Control Of Major Risk Factors Research Articles

S-53-1: SOCIOECONOMIC FACTORS AND PREVENTION OF CARDIOVASCULAR DISEASES IN ASIA

Focus on social determinants of health is important for primordial and primary prevention of cardiovascular diseases (CVD). There are multiple social determinants and are macrolevel factors: social and human development, location related factors, and policies that influence rural and urban planning, environmental pollution, healthcare infrastructure, health financing, quality of health systems, taxation on harmful products (tobacco, alcohol, trans fats), and subsidizing healthy foods. Individual level factors are: multiple social factors, education, income, employment, stress, early life events, addictions including tobacco, and availability, affordability and adherence to medicines and healthy lifestyles. Studies have shown that countries with better development have lower CVD incidence and mortality, also in Asia. Healthy lifestyles (healthy diet, physical activity, tobacco control) and awareness, treatment and control of major risk factors (hypertension, diabetes, dyslipidemias) are more in better developed Asian countries due to better health systems and universal health coverage policies. At individual level higher socioeconomic status and better educational level are associated with lower prevalence of CVD risk factors and better treatment and control of hypertension, dyslipidemias and diabetes. Interventions to address social determinants are limited and include focus on political, economic and social interventions. UN Sustainable Development Goals related to poverty eradication, zero hunger, good health and wellbeing, quality education, gender equality, decent work, economic growth, reduced inequalities, sustainable communities, responsible consumption or production, and climate action address social determinants of health. Creation of health infrastructure in rural and deprived locations, macrolevel financing, manpower deployment and workforce training are important evidence-based interventions. Interventions to improve quality of general education and health literacy and education of medical professionals and non-physician health workers have shown to ameliorate CVD related disparities. Public health interventions include life-course approach for prevention and control of risk factors, better and safe facilities for promotion of physical activity, tobacco, smoking and alcohol control policies, taxation on trans fats, sugars, sugar-sweetened beverages and salt, universal health care focussed on early CVD diagnosis and management, availability of medicines and focus on technological innovations to promote adherence to medicines and healthy lifestyles. At the individual level better CVD risk-factor control can be achieved by focus on individual social determinant and improved professional-patient communication via professional medical education, health worker related focus, patient health literacy, and greater patient involvement.

Recent Advances in the Emerging Therapeutic Strategies for Diabetic Kidney Diseases.

Diabetic kidney disease (DKD) is one of the most common causes of end-stage renal disease worldwide. The treatment of DKD is strongly associated with clinical outcomes in patients with diabetes mellitus. Traditional therapeutic strategies focus on the control of major risk factors, such as blood glucose, blood lipids, and blood pressure. Renin–angiotensin–aldosterone system inhibitors have been the main therapeutic measures in the past, but the emergence of sodium–glucose cotransporter 2 inhibitors, incretin mimetics, and endothelin-1 receptor antagonists has provided more options for the management of DKD. Simultaneously, with advances in research on the pathogenesis of DKD, some new therapies targeting renal inflammation, fibrosis, and oxidative stress have gradually entered clinical application. In addition, some recently discovered therapeutic targets and signaling pathways, mainly in preclinical and early clinical trial stages, are expected to provide benefits for patients with DKD in the future. This review summarizes the traditional treatments and emerging management options for DKD, demonstrating recent advances in the therapeutic strategies for DKD.

Primary Cardiovascular Disease Prevention: Risk Factors Control vs. Imaging Subclinical Atherosclerosis

The burden of cardiovascular disease in developed countries has shown dramatic improvements over the last 50 years, largely due the identification and control of major risk factors including, smoking hypertension and high cholesterol. However, due to the significant increase in obesity and diabetes CVD incidence rates will not reduce as far over over the next years. Risk prediction in asymptomatic individuals remains a major challenge. Primary preventive treatment is currently based on the assessment of individual’s global risk mainly through screening of conventional risk factors and their treatment with lifestyle intervention and pharmacotherapy, often based on multivariate risk equations, and yet a large proportion of CVD still occurs in individuals who are classified as carrying low- or intermediate-risk according to the risk scores. Atherosclerosis is the most common pathophysiologic process underlying CVD, often after a prolonged asymptomatic phase during which it may be possible to modify the course of the disease. Unlike conventional probabilistic risk scores, non-invasive imaging techniques such as carotid intima-media thickness (CIMT) along with plaque assessment (Figure 2), measured by B-mode ultrasound, and coronary calcium scoring (CAC) detected by CT scan have the advantage of direct visualization of the consequences of atherosclerosis on the arterial system. We consider the proposal that imaging of subclinical atherosclerosis is superior to risk equations as it directly identifies the disease and can effectively predict the risk of future CV events in low- and intermediate-risk individuals. In addition, imaging can improve the adherence to guidelines based treatment in patients and their physicians.

