Differences In Prevalence Of Risk Factors Research Articles

Secondary prevention in diabetic and nondiabetic coronary heart disease patients: Insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys

BackgroundPatients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012–13; and EA-V, 2016–17) in Germany.MethodsThe EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in Würzburg (EA-IV, EA-V), Halle (EA-V), and Tübingen (EA-V).Results384 EA-V participants (median age 69.0 years, 81.3% male) and 536 EA-IV participants (median age 68.7 years, 82.3% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8% vs. 19.6%) while the proportion of prediabetes was similarly high in the remaining population (62.1% vs. 61.0%).ConclusionBetween 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.

Abstract WP185: Not All Asians Are Alike: Disaggregation Of Stroke Mortality Among Asian Subgroups

Background: Stroke is the 5th leading cause of death in the US. National stroke mortality among Asian subgroups has never been reported. Our objective is to disaggregate national stroke mortality data among the largest Asian American groups by sex and characterize mortality trends across a 12-year period. Methods: We extracted National Vital Statistics System mortality data from 2006 to 2017 for 6 Asian subgroups and non-Hispanic Whites (NHWs). Stroke mortality was classified by ICD-10, including ischemic stroke (I630-699), intracerebral hemorrhage (I610-629), and subarachnoid hemorrhage (I601-609). 2006-2017 American Community Survey population data was extracted to calculate age-standardized mortality rates (AMRs) stratified by sex and race. Results: Participants included 2,593 Asian Indians, 7,585 Filipinos, 8,212 Chinese, 2,551 Koreans, 3,179 Vietnamese, 4,667 Japanese, and 781,966 NHWs. Mortality from hemorrhagic strokes exceeded ischemic stroke in groups except NHW (Figure 1A). From 2006-2017, deaths from ischemic stroke increased for all groups, with higher mortality in Filipino males compared to females (figure 1B). Deaths from subarachnoid hemorrhage increased only in the Vietnamese subgroup (figure 1D). A similar trend was observed for intracerebral hemorrhage in Vietnamese males (figure 1C). Conclusion: Disaggregation of US stroke mortality revealed important variations within the 6 largest Asian subgroups, including increased ischemic stroke mortality in all subgroups and increased hemorrhagic stroke mortality among Vietnamese. Considerations for this variation include differences in risk factor prevalence (cigarette smoking, obstructive sleep apnea) and social determinants of health. Future studies must collect disaggregated Asian subgroup data to provide tailored interventions to further reduce stroke mortality. Figures: See below

Preventing sudden cardiac death in young athletes – A perspective from the United States

Sudden cardiac death in young athletes is a rare, but devastating complication of several clinically silent conditions which can become unmasked during periods of intense physical activity. Prevention of sudden cardiac death starts with robust screening to allow the early identification of at risk individuals and the implementation of preventive strategies. The specific approach to screening (history and physical, with or without pre-participation electrocardiograms) varies across the globe with some notable differences between that used in Europe and the United States. The rationale for this variation is complex, but can be linked to the differences in risk factor prevalence, the healthcare infrastructure, and the capacity to identify and triage at risk individuals in a cost-effective manner. Beyond knowing the differences in the approaches to screening, establishing strategies that work (including novel techniques) and those that can be implemented in a successful and sustainable manner are key.

Survival trends of men and women with metastatic clear cell renal cell carcinoma.

