Prevention Of Coronary Heart Disease Research Articles

Using a digital health intervention "INTERCEPT" to improve secondary prevention in coronary heart disease (CHD) patients: protocol for a mixed methods non-randomised feasibility study.

Background: Digital health interventions (DHIs) are increasingly used for the secondary prevention of cardiovascular disease (CVD). The aim of this study is to determine the feasibility of "INTERCEPT", a co-designed DHI developed to improve secondary prevention in hospitalised coronary heart disease patients (CHD). Methods: This non-randomised feasibility study will be conducted using a mixed methods process evaluation with a sample of 40 patients in an acute hospital setting. Informed by behaviour change theory, the Intercept application (I-App) integrates a smartphone interface, health care professional portal, a fitness wearable and a blood pressure monitor. I-App is designed to support and motivate patients to set goals, self-monitor lifestyle and medical risk factors, and manage their medications, with the health care professional portal enabling monitoring and communication with patients. Using convenience sampling, eligible patients will be recruited in two phases, a pre-implementation phase and an implementation phase. During the pre-implementation phase participants will not immediately receive the I-App but will be invited to receive the I-App at 3 months follow-up. This will enable early learning about the processes of recruitment and conducting the assessment prior to full scale deployment of the I-App. During the implementation phase, participants will be invited to download the I-App to their smartphone prior to hospital discharge. Qualitative interviews will be conducted among a subset of patients and health care professionals to gain a greater insight into their experience of using the I-App. Primary outcomes will be assessed at baseline and 3-month follow-up. Using pre-defined feasibility criteria, including recruitment, retention and engagement rates, together with data on intervention acceptability, will determine the appropriateness of progressing to a definitive trial. Discussion: This study will provide important insights to help inform the feasibility of conducting a definitive trial of "INTERCEPT" among coronary heart disease patients in a critical health care setting.

Lipid-Lowering Strategies for Primary Prevention of Coronary Heart Disease in the UK: A Cost-Effectiveness Analysis.

We aimed to assess the cost effectiveness of four different lipid-lowering strategies for primary prevention of coronary heart disease initiated at ages 30, 40, 50, and 60 years from the UK National Health Service perspective. We developed a microsimulation model comparing the initiation of a lipid-lowering strategy to current standard of care (control). We included 458,692 participants of the UK Biobank study. The four lipid-lowering strategies were: (1) low/moderate-intensity statins; (2) high-intensity statins; (3) low/moderate-intensity statins and ezetimibe; and (4) inclisiran. The main outcome was the incremental cost-effectiveness ratio for each lipid-lowering strategy compared to the control, with 3.5% annual discounting using 2021 GBP (£); incremental cost-effectiveness ratios were compared to the UK willingness-to-pay threshold of £20,000-£30,000 per quality-adjusted life-year. The most effective intervention, low/moderate-intensity statins and ezetimibe, was projected to lead to a gain in quality-adjusted life-years of 0.067 per person initiated at 30 and 0.026 at age 60 years. Initiating therapy at 40 years of age was the most cost effective for all lipid-lowering strategies, with incremental cost-effectiveness ratios of £2553 (95% uncertainty interval: 1270, 3969), £4511 (3138, 6401), £11,107 (8655, 14,508), and £1,406,296 (1,121,775, 1,796,281) per quality-adjusted life-year gained for strategies 1-4, respectively. Incremental cost-effectiveness ratios were lower for male individuals (vs female individuals) and for people with higher (vs lower) low-density lipoprotein-cholesterol. For example, low/moderate-intensity statin use initiated from age 40 years had an incremental cost-effectiveness ratio of £5891 (3822, 9348), £2174 (772, 4216), and was dominant (i.e. cost saving; -2,760, 350) in female individuals with a low-density lipoprotein-cholesterol of ≥ 3.0, ≥ 4.0 and ≥ 5.0 mmol/L, respectively. Inclisiran was not cost effective in any sub-group at its current price. Low-density lipoprotein-cholesterol lowering from early ages is a more cost-effective strategy than late intervention and cost effectiveness increased with the increasing lifetime risk of coronary heart disease.

Emergence of Nano-Based Formulations for Effective Delivery of Flavonoids against Topical Infectious Disorders.

