novel interdisciplinary clinic for postpartum women with PEC designed to both educate women of their CVD risk and manage their risk factors. (2) To describe our one-year experience with this clinic, identifying attendance issues common to postpartum clinics. We performed a retrospective chart review using data obtained from standardized clinic booking lists. From these records, we extracted the following information: number of referrals, attendance dates (including adherence to visit) and patient demographics. Descriptive statistics were used to summarize patient demographics and percentages of missed visits were calculated. PPPEC Clinic Implemenation: All patients who attend this PPPEC clinic received education on PEC, its implications for future vascular health, and evidence-based strategies for CVD risk reduction through both a slide presentation, educational handouts as well as individualized CVD risk assessment by the interdisciplinary team (Obstetric Internist, nurse practitioner, pharmacist and dietician). Next, specific patient-directed lifestyle modification goals were developed in the form of an "Action Plan" for each CVD risk factor: blood pressure, cholesterol, glucose intolerance, physical activity level, weight, and smoking. These goals were reviewed at each follow-up visit. PPPEC Clinic Experience: From Sept 2010 to Feb 2012, there were 123 appointments in this bi-weekly clinic (63 new consults and 60 follow ups). The women's mean age was 29.4 years (range 17-43). Seventy-four percent of scheduled apointments were attended. Of those that were missed, half were initial consultations and halfwere follow-up appointments. This interdisciplinary PPPEC addresses an important gap in clinical care for CVD prevention for these high-risk women. This study identified suboptimal attendance of scheduled postpartum visits. Future plans include: (1) identifying barriers to postpartum clinic attendance and strategies to overcome them, (2) examining the effectiveness of the educational and clinical intervention model in reducing cardiovascular risk factors in these women.

Universal pediatric lipid screening: preventing future cardiovascular disease in high-risk children

Case 1: 11-year-old boy at a routine well-child visit A review of systems is negative. He plays three sports and maintains an optimal diet through his mother’s efforts and, recently, his own volition. His paternal grandfather died at age 40 years in a work-related accident. There is no known family history of lipid disorders. Examination shows normal BMI, normal blood pressure and no other abnormalities. Upon lipid screening, he is noted to have nonfasting non-HDL-C of 255 mg/dl. Upon fasting lipid profile, his LDL-cholesterol (LDL-C) is 240 mg/dl. His parents are subsequently tested and his 33-year-old father is noted to have a LDL-C of 250 mg/dl. In this patient, there were no features that would have triggered concerns for hyperlipidemia, such as a family history of hyperlipidemia or early atherosclerotic events. Despite an optimal lifestyle, he has dramatically elevated LDL-C due to a genetic dyslipidemia, heterozygous familial hypercholesterolemia (FH). The approximately 1 in 500 children born with FH demonstrate persistently elevated LDL-C concentrations of at least 160 mg/dl and typically over 200 mg/dl. Approximately 50% of affected men and 20% of affected women experience coronary heart disease events by the age of 50 [2,3]. Multiple studies have shown that relying on a family history of CVD events or hyperlipidemia to trigger screening is insufficiently sensitive and may miss 30–60% of affected children owing to a lack of knowledge about the family history, lack of In November 2011, after a systematic review of the relevant literature, the National Heart Lung, and Blood Institute (NHLBI) Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents published evidence-based, integrated guidelines on preventing cardiovascular disease (CVD) by reduction of athero sclerotic disease risk factors in children and adolescents [1]. These guidelines encourage the broad adoption of healthy behavioral patterns, beginning in childhood, to prevent the development of athero sclerotic CVD risk factors – so-called ‘primordial prevention’. The guidelines endorse a healthy diet and activity patterns at a population level, as well as the individual practitioner–child–family unit as cornerstones of CVD prevention. Predicated upon evidence linking childhood CVD risk factors to adult risk factor prevalence, subclinical athero sclerosis and CVD events, the panel also comprehensively updated and rationally extended a number of previous guidelines advocating individual -level identification and management of CVD risk factors including nutrition, physical activity, tobacco exposure, elevated blood pressure, obesity, diabetes mellitus and metabolic syndrome. One significant extension pertained to lipid disorders, where the panel recommended screening of all children once between 9 and 11 years of age with a nonfasting non-HDL-cholesterol (HDL-C). This recommendation was designed to identify those children with extreme lipid abnormalities, usually due to a genetic dyslipid emia, in whom the risk of early CVD is established and treatment is available. When abnormal values are confirmed, identified children should be treated with targeted nutritional changes, physical activity and, when