OP.3C.01] COMPARISON BETWEEN EUROPEAN SYSTEMATIC CORONARY RISK EVALUATION AND ITALIAN CUORE ALGORITHMS IN ADULT OUTPATIENTS FOLLOWED BY GENERAL PRACTITIONERS AND SPECIALISED CENTRES

Objective: Global cardiovascular (CV) risk stratification based on either European Systematic Coronary Risk Evaluation (SCORE) or Italian CUORE algorithms should be performed in all adult outpatients by both general practitioners (GPs) and specialised physicians (SPs). Design and method: To compare individual CV risk profile by using either European SCORE and Italian CUORE algorithms in adult outpatients followed by GPs and SPs in Italy. All available data were centrally analysed for global CV risk assessment and rates of control of major CV risk factors, including blood pressure (BP), serum cholesterol, triglycerides and glucose levels. CV risk profile characterization was based on both SCORE and CUORE algorithms. Study population was stratified according to referring physicians (GPs, cardiologists, diabetologists, other SPs). Results: We analysed data from an overall population sample of 10,404 adult outpatients (age 60.76.5 years, BMI 28.34.9 kg/m2, BP 136.714.4/82.18.2 mmHg, total cholesterol 212.240.7 mg/dl, HDL cholesterol 50.812.3 mg/dl), among whom 7,767 (74.7%) were followed by GPs, 1,239 (11.9%) by cardiologists, 1,006 (9.7%) by diabetologists and 392 (3.8%) by other SPs. Systolic/diastolic BP, total/LDL cholesterol and triglycerides levels were higher and HDL cholesterol was lower in patients followed by GPs and cardiologists compared to other groups. Conversely, BMI and fasting glucose levels were higher in patients followed by diabetologists than in other groups. All major CV risk factors and comorbidities were more frequently reported and controlled in patients followed by cardiologists than in the other groups, with the only exception of diabetes. Both European SCORE (4.74.5) and Italian CUORE (13.711.5) were significantly higher in outpatients followed by cardiologists than in those followed by GPs (4.03.6 and 11.59.7) and diabetologists (3.73.5 and 10.39.2) or other SPs (3.32.8 and 9.47.4; P < 0.001 for all comparisons). Conclusions: Despite proper use of drugs and better pharmacological control of major risk factors, both European SCORE and Italian CUORE algorithms reported higher CV risk profile in patients followed by cardiologists than in patients followed by diabetologists, GPs, and other SPs.

PREDICTABILITY AND PREDICTORS OF VOLATILITY SMIRK: A STUDY ON INDEX OPTIONS

The purpose of this study is to examine the presence of volatility smirk anomaly in index options and its predictability for future returns. The study tests the temporal properties of volatility smirk and further explores the factors determining the anomaly. The daily volatility smirk is computedfor the period 2004–2014 and the first lag of smirk is used in generalized least square (GLS) estimation framework, with set of control variables in two different specifications, to test the predictability as well as the determinants of volatility smirk. The study reports significant presence of volatility smirk in index options with an auto–regressive structure. Smirk predicts marginal returns and the predictability is robust to the control of major risk factors. It is also found that open interest of calls and puts, along with market risk premium and momentum premium, act as significant predictor of volatility smirk. The results are helpful in enhancing returns on investment in Index based funds and designing options strategies from the perspective of volatility risk. The study is first of its kind in the Indian market examining the reasons and consequences of existence of volatility smirk in index options.