Flavonoids are hydroxylated phenolic substances in vegetables, fruits, flowers, seeds, wine, tea, nuts, propolis, and honey. They belong to a versatile category of natural polyphenolic compounds. Their biological function depends on various factors such as their chemical structure, degree of hydroxylation, degree of polymerization conjugation, and substitutions. Flavonoids have gained considerable attention among researchers, as they show a wide range of pharmacological activities, including coronary heart disease prevention, antioxidative, hepatoprotective, anti-inflammatory, free-radical scavenging, anticancer, and anti-atherosclerotic activities. Plants synthesize flavonoid compounds in response to pathogen attacks, and these compounds exhibit potent antimicrobial (antibacterial, antifungal, and antiviral) activity against a wide range of pathogenic microorganisms. However, certain antibacterial flavonoids have the ability to selectively target the cell wall of bacteria and inhibit virulence factors, including biofilm formation. Moreover, some flavonoids are known to reverse antibiotic resistance and enhance the efficacy of existing antibiotic drugs. However, due to their poor solubility in water, flavonoids have limited oral bioavailability. They are quickly metabolized in the gastrointestinal region, which limits their ability to prevent and treat various disorders. The integration of flavonoids into nanomedicine constitutes a viable strategy for achieving efficient cutaneous delivery owing to their favorable encapsulation capacity and diminished toxicity. The utilization of nanoparticles or nanoformulations facilitates drug delivery by targeting the drug to the specific site of action and exhibits excellent physicochemical stability.

Association of blood pressure trajectories with coronary heart disease among the disabled population in Shanghai, China: a cohort study of 7 years following up

BackgroundMuch less is known about the importance of blood pressure (BP) trajectories concerning the incidence of coronary heart disease (CHD) in people with disabilities. Our aim was to evaluate this association.MethodsThis cohort study surveyed 5711 adults from the Shanghai Disability Health Survey from June 2012 to June 2019. The latent class growth mixture model was used to examine distinct BP trajectories. We evaluated the association of BP trajectories with the risk of CHD by Cox proportional hazard models. The model for CHD risk fitted to BP trajectories was compared with models fitted to other BP-related indicators by goodness-of-fit, discrimination, and calibration.ResultsDuring a median follow-up of 71.74 months, 686 cases (median age was 49.03 (54.49, 58.55) years, 51.90% female) with CHD were identified, with a cumulative incidence of 12.01%. Systolic BP (SBP) and diastolic BP (DBP) were categorized into three classes, respectively. A statistically significant association was only observed between SBP trajectories and CHD. Compared with the normotensive stable SBP group (n = 1956), the prehypertension-stable group (n = 3268) had a higher risk (adjust hazards ratio (aHR) = 1.266, 95% confidence interval (CI) 1.014–1.581), and the stage 1 hypertension-decreasing group (n = 487) had the highest risk (aHR = 1.609, 95%CI 1.157–2.238). Among the BP-related indicators, the SBP trajectory was the strongest predictor of new-onset CHD. Findings were similar when sensitivity analyses were conducted.ConclusionsSBP trajectory was a more important risk factor for CHD than other BP-related indicators and stringent BP control strategies may be effective for primary CHD prevention in the disabled population.

Causal association between major depressive disorder and coronary heart disease: a two-sample bidirectional mendelian randomization study

BackgroundMajor depressive disorder (MDD) is a highly heterogeneous mental illness and a major public health problem worldwide. A large number of observational studies have demonstrated a clear association between MDD and coronary heart disease (CHD), and some studies have even suggested that the relationship is bidirectional. However, it was unknown whether any causal relationship existed between them and whether causality was bidirectional in such an instance. Thus, we aimed to determine whether there is a bidirectional causal relationship between major depressive disorders and coronary heart disease.MethodsOur two-sample Bidirectional Mendelian Randomization Study consisted of two parts: forward MR analysis regarded MDD as exposure and CHD as the outcome, and reverse MR analysis considered CHD as exposure and MDD as the outcome. Summary data on MDD and CHD were obtained from the IEU Open GWAS database. After screening criteria(P < 5times {10}^{-8}), 47 MDD-associated SNPs and 39 CHD-associated SNPs were identified. The inverse-variance weighted (IVW) method, ME-Egger regression, and weighted median method were used to estimate causality. In addition, sensitivity methods, including the heterogeneity test, horizontal pleiotropy test, and leave-one-out method, were applied to ensure the robustness of causal estimation.ResultsBased on the MR-Egger regression intercept test results, there did not appear to be any horizontal pleiotropy in this study (MDD: intercept = -0.0000376, P = 0.9996; CHD: intercept = -0.0002698, P = 0.920). Accordingly, IVW results suggested consistent estimates of causal effect values. The results showed that people with MDD increased the risk of CHD by 14.7% compared with those without MDD (OR = 1.147, 95%CI: 1.045–1.249, P = 0.009). But there was no direct evidence that CHD would increase the risk of MDD(OR = 1.008, 95%CI: 0.985–1.031, P = 0.490). The heterogeneity test and funnel plot showed no heterogeneity in 47 SNPs of MDD (Q = 42.28, {I}^{2}=0, P = 0.629), but there was heterogeneity in 39 SNPs of CHD (Q = 62.48, {I}^{2}=39.18%, P = 0.007). The leave-one-out method failed to identify instances where a single SNP was either biased toward or dependent on the causation.ConclusionOur study supports a one-way causal relationship between MDD and CHD, but there is no bidirectional causal relationship. MDD increases the risk of CHD, but there is no evidence that CHD increases the risk of MDD. Therefore, the influence of psychological factors should also be considered in the prevention and treatment of CHD. For MDD patients, it is necessary to prevent cardiovascular diseases.