4566 Background: Clear cell renal cell carcinoma (ccRCC) is nearly twice as common in men as in women, and women with non-metastatic RCC have a better prognosis than men. The etiology for these disparities is not known, though sex-specific differences in risk factor prevalence and tumor biology have been reported. The differential impact of systemic therapies, including tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs), on prognosis in women and men with metastatic ccRCC is not defined. Methods: Clinicopathologic features and survival of patients with clinical stage IV ccRCC were obtained from the National Cancer Database (NCDB). Patients were grouped by date of metastatic diagnosis into three eras that correspond to major advances in systemic therapy: 2004-2005 (pre-TKI), 2006-2014 (TKI), and 2015-2016 (ICI). Uni- and multi-variable chi-square, logistic regression, and survival analyses were used for comparisons. Survival differences were assessed using Kaplan-Meier curves. Results: 15,025 male and 7,100 female patients with metastatic ccRCC were identified. Demographic features were similar between cohorts though females were slightly older (median 64.8 vs 62.7 mo, p < 0.0001), more likely to be black (6.5% vs 6.0%, p = 0.0119) or receiving Medicare benefits (46.4% vs 39.9%, p < 0.0001). In the combined cohort, median overall survival (OS) was higher in patients diagnosed in the ICI vs TKI (23.0 vs 16.5 mo) and pre-TKI eras (14.4 mo, log-rank p < 0.0001). Compared with men of the same age groups, OS was inferior for women age 50-64 yr (median 18.4 vs 21.1mo, p = 0.0084) and > 64 yr (15.3 vs 12.6mo, p = 0.0001), but not < 50 yr (20.3 vs 21.7mo, p = 0.6290). In the ICI era, median OS improved by a lesser absolute but similar relative amount for women compared to men (+5.6mo [+39%] and +7.2mo [+41%]), respectively). After controlling for age, race, Charlson-Deyo score, initial treatment modality, and insurance and socioeconomic status, women remained at increased risk of death in both the ICI era (HR 1.12 [95% CI 1.04-1.22], p = 0.004) and the TKI era (HR 1.08 [1.04-1.12], p < 0.001). Conclusions: Women with metastatic ccRCC have a worse prognosis than men which is not explained by demographic differences. This disparity is observed in both the TKI and ICI eras. This finding contrasts with previous studies suggesting women with localized RCC have a favorable prognosis compared with men. Further investigation into the sex-specific biology of metastatic ccRCC is warranted.

Comparing loneliness in England and the United States, 2014-2016: Differential item functioning and risk factor prevalence and impact.

The purpose of this study is to compare mean levels of loneliness, and correlates of loneliness, among older adults in the U.S. and England. Comparisons are conducted after attending to comparability of the loneliness measure between countries based on tests for discriminatory capacity and differential item functioning of the 3-item UCLA Loneliness Scale. Cross-sectional data from the 2015–16 wave of the National Social Life, Health and Aging Project (NSHAP) and the 2014–2015 wave of the English Longitudinal Study on Ageing (ELSA) were analyzed using graded item response models and multiple indicators and multiple causes (MIMIC) models. Risk factors included demographic variables, health characteristics, and social characteristics that were harmonized across surveys. Because of differences in the racial-ethnic composition of the U.S. and England, analyses were limited to white respondents (N = 2624 in NSHAP; N = 6639 in ELSA). Only respondents born 1925–1965 were included in analyses. Discriminatory capacity was evident in each item being able to distinguish a lonely from a nonlonely individual. Differential item functioning (DIF) was evident in country differences in the likelihood of endorsing the “lack companionship” item at a given level of trait loneliness, and in DIF among marital status, education, and gender subgroups that were comparable across countries. Overall loneliness levels are equivalent in England and the U.S. Risk factor impact did not differ between countries, but differences in risk factor prevalence between countries combined to produce a net result of slightly lower mean levels of loneliness in older adults in England than in the U.S. after risk factor adjustment. The fact that the impact of risk factors were similar across countries suggests that evidence of successful interventions in one country could be leveraged to accelerate development of effective interventions in the other.

Incidence of Heart Failure Among Immigrants to Ontario, Canada: A CANHEART Immigrant Study

Several known traditional cardiovascular risk factors contribute to the development of heart failure (HF); however, whether ethnicity is also an important predictor is not well established. We determined the incidence of hospitalization for HF among ethnic groups in Ontario, Canada, and examined differences in risk factor prevalence that may contribute to disparities in HF hospitalization incidence between groups. We conducted a retrospective observational study from 2008 to 2012 with the use of a linked cohort derived from population-based health administrative, clinical, and survey datasets. We followed 895,823 recent immigrants from 8 ethnic groups and 5.3 million long-term residents aged 40-105 years for incident HF hospitalization. Sex-stratified age-standardized HF incidence was lower among all immigrant groups than long-term residents. Among immigrants, Black men and West Asian women had the highest incidence of hospitalizations for HF (1.19 and 1.60 per 1000 person-years, respectively), and East Asians of both sexes had the lowest incidence. After adjusting for sociodemographic characteristics, comorbidities, and other risk factors, the association between ethnicity and HF hospitalization risk remained significant. HF hospitalization incidence varies widely among ethnic immigrant groups, highlighting the importance of ethnicity as a potential independent risk factor for HF development.