Age, sex, and secondary prevention of ischaemic heart disease in everyday practice

Many researchers have studied age- and sex-related differences in the management of patients with coronary artery disease. However, the results are inconsistent. To assess sex- and age-related bias in the secondary prevention in patients hospitalised due to ischaemic heart disease. Five hospitals with departments of cardiology serving a city and surrounding districts in southern Poland participated in the study. Consecutive patients hospitalised from 1 April 2005 to 31 July 2006 due to acute coronary syndrome or for a myocardial revascularisation procedure and aged ≤ 80 years were recruited and interviewed 6-18 months after hospitalisation. The hospital records of 640 patients were reviewed and 513 (80.2%) patients participated in the follow-up interview. Women were older and less educated than their male counterparts. Sex was not independently associated with the control of major risk factors in the post-discharge period, whereas age was related to a higher probability of having high blood pressure and a lower chance of smoking. Multivariate analysis showed that females were prescribed calcium antagonists (odds ratio [OR] 2.13; 95% confidence intervals [CI] 1.34-3.39) and diuretics (OR 1.52; 95% CI 1.00-2.31) more often than males. Age was independently related to the prescription rate of diuretics (≥ 70 years vs. < 60 years; OR 1.61; 95% CI 1.19-2.20). The prescription rate of antiplatelets, beta-blockers, angiotensin converting enzyme-inhibitors/sartans, lipid-lowering drugs, and anticoagulants was not related to age or sex. We found no major sex-related difference in the frequency of achieving recommended goals in secondary prevention, whereas age was related to a lower prevalence of smoking and a higher probability of having high blood pressure in subjects after hospitalisation for coronary artery disease.

DOBRA PRAKTYKA W OPIECE PROFILAKTYCZNEJ: OPIEKA PROFILAKTYCZNA I AKTYWIZACJA ZAWODOWA OSÓB NIEPEŁNOSPRAWNYCH Z CHOROBAMI UKŁADU ODDECHOWEGO

Respiratory diseases are a cause of long-term sickness absence, and even of partial or complete inability to work. This paper presents the first in Poland description of principles of good practice in occupational health service provided for people with respiratory diseases. The issues concerning the certification of the ability to work in this group of patients are discussed. The key-principles of preventive care of workers with obstructive and interstitial lung diseases with particular attention paid to the control of major risk factors are also presented. The importance of possible contraindications for job performance by workers affected by these diseases, as well as the responsibilities of occupational health physicians were highlighted. M

SURF – SUrvey of Risk Factor management: first report of an international audit

Despite the fact that subjects with established coronary heart disease (CHD) are at high risk of further events and deserve meticulous secondary prevention, current audits such as EUROASPIRE show poor control of major risk factors. Ongoing monitoring is required. We present a new risk factor audit system, SURF (Survey of Risk Factor management), that can be conducted much more quickly and easily than existing audit systems and has the potential to allow hospitals of all sizes to participate in a unified international audit system that will complement EUROASPIRE. Initial experience indicates that SURF is truly simple to undertake in an international setting, and this is illustrated with the results of a substantive pilot project conducted in Europe and Asia. The data collection system was designed to allow rapid and easy data collection as part of routine clinic work. Consecutive patients (aged 18 and over) with established CHD attending outpatient cardiology clinics were included. Information on demographics, previous coronary medical history, smoking history, history of hypertension, dyslipidaemia or diabetes, physical activity, attendance at cardiac rehabilitation, cardiac medications, lipid and glucose levels (and HbA1c in diabetics) if available within the last year, blood pressure, heart rate, body mass index, and waist circumference were collected using a one-page data collection sheet. Years spent in full time education was added as an additional question during the pilot phase. Three European countries - Ireland (n = 251), Belgium (n = 122), and Croatia (n = 124) - and four Asian countries - Singapore (n = 142), Taiwan (n = 334), India (n = 97), and Korea (n = 45) - were included in the pilot study. The results of initial field testing were confirmed in that it proved possible to collect data within 60-90 seconds per subject. There was poor control of several risk factors including high levels of physical inactivity (41-45%), overweight and obesity (59-78%), and ongoing smoking (15%). There were lower levels of individuals attending cardiac rehabilitation in Asia. More Europeans than Asians reached the low-density lipoprotein cholesterol target of <2.5 mmol/l (66 vs. 59%) reflecting differences in medication usage. However, blood pressure control was superior in Asia, with 71% <140/90 compared with 66% of Europeans (NS). This phase of SURF has confirmed its ease of use which should allow wide participation and the collection of representative risk factor data in subjects with CHD as well as ongoing data collection to monitor secular trends in risk factor control. Notwithstanding that this is a pilot study, the results suggest that risk factor control, particularly for lifestyle-related measures, is poor in both Europe and Asia.