Factors Associated With Coronary Heart Disease Among Adult Residents in Jinjiang District,Chengdu City.

Objective To analyze the prevalence of coronary heart disease among community residents over 18 years old in Jinjiang district of Chengdu city, Sichuan province, and explore its associated factors, so as to provide a reference for the prevention and control of coronary heart disease in communities. Methods From October 15 to November 10 in 2021, a total of 5220 adult residents from 33 communities in Jinjiang were selected by multi-stage stratified random sampling for face-to-face questionnaire survey, physical examination, and laboratory blood test.Binary Logistic regression was employed to predict the factors associated with coronary heart disease among adult residents in Jinjiang. Results The crude and standard prevalence rates of coronary heart disease among 5220 adult residents were 3.39% and 2.11%, respectively.Logistic regression analysis showed that age (OR=1.068, 95%CI=1.051-1.086, P<0.001), depressive symptoms (OR=1.639, 95%CI=1.037-2.591, P=0.034), regular exercise (OR=0.584, 95%CI=0.378-0.902, P=0.015), elevated blood pressure (OR=3.529, 95%CI=2.344-5.312, P<0.001), dyslipidemia (OR=2.152, 95%CI=1.291-3.587, P=0.003), and core knowledge score of chronic diseases (OR=1.144, 95%CI=1.066-1.228, P<0.001) were associated with coronary heart disease among adult residents in Jinjiang. Conclusions The prevalence of coronary heart disease is high among adult residents in Jinjiang district of Chengdu.The urban residents who are older, have depressive symptoms, lack of exercise, elevated blood pressure, dyslipidemia, and score higher on core knowledge of chronic diseases are prone to coronary heart disease.

Genetic Variations Within METTL16 and Susceptibility to Sudden Cardiac Death in Chinese Populations With Coronary Artery Disease

Despite recent advances in the prevention of coronary heart disease, the mortality rate of sudden cardiac death (SCD) remains high, which has become a substantial public health issue. Methyltransferase-like protein 16 (METTL16), as a newly discovered m6A methyltransferase, may be related to cardiovascular diseases. In the present study, a 6-base-pair insertion/deletion (del) polymorphism (rs58928048) in the METTL16 3'untranslated region (3'UTR) region was chosen as a candidate variant based on the findings of systematic screening. Then, the association between rs58928048 and susceptibility to SCD originating from coronary artery disease (SCD-CAD) in the Chinese population was investigated by conducting a case-control study that included 210 SCD-CAD cases and 644 matched healthy controls. Logistic regression analysis showed that the del allele of rs58928048 significantly reduced the SCD risk (odds ratio 0.69, 95% confidence interval 0.55 to 0.87, p=0.00177). Genotype-phenotype correlation studies in human cardiac tissue samples demonstrated that the lower messenger RNA and protein expression levels of METTL16 were associated with the del allele of rs58928048. In the dual-luciferase activity assay, the del/del genotype exhibited lower transcriptional competence. Further bioinformatic analysis showed that the rs58928048 del variant may create transcription factor binding sites. Finally, pyrosequencing showed that the genotype of rs58928048 was related to the methylation status of the 3'UTR region of METTL16. Taken together, our findings provide evidence that rs58928048 may affect the methylation status of the 3'UTR region of METTL16 and subsequently affect its transcriptional activity thus as a potential genetic risk marker for SCD-CAD.