Sex Differences in Ischemic Heart Disease: Advances, Obstacles, and Next Steps.

Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled "Women's Health Research-Progress, Pitfalls, and Promise," highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex- and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.

Disparities in liver cancer occurrence in the United States by race/ethnicity and state.

Liver cancer is highly fatal, and death rates in the United States are increasing faster than for any other cancer, having doubled since the mid-1980s. In 2017, it is estimated that the disease will account for about 41,000 new cancer cases and 29,000 cancer deaths in the United States. In this article, data from the Surveillance, Epidemiology, and End Results (SEER) Program and the National Center for Health Statistics are used to provide an overview of liver cancer incidence, mortality, and survival rates and trends, including data by race/ethnicity and state. The prevalence of major risk factors for liver cancer is also reported based on national survey data from the Centers for Disease Control and Prevention. Despite the improvement in liver cancer survival in recent decades, only 1 in 5 patients survives 5 years after diagnosis. There is substantial disparity in liver cancer death rates by race/ethnicity (from 5.5 per 100,000 in non-Hispanic whites to 11.9 per 100,000 in American Indians/Alaska Natives) and state (from 3.8 per 100,000 in North Dakota to 9.6 per 100,000 in the District of Columbia) and by race/ethnicity within states. Differences in risk factor prevalence account for much of the observed variation in liver cancer rates. Thus, in contrast to the growing burden, a substantial proportion of liver cancer deaths could be averted, and existing disparities could be dramatically reduced, through the targeted application of existing knowledge in prevention, early detection, and treatment, including improvements in vaccination against hepatitis B virus, screening and treatment for chronic hepatitis C virus infections, maintaining a healthy body weight, access to high-quality diabetes care, preventing excessive alcohol drinking, and tobacco control, at both the state and national levels. CA Cancer J Clin 2017;67:273-289. © 2017 American Cancer Society.

An Analysis of Female Athlete Triad Components in Elite Para-Athletes

The Female Athlete Triad (Triad) is a syndrome defined as the interaction of three interrelated conditions: low energy availability with or without disordered eating, menstrual dysfunction, and low bone mineral density (BMD). The Triad may also impact males, and may have long term health consequences if unaddressed. Although participation in elite para-sport is rapidly growing, no studies have assessed the prevalence of Triad risk factors in this population. PURPOSE: To evaluate the prevalence of Triad risk factors in an elite para-athlete population and association to sex and para-sport type. METHODS: Subjects were United States para-sport athletes who were training to qualify for the 2016 Summer or the 2018 Winter Paralympic Games. Participants completed an online questionnaire characterizing nutrition, menstrual status (if female), bone health, and awareness of the triad. Responses were analyzed to determine overall prevalence of Triad components, and significant differences based on sex and sport type (leanness vs. non-leanness). RESULTS: A total of 248 (144 male, 104 female) athletes completed the survey. Of these, 137 athletes competed in leanness sports and 109 athletes in non-leanness sports. Of the cohort, 40% (53 male, 45 female) of athletes indicated that they were currently trying to lose weight, and 61% (n = 151; 90 male, 61 female) indicated they were attempting to change their body composition to improve sport performance. Only 3% (1 male, 6 female) of athletes indicated that they had been previously diagnosed with an eating disorder. For pre-menopausal women, 32% (n = 29) reported less than 9 menstrual cycles in the past year. A total of 21% (27 male, 25 female) of athletes reported a history of a bone stress injury, yet 9% (8 male, 13 female) reported a diagnosis of low BMD based on DXA scan. There were no differences in risk factor prevalence between sexes or those competing in leanness versus non-leanness sports. Only 9% of athletes were aware of the Triad. CONCLUSIONS: Elite para-sport athletes have high prevalence of Triad components, regardless of sex or sport type. Awareness of the Triad in athletes is low. While consequences of the Triad in a para-athlete population are poorly understood, screening tools and education to increase awareness are required to optimize overall health of this population.