Effect of Aggressive Cardiovascular Risk Factor Treatment on Progression of Carotid Intima-Media Thickness: Experience of an Atherosclerosis Center∗

Atherosclerosis, the major cause of cardiovascular disease (CVD), is the abnormal deposit of cholesterol within the intima of the arterial wall. Conversely, in epidemiologic studies investigators have estimated that normal aging (arteriosclerosis) produces an annual thickening of the media of the arterial wall by >0.01 mm per year. An indirect method of diagnosing atherosclerosis involves ultrasound analysis of the common carotid intima-media (CCIMT) wall. The Atherosclerosis Center specializes in aggressive management of CVD risk factors. The Center performs serial CCIMT analysis with a computerized edge-detection ultrasound device (MICROMAXX, Sonosite) to monitor the progression of atherosclerosis. The device measures 100 markers within a 1-cm area of the CCIMT wall, 1 cm proximal to the bulb, to provide the mean and max thickness. The device also contains carotid ultrasound data of healthy people (ages 10−90 years), allowing comparison of IMT values with those of clinical patients.

Medidas antropométricas como preditoras de fatores de risco cardiovascular na população urbana do Irã

Overweight and obesity are an important public health problem in society, due to their association with various chronic diseases. The purpose of this study is to determine the prevalence and distribution of overweight and obesity, using different anthropometric measurements and to identify the best anthropometric indicator which is most closely related to cardiovascular disease (CVD) risk factors in an Iranian urban population. This cross-sectional study was conducted with 991 men and 1188 women aged 15 to 64 years. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and percentage of body fat were measured. A fasting blood specimen was obtained. CVD risk factors, including fasting blood glucose, triglycerides, total cholesterol (Tchol), low-density (LDL-C) and high-density-lipoprotein cholesterol (HDL-C) were assessed. Based on BMI, more than 49% of men and 53% of women were either overweight or obese with 10.2% of men and 18.6% of women being obese. In both men and women, the prevalence of overweight was greater among 40-49 year olds and the prevalence of obesity was greater among those 50+ years. Using the multiple regression analysis, BMI, WHtR and WHR explained the highest percentage of variation of triglycerides, Tchol/HDL-C ratio and LDL-C in men, respectively, whereas WHR explained the highest percentage of variation of triglycerides and WC explained the highest percentage of variation of Tchol/HDL-C ratio and LDL-C in women. Our data indicated that WHR and WHtR were the anthropometric indicators that best predicted CVD risk factors in men and WHR and WC in women.

Efficacy of optimal long-term management of multiple cardiovascular risk factors (CVD) on walking and quality of life in patients with peripheral artery disease (PAD): protocol for randomized controlled trial.

Peripheral artery disease (PAD) is an understudied chronic illness most prevalent in elderly individuals. PAD patients experience substantial walking impairment due to symptoms of limb ischemia that significantly diminishes quality of life (QOL). Cardiovascular disease (CVD) morbidity and mortality is increased in this population because of aggressive atherosclerosis resulting from untreated CVD risk factors. Despite current national guidelines recommending intensive CVD risk factor management for PAD patients, untreated CVD risk factors are common. Interventions that bridge this gap are imperative. The Vascular Insufficiency - Goals for Optimal Risk Reduction (VIGOR(2)) study is a randomized controlled trial (RCT) that examines the effectiveness of a long-term multifactor CVD risk reduction program on walking and quality of life in patients with PAD. The purpose of this article is to provide a detailed description of the design and methods of VIGOR(2). Clinical Trial Registration - URL: http://clinicaltrials.gov/ct2/show/NCT00537225.

A cohort study comparing cardiovascular risk factors in rural Māori, urban Māori and non-Māori communities in New Zealand

ObjectivesTo understand health disparities in cardiovascular disease (CVD) in the indigenous Māori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Māori in an area remote...

Efforts to close the evidence-practice gap in the management of cardiovascular risk factors in general practice: strategic or haphazard?