Mode of transport, genetic susceptibility, and incidence of coronary heart disease

BackgroundCar use has been associated with higher risk of coronary heart disease (CHD). However, whether the associations of transport modes with CHD vary by genetic susceptibility to CHD are unknown. This study aims to investigate the associations of genetic susceptibility and modes of transport with incidence of CHD.MethodsWe included 339,588 white British participants from UK Biobank with no history of CHD or stroke at baseline or within two years of follow-up (52.3% in work). Genetic susceptibility to CHD was quantified through weighted polygenic risk scores derived from 300 single-nucleotide polymorphisms related to CHD risk. Categories of transport mode included exclusive car use and alternatives to the car (e.g., walking, cycling and public transport), separately for non-commuting (e.g., getting about [n=339,588] excluding commuting for work), commuting (in the sub-set in work [n=177,370] who responded to the commuting question), and overall transport (transport mode for both commuting and non-commuting [n=177,370]). We used Cox regression with age as the underlying timescale to estimate hazard ratios (HR) of CHD (n=13,730; median 13.8-year follow-up) and tested the interaction between genetic susceptibility and travel modes with adjustment for confounders.ResultsCompared to those using alternatives to the car, hazards of CHD were higher for exclusive use of cars for overall transport (HR: 1.16, 95% confidence interval (CI): 1.08-1.25), non-commuting (HR: 1.08, 95% CI: 1.04-1.12) and commuting (HR: 1.16, 95% CI: 1.09-1.23), after adjusting for confounders plus genetic susceptibility. HRs of CHD were 1.45 (95% CI: 1.38-1.52) and 2.04 (95% CI: 1.95-2.12) for the second and third tertile of genetic susceptibility to CHD, respectively, compared to the first. There was, in general, no strong evidence of interactions between genetic susceptibility and categories of overall, non-commuting and commuting transport. Estimated 10-year absolute risk of CHD was lower for the alternatives to the car across strata of genetic susceptibility, compared with exclusive use of cars for overall, non-commuting and commuting transport.ConclusionExclusive use of cars was associated with a relatively higher risk of CHD across all strata of genetic susceptibility. Using alternatives to the car should be encouraged for prevention of CHD for the general population including individuals at high genetic risk.

Bempedoic Acid and Ezetimibe for the Primary Prevention of Coronary Heart disease in the Statin-intolerant Patient: A Cost-effectiveness Analysis From the Australian Healthcare Perspective

Bempedoic Acid and Ezetimibe for the Primary Prevention of Coronary Heart disease in the Statin-intolerant Patient: A Cost-effectiveness Analysis From the Australian Healthcare Perspective

Genetic Association and Potential Mediators between Sarcopenia and Coronary Heart Disease: A Bidirectional Two-Sample, Two-Step Mendelian Randomization Study.

To elucidate the bidirectional correlation of sarcopenia with coronary heart disease (CHD), as well as to investigate the mediating role of cardiometabolic factors and inflammatory biomarkers, a bidirectional two-sample, two-step Mendelian randomization (MR) study was conducted. Summary statistics were obtained from genome-wide association studies (GWAS). In our bidirectional two-sample MR, genetic variants associated with sarcopenia-related traits and CHD were instrumented for the estimation of bidirectional correlations. Besides, genetic variants associated with thirteen cardiometabolic factors and six inflammatory biomarkers were selected for further mediation analyses. To confirm the consistency of the results, several sensitivity analyses were carried out. Genetically predicted higher appendicular lean mass (OR = 0.835, 95% CI: 0.790-0.882), left hand grip strength (OR = 0.703, 95% CI: 0.569-0.869), right hand grip strength (OR = 0.685, 95% CI: 0.555-0.844), and walking pace (OR = 0.321, 95% CI: 0.191-0.539) reduced CHD risk, while genetic predisposition to CHD did not affect any of the sarcopenia-related traits. Seven mediators were identified for the effects of appendicular lean mass on CHD, including waist-to-hip ratio, hip circumference, systolic blood pressure, low-density lipoprotein cholesterol, total cholesterol, triglycerides, and fasting insulin. The mediation proportion ranged from 10.23% for triglycerides to 35.08% for hip circumference. Hip circumference was found to mediate the relationships between both left (mediation proportion: 24.61%) and right-hand grip strength (24.14%) and CHD, and the link between walking pace and CHD was partially mediated by waist-to-hip ratio (31.15%) and body mass index (26.66%). Our results showed that higher appendicular lean mass, hand grip strength, and walking pace reduced CHD risk, but the causal relationship was not bidirectional. Several mediators were found to mediate the causal pathways between sarcopenia-related traits and CHD, and intervention of these factors may be helpful in terms of CHD prevention in sarcopenia patients.