Abstract WMP50: Decomposition of Ethnic Differences in Stroke Recurrence--The Role of Education and Biological Stroke Risk Factors

Background: Race/ethnic disparities in stroke recurrence have persisted in the last decade in the USA. These disparities are often attributed to ethnic differences in risk factor prevalence and socioeconomic status. Methods: Incident ischemic stroke (IS) cases were ascertained in the Brain Attack Surveillance in Corpus Christi (BASIC) study, in Texas, USA in 2000-2011. Cases validated by stroke physicians were followed until death or a maximum of 5 years to determine 5-year cumulative stroke recurrence risk. Multivariable regression analyses and effect decomposition analyses (EDA) were used to examine the degree to which ethnic disparities are explained by education and biological risk factors. Results: There were 3,184 incident IS cases and 340 recurrent strokes (see Table). The ethnic difference in 5-year recurrence rate was 4.4% (p=0.004) greater in Mexican Americans (MA) than non-Hispanic whites (NHW). The age- and sex-adjusted hazard ratio (HR) of 1.43 (95%CI: 1.13, 1.79) comparing MA to NHW was attenuated after adjustment for education (HR=1.35, 95%CI: 0.91, 2.00), and further adjustment for biological factors (HR=1.28, 95%CI: 0.85, 1.92). EDA revealed that 57% of the recurrence risk disparity was due to differential associations (HR) between observed risk factors and recurrence (see Table). The remaining 43% was due to ethnic differences in risk factor prevalence. Conclusions: Ethnic differences in the strength of the associations between risk factors and recurrence, most notably education, diabetes, atrial fibrillation and hypertension explained 57% of the recurrence risk disparity. Further investigation of why some risk factors are more strongly associated with stroke recurrence in one ethnic group compared with others could yield valuable information on ethnic-specific stroke pathogenesis and secondary prevention strategies.

Risk Factors for Macro- and Microvascular Complications among Older Adults with Diagnosed Type 2 Diabetes: Findings from The Irish Longitudinal Study on Ageing.

Objective. To explore risk factors for macro- and microvascular complications in a nationally representative sample of adults aged 50 years and over with type 2 diabetes in Ireland. Methods. Data from the first wave of The Irish Longitudinal Study on Ageing (TILDA) (2009–2011) was used in cross-sectional analysis. The presence of doctor diagnosis of diabetes, risk factors, and macro- and microvascular complications were determined by self-report. Gender-specific differences in risk factor prevalence were assessed with the chi-squared test. Binomial regression analysis was conducted to explore independent associations between established risk factors and diabetes-related complications. Results. Among 8175 respondents, 655 were classified as having type 2 diabetes. Older age, being male, a history of smoking, a lower level of physical activity, and a diagnosis of high cholesterol were independent predictors of macrovascular complications. Diabetes diagnosis of 10 or more years, a history of smoking, and a diagnosis of hypertension were associated with an increased risk of microvascular complications. Older age, third-level education, and a high level of physical activity were protective factors (p < 0.05). Conclusions. Early intervention to target modifiable risk factors is urgently needed to reduce diabetes-related morbidity in the older population in Ireland.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Abstract A29: Racial disparities in prostate cancer: Estimating the role of diet, lifestyle, and genetic factors among African-American and Caucasian-American men