Diabetes mellitus: development of technologies in diagnostics, treatment and prevention

Diabetes mellitus is a most serious socio-medical and economic problems facing health authorities throughout the world. A major threat is vascularcomplications of the disease. The currently available diagnostic tools, up-to-date means for monitoring glycemia, introduction of innovative insulinpreparations and hypoglycemic agents, development of high-technology therapeutic modalities may greatly improve disease prognosis, reduce the frequencyof chronic complications, related disablement and mortality rates. The targeted control of major risk factors, viz. hyperglycemia, hypertension,and dyslipidemia, during the patients lifetime starting from the onset of diabetes remains the most promising strategy for the prevention of diabeticcomplications. An indispensable condition for efficacious management of diabetes is the elaboration of active screening programs for the early diagnosisof complications and optimal organization of the clinico-diagnostic process in the framework of multidisciplinary approach.

The 2006 Helsingborg Consensus Conference on European Stroke Strategies

The 2nd Helsingborg Consensus Conference on European Stroke Strategies, was held March 2006 with the aims to update core issues in stroke management, to monitor progress, and to set new targets for the year 2015. the congress was organized by the International Society of Internal Medicine, endorsed by the European Stroke Council and the International Stroke Society, and co-sponsored by the WHO Regional Office for European. The meeting prepared the 2nd Helsingborg Declaration which details principles of care, research and development areas, and targets for the year 2015 in 5 areas of stroke management: organization of stroke services, management of acute stroke, prevention, rehabilitation, and evaluation of stroke outcome and quality assessment. The burden of stroke in European will increase markedly in the next decades. There is substantial evidence on insufficient control of major risk factors for stroke, in particular hypertension. The organization of stroke services plays a key role in the provision of effective therapies, but stroke units and facilities for provision of thrombolytic therapy remain suboptimal. Cognitive long term effects of stroke, and caregiver strain, have been underrecognized areas. Quality assessment as an integral part of services is still not established in most geographical areas. Several of the original Helsingborg Declaration goals for 2005 were found not to have been met. Some goals for 2015 in the 2nd Helsingborg Declaration was therefore kept unchanged or only slightly modified. The present report summarizes the proceedings held during the conference and provides further perspectives on the 2006 Helsingborg Declaration.

Assessment of risk factors in coronary patients being followed by cardiologists: control of risk factors in coronary patients.

Control of risk factors for coronary heart disease secondary prevention is still very unsatisfactory. This study assessed 104 patients referred by cardiologists to discover how carefully National Cholesterol Education Program II recommendations were being followed. Average age of the cohort was 60.9+/-10.8 years, and 67.3% were men. A total of 57(54.8%) experienced a previous myocardial infarction and 83 (80.3%) a revascularization procedure. They saw their doctors 4.4+/-2.9 times a year and had blood tests 2.8+/-1.7 times a year. Blood pressure was >/=140/90 mm Hg in 57.8%, body mass index >/=25 kg/m2 in 62.5%, and the weight-to-hip ratio >/=0.95 in 42.9% of men, and >/=0.85 in 47.0% of women. Total, low-density lipoprotein, and high-density lipoprotein cholesterol and triglyceride values were 222.9+/-47.3 mg/dL, 144.9 mg/dL, 44.8+/-11.5 mg/dL, and 176+/-119.41 mg/dL, respectively. Low-density lipoprotein cholesterol was <100 mg/dL in 8.1%, and <130 mg/dL in 47.1%; the total cholesterol/high-density lipoprotein cholesterol ratio was 5.1+/-1.5 (>/=5 in 51%). In these patients, the control of major risk factors like high blood pressure, overweight, and high low-density lipoprotein cholesterol was poor.