Secondary prevention of Coronary Heart Disease (CHD) in the Moroccan population. Survey of Risk Factor (SURF) CHD II Morocco

Abstract Funding Acknowledgements Type of funding sources: None. Background Global Cardiovascular (CV) mortality is highly increasing, mainly in low and middle-income countries because of lifestyle change and the rise of cardiovascular risk factors. Controlling these risk factors is very important to reduce cardiovascular disease morbidity and mortality. Risk factor control is particularly important in patients with established cardiovascular disease since these patients are at very high cardiovascular risk. SURF is an international and simple clinical audit that aims to record and manage cardiovascular risk factors in patients with established coronary heart disease (CHD). The goal of this analysis is to investigate risk factor recording and management in secondary prevention of CHD in the Moroccan population, a country considered as a very high CV risk according to the European Society of Cardiology. Methods Data of Moroccan patients with documented coronary heart disease (including stable angina pectoris, acute coronary syndrome, PCI and CAGB) were collected via an online survey during routine clinic visits. Patients’ demography, risk factors, physical and laboratory measurements, and medications were recorded. Results A total of 324 patients were recruited in 3 different centers in Morocco. There was a male predominance (81.5%) and mean age was 66.5 (SD 10.6) years. Recording of risk factors was high for smoking (96.7%), physical activity (97.3%) and blood pressure (87.8%). However, for some risk factor measurements like LDL cholesterol (recording 29.9%), information was often missing. Risk factor recording in Morocco was higher than the North Africa and Eastern Mediterranean (NAEM) regional and global estimates for smoking and physical activity; similar for blood pressure; and lower for LDL levels. Considering the attainment of risk factor goals defined by clinical guidelines, 79.6% of patients never smoked or quit smoking, and 25.0% were practicing physical activity at least 30 min 3-5 times a week. Regarding risk factor measurements, 38.2% had blood pressure &amp;lt;140/90mmHg and 27.3% had LDL &amp;lt;1.8mmol/L. Cardiac rehabilitation programs were attended by 3.5 % of participants. The level of target attainment in Morocco was like regional and global levels for smoking; like regional but lower than global results for physical activity; and lower than regional and global estimates for blood pressure and LDL. Conclusion The patients enrolled in our registry have multiple modifiable risk factors, with a poor control. The results underline the need for interventions to improve secondary prevention of CHD in Morocco.

Secondary Prevention and Quality of Life of Patients with Stable Coronary Heart Disease

Aim. To assess the quality of life of patients with stable coronary heart disease (CHD) initially and 12 months after drug and non-drug secondary prophylaxis according to clinical guidelines.Material and methods. 73 patients (57 men, 16 women) with confirmed stable coronary artery disease were included in the study, of which 44 patients described a clinic for angina pectoris of functional class I-IV. The study included 2 patient visits: an initial treatment visit (V0) and a repeat visit after 12 months (V2). At both visits, blood pressure (BP), low-density lipoprotein cholesterol (LDL-c), quality of life (QL) were assessed using SAQ (Seattle Angina Questionnaire), drug therapy. Compliance with 5 basic principles of prevention was also assessed, which included: (1) healthy lifestyle (healthy lifestyle) (rejection of bad habits (smoking), moderate physical activity, lowcholesterol and low-carb diet); (2) normalization of body weight; (3) optimal drug therapy (the frequency of taking medications was evaluated using the original questionnaire); (4) achievement of target values of LDL-c in the entire group; (5) blood pressure in hypertensive patients. During V0, if necessary, drug therapy was adjusted in accordance with clinical recommendations. During V2, 57 patients (47 men and 10 women) were examined. The response was 80.8%.Results. After 12 months of follow-up, a statistically significant improvement in exercise tolerance (p=0.003), angina stability index (p=0.045) and the frequency of stress angina attacks (p=0.003) was noted when assessing the median of QL indicators. After 12 months of follow-up, 59% of patients used optimal drug therapy, including 4 drugs according to clinical guidelines. A healthy lifestyle (regular physical activity and smoking cessation) was achieved in 20.4% after 12 months of follow-up, the target level of LDL-c ˂ 1.8 mmol/L was achieved in 44.5% of patients, and the target blood pressure was achieved in 74,6%. The achievement of all 5 principles of secondary prevention of coronary heart disease according to the results of the work carried out by the visit after 12 months of follow-up was revealed only in 7% of patients (4 patients), and the implementation of 4 principles of prevention was noted in a quarter of patients from the group (24.5%, n=14).Conclusions. With drug and non-drug secondary prevention of coronary heart disease in patients with stable CHD after a year of follow-up, a statistically significant increase in QL indicators was noted due to increased exercise tolerance and a decrease in the frequency of angina attacks. Nevertheless, the basic principles of prevention were fully implemented only in 7% of patients.