Abstract Purpose: To assess the role of genetic and epidemiological risk factors in explaining racial disparities in prostate cancer incidence and mortality. Background: Black men are 1.6 times more likely to be diagnosed and 2.4 times more likely to die of prostate cancer than white men. An adequate explanation for these disparities remains elusive, as they have been shown to persist in equal care and equal access settings. Our group has previously shown associations between exposures of smoking, physical activity, body mass index (BMI) vitamin D level, coffee, lycopene, and genetic factors and risk of prostate cancer, particularly for lethal disease. We hypothesized that differences in the prevalence of these risk factors could explain a substantial proportion of the racial disparity in incident and lethal prostate cancer. Study Population: Our study utilized data on risk factor prevalence from the Health-Professionals Follow-Up Study (HPFS, N=51,529 men, 1986-2012) and the National Health and Nutrition Examination Study (NHANES III, 1988-1994), a nationally representative program of studies that gathers lifestyle and nutrition information. We used established relative risk estimates from the HPFS for the prostate cancer risk factors. Methods: To estimate the prostate cancer burden associated with these exposures, we calculated the population attributable fraction (PAF) for each risk factor by race. PAF can be defined as the reduction in incidence that would be achieved if the population had been entirely unexposed, compared with the current exposure pattern. We assumed that the risk ratio was the same among whites and blacks. To calculate the PAF, we used the prevalence of the exposure (risk factor) from the HPFS and NHANES III and crude and confounder-adjusted risk ratios from studies conducted in the HPFS cohort for each exposure and risk of lethal prostate cancer. We then calculated the difference in attributable risk between each race to estimate the reduction in lethal prostate cancer if black men had the same prevalence of risk factors as white men. Results: There were notable differences in risk factor prevalence by race. For example, black men had significantly lower levels of vitamin D, were less likely to drink coffee, and had a higher prevalence of obesity and smoking. The prevalence of several genetic loci for prostate cancer were also higher among black men. We estimated that if black men had the same prevalence of risk factors as white men, the percent reduction in prostate mortality was 18% for Vitamin D, 7% for obesity, 6% for genetic factors, 4% for coffee, 4% for current smoking, and 1% for lycopene. Conclusions: Certain lifestyle, dietary, and genetic factors are potentially responsible for a substantial proportion of the racial disparity in prostate cancer incidence and mortality. This important finding warrants further research and validation in additional cohorts, as our findings go beyond merely re-confirming that a racial disparity in prostate cancer persists: it suggests a strong underlying role for risk factors that could be addressed through prevention. The authors accept sole responsibility for all statements made in this abstract. Citation Format: Sam F. Peisch, Travis Gerke, Kathryn M. Wilson, Edward L. Giovannucci, Lisa B. Signorello, Lorelei A. Mucci. Racial disparities in prostate cancer: Estimating the role of diet, lifestyle, and genetic factors among African-American and Caucasian-American men. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr A29.

Sex-Specific Disparities in Risk Factors for Coronary Heart Disease.

In the past two decades, focused research on women at risk for cardiovascular disease (CVD) has helped to clarify our understanding of some of the sex-specific factors that are important in the prevention and early detection of coronary atherosclerosis with a resultant 30 % decrease in the number of women dying from CVD. In spite of these advances, CVD, specifically, ischemic heart disease due to coronary atherosclerosis is the leading cause of cardiovascular death of women in the USA. The 2010 landmark Institute of Medicine (IOM) report, "Women's Health Research--Progress, Pitfalls and Promise," highlighted the fact that although major progress had been made in reducing cardiovascular mortality in women, there were disparities in disease burden among subgroups of women, particularly those women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment [1]. The IOM recommended targeted research on these subpopulations of women with the highest risk and burden of disease. Causes of disparities are multifactorial and are related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. In this article, we review a few of the contributing factors to the disparities in ischemic heart disease in women with a focus on the subgroups of women of Black, Latino, and South Asian descent who are at high risk for morbidity and mortality from CVD.

The current state of ethnic and racial disparities in cardiovascular care: lessons from the past and opportunities for the future.

Significant racial/ethnic disparities have been documented in cardiovascular care. Although health care quality is improving for many Americans, differences in clinical outcomes have persisted between racial/ethnic minority patients and non-minorities, even when income, education level, and site of care are taken into consideration. Potential causes of disparities are complex and are related to differences in risk factor prevalence and control, use of evidence-based procedures and medications, and social and environmental factors. Minority patients are more likely to receive care from lower-quality health care providers and institutions and experience more barriers to accessing care. Factors such as stereotyping and bias in medicine are hard to quantify, but likely contribute to differences in treatment. Recent trends suggest that some disparities are decreasing. Opportunities for change and improvement exist for patients, providers, and health care systems. Promising interventions, such as health policy changes, quality improvement programs, and culturally targeted community and clinic-based interventions offer hope that high-quality health care in the USA can be provided to all patients.