Rational, aims and objectives: Guidelines for best practice management of cardiovascular disease (CVD) risk factors such as smoking, high blood pressure, high cholesterol, risky alcohol consumption, diabetes and obesity are in place in the primary care setting, yet many of these risk factors remain uncontrolled. This review examined: a) trends in the number of published provider-focussed intervention studies which aimed to improve the identification and management of modifiable CVD risk factors in primary care; b) the proportion of primary care research effort directed toward improving provider management of each CVD risk factor compared to the mortality burden associated with each risk factor in high income countries. Methods: An electronic database search of Medline, Cinahl and PsychInfo was conducted for the time period January 1 st 1999 to 31 st December 2010 to identify relevant articles. Results: There was a trend toward an increase in the number of provider-focussed interventions to improve the management of CVD risk factors in general practice over time. The proportion of research effort directed to risk factors varied between 6% for alcohol and obesity to 32% for high blood pressure. High blood pressure and smoking had the highest and second highest proportion of research effort and were ranked second and first, respectively, in terms of mortality burden. Conclusions: The allocation of research effort appears somewhat consistent with the health burden associated with the risk factors examined in this review, although an increase in smoking-related research may be needed.

Community screening for cardiovascular risk factors and levels of treatment in a rural Māori cohort

To document levels of cardiovascular disease (CVD), diagnosed and undiagnosed risk factors and clinical management of CVD risk in rural Māori. Participants (aged 20-64 years), of Māori descent and self-report, were randomly sampled to be representative of age and gender profiles of the community. Screening clinics included health questionnaires, fasting blood samples, blood pressure and anthropometric measures. Data were obtained from participants' primary care physicians regarding prior diagnoses and current clinical management. New Zealand Cardiovascular Guidelines were used to identify new diagnoses at screening and Bestpractice electronic-decision support software used to estimate 5-year CVD risk. Mean age of participants (n=252) was 45.7 ± 0.7, 8% reported a history of cardiac disease, 43% were current smokers, 22% had a healthy BMI, 30% were overweight and 48% obese. Hypertension was previously diagnosed in 25%; an additional 22% were hypertensive at screening. Dyslipidaemia was previously diagnosed in 14% and an additional 43% were dyslipidaemic at screening. Type-2 diabetes was previously diagnosed in 11%. Glycaemic control was achieved in only 21% of those with type-2 diabetes. Blood pressure and cholesterol were above recommended targets in more than half of those with diagnosed CVD risk factors. High levels of diagnosed and undiagnosed CVD risk factors, especially hypertension, dyslipidaemia and diabetes were identified in this rural Māori community. There is a need for opportunistic screening and intensified management of CVD risk factors in this indigenous population group.

Impact of Pharmacist Care in the Management of Cardiovascular Disease Risk Factors

Pharmacists may improve the clinical management of major risk factors for cardiovascular disease (CVD) prevention. A systematic review was conducted to determine the impact of pharmacist care on the management of CVD risk factors among outpatients. The MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials that involved pharmacist care interventions among outpatients with CVD risk factors. Two reviewers independently abstracted data and classified pharmacists' interventions. Mean changes in blood pressure, total cholesterol, low-density lipoprotein cholesterol, and proportion of smokers were estimated using random effects models. Thirty randomized controlled trials (11,765 patients) were identified. Pharmacist interventions exclusively conducted by a pharmacist or implemented in collaboration with physicians or nurses included patient educational interventions, patient-reminder systems, measurement of CVD risk factors, medication management and feedback to physician, or educational intervention to health care professionals. Pharmacist care was associated with significant reductions in systolic/diastolic blood pressure (19 studies [10,479 patients]; -8.1 mm Hg [95% confidence interval {CI}, -10.2 to -5.9]/-3.8 mm Hg [95% CI,-5.3 to -2.3]); total cholesterol (9 studies [1121 patients]; -17.4 mg/L [95% CI,-25.5 to -9.2]), low-density lipoprotein cholesterol (7 studies [924 patients]; -13.4 mg/L [95% CI,-23.0 to -3.8]), and a reduction in the risk of smoking (2 studies [196 patients]; relative risk, 0.77 [95% CI, 0.67 to 0.89]). While most studies tended to favor pharmacist care compared with usual care, a substantial heterogeneity was observed. Pharmacist-directed care or in collaboration with physicians or nurses improve the management of major CVD risk factors in outpatients.