Less risk factor at AMI onset, higher risk in prognosis---the paradoxical phenomenon from MIMIC-III database

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China (NSFC). Introduction Numerous epidemiologic studies have confirmed that Standard Modifiable Cardiovascular Risk Factors (SMuRFs) are independent risk factors for coronary heart disease (CHD) and are recommended by guidelines for the primary and secondary prevention of CHD. However, it is interesting to find that the increasing proportion of individuals without SMuRFs in CHD and acute myocardial infarction (AMI). Moreover, accumulating clinical trials have reported the inverse association between the number of risk factors and crude mortality in AMI. It is unknown whether this paradoxical phenomenon can be seen in critical ill patients. Purpose To analyze and validate whether the number of risk factors contradicts the mortality outcome in patients with AMI in the MIMIC-III (Medical Information Mart for Intensive Care III) database. Methods A total of 2484 AMI patients (62.8% male, mean age 71.2 [59.3;80.8] years) admitting to cardiac care unit for the first time from the MIMIC-III database were enrolled. Risk factors were defined as hypertension, diabetes,dyslipidemia, and smoking history. They were grouped according to the number of risk factors. Main outcome was mortality at 2-year following hospitalization. Kaplan-Meier curve and Cox proportional hazards models adjusting for baseline clinical characteristics and in-hospital treatment were constructed to evaluate the impact of numbers of risk factors on mortality in critical AMI patients. Results At 2-year follow-up, death was observed in 714 patients (28.7%). A total of 474(19.1%),1541(62%),469(18.9%) patients had 0,1-2,3-4 SMuRFs respectively. No risk group has a significantly higher 2-year mortality (Picture 1). Compared with no risk group, patients with 1-2 and 3-4 SMuRFs were correlated to an HR of 0.72(95%CI, 0.61-0.86) and 0.66(95%CI, 0.52-0.83) for all-cause mortality in the unadjusted model. Interestingly, after multivariate adjustment, less risk factor at AMI onset was still associated with poor prognosis. Conclusions Taking into confounders, critical AMI patients with less risk factors have higher risk in poor prognosis. Further studies on this paradoxical phenomenon are needed.

Historical Review of the Use of Relative Risk Statistics in the Portrayal of the Purported Hazards of High LDL Cholesterol and the Benefits of Lipid-Lowering Therapy.

The manner in which clinical trial investigators present their findings to healthcare providers and the public can have a substantial influence on their impact. For example, if a heart attack occurs in 2% of those in the placebo group and in 1% of those in the drug-treated group, the benefit to the treated population is only one percentage point better than no treatment. This finding is unlikely to generate much enthusiasm from the study sponsors and in the reporting of the findings to the public. Instead, trial directors can amplify the magnitude of the appearance of the treatment benefit by using the relative risk (RR) value of a 50% reduction of the risk of a heart attack, since one is 50% of two. By using the RR type of data analysis, clinical trial directors can promote the outcome of their trial in their publication and to the media as highly successfulwhile minimizing or disregarding entirelythe absolute risk (AR) reduction of only one percentage point. The practice of expressing the RR without the AR has become routinely deployed in the reporting of findings in many different areas of clinical research. We have provided a historical perspective on how this form of data presentation has become commonplace in the reporting of findings from randomized controlled trials (RCTs) on coronary heart disease (CHD) event monitoring and prevention over the past four decades. We assert that the emphasis on RR coupled with insufficient disclosure of AR in the reporting of RCT outcomes has led healthcare providers and the public to overestimate concerns about high cholesterol and to be misled as to the magnitude of the benefits of cholesterol-lowering therapy. The goal of this review is to prompt the scientific community to address this misleading approach to data presentation.