Ethnic and Gender Susceptibility to Metabolic Risk

Aggregation of metabolic risk factors-i.e., elevated plasma triglyceride (TG), reduced high-density lipoprotein cholesterol (HDL-C), elevated blood pressure, and raised plasma glucose-convey increased risk for atherosclerotic cardiovascular disease and type 2 diabetes. This study was carried out to determine the association of waist girth, ethnicity, and gender with susceptibility for metabolic risk. Included were 1671 adult women (50.7% black) and 1339 men (46.5% black) enrolled in the Dallas Heart Study. Subjects were stratified into three categories by waist girth-low, intermediate, and high, corresponding to BMI ranges of <25 kg/m(2), 25-29.9 kg/m(2), and ≥30 kg/m(2). Risk factor prevalence rose progressively through each waist-girth category. However, even among those with high waist-girth, prevalence of three or more risk factors was less than 50%. Several differences among the ethnic groups were noted; for example, Hispanic men had a higher prevalence of elevated TG compared to whites; black men, on the other hand, had a lower frequency of high TG. There were also fewer black men with low HDL-C than in the other groups. Black and Hispanic men had a higher prevalence of elevated glucose and updated homeostasis model assessment of insulin resistance (HOMA2-IR) than whites. More black men had elevated blood pressure than other groups. These differences were less pronounced among ethnic groups of women. Although ethnic and gender differences in risk factor prevalence may exist, it is notable that the majority of subjects, even when obese, did not have elevated risk factors. This finding points to the need to focus largely on subjects with metabolic risk factors when implementing therapeutic interventions.

Changes in Dietary and Physical Activity Risk Factors for Type 2 Diabetes in Alberta Youth Between 2005 and 2008

Unhealthy dietary and physical inactivity patterns inspired many initiatives promoting healthy youth and healthy schools in Alberta between 2005 and 2008. The purpose of this study was to examine differences in the prevalence of lifestyle risk factors for type 2 diabetes (T2D) between two province-wide samples of Alberta adolescents (2005 and 2008). The dietary and physical activity (PA) patterns of Alberta youth were assessed in two cross-sectional studies of grade 7-10 students, one in 2005 (n=4936) and one in 2008 (n=5091), using a validated web-survey. For each diabetes risk factor, participants were classified as either at risk or not at risk, depending on their survey results relative to cut-off values. Chi-square tests and logistic regression models were used to determine differences in risk factor prevalence between 2005 and 2008. Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p<0.05); and carbohydrate, protein, fibre and vegetable and fruit intakes were higher in 2008 (p<0.05). In 2008, a lower proportion of students were: overweight, obese, consuming high GI, high GL, high fat, low fibre, low veg/fruit intake (p<0.05). No differences existed in magnesium or PA levels between the two time points. Improvements were observed between 2005 and 2008 in terms of the proportion of adolescents having specific risk factors for T2D. The cause of these changes could not be determined. Continued monitoring of adolescent lifestyle habits and monitoring of exposure to health promotion programming is recommended.

Stroke seasonality associations with subtype, etiology and laboratory results in the Ludwigshafen Stroke Study (LuSSt)