Kidney function, albuminuria and cardiovascular risk factors in post-operative living kidney donors: a single-center, cross-sectional study

Mortality and renal or cardiovascular prognosis in living kidney donors (LKDs) has been reported to be as same as the general population; however, it is known that the prevalence of hypertension, albuminuria and metabolic syndrome increases after donation. At present, data from Japanese donors are scarce and as a result the actual medical status of LKDs remains unclear. To evaluate cardiovascular disease (CVD) risk factors in Japanese LKDs, we conducted a cross-sectional study on LKDs at our tertiary care hospital and clinic. Thirty-six out of 63 LKDs who underwent kidney donation at the kidney disease center of the St. Marianna University Hospital were enrolled. The kidney function, albuminuria, and CVD risk factors including hypertension, dyslipidemia, hyperuricemia, glucose intolerance (GI) and obesity were cross-sectionally investigated. The kidney function by inulin clearance was 55.2±10.3ml/min/1.73m(2) on average, indicating that 63.9% of LKDs were categorized into chronic kidney disease (CKD) stage 3 after donation. Albuminuria developed in 16.7%. Blood pressure (BP) was not elevated after donation, but ambulatory BP monitoring revealed that 39.4% of LKDs were categorized as having non-dipper type BP. GI was shown in 25% of LKDs. Prevalence of dyslipidemia and hyperuricemia were 41.7% and 27.8%, respectively. Body mass index was not significantly changed after donation. Seven LKDs (19.4%) were diagnosed with metabolic syndrome. Many Japanese LKDs were experiencing decreased kidney function corresponding to CKD stage 3. They also had a significant but not lower prevalence of albuminuria and CVD risk compared to the general Japanese population. LKDs should be followed closely with special attention to the management of renal and CVD risk factors.

Ethnic differences in systemic inflammation: An investigation of C-reactive protein levels among Moroccan, Turkish and Dutch groups in the Netherlands

ObjectiveC-reactive protein (CRP) is a sensitive, non-specific systemic marker for inflammation and tissue damage in the human body and independently associated with incident cardiovascular disease (CVD) and traditional CVD risk factors. The aim of this study is to describe and analyse ethnic differences in CRP levels between Turkish, Moroccan and ethnic Dutch groups. MethodsData were collected in the setting of a general health survey, in Amsterdam, the Netherlands, in 2004. From 1219 adults information on physical and psychological health, lifestyle and demographic background was obtained via health interviews. In a physical examination, measurements of anthropometry and blood pressure were performed. Blood samples were collected and high-sensitive CRP was determined. ResultsMean CRP levels, excluding acute inflammation, were higher among Turkish migrants (men: 2.1mg/l; women: 2.9mg/l) and Moroccan women (2.9mg/l) compared to the Dutch (men: 1.7mg/l; women: 2.3mg/l). ‘High CVD risk’ CRP levels (3mg/l≥CRP≥10mg/l) were also more prevalent in these groups. Ethnic differences in mean CRP levels persisted after controlling for sex, age, BMI and smoking. Ethnic differences in ‘high CVD risk’ CRP levels were attenuated by controlling for traditional CVD risk factors in men, but not in women. ConclusionTheir relatively high CRP levels put Turkish and female Moroccan migrants at higher risk of future cardiovascular events, especially women. Known determinants cannot explain ethnic differences in mean CRP levels. Traditional CVD determinants account for ethnic differences in ‘high CVD risk’ CRP levels among men, but not women.

Cardiovascular disease risk factors

With increasing longevity, the prevalence of cardiovascular disease (CVD) risk factors in hemophilia patients is expected to increase; however, evidence-based guidelines on management are lacking. The aim of the study was to determine the prevalence and management of CVD risk factors in hemophilia patients. A retrospective study of 58 adult hemophilia patients (≥35 years) attending Mayo Comprehensive Hemophilia Center between 1 January 2006 and 15 October 2009 were reviewed. The prevalence of CVD risk factors was hypertension 65.5%, diabetes 10.3%, smoking 12.5% and obesity 19.6%. A total of 31% did not have a lipid profile on record. Management of risk factors included antihypertensive medications in 84.2% and lipid-lowering agents in 12.1%. During their medical evaluation, four of seven active smokers received smoking cessation counseling and four of 11 obese patients received lifestyle modification advice. Eight patients (13.8%) experienced a CVD event: myocardial infarction (MI) (n=3), coronary artery disease (n=2), both MI and ischemic stroke (n=1) and hemorrhagic strokes (n=2). Only five of eight patients were on low-dose aspirin, of which aspirin was discontinued in one patient after he was diagnosed with hemophilia following a bleeding work-up. Another patient on dual antiplatelet therapy post stent placement developed epistaxis resulting in clopidogrel cessation. Hemophilia patients are at risk for CVD, similar to the general age-matched male population. Screening for CVD risk factors, with preventive dietary and pharmacologic interventions, play a key role in the prevention and long-term management of CVD. Collaborative efforts between primary care providers, cardiologists and hemophilia center specialists remain essential in managing these complex patients.