Ratio of visceral fat area to body fat mass (VBR) is a superior predictor of coronary heart disease.

Ratio of visceral fat area to body fat mass (VBR) is a superior predictor of coronary heart disease.

The Effect of Electronic Tindak Lanjut Tensiku (e-Titenku) Model to Knowledge of Coronary Heart Disease Prevention

Background: Cardiovascular disease is still a major global health problem. Hypertension is the most risk factor for the incidence of cardiovascular disease and increases the risk of death. Primary and secondary prevention efforts are needed by increasing patient awareness of identifying risk factors and carrying out preventive management. “Electronic-Tindak lanjut Tensiku”, known as e-TITENKU, is a web and smartphone-based application designed to manage coronary heart disease prevention in patients with hypertension. Purpose: The purpose of this study was to determine the effect of the e-TITENKU intervention model on knowledge of coronary heart disease prevention. Methods: This research design is true experiment pre and post control group design. The sample size is 120 respondents with primary hypertension in Banyumas Regency, Indonesia. The sampling technique used is simple random sampling. The inclusion criteria included respondents with primary hypertension, adults aged 40-65 years, cooperative and willing to be respondents, while the exclusion criteria were respondents experienced complications of other diseases due to hypertension. Results: The results of the study were that the age of the respondents in the intervention group was 64.91 years old, the systolic blood pressure was 169 mmHg and the diastolic blood pressure was 97 mmHg. The characteristics of the respondents in the control group were the mean age of 65.98, the mean systolic blood pressure of 172 mmHg and the diastolic of 93 mmHg. Conclusion: The e-TITENKU intervention model was able to increase the knowledge score of coronary heart disease prevention. This model can be used by nurses in hospital and community services.

Abstract P221: Intake of Ultra-Processed Foods in Relation to Cardiovascular Disease Incidence in US Men and Women With Diabetes Mellitus

Introduction: Recent evidence suggests that intake of ultra-processed foods (UPF) is related to unfavorable cardio-metabolic risk profiles among generally healthy populations. However, evidence on the relationship between UPF intake and cardiovascular disease (CVD) among patients with type 2 diabetes (T2D) is lacking. Hypothesis: We assessed the hypothesis that higher intake of dietary UPF is associated with higher risks of CVD among individuals with T2D. Methods: We prospectively followed 13,272 men and women participating in the Health Professionals Follow-Up Study (HPFS) and Nurses’ Health Study (NHS) with T2D at baseline and during follow-up (HPFS: 1986-2018; NHS: 1980-2014). Diet was repeatedly assessed using validated food frequency questionnaires every 2-4 years. UPF were categorized according to the Nova classification. CVD was defined as fatal and non-fatal coronary heart disease (CHD) (including nonfatal myocardial infarction, coronary artery bypass graft surgery, and coronary angioplasty and stent) and fatal and non-fatal stroke. Associations of UPF consumption with risks of CVD were assessed using Cox regression. Results: During 165,761 person-years of follow-up, 1,826 total CHD and 529 total stroke were identified and confirmed. After adjusting for demographics, lifestyle, medical history, dietary factors, and diabetes medication use, higher total intake of UPF was associated with higher risk of CHD. The multivariable-adjusted HRs (95% CIs) were 1.20 (1.02, 1.43) ( P trend = 0.03) when comparing the highest and lowest quintiles (Q5 vs. Q1) or 1.03 (1.01, 1.04) for each 1 serving/day increment of UPF. No association between UPF intake and risk of stroke was observed (Q5 vs. Q1: 0.92 (0.67, 1.24)). These results were consistent across subgroups in analyses stratified by age, sex, BMI, diet quality, physical activity, smoking, diabetes medication use, or diabetes duration. In addition, compared with participants who had a stable or decreased consumption of UPF (≤0 change in UPF) from pre- to post-diabetes diagnosis, participants who increased consumption of UPF (&gt;0 increment of UPF intake) after diabetes diagnosis had a 15% (1%, 31%) higher risk of CHD. Conclusions: Among participants with T2D, higher dietary UPF consumption was associated with a higher risk of CHD, but not stroke. These results provide further support for the current recommendations to limit UPF consumption for the prevention of CHD among patients with diabetes.