Data on seasonal differences in stroke incidence are conflicting. Little is known about seasonal variability in etiological stroke subtypes and population-based data on possible trigger factors are lacking. The Ludwigshafen Stroke Study is a prospective population-based stroke registry. All residents of the city of Ludwigshafen who suffer from acute stroke or TIA are registered. Patients with first-ever stroke (FES) were included for the present analysis. Between January 1, 2006 and December 31st, 2010, 1,779 patients (age 71.7±13.4years (mean+standard deviation; 897 (50.4%) women) suffered a FES. Incidence for FES was lowest in summer (reference) with significantly higher rates in winter (rate ratio (RR) 1.20, 95% confidence interval (CI) 1.05-1.37) and spring (RR 1.21 95% CI 1.06-1.38). First-ever ischemic stroke (FEIS) was more common in winter (RR 1.16, 95%CI 1.01-1.34) and first-ever intracerebral haemorrhage (FE-ICH) was more frequent in spring (RR 2.0, 95%CI 1.24-3.22) than in summer. In FES, systolic and diastolic blood pressure on admission (SBP/DBP) showed significant variation with lowest values in summer (SBP: p=0.02; DBP p=0.05). In subtypes of FEIS, cardioembolism tended to be more common in winter (p=0.14). There were no differences in risk factor prevalence between seasons. Leukocyte count on admission was lowest in summer (8.2±1.4/μl) and highest in winter (8.9±1.9/μl; p=0.008). The hematocrit showed a similar trend (p=0.06). Our data show higher incidence rates for FES in winter and spring, for FEIS in winter and for FE-ICH in spring. Variations in blood pressure on admission and leukocyte counts were associated with these findings and may possibly contribute to seasonal stroke variability.

Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary heart disease: baseline results from the STABILITY study

There is limited contemporary data on achievement of risk factor goals for secondary prevention of cardiovascular (CV) disease from countries in many regions of the world. This report describes the global and regional prevalence of CV risk factors and use of preventive medications at baseline in participants in the ongoing STabilization of Atherosclerotic plaque By Initiation of darapLadIb TherapY (STABILITY) trial. Detailed individual data on CV risk factors were obtained before randomization in 15,828 patients with chronic coronary heart disease (CHD) from 39 countries on five continents. Subjects had a history of myocardial infarction, prior coronary revascularization, or multi-vessel CHD without revascularization and at least one additional CV risk factor. The majority were taking a statin (97%), antiplatelet therapy (96%), beta-blocker (79%), or angiotensin converting enzyme inhibitor/angiotensin receptor blocker (77%). However, a large proportion of patients did not achieve guideline-recommended targets. For instance, in 29% low-density lipoprotein (LDL) cholesterol was >2.5 mmol/l and in 46% blood pressure was ≥140/90 mmHg or ≥130/80 mmHg in those with diabetes or renal impairment. The body mass index was >30 kg/m(2) in 36%, waist circumference ≥102 cm for men or ≥88 cm for women in 54%, and 18% were smoking. Regional differences in risk factor prevalence and target achievement were observed and were more marked for LDL cholesterol and obesity. The prevalence of modifiable CV risk factors was generally high in the STABILITY population. Although, most patients were receiving evidence-based secondary preventive therapy many subjects from all regions did not reach recommended secondary prevention goals.

CVD and obesity in transitional Syria: a perspective from the Middle East

PurposeSyria is caught in the middle of a disruptive nutritional transition. Its healthcare system is distracted by challenges and successes in other areas while neglecting to address the onslaught of Syria’s cardiovascular disease (CVD) epidemic. Despite the official viewpoint touting improvement in health indicators, current trends jeopardize population health, and several surveys in the Syrian population signal the epidemic spreading far and wide. The goal is to counteract the indifference towards obesity as a threat to Syrian’s health, as the country is slowly becoming a leader in CVD mortality globally.MethodsPubMed, World Health Organization, and official government websites were searched for primary surveys in Syria related to CVD morbidity, mortality, and risk factors. Inclusion criteria ensured that results maximized relevance while producing comparable studies. Statistical analysis was applied to detect the most common risk factor and significant differences in risk factor prevalence and CVD rates.ResultsObesity remained the prevailing CVD risk factor except in older Syrian men, where smoking and hypertension were more common. CVD mortality was more common in males due to coronary disease, while stroke dominated female mortality. The young workforce is especially impacted, with 50% of CVD mortality occurring before age 65 years and an 81% prevalence of obesity in women over 45 years.ConclusionSyria can overcome its slow response to the CVD epidemic and curb further deterioration by reducing obesity and, thus, inheritance and clustering of risk factors. This can be achieved via multilayered awareness and intensive parental and familial involvement. Extinguishing the CVD epidemic is readily achievable as demonstrated in other countries.