Solubility Enhancement of Atorvastatin Tablets by Solid Dispersions Using Fenugreek Seed Mucilage

Fenugreek seed mucilage (FSM) is isolated from the seeds of Trigonella Foenum-graecum, commonly known as Fenugreek, which is herbaceous plant. Fenugreek seeds contain high percentage of mucilage, which does not dissolve in water, but swell up and become slick when exposed to fluids. Atorvastatin is one of the HMG-CoA reductase inhibitors (statins), which are lipid-lowering medications used in the primary and secondary prevention of coronary heart disease. Atorvastatin is poorly absorbed orally, its oral bioavailability is very low (about14%) because it is very slightly soluble in distilled water and pH 7.4 phosphate buffer, which would limit its clinical application. The objective of this study is to enhance atorvastatin solubility in order to increase its bioavailability by the formulation of solid dispersion using fenugreek seed mucilage. Mucilage was extracted from the seed and evaluated for flow properties, pH value, FTIR spectroscopy and percentage practical yield. Then solid dispersions with different drug to polymer ratios were prepared from fenugreek mucilage and hydroxy propyl methyl cellulose (HPMC), after that saturation solubility was tested for fenugreek seed mucilage solid dispersion (FSMSD), hydroxxy propyle methyl cellulose solid dispersion (HPMCSD) and pure drug. Tablets were prepared from solid dispersion with the highest saturation solubility, then tablets were tested and evaluated. The tablets showed satisfactory physicochemical properties as 1.77%RSD in tablet weight variation, 1 min disintegration time, 5.24±0.457 Hardness and 89% drug release in 45 min. it is concluded that FSM is a promising excipient that can be used in dosage forms formulation to enhance solubility of low soluble drugs.

REMEDIES AND RECOMMENDATIONS CORONARY HEART DISEASES

Prevention of coronary heart disease is a series of complex measures aimed at preventing the onset of the disease, the development and occurrence of possible (predictable) complications, which can be even fatal. Prevention of coronary heart disease is indicated for both sick people and healthy people who are at risk of developing the disease. Patients diagnosed with coronary heart disease are shown non-drug treatment, which is a complete or partial elimination of risk factors. Risk factors are any predisposing factors that increase the likelihood of developing or worsening a disease. Risk factors for coronary heart disease are fundamentally divided into removable and non-removable.

Effects of β-blockers on all-cause mortality in patients with diabetes and coronary heart disease: A systematic review and meta-analysis.

Beta-blockers have been considered as an effective treatment in secondary prevention of coronary heart disease (CHD). However, there is still disputed whether β-blockers can increase all-cause mortality in patients with coronary heart disease and diabetes mellitus (DM). Here, our systematic review and meta-analysis is aiming to assess the effects of β-blockers on all-cause mortality in patients with coronary heart disease and diabetes mellitus. Four databases (PubMed, Embase, Cochrane Library and Web of Science) and other sources were searched to collect randomized controlled trials (RCTs) and cohort studies related to the treatment of β-blockers for coronary heart disease and diabetes mellitus patients. We further evaluated quality of evidence using the grading of recommendations assessment, development, and evaluation (GRADE) approach. Finally, a total of 16,188 records were identified, and four randomized controlled trials and six cohort studies (206,490 patients) were included. Random effects analysis revealed that β-blockers combined with routine treatment (RT) significantly decreased all-cause mortality in patients with coronary heart disease and diabetes mellitus compared with RT in control group (RR 0.59, 95% CI 0.47 to 0.75; p < 0.000 01; I2 = 72%). Subgroup analysis of all-cause mortality by the subtype of diabetes mellitus and definite MI patients (RR 0.54, 95% CI 0.45 to 0.65, p < 0.000 01, I2 = 29%) and the subtype of randomized controlled trials (RR 0.49, 95% CI 0.32 to 0.76, p = 0.001, I2 = 0%) indicated a relatively small heterogeneity and stable results. β-blockers application significantly reduced cardiovascular death as well (RR 0.56, 95% CI 0.42 to 0.74; p < 0.000 1; I2 = 0%). Our meta-analysis provided critical evidence of β-blockers treatment for patients with coronary heart disease (especially MI type) and diabetes mellitus, and discussed the advantages and potential metabolic risks for the clinical use of β-blockers. This study suggested that β-blockers application may improve all-cause mortality and cardiovascular death in coronary heart disease (especially MI type) and diabetes mellitus patients. However, given a small number of included studies, the aforementioned conclusion should be confirmed in a multi-center, large-scale, and strictly designed trial.